Redefining Postpartum with La Toya Luces MD

At Bay City Doulas, we aim to help our clients create a village. We consistently seek excellent providers to network with and learn from, which in turn consistently betters our practice and the care we provide. We were fortunate enough to foster a relationship with Dr. Luces recently, and we couldn’t wait to have her on our blog. La Toya is a wealth of knowledge, and after her own postpartum experiences, she switched her professional focus from being an OBGYN to a perinatal therapist. We hope you enjoy this week’s guest blog, redefining postpartum.

Redefining Postpartum- The importance of postpartum care and support up to 1 year postpartum.

I could not sit.

I couldn’t lay flat.

I couldn’t lay propped up.

Even laying on my side made my tailbone throb.

My Postpartum story

I was three months postpartum, and I was still having all of this hip pain from the pregnancy that I was sure would go away after I had the baby. I certainly wasn’t expecting to develop new tailbone pain that prevented me from being in any one position for too long. After my first baby, I was back to work at three months as a full-time OBGYN, doing 12-hour shifts and surgeries. This time, I was working for myself and expected to bounce back just like I did last time because I had done this before, and now I didn’t have an employer to answer to. I thought I would be able to slide right back into doing my part-time hospital contracting, speaking, content creation, advocacy, and education…

As you can imagine, this did not go well…

Between the constant pain, the guilt involved with juggling a baby and a three-year-old, the extreme fatigue from exclusively breastfeeding, and the resentment toward my support system for focusing on the baby and not acknowledging what I was going through (even though I hadn’t expressed it), not only did I not bounce back, I found myself in another burnout situation. After having burned out in my career, I would never have imagined it could happen postpartum.

It took a trip to Mexico, a pelvic floor physical therapist, a psychotherapist, and lots of time, patience, and healing to get me back to a point where I could resume all of my normal activities. Even at six months postpartum, the stress of exclusively breastfeeding started threatening my mental health, and at eight months, I decided to stop because I couldn’t do it anymore. Throughout this entire experience, I began looking at how postpartum is considered and treated in the United States.

Rethinking postpartum care

When a person is pregnant, they plan for the baby. Very little thought is given to their recovery plan. Then the baby comes, and most moms get forgotten. This is true from a medical standpoint as well. Consider it: how many appointments do newborns get vs postpartum moms? Sure, in recent years, there has been increasing focus on the 4th trimester, the first 12 weeks after birth, especially as it relates to decreasing rates of maternal morbidity and mortality. ACOG recommends OBGYN contact within three weeks of birth and a comprehensive postpartum appointment no later than 12 weeks. But even that is not enough because, after 12 weeks, you are STILL postpartum.

The true definition of the postpartum period is from birth up to the first year postpartum. One article describes the 4th trimester as the recovery phase and the rest of the postpartum period, up to 1 year, as the strengthening phase. I love this distinction because it highlights the difference between these two stages without completely disregarding the continued effects of pregnancy on our bodies. However you look at it, the fact remains that we still need care, love, and support well past the 4th trimester; I know I did!

At three months, most women are expected to “return to normal.” This expectation doesn’t only come from the people around them, but many moms expect to feel “back to themselves” by this time. When they don’t, it can garner feelings of brokenness. It can be isolating and sometimes even frightening. Is something wrong with me? Why don’t I feel ok?

You are not alone.

I want you to know you are not alone, and you are not broken. Time will heal your body, but probably more time than you think. Also, some things may never be the same because, as the saying goes, A baby changes everything.

Unrealistic expectations

Ok, let’s get into it. Let’s consider why expecting moms to “snap back” after the 4th trimester is unrealistic.

Persistent physical changes

There still may be physical changes that persist past the 4th trimester. This is particularly true for women who have had more than one child. As I mentioned, this was my story. Symptoms of pelvic organ prolapse and incontinence may not be entirely resolved by this time. Pain due to joint dysfunction or sciatica during the pregnancy can also persist postpartum. This highlights the importance of integrating pelvic floor physical therapy as a routine part of postpartum recovery and strengthening. I was fortunate to have access to one during my postpartum journey, but many, unfortunately, do not. Thankfully, a lot of these changes do resolve with increasing time after birth, but therapy can help make this waiting period less painful. It can also identify issues that need immediate attention.

If any pregnancy complications require bed rest or if there is simply less mobility during the final months, this can lead to deconditioning. It can take months to regain the strength lost during the pregnancy and early postpartum recovery.

Breastfeeding

I hear all the time that breastfeeding is protective against postpartum depression, but this is not a universal experience. I’ve already had tons of lactation consultants, and breastfeeding activists fight me on this, but I will stand firm. Even before my recent postpartum experience (I breastfed my first for 22 months with no issues), I spent over a decade caring for postpartum women. I’ve seen the stress, pain, and mental anguish that can come with breastfeeding, especially when you have supply issues. If it is important to keep breastfeeding for one year or beyond, this can significantly affect your sleep, mood, and body. Also, the decrease in estrogen levels that come with breastfeeding can mimic a menopausal state causing night sweats at the beginning of the breastfeeding journey, as well as vaginal dryness. This is important when you are ready to resume intercourse because it can lead to painful sex.

Intimacy

Speaking of sex, intimacy during the extended postpartum period can be such a complex issue. A lot of women have little or no desire to resume intercourse and may even feel pressure from their partner. The 6-week postpartum check may “clear” you for sexual activity, but most moms feel far from ready. I have told moms at their postpartum visits that they can blame me and say I said no when their partners ask if they are cleared for sex. Not that I advocate lying to your partner, but I understood why they would feel the need to. Low libido due to fatigue, resentment, depressed mood, Fear of getting pregnant again before you are ready, Fear about potential pain due to tearing that occurred during birth, or just no longer feeling excellent or sexy in the body that you are currently in. These feelings may persist for months, leading to tension within the relationship.

You may feel like this is a taboo topic to discuss, especially if you desire to resume intercourse, so you may not seek advice from your family or friends. You may also be too embarrassed to address it with your doctor. And, there’s always a chance that if you do, you may get a doctor who does not help you at best and, at worst, makes you feel ashamed for asking for help.

I was fortunate with my second to have my mom and mother-in-law alternate to give us some extra support during the first six months of my postpartum journey. For many women in the US, having any in-home support for this long seems like a luxury. Even friends that were very helpful in the beginning eventually assume that around 3-4 months, you’ve recovered and tend to offer less help than in the beginning. There is a general understanding that the newborn phase is challenging, but very little consideration is given to the later months.

Return to work

This is a big one. The return to work can be a significant upheaval in your postpartum journey. At a federal level, the support for postpartum is severely lacking, with some moms having to go back to work a few weeks postpartum. If you are lucky enough to be able to take time off, you usually have to go back around 3-4 months. This transition can be a great source of anxiety, guilt, and stress. Continuing breastfeeding, figuring out pumping at work, the possibility of bottle refusal, childcare issues, work dynamics, and more can make this time particularly difficult.

Poor infant (and mommy) sleep

You expect there to be little to no sleep early on in your postpartum period. You have a newborn who may be cluster feeding and has dysregulated (typical for a newborn) sleep patterns. It’s a time when you just power through. But the baby does magically start sleeping longer at three months. Even if a solid sleep pattern was established, there might be sleep regression, teething,g and other issues that continue to affect the baby’s sleep and, therefore, your sleep. If this coincides with going back to work, it can be a recipe for disaster. Sleep issues for the baby can last for months to years, especially if you are unable orn not wanting to sleep train. Even if the baby begins to sleep through the night, if you maintain your breastfeeding relationship, you may need to stay up late, wake to feed, or pump to keep your supply. All are adding to sleep disturbances that can harm your mental and physical well-being in those later months.

Mental health

“The Baby Blues” is a normal part of the postpartum transition and is a “non-disorder.” It happens because of the extreme hormone shifts that occur immediately after birth, combined with the extreme fatigue and overwhelm that come with having a newborn. It usually ends at two weeks postpartum. One essential thing to note is that “The Baby Blues” is NOT a mild form of postpartum depression. If you have mood changes in the past two weeks postpartum, it may be a sign of Perinatal Mood and Anxiety Disorder (PMAD), which includes postpartum depression. Many women have symptoms of depressed mood or anxiety early in the 4th trimester, but many dismiss it as “Baby Blues” and try to give themselves time to move past it. As the months go on, they realize they are not feeling better. This time can be filled with guilt and shame for not being happy or confusion about why she feels this way. She worries about being considered a bad mom or that the baby could be taken away.

This may cause her to continue to hide her true feelings and not seek out help.

For some context about how common this is and how serious of a problem it is, consider these numbers.

A landmark study of 10000 US mothers found that 21.9% of mothers had depression during the 1st year postpartum.

Another found that two-thirds to three-quarters of all maternal deaths by suicide occur between 6 weeks and one year postpartum.
Finally, there was a Canadian study found that the highest risk for perinatal suicide is at 9-12 months postpartum.

How to know

Sometimes, you may not know you have perinatal mood and anxiety disorder. You may say, “I just don’t feel like myself,” or “Something is wrong.” Every woman experiences these symptoms differently. You may feel angry, fearful, guilty, have little interest in the baby, have trouble with your appetite or sleep, and have difficulty concentrating or making decisions. You may even have thoughts of harming yourself or the baby. If you do, please know that you are not a bad mom but need help, so please reach out to your doctor.

So, moms, this is what I want you to do. If you are pregnant, please plan for way more support and for way longer than you think you will need. If you are postpartum, please speak up if you don’t still don’t feel well, physically or mentally, a couple of months after delivery. Things may get better with time, but some things may not, and there is no reason for you to suffer in silence. If you are neither pregnant nor postpartum, even if you can’t have a baby, please reach out to your postpartum family and friends who are a little further along in their postpartum journey, ensure they are doing ok, and offer your support.

In closing

As I write these words, I am 2 days away from being exactly one year postpartum. Let my story, struggle, and expertise reframe how you think about the postpartum journey. I sincerely hope that if you are also on this journey, you will be comforted that you are not alone or, maybe, make you grateful that nothing I wrote applies to you!

Seriously though, talking about these things is the first step to improving the experiences of postpartum women in this country. The more we are aware, the easier it will be to change behaviors and give postpartum moms the love, support, and care they deserve.

Thank you, La Toya, for coming on our blog today and sharing your postpartum journey. While everyone’s journey is individualized and different, we aim to normalize each aspect of postpartum and how it can affect people differently. To learn more about La Toya’s work with postpartum parents, visit her website here.