Women are taught to expect numerous changes to their bodies during pregnancy; from weight gain to weird cravings to swollen feet, there are just some things we know might happen. However, we don’t talk about the changes that might happen to your body after your baby is born nearly as much, which can lead women to think what they’re experiencing isn’t normal. Since hormonal and emotional changes are common after delivery, it can be difficult to know when what you’re feeling could signify postpartum depression, which can also be frightening.
In terms of physical changes, thinning hair, scar itching, breast engorgement, and more are usually completely normal ways your body adjusts to motherhood as hormones swing back to normal. Some changes are very common, especially when you reach six-seven months postpartum. Alyssa Dweck, M.D., a New York OBGYN and assistant clinical professor at Mount Sinai Hospital’s School of Medicine in Manhattan, and who has been practicing for more than 20 years, says she sees a multitude of “abnormalities” in patients that are not cause for alarm.
What’s Normal–and How to Know
“[Thinning hair and breast engorgement] are usually normal, although we always check for other problems that could be causing them. It is incredibly common for women to have significant hair loss at about six or seven months postpartum,” Dr. Dweck says. “It’s a very common thing to go in the shower and have clumps of hair falling out.”
Dr. Dweck says many women also worry about hemorrhoids and weight gain, as well as itchy C-section scars, but these issues are relatively common too. “I don’t want to call [these experiences] normal. I want to call them not abnormal,” she says. “Some people have a C-section and never get a scar. Some people never get hemorrhoids. It’s individual.”
Lindsey Scharfman, M.D., echoes that hair loss, engorged breasts, some bleeding, and dependent edema, where the body swells bilaterally, are all normal conditions to experience after having a baby. Her patients at Crystal Run Healthcare in West Nyack experience a spectrum of postpartum issues that wind up being nonissues.
Christine Catanzaro, R.N., a mother from Northport, had two children 17 months apart. She noted drastic physical differences in her body between having a boy and a girl. While she did not experience hair loss after her son was born, significant hair fell out after having her daughter. She also gained more weight, experienced more tearing in the labia region, and says her feet were more swollen. She experienced more emotional volatility after having her daughter, but partially attributes that to working nights, sleeping poorly, and having two very young children to parent.
“You don’t have time to feel sorry for yourself,” Catanzaro says. “These extra side effects, I wouldn’t change for the experience of having my kids.”
What’s Not Normal—and What to Do
Doctors agree that certain “normal” symptoms can morph into abnormal ones after birth, and new mothers need to watch their symptoms carefully. Bleeding, for example, is normal, Dr. Scharfman says, but only to an extent.
“Bleeding should be like a period or less,” she says. “If you’re going through one pad a day, that’s normal. But if it’s one to two pads every hour, that’s not normal, and you need to go to [the hospital]. It could be a postpartum hemorrhage.”
New mothers who experience severe dizziness upon standing, feel weak and cold, or have racing heartbeats could be anemic. And if one leg, for example, is more swollen than the other, that could signify a blood clot. If a woman experiences blurred vision, a headache that doesn’t go away with pain medication, or upper belly pain, she could have pre-eclampsia. All of these conditions require immediate medical attention.
There are also potentially less serious physical abnormalities that Dr. Dweck says need to be discussed with your doctor.
“When is it not normal? So, hair loss where it doesn’t seem to stop, or you’re having huge big bald spots…That needs to be addressed by your physician to make sure it’s not something other than just typical postpartum hair loss,” Dr. Dweck says. “As far as the itchy scar, [you just need to make sure] there’s no infection, that there’s no underlying skin condition…Any questions or concerns about it being ‘right’…It’s worth a check with your OBGYN.”
Olga Tusheva, M.D., an OBGYN at Montefiore Nyack Hospital in Nyack, mentioned breast pain as another issue that could become abnormal. “If one breast is significantly bigger than the other, if there is swelling or redness, tenderness, [or if changes are] not proportional to [breast] appearance, then the women should [see her OBGYN] to make sure everything in normal,” Dr. Tusheva says.
The 411 on Postpartum Volatility
Beyond bodily changes, new mothers should monitor their emotions and understand the signs of postpartum volatility. Dr. Dweck prefers not to call this issue “postpartum depression” because that terminology can be pejorative. She says it is one of the challenges women are most concerned about, after postpartum weight gain.
“The emotional volatility that comes about after having a baby, in a good way and in not such a good way, is notable,” she says. “And this is combined with sleep deprivation, which doesn’t help. So, it becomes a concern: How am I going to manage everything?”
Certain populations of women, Dr. Dweck says, are more prone to developing postpartum volatility. Among those most vulnerable are first-time mothers, women who are part of underserved populations, and women who have a history of anxiety or depression during pregnancy. If you start feeling down after having your baby, seek help as soon as possible, and try to get some sleep—it’s vital in managing these feelings, Dr. Dweck emphasizes.
Dr. Tusheva says “post-baby blues” are very common because mothers are often overwhelmed when they bring the baby home and the responsibilities of motherhood are fully realized. “It can happen to any woman, whether it’s her first time having a baby or third or fourth time being a mom,” she says. “We all can be overwhelmed by other people, the social pressure, [feeling] like we need to be the best mother we can be, and the attention imposed on us by our family—our moms, our husbands, mother-in-law, and other people who care about us.”
But when post-baby blues stick around for longer than a short while, they can become more serious. It is imperative to seek medical help.
“Once in a while the symptoms can persist and reach postpartum depression, which can be a very dangerous condition,” Dr. Tusheva says. “If she feels down, overwhelmed, stressed, if there’s any thought of harming herself or baby, all of those symptoms should be discussed with an obstetrician or a primary care physician or a psychiatrist. Someone who can help [her] feel better, as opposed to leaving the condition untreated and having it get worse.”
Hospitals conduct postpartum screenings before sending women home with their new babies, but Dr. Tusheva says every woman should be aware of what postpartum depression could potentially look like. Many things contribute to how a woman is feeling after giving birth, such as sleep, the baby’s health, the baby’s sleep patterns, the availability of support at home, socioeconomic status that relates to available support, or a history of anxiety or depression.
“If a woman is finding herself feeling helpless, hopeless, if she is catching herself thinking any type of thoughts concerning harming the baby or giving the baby away or how much her life would be easier without the baby, if she finds herself just being sad and upset,” Dr. Tusheva says, “I would say for days in a row as opposed to moments of temporary feelings or temporarily upset, then all of those are the concerning factors for developing PPD.”
Treatment for postpartum depression varies on an individual basis. The most important thing to do is seek help so your doctor and psychiatrist can help you feel better, sooner.
The Bottom Line
There are essential steps, Dr. Dweck says, that mothers can take in ensuring they remain healthy and happy after pregnancy. One of the most important things you can do is educate yourself about what to expect in the postpartum space.
“Be conscious, be mindful. Women these days, particularly in the communities I practice in, take a lot of care and try to empower themselves with information and education, whether it’s online or with other moms or new moms or family members,” Dr. Dweck says. “But often times you get misinformation out there. So, I think the bottom line is just to always check if something is out of the ordinary with your health care provider.”
Dr. Scharfman emphasizes the importance of sharing everything with your doctor—and speaking up if something doesn’t feel right. “Having a new baby is really hard,” she says. “If you have any questions, don’t hesitate to ask. If you think something is wrong, don’t just tell the nurse, tell the doctor. Don’t be afraid to reach out.”
When dealing with postpartum blues, Dr. Dweck says, do not be ashamed to talk about what you’re feeling. “And if you feel like you’re spiraling in that direction, please don’t suffer in silence. Get some assistance and talk to your health care provider,” she says. “It’s not a shameful situation. It is what it is, and it really is out of people’s control most of the time. Don’t be afraid to ask for help. That’s my biggest advice.”