Though more information than ever is available to couples planning to conceive, the majority of resources focus on pregnancy and birth. Comparatively few discuss the physical and emotional challenges of the postnatal period (birth to six weeks). Postnatal recovery can be even more daunting in Beijing, where issues with language and culture can further isolate new parents.
Dr. Juliette Kinn, an obstetrician and OB/GYN at Oasis International Hospital, shares one woman’s story. “I have a patient who delivered about a year ago. She doesn’t live in an expat area. Her friends kept moving away and her husband worked full-time. The baby needed her all the time. She came to me with lots of symptoms. I asked ‘How are things at home with the baby?’ Her eyes got red, but she kept smiling and saying they were fine. But actually, she felt so bad, so lonely inside. She couldn’t trust the ayi because she once stole a family [heirloom]. She told me she had one close friend but she didn’t live nearby. Taking a taxi was complicated with a baby, especially when she didn’t speak Chinese. I ended up staying an hour with her at the consultation, just talking.”
Post-Pregnancy Changes: Physical
Every woman’s experience will be different, but here are some of the physical changes that can be expected after giving birth:
• Immediately after delivery: Within minutes of the birth, the uterus begins to shrink. As a result, the placenta separates from the uterine wall and leaves the body. As the uterus continues to contract, some women experience abdominal pains. In the first 12 hours after birth, many patients also experience blood loss called lochia, which is similar to a heavy period. It is usually bright red for the first couple of days, then changes color and consistency as the weeks go by.
• Days after delivery: A couple of days after the birth, most women are able to feel the top of their uterus at or just below belly button level. Urinating after the birth may hurt, especially when there are stitches or grazing (broken skin caused by the friction of pushing the baby out). Many mothers feel the need to urinate frequently the first couple of days. Breast milk starts to come in three to four days after the birth, which may cause some initial discomfort.
• One to five weeks after delivery: The uterus continues to recede in a process known as involution. After about a week, it weighs half of what it did right after the birth – around 450g. After two weeks, it decreases to 300g. Lochia may change to a pinkish brown color up to four weeks after the birth, followed by a cream or white discharge that can continue up to eight weeks post-delivery.
• Six weeks after delivery: The doctor will also schedule a post-natal check at this point to check on the baby and the mother. If there were no complications, the mother is usually cleared to exercise, swim, take baths, and have intercourse again. Though the uterus has shrunk completely back into the pelvis at this point, many women might continue to look pregnant for several more weeks because the abdominal muscles stretched so much during pregnancy.
The return of periods varies greatly from person to person. The hormones that women produce while breastfeeding suppress the hormones responsible for menstruation, so the latter may not return until they stop breastfeeding completely or introduce solids into their baby’s diet. That said, it is possible for periods to return before babies are fully weaned. Mothers who bottle feed their baby can expect to menstruate four to six weeks after the birth.
During the postnatal period, women can also experience tiredness, perineal pain, breast issues, backache, hemorrhoids, constipation, postpartum depression, anemia, headache, and urinary discomfort. A doctor or midwife should be consulted if symptoms are present.
As is often the case, finding resources can be trickier in China. In France, where Dr. Juliette Kinn practiced before coming to Beijing, women who just gave birth are eligible for 10 to 20 sessions of government-sponsored “perineal re-education” to strengthen their pelvic floor muscles. Though pelvic floor exercises are recommended within 24 hours of delivery to help reduce swelling and speed up healing, there are no such classes to send her patients to in Beijing.
And yet, expat women here seem especially concerned with their post-pregnancy bodies. “Usually, we say no exercise before two months. Let the body recover by itself first, then you can go to the gym and work out,” says Dr. Kinn. “I see some patients here who, one to two months after they give birth, ask me ‘Can I go to the gym now? I have this’ [points to her belly]. There’s pressure to be skinny everywhere, but I think expats pay special attention here.”
Dr. Kinn herself is a new mother who felt the pressure to reclaim her pre-baby body. After moving to Beijing in January with her husband Alexandre Valdelièvre, she gave birth to their first child in late August. “I sometimes say to my husband ‘Oh, I’m so fat,’ but you have to take it easy. I just delivered and my body is changing,” she says while breastfeeding 3-week-old Arthur on the couch
Like Dr. Kinn, Yonnie Fung, yoga therapist and teacher, is a new mom. She gave birth to her daughter, Wednesday Eleanor Fairbrother, in February. In her private postnatal yoga therapy classes, the most common issues that Fung encounters are postpartum depression, sleep deprivation, incontinence, lower back pain, and general weakness in the body.
As both a yoga teacher and a new parent, Fung urges women to be kind to themselves after the birth. “This cultural obsession over getting skinny as soon as possible post-pregnancy only makes women feel bad,” she says. “Women nurture a life, carry it inside their bodies for nine months. Vaginal births are as taxing as summiting Everest, with none of the kudos. Caesarian births are major surgery.”
“Getting one’s pre-pregnancy body back doesn’t deserve any brain space. I think it’s more productive to focus on what enables us to flourish. Taking care of our minds and bodies does that. That means eating well, resting when we can, accepting help, carving out some mental space for ourselves and gradually getting back into some physical activity.”
Post-Natal Changes: Emotional
It is no secret that the first month is the hardest. Not only do women go through rapid physical changes, but both partners must also cope with sleep deprivation, the demands of caring for a newborn, and changing identities as new parents.
Fung says, “The first week [after birth]was intimidating. We were reluctant to leave the safety of the hospital, where help was just a press of the buzzer away. I spent the first month with my bum chained to the sofa and Wednesday’s mouth glued to my breast.”
“Depending on the minute, I felt a profound tenderness, protective, gigantic love, tired, lonely, contented, fear, joy. A lot of emotions came to visit in my first month. Then I started my meditation and breathing practices again. Hormones backed off. Things started to calm down from that point.”
It is completely normal to go through a range of emotions during the postnatal period. In the first days or weeks after the birth, many women get the “baby blues,” a generalized feeling of sadness caused by a combination of anxiety, hormones, and exhaustion. However, this soon passes and should not be confused with postpartum depression (PPD), a much more serious condition.
PPD generally presents later than the baby blues – around one to three weeks after the birth – and can persist for up to a year if left untreated. Symptoms can include trouble sleeping or sleeping more than normal, reduced appetite, a lack of interest or feelings for the baby, anger toward the baby, anxiety or panic attacks, excessive crying, feelings of doubt or helplessness, mood swings, and even thoughts of suicide.
PPD is not limited to mothers. Not only can dads experience depression, but their behavior can have more lasting effects on their child’s development, according to a 2008 study of more than 5,000 families conducted by the US-based Center for Pediatric Research. Depressed parents of both sexes were less likely to interact with their children, including reading, telling stories, and singing songs. However, babies with fathers who suffered from PPD had a much smaller vocabulary at 24 months than their peers. There was no such link for children of mothers affected by PPD. If you suspect that you or your partner is experiencing PPD, contact your doctor immediately.
Many new parents also report relationship issues after the birth. Exhaustion, lack of time, money, and feeling neglected are some of the most common reasons couples fight after having a baby.
No matter the situation, it is important to communicate honestly and listen to your partner. Though it might be difficult at first, make time to talk when you are both feeling calm. Listen to your partner’s viewpoint and acknowledge their feelings. When it comes to disagreements over how to care for the baby, accept that you will have different approaches to parenting and come up with a joint plan of action.
After the first month, you might feel comfortable leaving the baby with someone you trust, like a grandparent or an experienced ayi. Once you establish more of a routine, practice intentionality by setting aside regular time for you and your partner.
“Most of my patients breastfeed. It’s a special relationship between the mother and the baby, so sometimes the dad can feel neglected,” says Dr. Kinn. “I tell my patients: You’re a woman, take care of yourself. You’re a mother, take care of your baby. But you’re also a wife and a lover, so take care of your husband.”
“I also find it helps to keep some perspective,” says Fung. “Relationships are dynamic and this is just a short phase in the overall longer story. Just as there were phases before the baby, other phases will surely follow. Right now, we may seem to be all consumed by our newborn, but there will come a time when we will do ‘us’ things again. For now, I’ve found our regular date nights to be great for reclaiming our former selves.”
It is also important to seek out people who are going through the same thing as you. For example, many of Dr. Kinn’s patients are part of the WeChat group for Bumps2Babes, a parent support network that meets three times a week in the CBD area (see Resources).
“There’s a mom who just moved to Paris and is still asking questions in the group even though she doesn’t know anyone there,” says Dr. Kinn. “When someone asks a question, reading so many moms’ experiences shows them that every case is different.”
It is especially important to seek help as soon as possible if you have trouble breastfeeding. According to a 2011 study by the journal Obstetrics & Gynecology, women who have issues breastfeeding in the first two weeks after giving birth were 42 percent more likely to experience postnatal depression two months after delivery.
Luckily, Beijing has an active Le Leche League (LLL) branch with both English- and Chinese-speaking groups that meet monthly. Don’t convince yourself that breastfeeding is something to “power through” alone. Get support from your partner, friends, family, doctor, midwife, lactation consultant, and groups like LLL or Bumps2Babes.
Whatever you do, do not suffer in silence. Dr. Kinn says, “There are groups of moms to help and support you if you need. Don’t hesitate to ask for help. It can be hard, especially here when you don’t know where to go.”
“Sometimes you find an excuse like the weather is bad or you’re feeling tired, but you have to make the first step to meet people. Then, things come one by one.”
Oasis International Hospital 北京明德医院
Dr. Juliette Kinn is on maternity leave until January 2016. If you need to see an OB/GYN now, contact Oasis to schedule an appointment with one of the hospital’s other doctors. Mon-Sat 8.30am-5.30pm (some clinics open from 8.30am-12.30pm), daily 24hrs emergency care. 9 Jiuxianqiao Beilu, Chaoyang District (400 876 2747) www.oasishealth.cn 朝阳区酒仙桥北路9号
Yoga with Yonnie
Yonnie Fung teaches small group yoga classes and offers
private yoga therapy sessions from her studio in Andingmen.
La Leche League (LLL)
Membership for LLL costs RMB 300 per year. The English
-language meetings take place on the second and last
Tuesday of every month at 9.30am. (firstname.lastname@example.org) www.llli.org/beijing.html
This CBD-based parent support network has three weekly meetings: a coffee morning for parents with toddlers and babies, a meeting for parents with mobile babies and toddlers, and a meeting for parents with non-mobile babies (including expecting moms). The latter meets on Fridays. Dads welcome. For more info, email email@example.com.
Photos: Courtesy of Yonnie Fung and Dr. Juliette Kinn