The postpartum period is a stressful time for birth mothers as well as the immediate family in which a child is born into. On top of the common stressors surrounding the postpartum period such as sleep deprivation, body and hormonal changes, and the many demands of caring for a newborn, mothers have to adapt to their new parenting role (Osman et al., 2014). First-time mothers might feel insecure, inadequate, or unable to care for their infant and oftentimes feel overwhelmed, isolated, and exhausted.

Many stressors during the postpartum period have been identified including overload, working mother concerns, isolated motherhood, limited supportive resources, exhaustion, parenting demands, and changes in body and sexuality (Osman et al., 2014). Although most of the attention is focused on the six week postpartum period, sources of stress from overload were present at nine to twelve months postpartum. It is important to examine the societal frameworks around birth and aftercare to determine deficits and areas for improvement. Community resources and public health policy are crucial to prepare and support women throughout the first challenging postpartum period year.

In this section we will address health and wellness by identifying some of the challenges birth mothers face within the healthcare system. We will also take a look at sleep deprivation and nutrition and how this impacts recovery and life with a newborn. Lastly, we will also explore common mental health issues, risk factors, and associated protective factors.

4.7.1 Postpartum Health Care

In Chapter 3, we discussed the importance of prenatal care and the implications for caregivers and children. We know that consistent prenatal care helps identify potential concerns for the mother and child. Postpartum care addresses similar concerns, but more specifically, serves as a time to monitor and support the transition from pregnancy to motherhood. During postpartum care visits, potential problems can be identified and addressed such as persistent bleeding, inadequate levels of iron, blood pressure issues, emotional changes, and infections.

Pregnant women receive various levels of care and support during their pregnancy but this support may diminish once the baby is born. According to the World Health Organization, in the 42 days after the birth of a child, “the burden of maternal and neonatal mortality and morbidity remains unacceptably high, and opportunities to increase maternal well-being and to support nurturing newborn care have not been fully utilized” (WHO, 2022). The postnatal period is a critical yet neglected period of quality healthcare for mothers and their babies.

Social inequalities further burden the mother and child and can have a lifelong impact on their well being. The healthcare system is zoning in on providing positive postnatal experiences by recognizing the link between postnatal care and long term outcomes. The World Health Organization defines a positive postnatal experience as a time when “women, newborns, partners, parents, caregivers and families receive information, reassurance and support in a consistent manner from motivated health workers; where a resourced and flexible health system recognizes the needs of women and babies, and respects their cultural context” (WHO, 2022).

Like prenatal care, access and quality of postpartum care vary greatly depending on socioeconomic status, access to health insurance, race and ethnicity, and geographic location, among many other social determinants. Yet, nothing stresses the importance of postpartum care better than realizing that 50 percent of maternal deaths occur during the postpartum year. Not surprisingly Black and Indigenous mothers of color (BIPOC) and rural residents experience greater risks post birth (Kozhimannil, et al., 2011). It is important to note that most of these deaths are preventable and that there has been an increase in deaths for BIPOC women each year, despite medical advancements (CDC, 2019).

4.7.2 Sleep

Most of us have heard the phrase “say goodbye to sleep, once the baby comes,” (or some variation of this) recited to expecting parents. Although having a newborn brings many joys and warm feelings, we must also discuss the sleep deprivation that is unavoidable after birth. Sleep deprivation has been studied at length with medical residents, shift workers, and commercial drivers. However recently, researchers have become interested in studying sleep disruption related to new mothers. The mother’s sleep is interrupted by many things after having a baby including nighttime feedings, and other challenges related to infant care. Unsurprisingly, the greatest sleep disruption occurs one week postpartum.

One of the most common pieces of advice that postpartum mothers receive is to “sleep when the baby sleeps”. Although this might seem like a no-brainer, many mothers or primary caregivers might be inclined to catch up with other responsibilities while the newborn sleeps. Getting adequate rest during the fourth trimester is important for both the newborn and their caregiver. Yet, over 50 percent of women still experienced excessive daytime sleepiness at week 18 (Creti et al., 2017) and sleep disruption can last for months. Many factors contribute to sleep deprivation including a change in hormone levels, responding to newborn needs such as feeding and diapering, or attending to one’s own needs.

Postpartum sleep deprivation has been linked to increased risk of depression. According to the article “Sleep Deprivation and Postpartum Depression”, postpartum women will experience “ a sudden drop in levels of estrogen, progesterone, and thyroid hormones. This change affects the sleep cycle and lays the groundwork for depression. Over time, if sleep doesn’t improve, this raises the likelihood of developing postpartum depression” (Pacheco, 2023).

4.7.3 Nutrition

Throughout the pregnancy, expecting mothers have heard messages such as “drink lots of fluids.” Although women might be exhausted from demand among others, hydration is very important during the postpartum period, along with a nutrient dense diet. Having a healthy balanced diet full of vegetables and fruits will ensure the healthy growth and recovery of the infant and mother. Mothers who breastfeed should ensure that they include added calories to their diets. It is estimated that a breastfeeding mother burns an extra 500-700 calories daily (AAP, 2017). These calories are used by the body to produce milk which contains valuable nutrients and antibodies.

Breastfeeding provides many benefits to both the mother and child. Research demonstrates that mothers who breastfeed experience lower risks of breast and ovarian cancer, high blood pressure, and type 2 diabetes (CDC, 2021). As noted earlier, breastfeeding also aids in the bonding between a mother and child. Newborns benefit greatly from breastmilk because it is easy to digest and supplies valuable nutrients to the growing brain and body. The antibodies present in breastmilk help babies develop a stronger immune system which is necessary to protect them from sickness and disease (CDC, 2021).

Unfortunately, there are many factors which impact a mother’s ability to breastfeed or provide breast milk to their child. Poverty, inadequate health care, and lack of access to support services such as lactation counseling can impact a mother’s ability to breastfeed. Many working mothers are also pressured to return to work shortly after birth, which impacts their ability to breastfeed on demand, or to pump enough breast milk to keep up their supply. These factors, combined with “aggressive marketing by the breastmilk substitutes industry” impact a mother’s confidence and ability to feed their child (Global Breastfeeding Collective, 2018).

Racial identity and the intersection with poverty also impacts rates of breastfeeding. Black mothers experience barriers to breastfeeding when compared to White mothers. For example, they may have less education around breastfeeding practices as well as less support for evidence based practices from healthcare agencies in their neighborhoods, with a majority Black population (Beauregard, et. al., 2019). Additionally, Black mothers who are classified as low income will often have to return to work sooner than mothers from other racial groups. This impacts the intention of breastfeeding but also the logistics to feed or pump during work times, which may not always be feasible (Beauregard, et al., 2019).

4.7.4 Mental Health

As we have discussed previously, the birth of an infant brings many positive and negative feelings and emotions. Postpartum depression is a type of depression that occurs after delivering a baby. Although many people refer to postpartum depression as “baby blues,” the feelings surrounding postpartum depression are more intense and longer lasting (CDC, 2022). Postpartum depression is the most common psychiatric disorder observed during the postpartum period (Rai et al., 2015). Similarly to a major depressive episode, postpartum depression is characterized by a pervasive depressed mood, disturbances of appetite and sleep, low energy, anxiety, and suicidal ideation (Rai, 2015).

Additionally, new mothers may have feelings of guilt or inadequacy related to their ability to care for the infant, and a preoccupation with the infant’s well-being or safety strong enough to be considered obsessional (Rai, 2015). The number of women affected by postpartum depression vary by age, race/ethnicity, history of depression, and state. Recent data shows that 1 in 8 women experience symptoms of postpartum depression post delivery. In the state of Oregon, 15.7 percent of pregnant women self-reported postpartum depressive symptoms in 2020 (CDC, 2022). Research shows that social support, especially for racial/ethnic minority women can buffer against postpartum depression (Pao et al., 2019). Higher levels of social support have a strong protective association against postpartum depression and as the level of social support increases, the severity of postpartum depression symptoms decreases. This suggests that social support is a protective factor against postpartum depression.

Postpartum anxiety disorders are underdiagnosed and potentially more common than postpartum depression (Rai et al., 2015). One of the most common characteristics is nocturnal vigilance, which entails the mother lying awake listening to the infant’s breathing, and constant checking. This results in further sleep deprivation. Mothers may excessively worry and preoccupy about the health and safety of their infant.