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, cause 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. Mother’s feelings about herself, relationship changes within the family and financial tensions are examples of outside pressures that can slow a mother’s recovery from childbirth. 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.

Besides physical exams, and assessment of psychological bonding between mother and child, postpartum assessment also includes evaluation for fatigue. Because the majority of women work through most of their pregnancies and return home in 48 hours or less to accept full home responsibilities after giving birth, many women do not have the opportunity to rest and adapt in the postpartum phase.

Health care providers can lessen the level of maternal fatigue by recommending and initiating relief measures such as scheduling baby nurse care that allows for periods of rest. Overnight infant care provides professional nurturing care of the infant while mother receives much needed restorative sleep. Allowing the mother proper rest assists in her physical and mental recovery. Overnight baby nurse care also assists fathers and partners who may not have expected to take on the majority of newborn care.

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 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 has increased concern about her body’s functions and assumes responsibility for her self-care needs. This phase is ideal for teaching infant care. If PPD symptoms emerge, a temporary overnight baby nurse may be recommended to assist mother.

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.

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. Besides caring for baby, a professional baby nurse can direct families to these social support systems.