I just had yet another family–they only hired me for postpartum support, so didn’t get my normal spiel about postpartum care while we had prenatals together–tell me “we just don’t talk about what postpartum is actually like nearly enough in our society!”
I KNOW. Believe me, I’m trying. Hence, this series of posts about some of the considerations for working through postpartum. In my first post, I talked about some of the transformations that your body goes through when you birth, and if you haven’t read that one, I’d really appreciate it if you’d stop here and go do that. Everything I’m about to say is important because of those transformations, and I don’t want to have to repeat myself too much here. This post is about sleep. Rest, sleep, giving your body the space and inactivity that it needs to heal and put itself back together.
I have worked with several midwives who have different, sweet little ways of saying nearly the same thing, and I’m going to offer two different quips that I like, and you can pick which one works best with your own head.
Cocoon for four days, nest for ten.
Three days IN the bed, three days ON the bed, three days AROUND the bed.
Whichever saying you like, the main idea is that for three or four days, you are laying down in bed. Ideally, you will only be getting up to go use the bathroom, and that rather frequently, since someone will be bringing you water and tea and other nice things to drink so that you stay hydrated. For those first three to four days, your only job is to rest and make sure your baby gets fed, one way or the other. It is everyone else’s job to feed you. Your body needs a period of relative inactivity to let your ligaments pull back together, your pelvis to start to tighten back up, and for the placental site in your uterus to form a good, healthy, protective scab. (I talked about that in my first post. Please read it.)
After those first three to four days, feel free to graduate….to the couch. It’s still important to spend 90% of your time laying back. If you have stairs in your house, it’s best to plan only one round trip per day, so if you need to go downstairs to see your family, or get a change of scenery, just camp out there until it’s time to go back upstairs and to bed for the night. And while you’re on the couch, try not to sit up…your perineum has some healing to do, as well, and it’s kinder to keep the pressure off of it for a little while. Positions where you’re leaning back or side-lying are your friends during this time.
I often try to remind my clients that while the first week with a new baby is its own whole thing, it is often during the second week that the real exhaustion sets in, and when I’m usually getting texts asking how big of a blood clot is too big. I am going to try to not get too emphatic here, but it is absolutely vital that you rest deeply for two full weeks after birth. This way, you stay ahead of that second-week exhaustion a little bit more, and your uterus has time to heal without needing to communicate with you by sending out big blood clots.
(By the way, golf-ball-sized blood clots are a concern. Even smaller ones, say more shooter-marble-sized, can be something to talk to your doctor about if you have two or three of them in one hour.)
After those first two weeks, I like to have families use Penny Simkin’s “Sleep Formula.” The idea is that you track your sleep and stay in bed until you have accumulated a full eight hours. So, jot down when you wake up, make a decent guess at how many hours you get in each bit of sleep, and stay put under your blankets until you’ve been able to add up to the right amount. If it takes until 2:00pm the next day, so be it.
Everything is more difficult when you’re exhausted. Everything is easier to deal with when you’ve gotten sleep. And getting rest is one of the best ways to ward off–or minimize–postpartum depression. Getting more sleep is also the first recommendation for treatment for postpartum depression. I had one dear mother take the Edinburgh Postnatal Depression Scale when I sent it to her at about two to three weeks, and her score was a bit concerning. I went over, we talked about strategies for her to get a bit more sleep, and when I checked back in a few days later, she only had happy things to tell me. Even for the most rare and most extreme forms of Postpartum Mental Health issues, when a mother might need to go somewhere and be separated from her baby so she can get the help she needs, the most common form of treatment is a comfortable, quiet room and a few sleep aids.
I hope I’m making this clear–your body, mind, and emotions all need you to prioritize rest during the first few weeks postpartum. To sum up, here are the goals that you are aiming for:
- 3-4 days IN the bed, cocooning up in your blankets
- Days 4-14: still mostly laying back, but maybe on the couch instead of in bed. This is still a time to consider yourself on “bed rest.”
- Day 15-roughly 4-6 weeks: minimum eight accumulated hours of sleep every 24 hours
And I know that when you’ve got a darling little human who requires warmth and milk and care every two hours, this seems impossible. Here are a few strategies that may help:
- Trade off with your partner so that you’re not both getting up every time the baby needs care. Alternate taking naps through the day, getting up to change diapers (after those first 3-4 days, of course. During those first days, you’re not getting up unless you have to use the bathroom, right?)
- If you have pumped milk or are utilizing formula at all, really make sure that you and your partner are trading off for feeding sessions. That way, you’ll each get longer stretches of sleep.
- Any family in the area? Get a schedule going for who can come over and hold the baby while you get a bit more sleep. Start this before you have your baby, and get very clear with people that when they come over, they’re coming to support you, not just get to chat and hold a cute newborn. Set those expectations ahead of time, and even the most thick-headed Aunt will figure out how to support a new mother a bit better.
- If you’re a part of a mother’s group, see if you can get some community support that way, too. Wouldn’t it be lovely if we didn’t just drop off food for each other, but also started helping each other get this necessary sleep?
- Postpartum doulas exist to help you get those naps. I usually fold laundry, wash dishes, and start some dinner in a crockpot while I’m there, too. I know that’s an expense that not everyone can swing, but do you have out-of-area friends or family who might help? I just had a sweet mom get two visits gifted to her by some of her friends.
- If your baby needs extra care from a doctor for some reason–maybe they need bili levels checked a bit frequently for a few days–and you absolutely have to get out of bed and go do things during that first week or two, that’s certainly going to make exhaustion worse. As soon as possible, once the crazy is done and you can settle down and settle in, see if you can tuck your baby in as close to you as possible, and stay in bed for a full 24 hours. Penny Simkin calls this the “24 Hour Cure.” It is deeply restorative.
Those first few weeks with your baby are so precious, fleeting, and exhausting. My hope for you is that you will enjoy them to the fullest, and that will be most possible when you have been able to rest. There is nothing else that you need to attend to–just let yourself cuddle that sweet little squishy baby, keep them fed, and snuggle down with pillows and blankets for a bit. The rest of the world can either wait, or come to you. With food.
Snohomish County Doula 
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