There might be ideas that new parents will feel an earth-shattering, all-encompassing love or possibly become possessed by a quiet confidence in their parenting ability. The reality is that, for many new parents, the time after birth can feel tremulous and uncertain and your feelings might not match up with prior expectations.

Please know that there is not a right or wrong way to feel and, depending on how your birth went, you might feel anything from joy to numbness to anxiety and/or sadness. Allow yourself to feel however you are feeling and know that you can still be the parent you want to be with whatever feelings are present.

Setting Your Expectations

Feeding Your Baby

After the birth of your newborn, your body almost immediately begins adjusting to no longer being pregnant. From your body’s perspective, the goal is returning your body to its non-pregnant homeostasis and beginning milk production. There can be an assumption that breastfeeding is natural and easy, especially for first-time parents. However most new parents, even if they have breastfed in the past, find that breastfeeding can be challenging and effortful. Expect an adjustment period and practice reminding yourself that you and your baby both need time and space to learn this new skill.

Some suggestions for adjusting your expectations in the early days of breastfeeding:

• Don’t expect that you should “know how to do it.”
• Be open to asking for help. This could include seeking support from your local services, breastfeeding cafes or a lactation consultant.
• Consider talking with your health visitor or GP if supply or physical discomfort is a barrier to baby getting an adequate amount of nutrition.
• Approach breastfeeding with an open and flexible mindset:

1. don’t assume the current feed or pumping session will be hard or easy because the last one was - be open to the idea that every feed can look for those different and that this is normal
2. connect with the value of why you want to breastfeed each time you do it and let that guide your feed or pumping session
3. resist the urge to make your worth as a parent contingent on your breastfeeding journey -you can be an amazing parent with or without breastfeeding
4. make your pumping or feeding space feel comfortable for you -when you feel comfortable, baby will also feel comfortable.

The Baby Blues

All the physical changes your body will undergo are primarily the work of hormones. The hormone fluctuations of this period mean you might experience unpredictable changes to your mood and emotion changes in the first few weeks after birth. This happens to 70-80% of new parents and is not a sign that you are depressed. This is referred to as the baby blues and will typically resolve on its own a few weeks after delivery. Expect that you might not feel like yourself and make sure your support person or people are prepared to support you, as well.

Be prepared with a few strategies to survive this period:

• Keep social visits brief and with an end time.
• During a social visit, ask for breaks or for others to leave if you start to feel overwhelmed or exhausted.
• Consider limiting your activities for the first two weeks to take time to rest and bond with your new family.
• When you feel overwhelmed, practice taking at least 5 slow and deep breaths.
• Have ice packs on hand if you feel panicky, angry, or anxious. Place them on your chest, neck, or forehead to cool off.
• Have tissue boxes, soothing music, and trusted people nearby that make you feel better if you feel sad, lonely, or are grieving.

Baby Blues or Something Else?

The baby blues are a normal part of the postpartum period and nothing to stress about. It’s also quite normal to feel occasional sadness, anger, anxiety, or loneliness after a baby is born -this is a big life change. Persistent changes to your mood, emotion regulation, or functioning that last two weeks or longer is not normal or an expected part of this period.

PMADS

Perinatal Mood and Anxiety Disorders (PMADs) are a common condition in the postpartum period affecting anywhere from 20-25% of new parents. You’re at higher risk of developing a PMAD if you felt depressed or anxious during your pregnancy or a prior postpartum period, have been diagnosed with a mental health condition in the past, or had a high-risk pregnancy, stressful delivery, or postpartum complications. The most important factor in preventing PMADs is getting adequate sleep. This can feel very challenging, and while for many days or weeks it won’t always be possible ,try to enlist some help (partner/family/friend/nanny etc) so you can get at least 4-5 uninterrupted hours before waking to pump/feed your newborn as frequently as possible.

These symptoms will not resolve on their own, but PMADs are easily treated using therapy and/or medication from a qualified mental health professional. Most new parents feel better more quickly when they get treatment, and you and your family deserve for you to feel better. If you or a loved one has noticed that you’re not yourself or you're worried that you are at higher risk for developing a PMAD, you should seek help from your GP who may be able to signpost you to the right service that has experience working with new parents.

Preparing for the First Two Weeks

Spend time in your third trimester creating a postpartum plan for the first two weeks after your baby is born. This postpartum plan should include plans to make sure you and your baby are fed and cared for. To help you get sleep, consider having a support person complete at least 1 overnight feed, such as a partner, a family member, friend, or a nanny/sitter.

Here is an outline of questions to ask yourself for your postpartum plan for the first two weeks after delivery (list is not exhaustive -feel free to add more):

Baby's needs

• Who is in charge of feeding baby throughout the day and night?
• How are other baby tasks being handled and by whom? Clean clothes, diaper changes, bath time…
• Are you bringing in help from outside the home?
• When people come over to visit, do you want them to hold the baby to let you rest/complete tasks or do you want them to help around your home while you take time to hold and attend to your baby?

Physical needs

• How and when will you eat and stay hydrated? Plan out the times for meals and ensure access to snacks and water throughout the day and overnight.
• Where and when will you sleep? Are you “on call” for the baby or will someone else be the primary caregiver during that time.
• When baby wakes overnight, but you are not on call and breastfeeding, would it be helpful for someone else to bring you the baby and minimise your time awake and out of bed?
• What is your sleep set up? Think black out curtains, cool temperature, water at bedside, noise canceling headphones or sound machines.
• How will you have access to clean and comfortable clothes?

Spiritual needs

• How can your spiritual needs be met during this time? Are there important rituals that need to be arranged?
• When during your day will you take time to pray or meditate?

Support needs

• Who do you want and trust to be around you?
• Not everyone around you will be able to help with everything (that’s okay!). Identify who is best to be relied on for your different needs: childcare, household tasks, obtaining food, providing emotional support, providing social support.
• Everyone around you will be excited to see your new baby and won’t know your social limits. You will be physically exhausted, sleep-deprived, and learning your new infant -it is okay to limit social engagements to people, places, and time limits that feel good to you.

Mental health needs

• If you have experience with a mental health disorder, identify 1-3 signs/symptoms that you are not doing well. Tell them to a trusted person, like a partner, friend, family member, or your doctor, and ask them to let you know if they see these signs.
• Come up with a plan on what you will do if you need mental health support. Plans can be brief such as telling your doctor or calling your therapist.
• If you are already involved with a mental health provider, make sure to schedule an appointment within the first month after you have had your baby.

To reiterate, it is not always an easy time and you aren’t meant to do it alone, so please don’t hesitate to ask for help when you feel like you are struggling!

Dr. Shiloh Eastin is a perinatal psychologist at Columbia University Hospital Irving, New York. She is also a key member of the Ammi mental health programme content team.