"You need to get in bed and stay in bed," my grandmother told me two days after the birth of my daughter. She had arrived at my house to find me standing by the washing machine, knee deep in dirty laundry, crying.
"In my day that was the rule – in bed for two weeks just feeding the baby," she said, ushering me to the couch. "You get up too soon, your uterus might fall out!"
Ah, the power of a good wives' tale.
For the record, moving around after birth will not cause a new mom's uterus to fall out. Some amount of activity is, in fact, important to maintain strength, return to normalcy and, well, go to the bathroom.
Still, the age-old idea of a new mother "lying in" bed (figuratively, if not literally) for several days or weeks with her newborn baby has its merits. According to Dr. Jane Dimer, an obstetrician at Group Health Cooperative in Seattle, multiple studies show that maternal-infant bonding, milk production and the fragile physiology of the early postpartum period all benefit from a period of quiet and recuperation. Specifically, the traditional lying-in period of two or more weeks where mom does little or no other work than bonding with baby and feeding:
- • Promotes swift healing of the perineum after a vaginal birth and strong healing of the incision after a Cesarean.
- • Promotes the release of oxytocin (often called the "love hormone") which helps to bring mom's milk in and reduce levels of baby jaundice
- • Promotes mother-infant bonding, significantly reducing the chances of postpartum depression.
- • Helps mother and baby get maximum rest.
In a presentation to DONA International birth and postpartum doulas, researcher and nurse Bridget Lynch, RN, offered even more reason to adhere to some amount of lying in. Doing so allows a baby time to "settle in and acclimate to his or her new environment.
"Babies come into this world ready to bond; their central nervous systems are open and ready for new experiences. With too much activity, babies become over-stimulated and do not have the ability to calm themselves," Lynch said. "The social demands of entertaining well-meaning visitors deprive both mother and baby of much needed rest. Babies sense their mothers' fatigue and anxiety. They become increasingly irritable and difficult to console. However, babies of mothers who observe a lying-in period have a lower incidence of colic. The mother's familiar presence, adequate rest, and limited stimuli allow the baby time to integrate into his or her new environment."
If stepping back, laying low, lying in and allowing friends and family to step it up in the cooking, cleaning and shopping departments, is the prescription to reduce postpartum depression, promote healing and enhance the mother-baby bond, why don't more new moms take this medicine?
Dr. Jane Dimer, an obstetrician/gynecologist at Group Health Cooperative in Seattle, believes part of the reason is the family's financial dependence on a new mom who may both a needed breadwinner and the parent who keeps the family's benefits afload.
And, Dimer, adds "Women have few social or societal safety nets that allow for unplugging for the period of time postpartum. With the advent of 'virtual' work, women often continue to work even during their formal maternity leave."
Seattle mother Mariska Audriani, who says she wished she had spent more time sitting and less time go, go, going when her son Finn was born in October, puts it this way: "Multitasking has become second nature. To put the brakes on that drive all of a sudden is hard to do."
In my practice as a doula in Seattle, I consistently see new moms doing too much. Within days of giving birth, my clients are cleaning, taking miles-long walks, working virtually at home while their baby naps, entertaining multitudes of family and friends. I recently went to visit a client just two days after she gave birth at Valley Medical Center. When I pulled up to her home, I found her hoisting a large box out of her car after a frenzied trip to Costco.
"It seemed silly to ask someone to do my shopping," the mother told me, hugging her belly as we walked into the house (I carried the box). Three days later she was back at her doctor's office bleeding from burst stitches.
Seattle midwife Anne Hirsh, LM, CPM, of Rainy City Midwifery, says that a certain level of misinformation and hearsay perpetuates the problem of American women over-exerting themselves after a baby arrives:
"The myth of women birthing in the field and going back to work does not hold up when other cultural traditions are investigated," Hirsch says.
In Bali, Hirsch points out, "Women folk come over, do all the cooking and give mama and baby a massage every day."
"Sometimes I think if women in our county hear about other cultures where (lying in) is OK, they can relate to how out-of-control busy our culture is and can begin to allow themselves to slow down," Hirsch says.
China, most Latin American countries, and India all have strong traditions of lying in, specific foods to help mom regain strength, and a sense of community around the care of a new mother and baby. In fact, "every indigenous culture does this," Hirsch points out.
Seattle mom Annika Sgambelluri is one mom who took lying in seriously.
"I really took our doula's advice – one week in bed, one week on the bed, one week around the bed. It made such a difference allowing myself the time to rest," says Sgambelluri, whose son Che is 18 months old now. "I was better able to cope mentally with the demands of a newborn because I allowed myself to rest and not worry about housework. I had my husband, mother-in-law and mother to help so I could sleep when I needed to during most of the first six weeks. I believe, for me, this helped prevent postpartum depression. I was better able to care for my child, which made both of us happier and calmer."
Sgambelluri's was a smart move, says Hirsch.
"I tell (moms) that if they do this, they will likely be done bleeding and well-recovered by four weeks," she says. "If they don't, they likely will crash around week three. So why not rest on the front end?"
Seattle midwife Bev Schubert, LM, CPM, agrees. Rather than surrounding themselves with visitors, she urges her clients to surround themselves with people who will actually take over everyday jobs and allow the couple to simply rest, be with baby, and take short walks that will help mom recover from her birth.
"I discuss the first two weeks postpartum ad nauseum in the last few weeks before baby is born, making sure families know that I expect someone to be there for the first several days (at least) to care for mom and baby and partner, too, if at all possible," Schubert says. "I frame it as the ‘babymoon.' It is the time to lie around in bed, nursing, smooching, eating, sleeping and falling in love."
Hirsch gives this postpartum prescription to new parents well before baby arrives:
Week 1: Mom is in bed in pajamas so that when folks come to visit they know she is resting and don't expect her to entertain. Pajamas also give mom "permission" to rest and enjoy their newborn.
Week 2: Mom is on the couch in pajamas – again a subliminal message to them that they are taking it easy.
Week 3: Mom can get dressed and be up – around the house, not on major outings.
Week 4: She can return to doing chores.
In January, I went to visit a client in Fremont. Her baby was two weeks old to the day. It was noon. When I arrived, her sister greeted me at the door and led me to the new mother's room, where she lay in bed cooing at her baby girl. On the table was a breakfast tray. She was relaxed, smiling, rested. She had not done housework since the baby arrived. Instead, she was letting her family and friends rotate into the home to take care of her, she'd just started doing 30 minutes of gentle yoga each day, and she and her husband took a stroll with baby in the evening. She shared that her perineum, which had had a significant tear, was completely healed. Her mood was buoyant. Her baby was well latched, well attached and thriving. I asked her how she was feeling about the baby, her body and her new life as a mom.
"I am so in love!" the mom told me. "I love this baby! I love my body! I love all these people who have surrounded us. I've never let go in my life – and now I just don't know why I didn't."
She set up her support system after watching a self-admittedly "über independent" friend struggle through the postpartum period overwhelmed, depressed and unable to accept help from anyone.
"What I saw there was suffering," my beaming mama said. "All I could think of was how hard that was on the baby."