Preparing for the arrival of a new baby is an intense and emotionally charged time. Hormonal mood changes aside, the mix of joyful anticipation and anxiety is enough to give anyone emotional whiplash. Those first few months with a newborn (also known as the fourth trimester) often understandably center around the needs of the baby, but new parents also have increased needs as they adjust to a new family member and recover from the birthing experience. Let’s take a look at some strategies for anticipating a few of the challenges of early parenthood, focusing on maternal health and wellness. 

Mental Wellness
New babies, while adorable, are some of the most disruptive people you’ll ever meet. They need to eat every three to four hours, don’t know the difference between day and night (so long, full night’s sleep!), and have only one way of asking for help: crying. From a caregiver's mental health standpoint, these variables are a perfect storm for at least a little irritability. For millions of birth-givers though, the stressful conditions of child bearing and caring — combined with genetic predisposition — result in perinatal mood disorders such as depression and anxiety. Recent estimates suggest that as many as 1 in 7 women will experience postpartum depression, while postpartum anxiety affects at least 11 to 17% of birth givers. These numbers only take into account folks who were diagnosed after having a baby, and don’t include those who developed symptoms while pregnant, so estimates are most likely higher.

While a history of depression, anxiety, or other mood disorder is the most reliable predictor of postpartum mental health concerns, anyone can develop perinatal mood and anxiety disorders. Hormonal changes are the most likely culprit for those without a history of mood disorders who notice symptoms such as feeling hopeless, intense guilt, or unmanageable fear of something happening to their baby.

Here are some steps you can take to potentially prevent a severe mood or anxiety disorder from disrupting your early days with your new baby.

1. Know your history. Mental health issues are widely stigmatized, which often results in a lot of secrecy and shame. Ask your family about any history of diagnosed mental illness, as well as odd or concerning behavior, particularly in the women in your family. Asking about behavior as well as diagnoses may help alert you to any untreated or unacknowledged mental health issues, which is sadly common once you look two to three generations back.  
2. Screen for symptoms regularly. Your provider may have you complete assessments such as the Edinburgh Depression Scale and Patient Health Questionnaire to pinpoint shifts toward mood or anxiety disorders. If providers don’t screen regularly, ask them to!
3. Flexible self-care. I heavily emphasize “flexible” here, because there’s nothing more demoralizing than making a plan for all the ways you’re going to get sleep, work out, spend time with friends, and snuggle your baby, only to realize that your new boss (read: new baby) has decided to take things in a different direction. Sleep, movement, and connection are some of the most impactful ways we can buffer against mood disorder symptoms, so consider giving yourself a menu of options that address those needs. If sleep is off the table because you have a colicky infant, prioritize taking a walk or calling a friend. If your body needs recovery time and exercise is off the table, ask for help so you can rest more. Sometimes, no options for self care are available. This doesn’t mean you’re doing something wrong! In those times, practice self-compassion and wait it out. 
4. Seek support. If you’re concerned that you may have a perinatal mood or anxiety disorder, consider reaching out to a perinatal mental health specialist. This could be a counselor, psychologist, doula, or medication provider such as a nurse practitioner, physician’s assistant, or doctor. There are also online and in-person support groups for new parents that can give you a space to connect with folks who can offer non-judgmental support. 

Physical Wellness
While Instagram may be full of celebrity photos celebrating the return to skinny jeans 6 weeks after birth, it’s important that we realize that pregnancy and birthing recovery is not one size fits all. Physical wellness after pregnancy includes how our bodies recover from vaginal or c-section birth and how our bodies may have changed inside and out as a result of pregnancy. It can be an important mindset shift to acknowledge that we don’t necessarily need to “recover” from all the changes brought about by pregnancy. While it can be difficult to adjust to certain body changes, we can save ourselves a lot of anguish by sorting through what we really need to alter versus what we could benefit from accepting, especially as it relates to body image.  

Movement
The urge to get exercising again after a baby can be powerful, especially if you had to reduce your activity due to pregnancy complications, fatigue, or those extra stretchy ligaments. First and foremost, follow your doctor’s orders if you had a complicated birth or one that involved any sort of surgery. Secondly, start small — small time increments, low intensity, low weight, low impact. While pregnancy isn’t a disease that we need to heal from, we are in a vulnerable physical state post-delivery. Honor that fact by easing into movement and being responsive to any discomfort that arises as you go. Be aware of your motivation for movement. If you find you are hyper focused on losing baby weight or regaining pre-pregnancy strength or ability, consider how likely you would be to push a friend or loved one to get the same results.

Pregnancy-Related Conditions
The list of possible complications from pregnancy is long, so I’ll focus on one severe concern and one often misdiagnosed concern.

1. Cardiac problems post-pregnancy can be life threatening. Though they are more likely connected to pre-existing heart issues, symptoms such as chest pain when standing or lying down, erratic heart beat, or shortness of breath can result from pregnancy, and are cause to call your doctor immediately. 
2. Postpartum thyroiditis is a condition in which the hormones of pregnancy alter the thyroid gland’s performance. The thyroid and hormones it produces are responsible for managing metabolism, which impacts how much energy our cells use. When our thyroid becomes inflamed or less functional, we can experience a range of symptoms that often get mistaken for depression or anxiety. If you find you’re feeling sluggish, gaining weight, feeling cold, or notice changes to your hair and nail texture in addition to feeling sad, tearful, anxious, irritable, or excessively guilty, ask your provider to check your thyroid levels. 

There’s no way to fully predict or prepare for what it will be like to have a new baby, but setting an intention to be compassionate with yourself and flexible in your approach can help you make the most of this exciting (nerve-wracking, joyful, frustrating, life-changing) time. 

How have you adapted your post pregnancy plan to work for you? What challenges have you faced? Let us know in the comments!

Written for Fitness Blender by Candice CM, PhD
Licensed Clinical Mental Health Counselor Supervisor

References

Kendig, S., Keats, J. P., Hoffman, M. C., Kay, L. B., Miller, E. S., Moore Simas, T. A., Frieder, A., Hackley, B., Indman, P., Raines, C., Semenuk, K., Wisner, K. L., & Lemieux, L. A. (2017). Consensus Bundle on Maternal Mental Health: Perinatal Depression and Anxiety. Obstetrics and gynecology, 129(3), 422–430. https://doi.org/10.1097/AOG.0000000000001902

Puryear, L. J., Nong, Y. H., Correa, N. P., Cox, K., & Greeley, C. S. (2019). Outcomes of implementing routine screening and referrals for perinatal mood disorders in an integrated multi-site pediatric and obstetric setting. Maternal and child health journal, 23(10), 1292-1298.

Smith, G. N., Louis, J. M., & Saade, G. R. (2019). Pregnancy and the postpartum period as an opportunity for cardiovascular risk identification and management. Obstetrics & Gynecology, 134(4), 851-862.

Stagnaro-Green, A. (2002). Postpartum thyroiditis. The Journal of Clinical Endocrinology & Metabolism, 87(9), 4042-4047.