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The Postpartum Period and its Symptoms 

with MAM expert Dr.  Alexandre Saosaka

Learn all about the postpartum period. Discover the changes in a mother's body after giving birth and all you need to know about postpartum depression with MAM Expert Dr. Alexandre Saosake.

The postpartum period, also known as the puerperium and "fourth trimester", refers to the time after birth when changes related to pregnancy return to the pre-pregnancy state. In addition to the physical changes during the postpartum period, there are also hormonal changes taking place. These changes can have an impact on the mother’s emotional state, which sometimes seems like an emotional rollercoaster. Together with MAM Expert Dr. Alexandre Saosaka we have summarized the hormonal changes to understand the impact on your emotional wellbeing and potential symptoms of postpartum depression. 


How long does the postpartum period last?

The postpartum period begins with the birth of the baby. The end is not exactly defined, but is generally considered to be six to eight weeks after delivery, as then the effects of pregnancy start to reorganize and gradually return to the pre-pregnancy state. However getting back to a pre-pregnancy condition will happen only gradually after giving birth.


What happens to hormones right after giving birth? 

After giving birth to your baby many hormonal changes are taking place. Some of them can have a bigger impact on your mental state than others. However immediately after giving birth there will be a change in hormones over the next few days:
  • Human chorionic gonadotropin (hCG) is the main pregnancy hormone and declines exponentially immediately after childbirth. The hCG levels then typically return to normal non-pregnant levels two to four weeks after a full-term delivery .
  • Progesterone and estrogen will decrease right after the baby is born. During pregnancy our bodies produce a great amount of estrogen and progesterone, which are the key to creating our “happiness hormones” dopamine and serotonin. So a decrease in both of those hormones, can have an impact on your mood.
  • Oxycotin is released to encourage contractions during childbirth. In addition it plays a major role in forming an attachment between the newborn and mother. However postpartum oxycotin levels will decrease, which can lead to emotional changes, known as “baby blues” in the first few days after giving birth.
  • Prolactin will increase in order to encourage your milk supply. Prolaction can also affect dopamine which can result in low energy levels and emotional moodiness.

What happenes to the hormones levels during the first few weeks after giving birth? 

Over the first few feeks and months your hormones will continue to change and adjust to your baby’s development. Around three months postpartum estrogen and progesterone will return to pre-pregnancy levels. In breastfeeding mothers prolactin and oxycotin will still be increased.
The change in hormones cannot only have an impact on your mood but will also affect your body. The drop in estrogen for example has an impact on hair follicle shedding, which can lead to the known “postpartum hair loss” . But don’t worry, it is usually self-limiting, with restoration of normal hair patterns within 6 to 15 months postpartum.
Furthermore, you may experience “postpartum insomnia” due to the lack of sleep and its decreasing impact on melatonin, a hormone which helps with your day-night-ryhtm.
By the time you start to introduce your baby to solids, the need for breast milk will decrease, leading the levels of prolactin, the “milk-producing” hormones to drop. This will start stimulating your natural cycle again. However the timeline for this can be different for everyone.

What is the difference between “normal” hormonal imbalances and postpartum depression?

As you can see there are many hormonal changes taking place after giving birth which can have an impact on your mood and energy. Many postpartum symptoms are usually self-limiting and will settle down during the first few weeks. Sometimes more severe symptoms of a postpartum depression can occur. It is always important to take these symptoms seriously and seek help from your  health care professional when needed.
Sometimes a postpartum depression can be mistaken for the “baby blues” , but the symptomes are more intense and last longer.
Symptoms of baby blues will last in general a few days to a week or two after giving birth, while signs of postpartum depression include the following and will continue to last:

  • Depressed mood or severe mood swings
  • Excessive crying
  • Difficult bonding with your baby
  • Withdrawing from family and friends
  • Loss of appetite or eating much more than usual
  • Inability to sleep (insomnia) or sleeping too much
  • Diminished ability to think clearly, concentrate or make decisions
  • Restlessness
  • Recurring thoughts of death or suicide

  • Overwhelming fatigue or loss of energy
  • Reduced interest and pleasure in activities you used to enjoy
  • Intense irritability and anger
  • Fear that you're not a good mother
  • Hopelessness
  • Feelings of worthlessness, shame, guilt or inadequacy
  • Severe anxiety and panic attacks
  • Thoughts of harming yourself or your baby


How to relieve symptoms of postpartum depression:

If you are feeling overwhelmed and those feelings are becoming stronger, talk to your medical health care provider. It is very important to carry out an early diagnosis with the follow-up and supervision of an experienced obstetrician, so that the best approach can be taken according to the degree of psychological changes. It is okay to reach out and voice your concerns when struggeling, taking care of yourself is important for you and your baby.



MAM-expert

DR. ALEXANDRE SASAOKA

CLÍNICA GESTA ITAIM

Graduated from the University of Medicine of Santo Amaro, medical residency and Gynecology and Obstetrics at Santa Casa de São Paulo, sub-specialization in Fetal Medicine at Santa Casa de São Paulo, member of the International Society of Ultrasonography in Obstetrics and Gynecology, Master's student in Fetal Medicine at the University Federal of São Paulo and part of the clinical staff of Hospital Israelita Albert Einstein.

Sources:

Reyes FI, Winter JS, Faiman C. Postpartum disappearance of chorionic gonadotropin from the maternal and neonatal circulations. Am J Obstet Gynecol. 1985;153(5):486.

 Midgley AR Jr, Jaffe RB. Regulation of human gonadotropins. II. Disappearance of human chorionic gonadotropin following delivery. J Clin Endocrinol Metab. 1968;28(12):1712.

ACOG Committee Opinion No. 736: Optimizing Postpartum Care.Obstet Gynecol. 2018;131(5):e140.

Dennis CL, Fung K, Grigoriadis S, Robinson GE, Romans S, Ross L Traditional postpartum practices and rituals: a qualitative systematic review.Womens Health (Lond). 2007;3(4):487.

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