Mothering the Mother: The Importance of Postpartum Careby Rev. Pilar (Ma’at) Grant Nov 02, 2011
What is the Postpartum Period?
As a midwife, I have worked with pregnant mothers and their families for over twenty years. I myself am a mother of seven amazing and beautiful human beings. During this time, I have witnessed as well as experienced how women are almost forgotten after the birth of their babies.
Postpartum, also called the fourth trimester, puerperium and postnatal is recognized as the period just after birth and the subsequent six weeks that follow. Postpartum is as important as any other phase of the birthing process. During pregnancy, labor and birth of the baby, a mother’s overall health is depleted. The mother is constantly giving of her life force energy, therefore it is most important she is replenished and cared for after birth. Many elders have told me women who don’t take care of themselves in their childbearing years, especially after the birth of a baby, are sure to feel discomforts during menopause.
Postpartum is a significant time for the mother, baby and family. Many physiological, psychological and spiritual changes occur. During this time, the uterus contracts, breasts may enlarge and become tender in preparation for breastfeeding and hormones fluctuate. Internal organs that have moved to accommodate the baby are slowly shifting back to their original positions. As mothers, we need to desire and expect quality holistic postpartum care. As health practitioners, it is imperative that we are more attentive to the postpartum mothers we are serving. Caring for the mother in a loving way will help restore strength, vitality, muscle tone, mental clarity and an overall sense of well being.
Major Areas of Concern for Mother Postpartum
There are five major physiological changes that postpartum mothers experience.Healing of the uterus and uterine wall
After the birth of the placenta, the top of the uterus is at the level of the navel. The uterus will remain this size for about two days and then it continually gets smaller. In about five to six weeks, it has regained its pre-pregnant size. The regeneration happens very quickly except at the placental site. Complete healing of the placental site takes up to six weeks or more. Wise women have told me that it can take up to three months for the placental site of the uterus to heal. They suggest that mothers refrain from sexual intercourse and inserting anything into the vagina for three months.
Vaginal restoration and healing of the pelvic floor muscles including the perineum
There are many changes in the vagina after birth. Vaginal discharge is experienced, whether it is a vaginal birth or caesarean. This is called lochia. It is much like a menstrual period and can be experienced for two to six weeks after birth. Lochia comes from blood and tissues that have built up in the uterus during pregnancy. In vaginal births where tearing has occurred, the mother usually experiences swelling and pain. The tearing may be repaired by the use of stitches depending on the severity. If this is the case they will dissolve over the course of a week. For a mother who has not experienced tearing, the vaginal lips can still appear slightly swollen. Although the vagina stretches significantly to accommodate the birth of the baby, immediately after birth, the vagina shrinks tremendously forming a smooth walled passage. The perineum, the area between the vagina and anus, may also be sore due to a tear during labor or an episiotomy.
Restoring strength and tone to the abdominal wall muscles
The abdominal wall will remain soft and flabby for a while after birth due to the rupture of the elastic fibers and the prolonged distention of the uterus. It usually takes several weeks for the abdomen to return to its pre-pregnancy appearance. For mothers of 3 or more children, the abdominal wall may have separated and will remain lax.
Establishing a good milk supply and successful breastfeeding
The same hormones that initiate contractions in labor help to initiate breast milk. Within 24 hours after birth, the breast produces colostrum, a golden yellow liquid that is full of antibodies that serve as the newborns first immunization to disease. Breast milk has the proper amount of sugar, fat, water and protein for the baby’s growth. Not only is breastfeeding good for the child, it is also great for the mother as well. Suckling on the breast creates a rush of oxytocin in the mother’s body. This hormone helps the body secrete milk. Suckling also helps in contracting the uterus and protects the mother from hemorrhaging.
Endocrine system and hormonal shifts
After giving birth, estrogen and progesterone, which are released by the endocrine system, significantly lower. During pregnancy, the body produces these hormones in abundance. It takes around three days for hormonal levels to return to their pre-pregnancy state. The body experiences a shock with the sudden change in hormones, impacting the mother’s mood, body functions, digestion, and ability to sleep.
Due to major shifts in hormones after birth, mothers may experience mood swings. In the first week, postpartum women usually start out happy and joyful because of the high of the birth. However, in a few days the joys of birth can turn into depression and or a sense of melancholy. This is due to the physical and mental stress of birth, a breakdown of tissue components and a withdrawal of estrogen and progesterone leading to an imbalance of electrolytes and hormones.
Without proper care, many women develop postpartum mood disorder. Postpartum mood disorder is a mental health disorder striking within the first year of giving birth. It can occur in any woman after birth whether she is a first time mom or not .The postpartum mood disorders can range from Baby Blues to Psychosis.
Baby Blues is a condition that affects 80 percent of new mothers, with the onset between 3-14 days postpartum. Twenty percent of women with baby blues will go on to develop Postpartum Depression. Postpartum Depression affects up to 25 percent of new mothers. Symptoms can be exhibited right away or several months after delivery. Prior incidents of postpartum depression sometimes may put a woman at a 50 to 80 percent higher risk of recurrence. Postpartum Psychosis is the most severe postpartum mood disorder. PPP is rare, believed to affect only one to two new mothers in one thousand. Treatments of these illnesses may require medication, psychotherapy and, in extreme cases such as Postpartum Psychosis, hospitalization.
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