The postpartum period is a stressful time for birth mothers and the immediate family into which a child is born. 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 may often 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 the body and sexuality (Osman et al., 2014). Although most of the attention is focused on the 6-week postpartum period, sources of stress from overload were also present at 9 to 12 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 for preparing and supporting women throughout the first challenging postpartum 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.

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, it serves as a time to monitor and support the transition from pregnancy to motherhood. During postpartum care visits, potential problems, such as persistent bleeding, inadequate levels of iron, blood pressure issues, emotional changes, and infections, can be identified and addressed.

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 health care 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 people 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).

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 1 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 experience 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, and attending to one’s own needs.

Postpartum sleep deprivation has been linked to an 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).

Nutrition

Throughout the pregnancy, expecting mothers are frequently told to drink lots of fluids. Hydration is very important during the postpartum period, as is 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 increase their caloric intake. 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 breast milk because it is easy to digest and supplies valuable nutrients to the growing brain and body. The antibodies present in breast milk help babies develop a stronger immune system, which is necessary to protect them from sickness and disease (CDC, 2021).

Unfortunately, there are many factors that 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).

The intersection of racial identity and poverty also impacts rates of breastfeeding. Black mothers experience more barriers to breastfeeding than White mothers. For example, they may have less education about breastfeeding practices, and health-care agencies provide less support for evidence based practices in 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 not only the intention of breastfeeding, but also the logistics of feeding or pumping, which may not always be feasible during work hours (Beauregard et al., 2019).

Mental Health

As we discussed previously, the birth of an infant brings many positive and negative feelings and emotions. Postpartum depression is depression that occurs after delivering a baby. Although many people refer to postpartum depression as the “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 varies by age, race/ethnicity, history of depression, and state. Recent data shows that one in eight 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 provide a buffer against postpartum depression (Pao et al., 2019). Furthermore, 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 while listening to the infant’s breathing and engaging in constant checking. This results in further sleep deprivation. Mothers may excessively worry and preoccupy about the health and safety of their infant.

Paternal depression, or the postpartum depression experienced by fathers, is something that also must be considered. While the father may not experience the same body changes as the birth mother, they are still subject to hormonal changes, lack of rest and sleep, and societal and familial pressures. It is estimated that up to 10 percent of fathers experience postpartum depression (Paulson & Bazemore, 2010). Paternal depression may look similar to maternal depression, but it can be distinct. Some common symptoms include experiencing anger or irritability, losing interest in activities, distancing oneself from family and friends, feeling discouraged or frustrated, and experiencing sadness or hopelessness (Cleveland Clinic, 2019).

Licenses and Attributions for Health and Wellness

“Health and Wellness” by Christina Belli and Esmeralda Janeth Julyan is licensed under CC BY 4.0.

“Sleep” by Esmeralda Janeth Julyan is licensed under CC BY 4.0.

“Mental Health” by Esmeralda Janeth Julyan and Christina Belli is licensed under CC BY 4.0.