From Chapter 9, “Self-care Strategies for Postpartum Women,” Postpartum Depression: A Guide for Front-Line Health and Social Service Providers (© 2005 CAMH)
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Getting as much sleep and rest as possible
Depending on how long labour and delivery take, most mothers go through a few days during and immediately following the baby’s birth when they get little or no sleep. Even after the first few days, women caring for a new baby are likely to have their nighttime sleep interrupted by frequent awakenings to feed their baby. Considering all the sleep disruptions, most mothers not surprisingly feel perpetually tired or exhausted during the first weeks after giving birth.
Strategies for catching up on sleep
Getting sleep during a postpartum hospital stay
Many mothers feel as though they are unable to rest during their hospital stay, due to disruptions associated with care from hospital staff, other patients in the same room and visitors. To minimize disruptions, mothers can tell caregivers when they are trying to rest and ask not to be disturbed for a while.
Tips for mothers:
- You can help keep things quiet in your hospital room by putting meal trays outside the door when you’ve finished eating, and by letting caregivers know when you are resting and do not wish to be disturbed.
- Attach a “do not disturb” sign to the door of your room when you are trying to rest, so that visitors and caregivers will know you are sleeping.
Family and friends will naturally be curious and excited to meet the new baby, and the mother may be delighted to introduce her baby to the important people in her life. However, a constant flow of visitors can add to the stress and exhaustion of the early postpartum period. Family—particularly partners—can support mothers by discouraging visitors from coming at inconvenient times. They can also encourage mothers to consider their own need for rest and quiet.
If women feel uncomfortable about telling people when they should or should not visit, they can ask their support people (partner, parents, relatives) to help in arranging visits at a convenient time. New mothers can also ask visitors to be flexible and allow them to cancel at the last minute if they are feeling tired and not up to seeing anyone.
Tips for mothers:
- You may want to plan an “open house” when everyone can come meet the baby at once. Before giving birth, give your family and friends an idea when you would like them to visit. You might suggest intervals for visits that you find are convenient for you and the baby, for example, from 2:00 p.m. to 3:00 p.m. Encourage people to come after the first week postpartum.
- If you find that people do not always respect your wishes about when you would like them to visit, your partner and/or family members can let visitors know that you are resting and ask them to come at another time.
- Try putting a “do not disturb” sign beside the doorbell and unplug the telephone when you want to take a nap.
Mothers who are home alone with a new baby during the day may find it difficult, if not impossible, to make time to prepare (or even to eat) meals. Yet a new mother can take some steps to provide nourishing food for herself. Being thoughtful about nutrition is a positive form of self-care.
First, she can ask others to help with food preparation, if they are willing. Visitors could come at mealtime and bring along enough food for everyone. The new mother could invite relatives and friends to give a one-dish meal that is ready to freeze as a welcome gift. Suggestions for this type of gift include a casserole, a hearty soup, a stew or a curry. Alternatively, healthy frozen entrees are available at supermarkets, and the new mother could buy these to have on hand when cooking seems like too much of a chore.
Mothers can take a few minutes during the baby’s morning nap or when the baby goes down at night to prepare small meals or snacks for themselves for the coming day. Mothers can eat nutritious, high-energy snack foods while feeding the baby.
Mothers, especially those who are breastfeeding, should stay well hydrated. Dehydration can exacerbate feelings of low energy. Mothers should drink before they are thirsty, as thirst is an early sign of dehydration. A mother is drinking enough when her urine is pale yellow.
Tips for mothers:
Finger foods that mothers can snack on while feeding the baby:
| cut-up fresh fruit
|| dried fruit
| trail mix*
|| dhal or naan breads
|| Chinese buns
| pita bread with hummus
|| crackers with cheese
|| toast and peanut butter**
Examples of foods to keep ready-to-eat in the refrigerator:
|| leftover rice and peas
| soup or stew
|| pasta salad
Keep bottles of water, milk or pure fruit juice handy. Limit coffee with caffeine to no more than two mugs (250 mL/8 oz.) per day. Many women find tea a comforting drink and it is lower in caffeine than coffee. Herbal teas are caffeine-free. If you use alcohol, you should limit it to an occasional drink, especially if you are breastfeeding.
* Breastfeeding mothers who have a family history of allergies should avoid peanuts and discuss with their doctor whether they should avoid other foods.
Moderate exercise in the postpartum period can improve overall energy levels, relieve stress and muscle tension, improve muscle strength needed to carry and feed the baby, and help a woman’s body recover more quickly from pregnancy and childbirth.
Tips for mothers:
- The process of returning to or beginning physical activity after giving birth varies from individual to individual. If you had a healthy, uncomplicated pregnancy and delivery, and feel comfortable, you can begin a mild exercise program immediately. Light intensity activities may include stretching, walking and pelvic floor exercises. If you had a Caesarean birth or complications during your pregnancy or delivery, consult your doctor or other health care provider before resuming physical activity.
- Be on the lookout for fitness or yoga classes in your community. Specific postpartum classes will usually welcome your baby—the baby can either participate with you (babies make great free weights), or child care may be available. These classes also provide a great opportunity to meet other mothers of young babies in your area.
- Brisk walks with the baby in a stroller are great exercise, since the stroller provides some extra resistance. In the winter or bad weather, consider taking the baby for a walk around your nearest shopping mall; or, if you live in a community without an appropriate place for indoor walking, dress yourself and the baby up warmly and go for shorter periods of time, or try another form of exercise (e.g., exercise videos).
- Keep safe when being active. If physical activity causes any pain or you experience heavy bleeding, stop the activity and talk to your doctor or other health care provider. Remember to drink enough when being active.
- If you are breastfeeding, you may find that wearing two bras helps to stabilize your breasts.
Developing and taking advantage of a support network
Given the many demands of a newborn, many mothers spend most of the day at home alone with their children, often having little or no contact with other adults. Consequently, mothers commonly feel trapped and lonely.
Mothers alone with a new baby may feel isolated, especially during bad weather, when it might not seem worth the effort of bundling up to face the cold or heat. Social isolation can negatively affect the mother’s mood and may exacerbate depression, particularly if she is accustomed to socializing regularly with other adults (e.g., at work, at the gym, for leisure activities).
Talking to other mothers of new babies
One of the best ways for women to deconstruct the myths about motherhood is to talk to other mothers about their experiences. Mothers who are lucky enough to have family and friends with young children may have the opportunity to do this through informal social networks. For mothers who don’t have an existing support network of new parents, joining a group that puts mothers in touch with each other may help them to feel less alone, and to recognize that many other mothers face similar challenges and struggles.
However, women who are depressed may find a neighbourhood mothers’ group intimidating or upsetting: women with depression may feel that the other members of the group seem to be coping better than they are, exacerbating their sense of guilt and inadequacy. In this case, women may find PPD-specific groups a better choice. Although these groups are harder to find, they do exist in many areas.
Tips for mothers:
- Join a group for mothers of new babies. Many public health units and community groups or agencies organize weekly groups for mothers. You can also try organizing your own informal mothers’ group by arranging to meet with family and friends who have young children.
- Ask your support people to help you get some time outside the house or apartment without the baby. For example, meet a friend for lunch or to go shopping while someone else watches the baby.
- If getting out of the house or apartment just seems too overwhelming, try starting out by using the telephone or e-mail to re-establish social contacts.
Involving the partner as much as possible
For women with supportive partners, the partner will probably be as keen as the mother is to learn how to be a good parent. A mother can take advantage of the partner’s willingness to help with all and any tasks, such as diaper changes, settling or calming the baby, feeds and post-feed burping, and household chores.
Alone, or “quality,” time for the partner and newborn can help the two of them bond, and gives the mother a much-needed chance to rest and have time for herself.
Tips for mothers:
- You may think you know best how to handle, feed and otherwise care for your new baby. When you see your partner doing things differently, you might be tempted to try and take over or suggest a better way to do things. Resist this temptation; your baby needs to learn how it feels to be handled by different people. Otherwise, down the road, your child may only settle with you, which only makes it harder for others to help out when needed.
- If you find yourself feeling anxious or hovering over your partner when he or she is caring for the baby, you will probably both feel better if you leave the room or home.
Asking other support people for help
Mothers often feel guilty or embarrassed about asking for help because they may feel they shouldn’t need it. Looking after a new baby is hard work, and mothers can use all possible assistance. Mothers may want to make a list of names and telephone numbers to have for situations when they might require or want some help.
Tips for mothers:
- When friends or family members offer to help, take advantage of the offer. Tell them exactly what they can do to help (e.g., bring over dinner, do a load of laundry, watch the baby while you have a nap or take a bath) and when you would like them to do these things.
- If someone is available to look after the baby, take advantage of the time to rest, and resist the temptation to do housework. (The mess will still be there when you get up from your nap, but you may not have another chance to catch up on the missed sleep.)
- When a support person is available to take care of the baby, take advantage of the opportunity to get out on your own for some quiet time to rejuvenate, to enjoy the company of other adults or to do whatever else you feel like at the time.
Heeding the warning signs of stress and responding appropriately
An important aspect of self-care is becoming familiar with your limits and warning signs: signals that suggest you are feeling overwhelmed, stressed and need a break. Service providers should encourage mothers to watch for their own triggers (i.e., people or activities that tend to make them feel stressed or unhappy), as well as warning signs that they may become anxious or down if they continue what they are doing.
Listening to signals
Service providers should urge a woman to listen to her own signals, which may include:
- the shakes, jitteriness
- back pain
- door slamming
- raised voice, sarcasm
- rejections or obstinate refusals of help
- clenched jaw, palpitations
- holding the breath
- noises sounding louder than usual
- distressing thoughts (e.g., “I can’t stand this,” or “I’m not coping” or “I need help.”)
- muddled or confused mindset
- irritability or numbness
- decreased confidence in one’s abilities (e.g., as a mother)
- indecisiveness, unable to make decisions.
Service providers should urge new mothers to experiment with activities that may be calming when triggers or warning signs indicate that they are starting to feel overwhelmed.
Tips for mothers:
- Take a shower or bath.
- Do deep breathing—focus attention on breathing, rather than on negative thoughts.
- Telephone a friend or caregiver.
- Tell yourself: “It will be all right. I am doing the best I can at the moment.”
- Try positive self-statements: “I can do this” or “You can get through this.”
- Relax tense muscles.
- Remind yourself that you are not alone; others are in the same situation.
If a mother continues to feel overwhelmed or anxious when using these simple strategies, or if the feelings persist, the woman may require medical and/or psychological treatment.
Self-care is not a substitute for appropriate medical or psychological treatment. However, self-care strategies should be considered as part of a comprehensive treatment plan. These strategies may empower a woman to take some of the necessary steps toward her recovery.
Useful self-care strategies for all postpartum women include:
- recognizing unrealistic expectations about what motherhood might be like
- getting as much rest as possible: limiting visitors, letting others know when she is resting
- asking support people for help preparing food, caring for the baby, doing housework
- accepting help that support people, including the partner, may offer
- eating well: preparing one-dish meals, encouraging visitors to bring food, stocking up on healthy, high-energy snacks
- getting moderate exercise: taking it slow, going for walks with the baby, postpartum fitness classes
- building a strong support network: getting out of the house as much as possible, making an effort to meet other mothers with new babies, keeping in touch with family and friends