Stages of postpartum

Jul 21, 2022 | 0 comments

Whenever I begin working with a mother in clinic, one of the first things I begin to think about is what stage of postpartum she is in.

The stage of postpartum influences what body systems are in most need of nurturing and assist me in understanding what the most important factors will be to consider for her particular health and healing.

Stages can be obvious, like the chronological time since birth – 12 weeks, 3 months, 6 months postpartum, etc, and there are some similarities between mothers across these time periods that are important to be mindful of when considering a woman’s health. I’ll explore these more below.

But because of the unique experience every mother, baby, and family have in postpartum, chronological time is not the only or the most accurate way to assess what stage of postpartum a woman in is.

I also consider other stages, which are not necessarily related to a specific time point, but better defined by unique mother/baby factors. More on these below.

This article will cover:

  • Defining postpartum
  • How I see the stages of postpartum
  • Chronological stages
    • 0-48 hours post birth
    • 2 days – 6 weeks
    • 6 weeks – 6 months
    • 6-12 months
    • 12-24 months
  • Non-chronological stages
  • Conclusion

Defining postpartum

Depending on where you look or who you talk to, postpartum can be defined very differently.

Many sources, particularly in a medical setting, only define postpartum as the first 6 weeks post birth.

A slightly more comprehensive, yet still limited take on the stages of postpartum outlines the initial or acute stage (0-12 hours post birth), the subacute stage (2-6 weeks post birth), and the delayed stage (up to 6 months) of postpartum; three distinct yet continuous phases [1].

Others recognise that postpartum continues for much longer than the first 6 weeks or 6 months, extending the phase out to the first 12 months, dividing it into early and late stages – early postpartum (0-6 months) and late postpartum (7-12 months).

This is a good start, since over 90% of women report a health problem in the 12 months after birth [2], such as depression, anxiety, fatigue, sexual concerns, gastrointestinal problems, genitourinary issues, or breastfeeding challenges.

Others again recognise that ‘postpartum is forever’ and once a woman goes through pregnancy and birth, her physiology is forever changed.

How I see the stages of postpartum

Strict definitions of the stages of postpartum can be useful in some contexts, like in a research or medical context.

In a real-life clinical setting, working with mothers, I find combining an understanding of both the chronological stages and non-chronological stages to be most beneficial in supporting women.

Postpartum is greatly influenced by each mother’s unique experience of pregnancy and birth, as well as her pre-existing or underlying health conditions and her social circumstance and her mental/emotional wellbeing, not to mention all the individual factors relating to her baby and other family members.

Chronological stages

These are some of the physical and emotional considerations that come with the chronological stages of postpartum. It’s important to note that there is still a lot of variation between mothers across time, for example, some women may have their menstrual cycle return within the first few months postpartum, while others may not see it return for over a year or more.

0-48 hours post birth

Physical:

  • Immediate physical recovery from birth, which might involve care for birth injuries or complications like tears, episiotomies, caesareans, or hemorrhages.
  • Physical changes as the body begins to shift from the pregnant state to the postpartum state are rapid and change can happen quickly in these early days, including breast, digestive, and uterine changes.
  • The risk of other complications remains high in this stage (haemorrhage, eclampsia, embolism, etc.) and mothers should rest as much as possible to set recovery on the right trajectory.
  • Lochia will begin, a normal discharge from the uterus after birth. Afterpains will begin and continue until around 72 hours post birth.
  • Breastfeeding is being initiated and established; colostrum is the type of breast milk during this stage.

Emotional:

  • Bonding may or may not be immediate, and there may be immediate emotional trauma from the birth experience.

 

2 days – 6 weeks (The Fourth Trimester)

Physical:

  • During this phase, the recovery from birth continues. The physical recalibration after pregnancy is ongoing, albeit it moving more slowly than the early days after birth. There are major shifts in hemodynamics, hormone levels, tissues of the genitourinary tract, and metabolism. Lochia will continue.
  • Milk ‘comes in’ around day 3-4 with breast engorgement and a risk of clogged ducts and mastitis high. Breastmilk supply continues to establish and regulate during the first 6 weeks, at least. Breastfeeding challenges may arise; sore nipple, mastitis, low milk supply, and thrush. Appetite may increase in line with breastfeeding and the increased nutritional needs therein.
  • Constipation is common during this time, and therapeutic food or supplemental support can be useful to help with easy bowel motions.
  • Caesarean recovery involves daily tending to the incision site, with a focus on tissue healing and extended rest.
  • There is a dramatic change in sleeping patterns with the arrival of a newborn, which can be very tiring.
  • High needs babies (aka unsettled babies, colicky babies) may sleep less, and require more physical closeness and regulation, asking mothers to pour a lot of energy into their care.

Emotional:

  • Bringing baby home for the first time if the birth was in a setting away from home, can be a joyful and/or scary experience.
  • The baby blues are common in the first week after birth, resulting from the big hormone shifts occurring post pregnancy, which is a transient state. Other big emotional shifts can occur during the fourth trimester, and postpartum anxiety and/or depression can emerge at this time.
  • It’s common for mothers to feel a sense of overwhelm by the many demands of their new role, as well as grapple with their personal identity.
  • Personal relationships may be challenged or changed by the family dynamics, particularly the relationship with spouse/partner and/or parents.
  • A mother’s birth experience continues to be processed and understood and processed (this process may occur now or not until a later time, or may be an ongoing process over months/years).
  • Highly sensitive babies can be particularly challenging for a new mother’s emotional state.

 

6 weeks – 6 months

Physical:

  • Post-pregnancy physical recovery slows down and become more gradual during this stage, with ongoing and important changes to connective tissues that were altered in pregnancy, muscle tone, pelvic floor health, and nutrient repletion. It can take up to 6 months for complete restoration of connective tissues.
  • Postpartum hair loss usually begins around 6-8 weeks postpartum and will typically continue for a few months after it first starts.
  • Many parents report a challenging period of sleep around 3-4 months, which can be very depleting.
  • Physical aches and pains from breastfeeding, carrying a growing baby, awkward sleeping positions can arise.
  • Postpartum thyroiditis can first begin to manifest during this time, as can the impacts of nutrient deficiencies.
  • There may be a return to exercise and movement and a rebuilding of strength and fitness. The menstrual cycle may return.
  • Sexual problems are highest in the first 6 months post birth, including painful intercourse, vaginal dryness, a feeling of tightness or looseness, bleeding or irritations after sex, or low libido.

Emotional:

  • Maternal mental health remains a top priority, as postnatal depression and/or anxiety can become a challenge at any point post-birth, including many years later.
  • A sense of personal identity may be reforming. There may be a return to intimacy and sexuality as a mother.
  • New relationships form as a woman re-enters the world as a mother, possible connecting with a mother’s group or forming new friendships. Pre-existing relationships may take on a new dynamic.
  • Mothers may be considering or initiating their return to work, encompassing all the factors that come with this, from childcare to juggling work & motherhood.
  • Other mothers feel a sense of social isolation, feeling cut off or disconnected from the world due to their home and mothering responsibilities.
  • There may be pressures to ‘get out and about’ or return to ‘normal’ life again, and variable feelings about body image and confidence in an unfamiliar postpartum body.

12-24 months

Physical:

  • There may be plans to grow the family and try to conceive the next child.
  • Breastfeeding may be ongoing or weaning may occur.
  • Long-term complications from pregnancy and birth may be impacting quality of life, e.g. pelvic floor issues or prolapse.
  • Postpartum depletion can lead to a sense of exhaustion and burnout at this stage.

Emotional:

  • Many women step more confidently into the role and identity of mother. Mental health remains a focus for the first few years of motherhood.

 

Common non-chronological stages

Not all of the experiences of early motherhood will fit neatly into a few boxes based on timeframe. This creates distinct categories or stages that many women commonly go through, albeit at varying points along their journey.

Not all women will go through each stage, but these are the common ones as I see them. Each has its own unique requirement for physical, emotional, and social support.

 

  • The stage of broken sleep – varies greatly from family to family. For some families, this stage lasts 1-2 years
  • The stage of breastfeeding
  • The stage of return to movement and exercise
  • The stage of rekindling intimacy and sexuality
  • The stage of changing relationships
  • The stage of the return of the menstrual cycle
  • The stage of growing your family (or trying to conceive)
  • The stage of grappling with your new identity (or mourning the loss of your old identity)
  • The stage of returning to work
  • The stage of weaning (night and/or complete weaning)
  • The stage of mental health or mood changes
  • The stage of postpartum weight loss
  • The stage of postpartum depletion

Conclusion

In conclusion, there are various ways in which the stages of postpartum can be defined or categorised. In my work, I find it most useful to combine an understanding of both the chronological stages (and the common experiences within them) with the non-chronological stages that women will move through at different points in time.

 

Getting the right support for the specific stage/s that you are currently in is important and it can be valuable to talk with someone who has a good understanding of the needs of mothers at these different points in time. I offer free 15 minute clarity calls for mothers to discuss these questions and more, where I can either guide you towards the best support person for you or provide some advice myself. You can book a call here.

 

You can also contact me here, or follow me over on Instagram where I share daily about maternal health and postpartum recovery.

 

Georgie xx

 

References

  1. Romano M, Cacciatore A, Giordano R, La Rosa B. Postpartum period: three distinct but continuous phases. J Prenat Med. 2010;4(2):22–5.
  2. Rouhi M, Stirling C, Ayton J, Crisp EP. Women’s help-seeking behaviours within the first twelve months after childbirth: A systematic qualitative meta-aggregation review✰. Midwifery. 2019 May 1;72:39–49.
Georgie

Georgie

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