A Guide to Postpartum Care

Bringing your newborn baby home from the hospital can be one of the most exciting (and sometimes terrifying) moments of your life. After months of anxiously awaiting your bundle of joy’s arrival, you may feel ready to take on the seemingly endless feedings, diaper changes, and sleepless nights. Despite diligent preparation, motherhood can present its own set of challenges and the journey ahead isn’t always ideal.

Lisa Boyars, MD, a perinatal and reproductive psychiatrist in both Women’s Reproductive Mental Health of Texas within UT Health Austin’s Mulva Clinic for the Neurosciences and the Comprehensive Fetal Care Center, a clinical partnership between UT Health Austin and Dell Children’s Medical Center, shares tips on navigating the postpartum period.

What is the postpartum period?

The postpartum period, often referred to as the “fourth trimester,” begins after the delivery of your baby and can last weeks, months, and even up to a year. During this time, your body is adjusting to both physical and emotional changes.

“From a terminology standpoint, postpartum simply means the time after childbirth,” says Dr. Boyars. “In medicine, there is no hard cutoff in terms of when someone is no longer considered postpartum, although the postpartum period is often thought of as that first year following delivery.”

As you and your partner are welcoming the newest member of your family, you shouldn’t feel any pressure to return to “normal.” In fact, many find themselves transitioning to the “new normal” instead.

Postpartum Blues

Postpartum blues, also known as baby blues, are transient feelings of sadness that you may experience after childbirth. One minute, you may be full of pride as you take on your new role as a parent, while the next, you may begin to doubt your ability to care for your baby. You’re not the first to experience this emotional rollercoaster.

“Four out of every five women experience postpartum blues,” shares Dr. Boyars. “This can start within a day or two, and even as soon as one hour, after childbirth. Symptoms often include a range of emotions, such as sensitivity, anxiousness, irritability, tearfulness, and even feeling uncomfortable when taking care of an infant all alone. Postpartum blues typically only last up to two weeks and resolves itself without treatment. Moms are generally able to be quite functional as well.”

Postpartum Depression

Postpartum blues can turn into postpartum depression when feelings of sadness last longer than 2 weeks and begin to interfere with your ability to function throughout your daily life or attend to your baby’s needs.

Postpartum depression can affect the following aspects of your life:

• Ability to derive pleasure from things that you enjoy
• Appetite
• Mood
• Sense of self-worth
• Sleep and energy levels

Risk factors for postpartum depression include:

• History of past postpartum depression
• History of depression
• Difficult pregnancy or birth, including having an infant in the neonatal intensive care unit (NICU)

“Postpartum depression is a bit of a misnomer, because nearly 50% of cases of postpartum depression begin during pregnancy,” explains Dr. Boyar. “In a research setting, we would call this peripartum depression, as ‘peri’ means around the time of pregnancy.”

Postpartum depression that occurs before pregnancy ends, typically begins in the late third trimester. However, postpartum depression can also develop up to 12 months after childbirth.

Download and view our Differentiating Baby Blues From Postpartum Depression Flyer.

<br>Postpartum Anxiety

Anxiety is a natural stress response. However, postpartum anxiety involves the constant worry that something bad may happen to your infant, which often results in over-checking in on the baby, constantly watching the baby monitor, not allowing others to help care for the baby, and not leaving the house unless the baby comes along. Postpartum anxiety can be experienced as thoughts, feelings, and physical sensations.

“Feeling some level of anxiety is expected during the postpartum period,” assures Dr. Boyars. “An anxiety disorder is the near constant worry that something bad is going to happen. Perinatal anxiety is near constant worry that something is going on with the pregnancy. Postpartum anxiety is the near constant worry that about something is going wrong with the infant. We work with women to develop strategies to help them cope with or control the anxiety.”

Intrusive Thoughts

An intrusive thought is an unwanted idea that can suddenly cross your mind and make you feel uneasy. A common intrusive thought associated with the postpartum period is the idea of accidentally dropping your baby while you’re holding them.

“Intrusive thoughts can make you feel like you’re stuck in a loop, and you may develop repetitive activities where internal activity or behavior temporarily prevents distress,” explains Dr. Boyars. “Intrusive thoughts are often referred to as obsessive compulsive disorder (OCD), but not everyone who has intrusive thoughts has OCD.”

Postpartum Psychosis

“Postpartum psychosis is a very rare and serious disorder,” says Dr. Boyar. “It usually develops rapidly, within a week or two after the delivery, when sleep is often heavily impaired.”

Symptoms of postpartum psychosis include:

• Decreased need for sleep
• Delusions or strange beliefs
• Hyperactivity
• Suspicions

Consider seeking help from a health professional if you or someone you know has symptoms of postpartum psychosis.

Who is commonly affected?

Postpartum disorders can affect both partners regardless of gender. Depression can develop with any monumental life event, especially that of having a baby.

“Postpartum disorders are not just something that the mom feels. Her partner can experience it, too,” explains Dr. Boyars. “Understandably, there can be some difficulty adjusting to something as life-changing as bringing a baby home.”

What treatment options are available?

“When treating postpartum disorders, I think about whether there’s a role for medications,” says Dr. Boyars. “It’s important to me to think about the tools and skillsets that I can offer patients outside of medications, especially for those patients who may not be interested in taking medication to help improve their mood.”

Medication Management

Antidepressants are commonly used to treat depression and anxiety. Your ob-gyn or primary care provider may be able to prescribe these forms of medication or they may suggest you receive a higher level of care by referring you to a specialist, such as a psychiatrist.

“Brexanolone is a new treatment option that may be available to some women,” shares Dr. Boyars. “Brexanolone is a neurosteroid made from progesterone, and it is given through IV infusion at the hospital. The infusion can help balance the levels of progesterone when hormone levels suddenly drop after the delivery of the baby.”

Non-Medication Management

Non-medication strategies often involve counseling with a qualified psychologist or therapist who utilize evidence-based approaches, such as cognitive behavioral therapy, interpersonal psychotherapy, or group therapy.

“There are other supportive measures that don’t involve medications and can make a difference,” says Dr. Boyars. “One of the biggest ones is consolidating as much sleep as possible. There is also a lot of research around exercise, yoga specifically, and mindfulness, paying attention to the present moment.”

Caregiver Tips

If your loved one is struggling with their mental health in the postpartum period, there are several ways you can get involved.

Tips for caregivers:

• Facilitate rest: Sleep is often impaired by depression, anxiety, and other maternal mental health conditions. If your partner or someone you know is experiencing postpartum depression, encourage them to take naps during the day and limit the number of visitors.
• Be proactive: Instead of asking what you can to help, create a list of tasks that can support your loved one, such as cleaning pump bottles, doing laundry, looking after the baby, and organizing meals.
• Provide Support: Be an effective listener. While offering advice can be beneficial, listening can help create a safe space. Build a network of support with other parents or those who have recently experienced the postpartum period.

Additional resources include:

• Pregnancy and Postpartum Health Alliance of Texas
• Postpartum Support International

Remember that bringing a life into the world is a lot of hard work, and you deserve time to rest and get into the groove of motherhood. While transitioning into the “new normal” can present many challenges, remember that these difficulties do not make you a bad parent.

“Every journey through the postpartum period is going to be different for each person,” shares Dr. Boyars. “We are here to listen and support you to ensure we address your needs so that you can reach your health goals.”

For more information or to make an appointment with Women’s Reproductive Mental Health of Texas, call 1-833-UT-CARES (1-833-882-2737) or visit here.