New mothers often experience conflicting feelings of joy and emotional letdown during the first few weeks after birth. This is often called postpartum blues, or the "baby blues". She may feel down, but overall she finds pleasure in life. These feelings are normal and temporary.
The transition to motherhood brings many hormonal changes, changes in body image, and changes in intrapsychic reorganization. Fluctuating hormones in pregnancy and puerperium, the four-week period following childbirth, have an effect on mood, causing early elation at delivery that can be followed by mild depression with tearfulness, irritability, and fatigue. These feelings peak on the fifth day postpartum. Most women recover and adapt to these postpartum changes in a few days.
However, the physiological factors that affect mood can interact with minor anxieties and stresses to result in a clinical depression. Postpartum depression (PPD) is recognized by a persistent mood of despondency and the mother's disinterest in bonding with baby. Beyond 5 days, the persistence is not expected and should be reported to a health care provider immediately. Additional infant care by a baby nurse can also be recommended as this allows mother to alleviate physical and mental fatigue.
Typical postpartum change/recovery is described in three phases:
Phase 1- Taking In -
Mother is passive and willing to let others care for her. Conversation centers on her birth experience. Mother has great interest in her infant but has little interest in learning about caring for the child, as her primary focus is on recovery from birth and her need for food, fluids, and deep restorative sleep. She is willing to let others handle the care of the child.
Phase 2- Taking Hold -
Mother begins to initiate action and becomes more interested in caring for her infant. She becomes critical of her "performance". She has increased concern about her body's functions and assumes responsibility for her self-care needs. This phase is ideal for teaching infant care by a baby nurse.
Phase 3- Letting Go -:
Mothers, and often fathers, work through giving up their previous lifestyle and family arrangements to incorporate the new infant. Many mothers must give up their ideal of their birth experience and reconcile it with what actually happened.
Postpartum assessment typically includes physical valuation, and assessment of psychological bonding, but must also include evaluation for fatigue. Because today's lifestyle often has the woman working through most of her pregnancy, rooming-in after delivery with responsibility for newborn care, and then returning home in 48 hours or less to accept full home responsibilities, many women do not have the opportunity to rest and adapt in the postpartum phase.
Healthcare providers can lessen the level of maternal fatigue by recommending and initiating appropriate relief measures such as taking on the care of the newborn for a few hours, or scheduling baby nurse care that allows for periods of rest. Allowing the mother proper rest assists in her proper recovery.
In some cases, medication is necessary to help mothers with PPD. However, postpartum support can be received through social service agencies, public health nurses, parenting courses and group discussions. These social avenues show mothers they are not alone, and aid them in personal support as well as bonding with baby.