Jennifer Keiger is wearing a white lab coat and smiling at the camera
Jennifer Keiger
Jennifer Keiger, a family nurse practitioner with Novant Health WomanCare - Kernersville, has a passion for helping women adjust to one of the most profound changes they’ll ever go through: New motherhood.

“We didn't talk about this stuff 30 years ago,” she said of some of the things that can happen to a postpartum body and mind. “Women may not know there are resources available. Some of these things are embarrassing to talk about, and they may be reluctant to ask even their healthcare provider.”

There’s plenty of advice on what to expect when you’re expecting. Here, Keiger gives some candid comments on what to expect after you’ve delivered.

What are some postpartum physical, mental and psychological changes women are often surprised by?

Becoming a new mom absolutely encompasses your whole being – spiritual, emotional, physical, every bit of it. Starting with physical, you’re obviously going to experience changes in your body where your abdomen and your belly now have a little pooch. Your breasts have taken on a different shape. You may have new aches, ranging from joint aches to musculoskeletal aches, that you've never had before. It’s not because you’re weak. It's because your body produced hormones to spread out those joints and make your tendons and ligaments a little more stretchy so that your body could accommodate for the birth of a human being. First-time moms especially will complain of joints aching, of low back aching, shoulders and legs aching, knees and feet. Everything is impacted; every joint is impacted. They all get better within a couple of weeks.

Your abdominal muscles will stretch out. They can actually stretch to a significant degree, depending upon how much weight a woman gained or how quickly the baby grew. Or if there's multiple babies versus a single pregnancy, the abdominal muscles will stretch quite drastically. And there’s a myth that a lot of women hear that makes them feel their body should be “back to normal” by six weeks postpartum. That’s an absolute falsehood.

Your body does heal internally – your cervix, uterus, ovaries, vaginal tissue – in six to eight weeks. But the changes to your abdominal muscles can actually take anywhere from 12 to 18 months to return.

Hair loss is one postpartum concern I’ve seen mentioned. How common is that, and does it usually correct itself – or do you recommend treatment?

Jennifer Keiger talking with a patient. The patient is sitting on an exam chair.
Jennifer Keiger talking with a patient

It is a real phenomenon. During pregnancy, we have higher levels of estrogen, which has a positive impact on our hair follicles, reducing the amount of hair loss we have. Plus, prenatal vitamins give us a boost in our glow and the fullness of our hair. So, we actually reduce the amount of hair loss we normally would have during pregnancy, but postpartum, because of the fall of estrogen and the significant shifting of hormones, the hair follicles now shed what was retained in pregnancy.

It can happen just a couple of weeks up to six months after giving birth. It can look quite significant and leave women feeling as if they are going into male baldness pattern, but I promise that’s not happening. This is a normal shedding cycle of the hair follicle in response to the reduction of estrogen. Roughly 30% of women will experience a noticeable hair loss. But if a woman sees copious amounts of hair loss, especially after the six-month time frame, she should speak to her provider to make certain she’s not battling low thyroid or iron deficiency anemia.

I’ve also heard about postpartum bleeding. How common is that? How much is normal, and when should a new mom seek treatment?

Yes, your uterus has to shed the lining where the placenta was attached. This bleeding is absolutely normal and to be expected. The first phase is called lochia rubra. This is a darker red, period-like bleeding and can last anywhere from three to five days. After that, the bleeding turns more yellowish to a brownish color and can last for another week’s time, and then it can start to become a whitish to a clear discharge. Intermittently, you may still see streaking of brownish blood in between these episodes and during these episodes for possibly up to a six-week period.

If you bleed longer than that or have bright, red bleeding for longer than about five days, that could indicate an infection. Talk to your healthcare provider about that.

Do new moms ask you about when it’s OK to resume sex?

Yes. The six-week postpartum checkup is very important for many reasons, as we are checking how well the body has healed, and we can determine whether or not the body is healed enough for exercise and sexual activity resumption. I stress waiting until you have been cleared from that checkup before beginning an exercise routine or sexual activity, especially for women who had particularly difficult deliveries or recoveries. This checkup also allows us to determine the best type of contraception for your personal scenario. Your healthcare provider can discuss what is right for you and how long to give those types before depending on them for reliable contraception.

One important factor to remember: Ovulation can occur within a couple of weeks after delivery, so at least use condoms. Also keep in mind, sex may not feel the most comfortable at first, but as the body continues to heal over time, it should become less painful and/or less uncomfortable. For breastfeeding mothers, vaginal dryness may be very bothersome from the reduction of estrogen in the vaginal tissue. If there are any concerns with sexual activity resumption, let your provider know.

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Postpartum depression: How common is that? What can women do about it?

There are hormonal fluctuations that happen, especially during the first two to four weeks after delivery. There are various phases of emotional fluctuations that women will experience in response to this, ranging from the “baby blues,” which is just normal, emotional crying – an “I feel a little overwhelmed, but I'm able to continue my daily activities and continue to care for my baby” sort of feeling. Those can last for the first two weeks.

But if those last longer, we worry about postpartum depression, which includes feelings of extreme sadness, disconnection and not wanting to care for yourself and your baby. And it may encompass some anxiety. Women who have a history of depression and anxiety are at greater risk for postpartum depression. Between 10% and 20% of new moms are said to experience postpartum depression, but that number may be low because some women just don't let us know about it.

If a mother is experiencing extreme sadness, loss of interest in caring for herself or caring for baby or an extreme withdrawal beyond those first two weeks after delivery, we need to know about it. Otherwise, we think you're doing fabulous and won't see you again until six weeks later. And we can help you sooner than that.

Postpartum depression is very treatable. Our best medications include things like Lexapro, Zoloft, Prozac. They are very helpful and can be taken safely in the postpartum and breastfeeding period. They can be taken on a short-term basis until this passes. But some women may need them for six months or longer.

What are the most common questions you get from new moms about their physical and mental health?

First-time mothers, especially, wonder if it’s normal to feel overwhelmed. And it absolutely is. You have had an extreme life change. It’s a change not just for you but for your relationship with your partner. The whole family dynamic changes – whether or not you have other children.

New moms often want to know: How can I know the difference between just some anxiety and actual, true depression? My answer goes back to what I said earlier about if you feel like withdrawing entirely – don’t feel like taking care of yourself – let your provider know.

Do new moms ask you how long it might take to lose baby weight?

Pregnancy weight gain is a concern most women have, and it’s important to have a healthy weight gain in pregnancy. What you gain in pregnancy does come off for most women, and breastfeeding helps to expedite this process. It is common for women to lose about 10 pounds by their six-week postpartum checkup. Wait until that time to be cleared from your healthcare provider before you begin an exercise routine. Slow but steady weight reduction equals more permanent results. Women can usually expect to see their weight back at its pre-pregnant amount by six to 12 months.

Is there anything women can do, pre-delivery, to stave off some postpartum problems?

We do our best to educate women at every visit to try to take the best care of themselves during pregnancy. If a woman takes the best care of herself, pre-pregnancy and during pregnancy – especially that third trimester – she’ll fare better postpartum.

That encompasses eating lots of colorful fruits and vegetables; having a good, healthy amount of lean protein in her diet; and hydration – consuming at least 70 ounces of water a day. Regular exercise – regular (not hot) yoga, walking at a moderate pace for at least 30 to 45 minutes a few times a week, Pilates – those are the best forms of exercise. Moving the body gets natural endorphins flowing and triggers the brain to continue to make those endorphins.

Being a mom is a 24/7 job, and new moms have to do it on very little sleep. How do you recommend new moms make time to care for their own health when they’re so focused on their newborn?

It is crucial that women take time – even 15 or 20 minutes – to sit down and relax. I remember when I was a new mom thinking: Oh, goodness. I've got 20 minutes to wash bottles in between feedings, or I've got a few moments to tidy up while baby was sleeping. And I had to tell myself to stop.

You have to make yourself a priority; you are one of the main ones now providing the care for this baby. And without this type of attention, the baby cannot thrive. Delegate responsibilities if you can. Rest. Reach out to your support network. Don’t hesitate to call upon them for help preparing food, getting laundry done, anything and everything. You've got loved ones ready and waiting to help.

Are there any myths about being a new mom that you’d like to debunk?

All too often, we put so much emphasis on those first six weeks. Your body is not going to be the same within six weeks of giving birth as it was pre-pregnancy. Don’t expect it to be.

Just be as active as you can, eat as healthy as you can, stay hydrated and rest. Bladder control may be an issue now. Kegel, or pelvic floor, exercises are important for that. It's super important to start soon – maybe two weeks after you've given birth. The best way to teach yourself to do them is to start, stop, start and stop a stream of urine while urinating. If you were successful in cutting off that stream of urine, then you were squeezing the right muscles.

Embrace your postpartum body. Remember: This is your badge of honor.

Anything else you’d like to share?

I want moms to remember: Your experience is yours and yours alone. Don't compare yourself to anybody else. Don't judge yourself based on what others are putting out on social media or what you may see on the internet. You will reach your milestones in your own time frame. Cut yourself some slack in this new season of life.