Postpartum Body Changes

By Alison Heyerdahl

When you’re pregnant, it seems as if all you’re focused on is making sure that your baby is healthy, and is growing according to all the expected milestones.  However, your body has also gone through an enormous transformation during pregnancy and after delivery, but your health often gets put on the backburner as you worry about caring for your new baby and trying to navigate life on very little sleep.  Many women struggle postpartum because they feel so unprepared to deal with all the new changes to their physicality, and end up anxious, depressed, and overwhelmed.

After birth, it is important to give yourself time to heal and to understand the changes your body will be going through in the early months of motherhood.  Below are some of the most frequently asked questions postpartum:

What happens to your hormones after delivery?

Following birth, your hormones, estrogen, and progesterone go from the highest they will ever be (the equivalent of taking 100 birth control pills a day) to the lowest in the shortest amount of time.  This sudden shift often contributes to feelings of sadness, irritability, anxiety, depression, and moodiness.  It’s almost analogous to PMS on steroids.  Although these symptoms generally resolve within a week or two after birth as the hormone levels stabilize, it can last longer and cause disturbances to your daily life.  Known as postpartum depression, this condition affects 1 in 10 women after birth and often requires medical intervention. 

Another surprising hormonal symptom some mothers experience is postpartum thyroiditis.  Thyroid hormones help regulate body temperature, metabolism, and organ function.  Inflammation of the thyroid gland, postpartum thyroiditis, affects around five to ten percent of women.  Symptoms of postpartum thyroiditis include insomnia, weight gain/loss, dry skin, and constipation, and is often successfully treated with medication. 

The hormone relaxin is released during pregnancy to accommodate your growing womb and ensures that your pelvis can stretch during the birth of your baby.  It is secreted by the lining of the uterus, ovaries, and placenta, and plays a vital role in childbirth, promoting the softening of your cervix and allowing your pelvis to open for the passage of your baby.  Relaxin affects all the joints of the body, and for about five months after birth, you will be more prone to straining your ligaments.

How long does it take for your hormones to go back to normal after birth?

Fully recovering from pregnancy and childbirth can take many months.  In the first three months after birth, you’ve probably established a good breastfeeding and sleep routine for your baby, but you’re still experiencing a rollercoaster of emotions.  Your hormones will be working hard to get back to their normal levels at this stage.  However, cortisol (your stress hormone) may be increased due to the stressors of having a baby.  Add the lack of sleep, and your dopamine and serotonin (happy hormones) levels may be dwindling a bit too, which may have a negative impact on your mood. 

At six months postpartum your hormones will begin to reach their normal pre-pregnancy levels.  At this stage, you will have likely introduced your baby to solids, and her demand for breast milk will have regulated, which means there’s no need for excess milk production as in the early months.  This is also the time that many women have their first postpartum period. 

Can hormones after pregnancy cause weight gain?

Most women who gain the recommended amount of weight during pregnancy remain two to five pounds above their pre-pregnancy weight a year after giving birth, and 15-20% of these women will remain 10lbs heavier.  Furthermore, those who gained more than the recommended amount will be 10 – 12 lbs heavier postpartum.   

A common misperception is that breastfeeding helps with getting rid of those extra pounds, but this is actually seldom the case.  While breastfeeding burns an extra 400 – 500 calories a day, the hormone prolactin, which stimulates milk production, also increases our appetite.  This may have been an advantage to our ancestors, who would have to stock up on food in times of abundance to maintain sufficient energy reserves during times of scarcity, but it makes losing that pregnancy weight in the modern age very difficult. 

Another factor that makes postpartum weight loss more difficult is age.  Women in their 30s often hang onto more pregnancy weight than women in their 20s, and this worsens as women head towards the 40s.  The average 35-year old woman holds onto an extra five pounds after birth, and women over 40 tended to hold an extra ten pounds of weight. 

Lastly, postpartum weight gain is also determined by how many children you’ve had.  With each baby, women tend to hold onto additional belly fat. 

What happens to my pelvic floor after birth?

After birth, and particularly a vaginal birth, you may experience heaviness or a ‘dragging’ feeling in your vagina.  The weight of the baby pressing down onto your pelvic floor often stretches all the muscles and ligaments in the region, making it difficult to fully control your bladder.  Furthermore, all the pressure during labor, and the physical act of the baby’s head coming through the vagina can cause swelling in all the structures of the pelvic floor, which pinches the urethra making it difficult to urinate.  The swelling usually settles down soon after birth, making it easier to return to normal toilet routines, but the pelvic floor strength may take some time and effort to improve. 

The pelvic floor includes all the muscles, ligaments, tissue, and nerves that support your uterus, bladder, vagina, and rectum.  Weakness of the pelvic floor can result in urinary and fecal incontinence or prolapse.  Although this can be quite disconcerting, there is a lot that can be done to improve the condition.  Pelvic floor physical therapists can teach you how to strengthen your pelvic floor so that it can perform its supportive job again.

In our next article, we will outline other ways our bodies change postpartum.