Specialist Offers Insights for Navigating Postpartum Care & Challenges

To many people, postpartum simply refers to the first few weeks after childbirth.

However, recent studies reveal that postpartum changes linger much longer than that – and they even affect the brain! 

According to registered nurse and postpartum specialist Rachelle Miller, we now understand that the postpartum period extends to around 12 to 18 months after giving birth. 

Registered nurse and postpartum expert Rachelle Miller

Miller works as a nurse with The Mama Coach, a global team of Registered Nurses and Nurse Practitioners in community-based private practice. Founded by Carrie Bruno, Registered Nurse and International Board Certified Lactation Consultant, The Mama Coach meets the growing need for nursing care, support and education for families around the world. Miller says this new approach gives her more time with patients than in traditional healthcare settings, “getting to know them on a deeper level and helping them achieve their goals in their parenting journey.”

Based on her many years of experience, Miller has gained valuable insights into those first few months with a new baby. From physical and emotional changes to new routines, the postpartum period is a time of great joy paired with tremendous challenges. 

Knowing what to expect – and, just as importantly, when to ask for help – is key to successfully navigating this special time, not just for new moms, but for the whole family!

What to Expect After Baby Arrives

If you’re a first-time mom-to-be, you can anticipate a myriad of physical and mental changes after childbirth. Knowing what’s considered normal after having a baby makes it easier to spot signs of trouble, so you’ll know when to check with a doctor or therapist.

Your Body   

Physically, those initial days in the hospital are primarily focused on recovery. 

New mom seated with adorable baby looking over her shoulder

On Day 2, your newborn will typically nurse frequently, a biological mechanism designed by nature to stimulate milk production. It's crucial for moms to recognize that Day 2 often entails cluster feeding, in which baby craves lots of short feedings over the course of a few hours. Cluster feeding serves a vital purpose in milk production. While it can feel overwhelming, being armed with knowledge about this process empowers you with greater confidence and preparedness. 

Some new mothers find that breast changes after childbirth may prove uncomfortable. Although engorgement might occur initially, techniques like reverse tissue softening and hand expression can effectively manage this discomfort. Equipping yourself with these skills can offer both physical and mental relief. 

Regardless of your delivery method, your healthcare provider should brief you on the changes your uterus will undergo after your baby is born. By Day 14 postpartum, your uterus should no longer be palpable by external abdominal pressure. 

The clotting of uterine vessels is also crucial in preventing postpartum hemorrhage. If you are breastfeeding, you may experience uterine contractions due to oxytocin, a hormone aiding lactation while also inducing contractions for clotting and uterine shrinkage. Unfortunately, the uterus isn't reassessed until the six-week postpartum appointment after discharge. Thus, it's imperative to familiarize yourself with normal postpartum bleeding patterns. 

In her practice, Miller teaches moms that it's vital for family and friends to be educated on the signs and symptoms of hemorrhaging and clotting. This helps moms identify any need for medical attention. Mothers who have undergone vaginal tears or episiotomies are at higher risk for hemorrhage, and require even closer monitoring. Unfortunately, many moms aren’t necessarily informed about the risk of hemorrhaging before going home.

Following discharge, bleeding gradually subsides for most moms. General guidelines suggest seeking medical attention if postpartum bleeding saturates a pad within an hour. Miller adds that, any feeling of something being "off" or "abnormal" for a postpartum mom should be taken seriously by her support network. Validating feelings and concerns during the postpartum period is paramount in supporting the new family effectively.

Your Mind   

More and more neuroscientists are taking an interest in studying the postpartum brain. 

“This line of research holds promise in guiding us toward better care for families during this delicate phase,” Miller says.

One fascinating aspect of the postpartum experience, she continues, is in synaptic pruning. This term describes how the postpartum brain focuses on survival and nurturing tasks. MRIs reveal that changes in the gray matter of a postpartum mother's brain can last for up to 18 months post-birth. 

“It's the scientific rationale behind ‘mom brain,’” Miller explains, “where forgetfulness or misplaced items may occur as our brains prioritize caring for ourselves and our newborns.”

Normalizing this to mothers and educating them on their changing brains can be so reassuring. When you aren’t feeling like yourself, it is helpful to understand why!

How the Postpartum Journey Affects the Family

Did you know your spouse or partner may also be affected by the postpartum experience? 

Young mom and dad on the front steps with their adorable baby

Non-birthing parents frequently go through hormonal shifts and other physical and emotional changes after a new baby arrives. 

“We have to remember,” Miller says, “throughout this journey, compassion and understanding for the postpartum family as a whole is key.”

In her professional experience, Miller has witnessed firsthand the significant challenges postpartum families encounter while adjusting to life with a newborn. The adjustment period often manifests as a struggle – not only for the mother but also for the non-birthing parent and for older siblings

It's crucial that postpartum care includes facilitating the bonding experience between every family member and the newborn. Families should intentionally create strategies to share various tasks and responsibilities associated with infant care. For example, dads and older kids can often help with things like feeding, diaper changes and housekeeping.

Miller says it’s important to acknowledge the changes experienced by non-birthing parents because this issue is almost never discussed. “While society may joke about ‘sympathy pregnancy,’ she observes, “it's essential to recognize that biological symptoms can indeed manifest in a non birthing parent due to hormonal shifts.” 

Couvade Syndrome is a proposed condition in which expectant non-birthing parents experience some of the same symptoms as a pregnant partner. Their symptoms can include weight gain, morning sickness, and disturbed sleep patterns. Postpartum mental health changes such as anxiety and depression are also common in non-birthing partners, as they adjust to changes in their own lives during this period. 

Having this awareness empowers families to navigate those challenges with greater understanding and more effective communication. Knowing how postpartum changes affect everyone helps in finding appropriate care and coping strategies.

Planning Ahead for the Postpartum Experience

Miller tells us that the most successful postpartum journeys she’s observed are those of moms who start preparing for the postpartum period during their pregnancy.

When you proactively delegate even the most minor tasks and educate your family, you can facilitate a smoother transition into life with a newborn.

“Recently, I had the privilege of providing services to a well-supported postpartum family,” Miller recalls, “and it was truly beautiful to witness the simple yet impactful ways their extended family rallied around them. This support had a profound effect on their cohesion and well-being as a family unit.”

Miller also emphasizes that the best approach to support may vary for each family.

What remains universal is the need for expectant mothers to feel empowered to articulate their needs and boundaries. Every new mom deserves the opportunity to shape her postpartum experience according to her desires, “and it's our role as healthcare professionals to empower them in achieving this.”

She points to the need for community resources to work very diligently to effect a culture change surrounding the postpartum period in America. “Education is my number one suggestion for baby registries,” she says. “The more we know, the more we can narrow down our own unique goals for a postpartum and newborn experience.”

Dealing with Postpartum Depression

According to the American Psychological Association, postpartum depression (PPD) is a mental health condition that affects individuals who have recently given birth. 

It typically develops within the first few weeks to months after childbirth but can occur up to a year postpartum. Families should be aware that the non-birthing parent can also experience postpartum mental health issues, including postpartum depression.

PPD Symptoms 

PPD is characterized by persistent feelings of sadness, hopelessness and despair. Patients often experience additional symptoms of anxiety, irritability, and difficulty bonding with the newborn. PPD can interfere with daily functioning and the ability to care for oneself and the baby. 

Although symptoms present differently in each mother, those having difficulty caring for themselves or their new baby, or who have difficulty regulating, should ask their health provider about treatment.

Lack of Adequate Care 

In America, Miller notes that postpartum care falls short of meeting the needs of new mothers, 

“Most expectant parents are shocked to learn that the United States maintains one of the highest rates of maternal mortality among developed nations,” she notes, “with approximately 700 women succumbing to pregnancy-related complications each year. Even more alarming, Black women face a three to four times greater risk in this regard.”

The Need for Better Screening

Presently, our approach to screening for postpartum depression or postpartum anxiety lacks the necessary depth and inclusivity. There is also no routine screening for non-birthing parents.

Typically, mothers are only presented with a questionnaire during their six-week postpartum visit with their OBGYN. The concern is that moms often face “societal pressures to exhibit nothing but sheer joy. The stigma surrounding any emotions that don’t paint moms as thriving can keep her from sharing honest communication during the assessment.”

It is Miller’s greatest hope to see a substantial overhaul of this assessment process. Every mother, she says, deserves a comprehensive mental health evaluation during the postpartum period, fully covered by their insurance. 

Pressure to Be “Perfect”  

It's also imperative to recognize and address the profound impact that social media has on postpartum mental health. 

For one thing, misinformation spreads as quickly as evidence-based education, contributing to the challenges new parents face. 

Another challenge is the curated facade often portrayed on social platforms. This can intensify feelings of despair for mothers grappling with postpartum mental health issues, as they compare their struggles to the seemingly perfect moments showcased by others. 

Moving forward, Miller hopes the current generation of mothers will continue to find healthy ways to navigate that hurdle. She points to a need for more online communities that are rooted in safe practices.

Treatment for Postpartum Depression  

Seeking out a therapist who specializes in postpartum care is one of the most effective ways to tackle postpartum depression. 

Once a diagnosis is obtained, Miller says that ensuring proper nutrition, sleep and activity is crucial to reinforcing the therapy and caring for the whole self. 

“Emphasis on the sleep, moms! We know you aren’t getting it!”

How Pacifiers Can Help with Postpartum Soothing

Miller recently shared a table with Ninni cofounder Joy Williams at a workshop where the two were both presenting.

Adorable baby with Ninni pacifier cradled on mom's lap

“It was truly an honor to discuss her passion and pursuit to meet the needs of moms and babies!” 

She says it’s important for parents and caretakers to understand that pacifiers ARE soothers, and that soothing your baby is important for many reasons. 

During the postpartum period, mamas and babies are getting to know each other and creating a rhythm. It isn’t always sunshine and rainbows, and in those tough moments, it’s important to have the right tools in your tool belt.

Utilizing a pacifier used to be so frowned upon despite the fact that sucking is a reflex that babies are born with. The problem, Miller observes, is that most pacifiers are not designed thoughtfully. In other words, the design does not consider the relationship between oral function, development, and the human nipple. 

“We have had the best template all along from mothers, but Ninni is the first to jump on that design and embrace it!” 

The result is a baby with improved oral function that is both soothed and satisfied – and that means more peace of mind for moms and babies alike!