fourth trimester, Postpartum, self-care

5 Ways to Reduce the Stress of Returning to Work after Baby


Integrating your new mom-life with work-life after maternity leave can seem incredibly insurmountable. Managing a new schedule, embracing new responsibilities and processing emotions are but three of the most common tasks we all encounter when returning to work after having a baby.  It is overwhelming to think about, but it can be done successfully.  It is important to recognize that the path to a successful integration of work and life looks different for everyone. It is not a one size fits all plan. Through trial and error, you will come up with a plan that works best for you and your family.

Be prepared that the first day back at work will be emotionally and possibly physically difficult for you.  More than likely, you will find yourself crying no matter how prepared you feel about returning to work.  Know that you are not alone. Grant yourself the grace to feel the emotions that wash over you that first day back, and then allow yourself time to process each emotion before you press on.  It is ok to feel sad, angry, anxious, worried, disappointed, frustrated, mad, excited, relieved, overwhelmed.  You name the emotion and a mom out there has felt it upon returning to work after maternity leave.

So, what can you do to make the transition back to work as seamless as possible?  Ideally, you want to start doing your research and planning several weeks prior to returning to work to reduce the stress of the first day back.  Here are a few ways to make the transition back to work less formidable.


  1. Take inventory of your new identity

Be realistic with your own expectations of yourself.  Acknowledge that work life will be different.  You have two jobs now instead of just one.  You have a responsibility to your family and to your work that at times will conflict.   Your priorities may sit differently than they did before and different from your coworkers.  You will have to define for yourself what is most important, what you are willing to fight for and what you are willing to sacrifice.


  1. Identify your individual needs

Identify your individual needs as a working mother.   It will look different for every mom.  Are you going to need breaks to pump or breast feed?  Will you be responsible for childcare?  Will you need a flexible schedule?  Will you need to reduce your travel days initially?  Will you need to work remotely?  Have a deliberate discussion with your life partner about their needs and the needs of the family.  Keep a running list of your needs as you process the idea of returning to work.


  1. Consider the needs of your employer or business partner

After you have come up with a list of your needs, consider the needs of your employer or business partners.  How can the needs of each co-exist?  Be willing to consider creative options and solutions.  Document your ideas so that they become cohesive and presentable.


  1. Voice your needs to your employer or business partners:

After you have a list of your needs, present these clearly to your employer or business partners.  Ideally, presenting these needs will be done prior to returning to work so that the expectations are well known when you return for your first day.  Communicate your creative solutions clearly with your employer or business partners. Be sure that they are in agreement that these solutions will work for both you and them.


  1. Find reliable child-care

Reliable child-care is paramount.  I don’t have to tell you how hard it is to trust a stranger with your new baby.  Consider all of your options: facility day-care, in-home daycare, nanny, au pair, family or friends are all great options.  Do your research and make a decision based on what works best for your individual needs.  In addition, identify a back-up plan.  If you chose a day-care facility or in-home daycare you will need a back-up when baby is sick.  If you chose nanny, friends, or family you will need a back-up plan in case the chosen caregiver no shows or calls in sick.  Mentally prepare for a day like that so you have a step-by-step plan in place if the need ever arises.


Dear momma, don’t despair.   I know that as that day looms closer, it seems scary and overwhelming.  Have faith that you will find a new normal that will work best for you and your family. I promise as the days pass by, the emotions won’t be so raw.   Talk to other moms who have gone before you.  Ask for help when you need it.  Believe it or not, this experience will make you a stronger momma and working professional.  You’ve got this momma!


fourth trimester, Postpartum, self-care

The Truth about Self-Care after Birth


I stare at the clock as the hour approaches.  The baby is still feeding, for some reason he has chosen to take longer this time.  I still have to move the clothes from the washer to the dryer, fold the laundry that is in the dryer and cut up some vegetables for dinner.  But, first I have to figure out how I can get this baby off the breast so that I can make my appointment for my pedicure, my chosen weekly self-care activity.   Ugh this is stressful.  There is so much to do and not enough time.  Self-care has become more stressful than relaxing because I have to do time gymnastics to fit it in to my schedule.  Not only am I having a hard time fitting self-care into my routine, but I also feel guilty when I can’t check it off my to do list. Self-care has left me more frazzled than emboldened.

The fourth trimester is emotionally, mentally and physically challenging. Too often, extraordinary demands are placed on a mom leaving her exhausted and empty. Women lose themselves to the daily obligations of caring for a newborn. Moms feel the pressure to be everything to everyone all while keeping the house clean and organized, cooking healthy meals and taking care of themselves. The quest to keep your cup full while filling every one else’s around you was promised to be solved by the addition of self-care as a routine part of your life. Moms have been preached to about the importance of self-care activities in maintaining a connection with one’s self.

The push for self-care is well intended, but the definition of self-care should be clarified.

Most women think of facials, pedicures and coffee with friends when they think self-care.


While these activities are great and can help recharge a mom struggling to make it through the day, without a change in mindset these self-care activities will become another box to check off the forever-growing to-do list.

Self-care is so much more than pedicures, hair appointments and exercising with a friend.


Self-care is:

  1. Embodying an understanding of your self worth and finding ways to respect it. Self-care involves caring about yourself by accepting your limits.
  2. It is about having the strength to recognize your limits, set boundaries in line with your limits and having a willingness to say “no” even when it means disappointing someone.
  3. It is about letting go of the pride of being busy and the constant struggle for improved efficiency as a mom.
  4. It means removing some of the unnecessary (but often perceived as necessary) items on your to do list.
  5. Self-care is respecting your feelings, thoughts, and personal needs.
  6. It is accepting that letting down others is not failure, but preservation of your self. We all have our limits that are as individual as we are.

We all reach our limits, leaving us exhausted, overwhelmed and empty.

Setting boundaries and saying no may be uncomfortable at first, but as you free up quality time for yourself and family, you will come to realize that boundaries are empowering. Your time will become your own and will be of greater quality. When you are able to accomplish this you will feel fuller than you ever have.

When you take the step to create boundaries and regard your needs as a priority, you will be a better mom, partner, colleague, and friend. That is true self-care.



fourth trimester, Postpartum, self-care

Finding Your Village


Being a new mom can be isolating. We tend to hole ourselves up in our homes just trying to survive on a daily basis. After several weeks of this “survival” behavior, it becomes a bad habit, and the idea of going out to meet someone seems like a mountain of a hurdle to jump. We feel the pressure of balancing house chores with taking care of a newborn all while being attentive to our partners and trying to feel “normal” ourselves. It does not leave much for anyone or anything else. While some women thrive on being alone, I would argue that a majority of women need stimulus from other women. We need a mom village! While you may already have your tribe prior to having a baby, after baby arrives, sometimes those people change as you begin to identify with other women who have children or are soon to be mothers. This is normal. I would even venture to suggest that it is necessary. I encourage women to get out and meet other new moms to share stories, concerns and help provide support. There is strength and healing in sitting with another mother and hearing “I get what you are going through.” When I had my son I was lost on how to find my mom village. The last time I sought out friends who were not work related was probably in college. I had no idea how to begin. What I failed to realize is that the struggles experienced during the first few weeks of new motherhood can be a uniting factor for women. Here are some tips to consider when you are seeking your mom village.


  1. Get out of the house and socialize. Go to a park, walk around the mall, go to the gym or head to a coffee shop.
  2. Meet women in person. Research local mom groups on-line, but plan meet-ups in person. You are more authentic self when you are face to face. It is easier to project only successes on social media and avoid failures.
  3.  Keep your mom village local. You will find that it is difficult to meet up with women who do not live in the same proximity as you. Keep the logistics simple to improve the chances of being able to spend time together.
  4. Be vulnerable. Be willing to share your experiences of motherhood (the good, the bad, the ugly) with other new moms.
  5. Listen. Most women aren’t looking for a fix, they are just looking for someone who will listen and commiserate.
  6. Ask for help when you need it. Offer help when you can.
  7. Include family in your village such as aunts, cousins, sisters, mothers and even grandmothers.
  8. Ask for support and share support.
  9. Spend your time building each other up and avoid talking about other women, which will only serve to bring you down.
  10. Be open to learning to mom together.

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Sharing in the experience of new motherhood with other women, being authentic and vulnerable can lead to some of the tightest, longest lasting bonds you can forge. Your new mom village can lead to life long friendships that you will share the highs and lows of life with. You will find joy and comfort sharing in your struggles together. You will learn how to mom together. Your village will help you to thrive as a new mom. It takes a village to raise a mom!

You got this momma!


body image, fourth trimester, Postpartum, self-care

Postpartum Hair Loss is REAL!


I knew it was an inevitable part of the fourth trimester, but for some reason I was still alarmed when it started. Hair loss, ladies, that is what I am talking about. Lots and lots of hair everywhere! Hair in the shower, on the bathroom floor, in the brush, on the baby! Ugh, so gross. I thought for sure I was going bald! How can this be normal? Well, thankfully, it is.

Postpartum telogen effluvium also known as postpartum hair loss is completely normal. Ninety percent of mothers will experience some degree of hair loss during the postpartum period. It usually begins one to four months after delivery. It is self-limited, so by six to fifteen months after delivery your normal hair growth/loss pattern will usually return.

What is the cause you ask? During pregnancy, the change in the hormonal milieu results in the ratio of hair follicles that are in the growth phase (called anogen phase) relative to the hair follicles in the resting phase (called telogen phase) increases drastically. The result of this change is lusciously full locks by the third trimester. Then once you have had your sweet little nugget, those same hormones change abruptly which affects your entire body, to include your hair. After delivery, the ratio of hair in the growth phase (anogen phase) compared with the hair in the resting phase (telogen phase) reverses resulting in more obvious hair loss. As the hormones balance out over time you will notice that your hair growth and loss returns to its original pattern usually by about 15 months after delivery.

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What can you do to encourage healthy hair growth and reduce further damage?

  1. Eat a healthy diet full of fruits, vegetables and lean meats (such as eggs, chicken, fish).
  2. Avoid over styling your hair with heat (blow dryer, curling iron, flat iron) or chemicals (improper coloring techniques).
  3. Avoid wearing your hair up in tight ponytails or buns.
  4. Get plenty of sleep.
  5. Continue your prenatal vitamin – especially if you are breastfeeding.
  6. Reduce stress.
  7. Gentle scalp massage – encourages blood flow to the hair follicles.

Because postpartum telogen effluvium is self – limited there are no medications that are FDA approved to treat this condition. Your normal hair growth and loss pattern will return on its own. I get a lot of questions about Rogaine. Rogaine for women is not appropriate for postpartum hair loss.

What if your hair loss seems excessive? If you feel like your hair loss is excessive, you are noticing bald spots, or your hair is not re-growing over time, you may have an underlying medical condition that should be evaluated. A dermatologist would be able to evaluate your symptoms, medical history and perform testing to determine the source of hair loss. A few of the common medical conditions that can be associated with hair loss include:

  1. Anemia
  2. Thyroid disease
  3. Diabetes
  4. Polycystic ovarian syndrome
  5. Lupus
  6. Skin conditions such as seborrheic dermatitis or psoriasis


You got this momma!

fourth trimester, Postpartum, self-care

Surviving with “Mom Brain”


It is pouring rain outside as the car window fogs, I forgot the umbrella (of course), and now I have to run back into the grocery store because I forgot to grab diapers during my first grocery run. How did I forget to grab diapers? I had a living reminder staring at me from the shopping cart. As I plan my strategy to dodge the raindrops and run back into the grocery store for the second time with my little guy in tow (fun), I wonder what has happened to my brain. I am more forgetful, my brain feels foggy, and I have the emotional lability of a toddler. What is happening to me??

I think most new moms can relate to this (please say yes!). If you are a mom then you have probably heard of, or experienced “mom brain”.   Most women complain of increased forgetfulness, lapses in judgment, and/or emotional instability after baby is born. So what is up? Is this normal? Are we all losing our minds?


Well, the answer is not so simple, but I can assure you that you are not losing your mind. The brain is a complex organ that we in the medical field have yet to completely understand. It truly is the final frontier. Pregnant and postpartum brains have been even more elusive because up until recently there has been very little research to evaluate the changes that may occur in the brain as a result of pregnancy.   A new research paper published in 2016 describes visible changes in the brain in women during pregnancy and lasting up to two years after delivery. A group of researchers from Barcelona scanned the brains of women during pregnancy and again at intervals postpartum. These researchers demonstrated definite changes in the grey matter of the brain in the areas associated with social cognition. These changes are believed to help women understand the needs and emotions of their babies. While this change is extremely helpful for new moms to connect to their new babies, it also can explain why postpartum women have more intense emotional responses in general. This may explain why I now can no longer watch movies, TV shows, and commercials that have anything to do with children in distress.


As far as cognition and judgment… “Mom brain” really should be called “a preoccupied, hyperemotional, sleep deprived woman”. I know it feels like you are getting dumber by the second, but there is no research at this time to suggest that memory, cognition and overall judgment is affected by physical changes in the brain as a result of pregnancy or postpartum. Rather, the foggy feeling many women describe as “mom brain” is more likely a result of a combination of sleep deprivation, preoccupation with other tasks and thoughts, and distraction. A new mom goes from just thinking of herself, her partner and her job to suddenly thinking of a new mini person with all of the associated necessities that this little peanut comes with on little to no sleep and a hyperemotional brain. Sounds like fun! Let a man try to remember anything under those conditions!


Unfortunately, the causes of “mom brain” are difficult to avoid, but we can learn to manage symptoms. Here are some tips on how to function in the world with “mom brain”:

  1. Be patient with yourself. Remember there are physical changes your brain has undergone to make you the best mom you can be, but it does have other effects. So don’t cringe when you start crying at the Hallmark commercials. Give yourself room to be emotional and don’t judge. However, if your emotions are affecting your daily living or your ability to care for yourself or your family, then you should seek help from your physician or midwife.
  2. Make lists, lots and lots of lists. Find a good app on your phone for lists or do it the old fashion way with pen and paper. Just don’t leave home without it!
  3. Give yourself time to get tasks done. Rushing intensifies the feelings of fatigue and absentmindedness.
  4. Plan ahead. In my pre-baby life, I was accustomed to doing everything very last minute and in general flying by the seat of my pants. I have found out the hard way that the more I do it the old way, the more I forget. I have invested in a good calendar that I can share with my husband. I have made it a habit to prepare for the day the night before.
  5. Engage your partner with tasks to help you throughout the day.
  6. Get as much sleep as possible, even if it means frequent naps when baby naps.
  7. Make time for yourself daily, even if it is only thirty minutes. Make it a time to relax, decompress and allow your mind to wander.

You’ve Got this Momma!!!

fourth trimester, Postpartum, self-care

Prioritizing Sleep as a New Mom


I don’t know about you, but I require 8 to 9 hours of sleep daily to feel rested. Sleep requirements differ between individuals, but studies show that most people require 6 to 8 hours of sleep daily to feel rested and function at their highest capacity. Sleep is imperative for our bodies to heal, recover and rejuvenate.

Sleep in the fourth trimester can be quite elusive. I am pretty sure I didn’t sleep for the first two weeks my little guy came home, and I have very little memory of those days with him. I was so exhausted. I was trying to do it all…visit with friends when they wanted to stop in, cook, clean and take care of my little peanut. I felt guilty for wanting to sleep. It gives me the heebie-jeebies just thinking it about it now! If I could go back and tell my new mom self one thing, it would be sleep, make it a priority. Lack of sleep affects the body in such a profound way. You may not feel the results of fatigue immediately, but believe me it will hit you eventually.


Here are 5 ways sleep deprivation affects your body:

  1. Your body produces stress hormones causing you to be in a constant state of flight of fight.
  2. It increases your heart rate and blood pressure.
  3. It increases your risk for depression and anxiety.
  4. It depresses your immune system so your body has a harder time fighting off infections.
  5. It distorts your judgment depressing your ability to make sound decisions.


I encourage every momma out there living through the fourth trimester to take control of your health and well being by making sleep a priority every day. A well- rested momma is a more effective, loving, nurturing momma.


Here are some quick tips to help you prioritize and improve sleep:

  1. Sleep when baby sleeps. I know this seems obvious, but it is very tempting to spend baby’s nap times cooking, cleaning, doing laundry, visiting with guests, watching TV, interacting with social media, etc. All of these activities are fine as long as you are not sacrificing sleep to do them. Nap times are a precious commodity especially when baby is not yet sleeping through the night, so use this time to your advantage and get some rest.
  2. Ask for help and don’t turn down help. Let other people do chores for the first few weeks, until you and baby get the hang of each other. This frees up time for you to rest.
  3. Maximize your room for comfortable sleep. Make sure your room is quiet, dark and cool.
  4. Invest in a white noise machine or app.
  5. Avoid feeling guilty for sleeping.
  6. Avoid TV, computers, smart-phones within 30 minutes of sleeping. These devices will actually stimulate your brain making it more difficult to fall asleep.


Sleep will change your fourth trimester experience. It is vital to self-care during the fourth trimester. Prioritize sleep and you will be better prepared to care for your new baby, your family and yourself.

fourth trimester, Postpartum, self-care

What you need to know about Gestational Diabetes After Pregnancy

Gestational diabetes is a change in how your body manages sugar during pregnancy. It is diagnosed by a blood test drawn after drinking a sugar loaded drink at around 26-28 weeks pregnant. Gestational diabetes can either be diet controlled or require medications to control blood sugar levels during pregnancy.  Women who are diagnosed with gestational diabetes, particularly gestational diabetes requiring medications to control blood sugar levels during pregnancy are at a higher risk for developing diabetes later in life.


If you were diagnosed with gestational diabetes while you were pregnant here are a few things you need to consider after delivery:

  1. You should have a diabetes-screening test performed after your six week postpartum visit with your obstetrician.
  2. Start exercising. Thirty to forty minutes of aerobic activity at least 5 days a week has been shown to reduce the risk of obesity and diabetes. Brisk walking is a fantastic choice for the postpartum momma. Walking is low impact, free, and easy to do in the company of your baby.
  3. Practice mindful eating to avoid over eating. Pay attention to your food when you are eating. Avoid eating while chatting with friends, watching TV or reading.
  4. Drink water. Avoid excessive sugar in sodas, sports drinks and fruit juices. Try flavoring your water with cucumbers, lemon, lime, or other fruits using a diffuser or just cut them up and put them directly in your water.
  5. Reach for fruit when you need a quick snack. Apples and bananas are easy to eat one handed and are not super messy.
  6. Eat your veggies. Fill most of your dinner plate with veggies instead of bread and pastas.
  7. Avoid eating foods that come out of a bag or box. These foods are usually high in sugar.


Small changes now could make a huge impact on your health in the future. In addition, you are teaching your children how to eat properly. They learn many of their habits by mimicking you. So improving your eating and exercise habits now will not only benefit you but also your children. Postpartum is the perfect time to take control of your health!

Breastfeeding, fourth trimester, Postpartum, self-care

Three at home tricks to managing breast engorgement.

Looking back on my postpartum experience, I have to say one of the most painful experiences I had was breast engorgement the day my breast milk came in.  As I recall, my milk came in about 4 days after delivery.  I had already been discharged from the hospital and had no idea what had hit me!  I know, I know, but you are an Ob/Gyn what do you mean you had no idea what hit you.  Well, you don’t truly get it until you experience it yourself.  No one tells you how painful it is!  Even my patients!  I have never had a patient describe to me the pain of breast engorgement.  Over night, my breasts tripled in size and were rock-hard.  I literally thought they were going to explode. Ugh, it was awful.  I of course panicked.  But before YOU panic, here are three simple measures you take at home to relieve breast engorgement:

  1. Take a warm shower and gently massage your breast to hand express milk.  The key word is GENTLY.  I wanted to wring my breast out to get the milk out as fast as possible and relieve the pressure.  Not only did that attempt leave me in tears in the shower, it was also wildly unsuccessful.   It just doesn’t work that way! Use both hands and start GENTLY massaging close to the chest wall and work your hands toward the nipple.
  2. Pump or feed every two hours.  You can place a warm compress on your breast prior to breast feeding or pumping or take a warm shower just prior to feeding or pumping.  If you are pumping, try to avoid pumping for more than 20-30 minutes. Place your pump on the highest setting that is comfortable for you.  Check your pump parts to make sure your flanges are fitting correctly on your breast and that your membranes are correctly placed within the pump.  Don’t forget to attach the bottles to the flanges!  Yes, in a late night stupor I forgot to do that.  Talk about crying over spilled milk!  If you are breastfeeding, be sure that your little one is latching well, if you are experiencing trouble with latching contact a lactation consultant for hands on help.
  3. Ibuprofen 600mg – 800mg every 6-8 hours will decrease inflammation, as well as help manage some of the pain.  Remember to avoid taking ibuprofen on an empty stomach.