Postpartum

What is postpartum?

The postpartum period is an exciting, dynamic time in a woman’s life, and the family physician plays an important role in promoting a smooth transition through this period. Physicians can ensure quality postpartum care through a thorough and consistent approach to medical and psychological conditions. The postpartum period begins one hour after delivery of the placenta and generally lasts six weeks.

What are some of the benefits of exercise for postpartum women?

Exercise has the following benefits for postpartum women:

• • It helps strengthen and tone abdominal muscles.
  • It boosts energy.
  • It may help prevent postpartum depression.
  • It promotes better sleep.
  • It relieves stress.
  • It can help you lose the extra weight that you may have gained during pregnancy.

How much should I exercise after I have a baby?

After having a baby, you should get at least 150 minutes of moderate-intensity aerobic activity every week. You can divide the 150 minutes into 30-minute workouts on 5 days of the week or into smaller 10-minute sessions throughout each day. For example, you could go for three 10-minute walks each day.

What is an aerobic activity?

An aerobic activity is one in which you move large muscles of the body (like those in the legs and arms) in a rhythmic way.

What is a moderate-intensity activity?

Moderate intensity means you are moving enough to raise your heart rate and start sweating. You can still talk normally, but you cannot sing. Examples of moderate-intensity aerobic activities include brisk walking and riding a bike on a level surface.

What is a vigorous-intensity activity?

A vigorous-intensity activity is one in which it is hard to talk without pausing for breath. If you followed a vigorous-intensity exercise program before pregnancy, it may be possible to return to your regular workouts soon after the baby is born. Be sure to get your health care professional’s approval.

What are muscle-strengthening workouts and how often should I do them?

This type of exercise works the body’s major muscle groups, such as the legs, arms, and hips. Examples include yoga, Pilates, lifting weights, sit-ups, and push-ups. There also are special exercises (called Kegel exercises) that help tone the muscles of the pelvic floor. Muscle-strengthening activities should be done in addition to your aerobic activity on at least 2 days a week.

When can I start exercising after pregnancy?

If you had a healthy pregnancy and a normal vaginal delivery, you should be able to start exercising again soon after the baby is born. Usually, it is safe to begin exercising a few days after giving birth—or as soon as you feel ready. If you had a cesarean birth or other complications, ask your health care professional when it is safe to begin exercising again.

What are some guidelines I can follow when I begin exercising after pregnancy?

Aim to stay active for 20–30 minutes a day. When you first start exercising after childbirth, try simple postpartum exercises that help strengthen major muscle groups, including abdominal and back muscles. Gradually add moderate-intensity exercise. Remember, even 10 minutes of exercise benefits your body. If you exercised vigorously before pregnancy or you are a competitive athlete, you can work up to a vigorous-intensity activity. Stop exercising if you feel pain.

What are some ways to start exercising?

When you are ready to start exercising, walking is a great way to get back in shape. Another good way to get daily exercise is by joining an exercise class.

Where can I find out about exercise classes?

Check with your local fitness clubs or community centers for classes that interest you, such as yoga, Pilates, spinning, and dance. Some gyms offer special postpartum exercise classes and classes you can take with your baby.

What can I do if I want to exercise but I don’t want to join a gym?

If you do not want to join a gym but want the benefits of having someone to exercise with, ask a friend to be your workout buddy. If you want to exercise on your own, check out fitness videos and online exercise programs. Many are designed for women who have just had a baby.

How can I stay motivated once I start exercising?

You may already have a great exercise tool in your pocket. Smartphone apps for exercise and fitness can help you stay motivated, keep track of your progress, and connect you with others with the same exercise goals. Many apps are free or cost very little.

How should I prepare for my workout?

As you get ready for your workout, follow these steps:

• Wear loose-fitting clothing that will help keep you cool.
• If you are breastfeeding, feed your baby or express your milk before your workout to avoid any discomfort that may come from engorged breasts.
• Wear a bra that fits well and gives plenty of support to protect your breasts.
• Have a bottle of water handy and take several sips during your workout.

What are baby blues?

About 2–3 days after childbirth, some women begin to feel depressed, anxious, and upset. They may feel angry with the new baby, their partners, or their other children. They also may:

• Cry for no clear reason
• Have trouble sleeping, eating, and making choices
• Question whether they can handle caring for a baby

These feelings often called the baby blues, may come and go in the first few days after childbirth.

How long do the baby blues usually last?

The baby blues usually get better within a few days or 1–2 weeks without any treatment.

What is postpartum depression?

Women with postpartum depression have intense feelings of sadness, anxiety, or despair that prevent them from being able to do their daily tasks.

When does postpartum depression occur?

Postpartum depression can occur up to 1 year after having a baby, but it most commonly starts about 1–3 weeks after childbirth.

What causes postpartum depression?

Postpartum depression probably is caused by a combination of factors. These factors include the following:

• Changes in hormone levels—Levels of estrogen and progesterone decrease sharply in the hours after childbirth. These changes may trigger depression in the same way that smaller changes in hormone levels trigger mood swings and tension before menstrual periods.
• History of depression—Women who have had depression at any time—before, during, or after pregnancy—or who currently are being treated for depression have an increased risk of developing postpartum depression.
• Emotional factors—Feelings of doubt about pregnancy are common. If the pregnancy is not planned or is not wanted, this can affect the way a woman feels about her pregnancy and her fetus. Even when a pregnancy is planned, it can take a long time to adjust to the idea of having a new baby. Parents of babies who are sick or who need to stay in the hospital may feel sad, angry, or guilty. These emotions can affect a woman’s self-esteem and how she deals with stress.
• Fatigue—Many women feel very tired after giving birth. It can take weeks for a woman to regain her normal strength and energy. For women who have had their babies by cesarean birth, it may take even longer.
• Lifestyle factors—Lack of support from others and stressful life events, such as a recent death of a loved one, a family illness, or moving to a new city, can greatly increase the risk of postpartum depression.

If I think I have postpartum depression, when should I see my health care provider?

If you think you may have postpartum depression, or if your partner or family members are concerned that you do, it is important to see your obstetrician-gynecologist at Pure OBGYN as soon as possible. Do not wait until your postpartum checkup.

How is postpartum depression treated?

Postpartum depression can be treated with medications called antidepressants. Talk therapy also is used to treat depression, often in combination with medications.

What are antidepressants?

Antidepressants are medications that work to balance the chemicals in the brain that control moods. There are many types of antidepressants. Drugs sometimes are combined when needed to get the best results. It may take 3–4 weeks of taking the medication before you start to feel better.

Can antidepressants cause side effects?

Antidepressants can cause side effects, but most are temporary and go away after a short time. If you have severe or unusual side effects that get in the way of your normal daily habits, notify your ob-gyn or other health care professional. You may need to try another type of antidepressant. If your depression worsens soon after starting medication or if you have thoughts of hurting yourself or others, contact your health care professional or emergency medical services right away.

Can antidepressants be passed to my baby through my breast milk?

If a woman takes antidepressants, they can be transferred to her baby during breastfeeding. The levels found in breast milk generally are very low. Breastfeeding has many benefits for both you and your baby. Deciding to take an antidepressant while breastfeeding involves weighing these benefits against the potential risks of your baby being exposed to the medication in your breast milk. It is best to discuss this decision with your ob-gyn or other health care professional.

What happens in talk therapy?

In talk therapy (also called psychotherapy), you and a mental health professional talk about your feelings and discuss how to manage them. Sometimes, therapy is needed for only a few weeks, but it may be needed for a few months or longer.

What are the types of talk therapy?

You may have one-on-one therapy with just you and the therapist or group therapy where you meet with a therapist and other people with problems similar to yours. Another option is family or couples therapy, in which you and your family members or your partner may work with a therapist.

What can be done to help prevent postpartum depression in women with a history of depression?

If you have a history of depression at any time in your life or if you are taking an antidepressant, tell your ob-gyn at Pure early in your prenatal care. Ideally, you should tell him or her before you become pregnant. He or she may suggest that you begin treatment right after you give birth to prevent postpartum depression. If you were taking antidepressants before pregnancy, your ob-gyn or other health care professional can assess your situation and help you decide whether to continue taking medication during your pregnancy.

What support is available to help me cope with postpartum depression?

Support groups can be found at local hospitals, family planning clinics, or community centers. The hospital where you gave birth or your health care professional may be able to assist you in finding a support group. Useful information about postpartum depression can be found on the following websites:

National Women’s Health Information Center – http://www.womenshealth.gov/mental-health/illnesses/postpartum-depression.html

Medline Plus – http://www.nlm.nih.gov/medlineplus/postpartumdepression.html