The Ultimate Postpartum Guide: What happens after you give birth

Nearly 90 percent of women will have a child. Yet for an event so common-and dramatically life-altering-its striking how rarely we discuss what happens to us. Forget diapers and pacifiers. We want to talk about how motherhood transforms our minds, our bodies, and our health. (And why talking about it just might save our lives.) Welcome to the WH unfiltered reality guide.

Motherhood is magical

Really, thats the only word that can describe the act of creating, delivering, and raising a child. But theres another sleight of hand at play, one thats rarely discussed: the mysterious power to make the woman who endured nine months of pregnancy, hours of labor, and birthing a baby the size of a small pumpkin (according to the fetus-size-as-produce chart) feel virtually invisible after birth.

Dont get us wrong-few things in life are sweeter and more rewarding than a babys gummy smile. But while newborns are doted upon, moms are often relegated to the background, with limited help or resources as they navigate one of the most profound physical and psychological shifts a woman can experience. Indeed, nearly three-quarters of mothers say society doesnt understand or support them, according to a recent survey.

One reason: Theres a myth that motherhood comes naturally and that were completely fulfilled just by taking care of our babies, says Elizabeth Fitelson, MD, an assistant professor of psychiatry at Columbia University Medical Center. So why would we need help or-gasp!-make ourselves a priority?

Let’s bust that misconception wide open. Yes, motherhood can be joyous. But it can also be full of angst, sadness, and confusion. Most often, its a shifting maelstrom of all those emotions and more. And, oh yeah, physical and mental changes that last a lifetime-not just the six weeks after delivery (the clinical definition of the postpartum period).

We say: Eff the unrealistic expectations that women should heal from giving birth, master breastfeeding, and return to work in less time than it takes to train for a half-marathon! We need a postpartum revolution-to say the unsayable and acknowledge the hard truths about modern-day motherhood. Celebs like Chrissy Teigen, Cardi B, and Serena Williams are already leading the charge by publicly sharing their postpartum struggles. Netflixs raw sitcom The Letdown vividly busts new-mom stereotypes. And women are using hashtags like #TakeBackPostpartum and #MotherhoodUnfiltered to inspire and encourage others with stories of the less-than-picture-perfect side of momming.

It takes a village to raise a child. But moms are equally in need of a community of support. Enter ours. Its about to get very real.

Why didn’t anyone tell us about this?

You knew delivering a human was going to be tough, but guess what: That was just the beginning. Some crazy sh*t happens to your body after delivery. Fortunately, weve got the remedies for your postpartum parts.

Your ass, not your vagina, will hurt the most. Between stretching, pushing, and tearing (most women do), your perineum-i.e., the vagto-anus zone-may feel battered and bruised. Nab a few padsicles (maxipad icepacks) from the hospital.

You might get rrhoids. Another pain in the butt? The stress of carrying, then pushing out, a baby can cause veins in or around the anus to pop out, throb, and itch. Soak in a sitz bath or send your S.O. to the store for an OTC cream. (Its the least he can do.)

You’ll have the period to end all periods. Lochia-gory postpartum blood-can flow for up to six weeks. Disposable mesh panties are unsexy but comfy and can hold the ginormous pads (tampons can irritate healing tissue) youll need.

You’ll have contractions. This is a good thing! Its your uterus shrinking back to its normal size. Nursing moms: Expect them when your baby feeds; a chemical released during breastfeeding triggers the contractions. Get help in the form of a heating pad.

You’ll be scared to poop. Narcotic pain meds can stop you up, as can the sheer fear of having a BM when everything down there hurts like, well, a mother. We promise, it wont be that bad, but lots of water and fiber-rich foods will help get things moving.

The gash in your gut is going to hurt. A C-section is major surgery, so expect serious soreness. Take any pain meds your doc prescribes (theyre safe, even if you breastfeed), and hold your hands over the area when you cough or laugh.

Feeding Frenzy

At first, nursing can-pun intended-suck. But conquer these challenges and you’ll reap health perks for yourself and your baby.

You dont have milk straightaway. Dont panic. For a day or two, your body produces colostrum, a highly concentrated fluid made of antibodies. Be patient-and prepare. When your milk does come in, your girls may go up a few cup sizes until your supply settles.

You feel like a 24/7 milk factory. Because you kinda are. Newborns need to nurse 8 to 10 times in a 24-hour period, for as long as 40 minutes at a time. That adds up to as much as seven hours-almost a full workday. Enlist your partner, friends, and family to take care of diapering, burping, or meal prep. Your nipples hurt as if they have rug burns. Repeatedly putting your nips in a wet mouth can make them dry and cracked, which equals toe-curling pain when baby latches on. Apply a drop of olive oil or an OTC nipple cream after each feeding and call a lactation specialist if pain persists. Your babe might have an easily fixed issue.

You woke up with jugs the size of basketballs. Hallelujah! Baby started sleeping through the night. Too bad no one told your boobs, which prepped milk at the normal feeding times. Pump or hand-express just enough milk so youre comfortable. If you fully deflate the breast, your body will keep making milk at that time.

Your breasts can get backed up. Leftover milk can gum up the ducts that channel milk to the nipple, causing a tender lump, and potentially mastitis, a painful infection. Have baby feed on the side with the blockage while you massage it. Vibration, like from a kids toothbrush, may also help. To prevent future milk jams, dont skip feedings.

The Politics of Breastfeeding

The debate on breast is best versus formula feeding distracts from the real problem: Doctors heavily promote breastfeeding, but the government doesnt fully support moms efforts. Breastfeeding in public wasnt legal in all 50 states until this year. Inadequate paid leave forces many mothers to return to work before they can establish a milk supply (it can take up to six weeks), and 60 percent of working moms dont have a safe, private place to pump. Is it any wonder two-thirds of moms dont reach their BF goals? Here’s what you can do to take action.

Ask your congressional leaders to back the Supporting Working Moms Act, which would provide workplace protections for pumping and breastfeeding.

Have your colleagues backs (or, er, fronts). To new moms who are breastfeeding, support from female coworkers is even more important than that from their significant others, friends, and relatives. Offer encouragement so she can take pumping breaks.

Petition local public venues (like stadiums and arenas) to install freestanding lactation pods, like those made by Mamava. No woman should have to pump in a port-a-potty.

A Matter of Life or Death

Babies have a flurry of checkups in the days and weeks after leaving the hospital. Though moms are also at risk during this period, most wont see a doctor until their six-week checkup. An estimated 700 women die in the U.S. every year from pregnancy- and childbirth-related causes-thats more than in any other country in the developed world. Another 65,000 nearly die. And women of color are particularly vulnerable, according to the Centers for Disease Control and Prevention.

More devastating, research says that half of these deaths may be preventable. Why: New mothers arent told of the risks and problematic signs, and postpartum nurses dont receive enough education on symptoms that could indicate life-threatening complications, one study found. Whats more, women living in rural maternity care deserts dont have enough access to obstetric services, says a new March of Dimes report.

To address the unacceptably high maternal-mortality rate, the American College of Obstetricians and Gynecologists (ACOG) recently released guidelines suggesting that a moms first doc visit should come within three weeks of delivery, with follow-ups as needed. When women are seen sooner, doctors are more likely to spot cardiovascular problems, hypertension, and mental health issues that are big factors in these mortality rates, says ob-gyn Tamika Auguste, MD, a coauthor of the ACOG opinion.

If youre expecting, schedule an appointment within a few weeks of your due date. And if worrying symptoms (swelling, headaches, heavy bleeding, breathing difficulties) crop up before this visit, call your doctor, stat.

Who Am I Now?

The seismic identity shift experienced by freshly minted moms can be disorienting, slightly terrifying, and bittersweet. We sat down to get real about this transition with reproductive psychiatrists Alexandra Sacks, MD, and Catherine Birndorf, MD, authors of the forthcoming What No One Tells You: A Guide to Your Emotions From Pregnancy to Motherhood .

Why do women often feel a loss of identity after having a baby?

Sacks: Its a wild change thats actually analogous to puberty. Just like how a child evolves into a teenager and an adult, theres a period of body morphing and hormone shifts that a woman goes through when she becomes a mother. Plus theres an identity transition: You go from living a life where you are at the center to waking up and realizing you are responsible for, and in love with, a completely dependent human who now runs the show.

What do you wish more women knew about this metamorphosis?

Birndorf: That almost every new mother is ambivalent in some way about becoming a mom.

Sacks: Exactly. Women come to me and say, Today I felt like I wanted my old life back, or, Did I make a mistake having a baby? They are afraid to admit it and think something is wrong with them. Thats why talking about the highs and lows is so important. Knowing youre not alone can be incredibly powerful.

What can women do to find themselves again?

Sacks: Write down everything that was most pleasurable to you before you became a mom-what made you feel balanced and well. Then put the list on your refrigerator so you can check in and see how much of it you have cut out in the craziness of early parenting. Were often too busy in the transition to motherhood to put ourselves first, and this list can be an important reminder.

The Politics Of Paid Leave

The U.S. is the only developed country in the world without mandated paid family leave, and policies created by individual states cover just 15 percent of workers. As a result, one in four women return to work just two weeks after giving birth. Whats most frustrating: Research shows paid leave policies would benefit everyone. They increase productivity, reduce reliance on government subsidies, and lower infant mortality rates.

Take Action: Urge your elected officials to vote for the FAMILY Act, which would create a national program providing all workers up to 12 weeks of partial income to deal with pregnancy, caregiving, or health issues.

Trying NOT To Conceive

Post-baby, changes to your repro goals may lead you to rethink your birth control. Let us help you guide your choices, whatever your situation.

Best for Women who are still breastfeeding Progesterone-only contraception such as the mini-Pill, intrauterine devices (IUDs), the shot, or an implant. Combined hormonal methods-those containing estrogen-may hurt moms milk supply. Best for Women who want to get pregnant again soon Condoms, cervical caps, and diaphragms. Theyre commitment-free, so you can toss them whenever youre ready to try again.

Best for Women who are on the fence about having more kids LARCs (long-acting reversible methods), including an IUD, an implant, or a shot. Theyre 99 percent effective, and once theyre in place you dont have to think about birth control again until youre ready to try for another baby.

Best for Women who are over it Vasectomy. And after years (maybe decades) of handling the birth control in your relationships, youve earned a break. It can take three months to be effective, so if you dont want an oops baby, use condoms until you get the green light from the doc.

Im exhausted and hormonal. My giant breastfeeding boobs hurt 24/7. I pee a little every time I do a jumping jack.

Beyond the Blues

As many as 15 percent of new moms develop a post-partum mood and anxiety disorder (PMAD)-yet only half of sufferers are identified. The key to getting help: spotting the red flags that signal the shift from normal woes to a serious problem.

B onding Difficulties Baby Blues: Your connection is a slow build, not love at first sight. PMAD: Youre indifferent to or ambivalent about your child, or you actively dislike them. Mood Swings Baby Blues: You ugly-cry one moment and belly-laugh the next. PMAD: You have severe emotional shifts that last longer than three weeks.

Anxiety Baby Blues: You feel unsettled and on edge. PMAD: Obsessive fears make it hard to function. E.g., You stay up all night to compulsively check on the baby.

Scary Thoughts Baby Blues: You worry about accidents (like dropping the baby). PMAD: You persistently think about harming your child, even if you never would act on it.

For the Long Haul

Six months after giving birth, writer Sara Gaynes Levy is still navigating fitness as a new mom.

At my postpartum checkup, I asked my OB if there was anything I needed to be careful about as I got back into working out. Her vague response: Dont do anything that doesnt feel comfortable.

Um, what? My entire life is uncomfortable! Im exhausted and hormonal. My giant breastfeeding boobs hurt 24/7. I pee a little every time I do a jumping jack. (People: A warning would have been nice!) And Im still recovering from the last year of my life: the first-trimester nausea that left me so weak I could barely stand up to take a shower; the third-trimester belly that let me drop down only an inch during modified pushups; the baby that compressed my lungs for a quarter of a year.

Theres a mental shift too. Ive spent years trying to get comfortable with discomfort. Running long distances, holding deep yoga poses, lifting heavy weights-none of that necessarily feels good in the moment, but Im stronger for it. In fact, thats always been the point of exercise for me: It helps me feel powerful, awake, on top of my game. But now that my body is in something of a state of disrepair, Im no longer always able to tell when discomfort is building it up or breaking it down.

It only gets more confusing when I have to choose between taking care of my body by sleeping and taking care of my body by exercising. I want to be the best version of myself for my daughter, but I dont always know which one to pick. Its a new kind of challenge, one without a clear finish line.

Most days I choose the physical discomfort (although, I promise, if I have a day where I feel like its punishing me, I back down) because I want my daughter to see that every drop of sweat on my face is proof of a victory. I want her to share in that strength and see exercise as something to be proud of. Im pushing through the aches-for both of us.

Lets Talk About Sex

And how almost a quarter of women still find it painful a full 18 months after childbirth. Overcome these issues and the only thing standing between you and a stellar romp will be the kid who wakes up just as you get your groove on.

Scars: If you tore or had an episiotomy, still-healing tissue can be sore. Add bedroom activities that dont involve penetration. C-section incision still itchy and sensitive? Avoid positions that put weight on your stomach.

Leaks: Chemicals released during sex can trigger letdown, even if youve stopped breastfeeding. Meaning: Your boobs may spray. And with your weakened pelvic floor, pee might also trickle out. Keep a towel (and a sense of humor) close by.

Hormones: Still breastfeeding? Low estrogen levels can make the vagina less elastic and cause it to dry out. Plus, nursing curbs testosterone (the mone that amps up desire). Lean on lube and longer foreplay.

Libido: Dissatisfaction with your body and sheer exhaustion can make you feel meh about getting down. Spend time with your guy without sex being the sole goal. Tell him: Netflix, sans chill.

The Politics of Childcare

Talk about sticker shock: The average cost of childcare in the U.S. is $8,700 a year. That price tag, combined with a lack of family-friendly work policies (e.g., flex time), drive many women out of their jobs, which can create financial hardship. Having a baby is one of the leading causes of poverty, says Kristin Rowe-Finkbeiner, cofounder and CEO of MomsRising.com and author of Keep Marching: How Every Woman Can Take Action and Make Change in Our World.

Take Action: Urge your elected officials to vote for the Child Care for Working Families Act, which would limit childcare costs to 7 percent of low- and middle-class parents income. If youre in need of financial help, contact advocacy group Childcare Aware (childcareaware.org). It can connect you with assistance resources in your state.

Rethinking Mom Brain

Forgetting appointments or even (occasionally) your own name-the mental struggle is legit. As in scientifically proven: Brain scans show moms have less gray matter. But that could be a good thing. It may be our brains version of nesting-a streamlining and restructuring that helps us adapt to the extra skills and attention needed to nurture another human being, says Kelly Lambert, PhD, a professor of behavioral neuroscience at the University of Richmond. In which case: Embrace these new superpowers.

Mad Multitasking Skills: Moms have increased activity in their prefrontal cortex, an area of the brain associated with decision-making. That quick thinking comes in handy when juggling the demands of motherhood.

Enhanced Empathy: Youll feel for your kids, even during the most epic tantrum, because the part of your brain linked with understanding others emotions grows.

A Shield Against Stress: Maternal brain changes may make you less likely to lose your sh*t in tense situations, preliminary research suggests. Call on this prowess when your preschooler flips out over the seam in her socks.

A Razor-Sharp Memory: Changes to the hippocampus may boost your powers of recall. The catch: It pertains only to info about your kids. Youll remember exactly where your toddler left his monster truck, but you still might scramble for a coworkers name. Womp.