• Pregnancy and birth are huge physical and psychological events 

  • Doula and author Sophie Messager explores the vital importance of postnatal rest for new mothers

  • We have therapists and counsellors who specialise in working with pregnancy, miscarriage, and postnatal depression – find yours here 

Postnatal recovery matters, because the wellbeing and the needs of the mother do not end with the birth process. Our culture sees values in investing in birth preparation, but there doesn't seem to be the same focus on postnatal preparation. The mother is the centre of attention whilst pregnant, but once the baby has been born, all the attention shifts towards the baby, as shown, for example, in the type of the gifts given to new parents. What babies need are not plush toys and babygrows, but – beyond warmth, shelter and food – what they need most are loving carers. 

People cannot pour from an empty cup, so the focus of attention and gifts, rather than being directed at the baby, ought to be directed at the parents, and most importantly, at the mother, so she feels strong enough to meet the intense needs of her newborn, whilst navigating the tremendous physical and emotional changes that are going on inside her.

As postnatal doula and founder of the Slow Postpartum movement Jojo Hogan says:

"If birth is like a wedding day (lots of planning, high expectations, being the centre of attention, lasts for about a day or so, get something special at the end), then the postpartum should be like a honeymoon (Equal amounts of planning and investment. Time, space and privacy to relax, bond and fall in love. Lots of people and services around to care for and look after you and a peaceful and blissful environment where all your needs are met for a few days or weeks)."

New mothers and mental health

The lack of support new mothers get has a tremendous impact of their wellbeing, both physically, emotionally, and spiritually. Physically it means that they do not get to rest after the birth and recover from growing and birthing a baby (and in the case of a caesarean birth, whilst recovering from major abdominal surgery). Nor can they cope with the interrupted sleep that a new baby brings, because there is nobody else to hold the baby whilst they sleep, and they still need to look after their household as partners often only have two weeks of leave. They also have no support and guidance from experienced mothers around them to help build confidence in their mothering skills or make sense of the experience and the changing sense of self that motherhood brings. The lack of social support also means that new mothers are lonely, and more likely to experience depression.

Not only do mothers get virtually no support, but we also live in a culture that glorifies busy, and puts immense pressure on new mothers to "go back to normal" as soon as possible. This can lead to feelings of shame and inadequacy, and to new mothers hiding their struggles and failing to seek support because they mistakenly believe that they are the only ones struggling.

It hasn't always been this way. Traditionally, on every continent and in every culture, there is, or used to be, a period of about a month during which the new mother is looked after and nurtured. Family and community members (usually women), come to take care of the new mother and her household so that during that time all she needs to do is rest and get to know her baby. Regardless of the culture, the nurturing aspects are remarkably similar, and encompass four pillars: rest, food, bodywork and social support.

The social support constitutes the foundation on which all the other aspects are built. Another experienced adult and pair of hands in the house is necessary, otherwise how else is the woman going to rest, get some nutrition foods or massage?

Why postnatal rest is so important

Rest is an essential part of the recovery process. It seems common sense, that after spending a lot of energy growing and birthing another person, combined with the broken sleep pattern that caring for a new infant brings, the new mother needs some rest and recovery. Some say that birth is like running a marathon. Every single athlete knows that the rest and recovery is a very important part of the process.  I'm no marathon runner, but I was fascinated to see the similarities between marathon recovery and birth.  It includes recovery specific nutrition, rehydration, pain and muscle recovery (including epsom salt baths for muscle soreness), massage, a period of rest, and there is even a mention of the post exercise blues that comes after a big event. In cultures that still have this tradition, new mothers recovery very well. A mother from Kenya told me that when she gave birth, people fought over who would cook her dinner, and that she didn't even wash herself.

In the book The Golden Month, the author, Jenny Allison, interviews a mother from Mali:

"I had ten children, and never had any problems. My mother in law looked after me very well and whenever I gave birth, she helped me. She usually massaged me daily as long as I needed for the first 40 days. She fed me chicken soup, fish soup, and eggs. With this complete care, I gave birth ten times without any problems. For 40 days, all I would do was feed my baby and lie next to him or her. I did nothing, no work at all, not even domestic work."

Having another adult also means that the woman is never alone as she navigates the challenges that new motherhood brings. This in itself in paramount in order for the mother to be able to self regulate. The polyvagal nervous system theory tells us that the social engagement system is the foundation onto which the rest and relaxation response is built.

Food wise, there is an understanding that the new mother needs to replenish lost nutrients, and stay warm, so the dishes prepared are warm (in both senses of the term-served warm, but also cooked with warming herbs and spices), nutrient dense, easy to digest, and comforting to eat.

Bodywork is also essential, because traditional postpartum wisdom understands that women's bodies have undergone tremendous changes, and that they need time to heal. When a woman grows and births a baby, her whole body undergoes remarkable transformations. Her uterus grows from the size of a pear to that of a watermelon. Her pelvis tilts forwards, the curves of her spine increase, the muscles and ligaments around her belly stretch and grow. The organs inside her abdominal cavity get pushed up to accommodate her growing baby. During the birth, her uterus, pelvis, pelvic floor and vagina open and stretch to let the baby out. Then, after the baby is born, her body has to undergo all those changes in reverse. These changes also include tremendous hormonal changes, and the beginning of lactation. When you take this into account, it seems crazy that our medical system doesn't have anything in place to ensure that all the tissues and organs have gone back where they belong. Many cultures have specific postpartum massages, which are akin to empirical osteopathy, to ensure that all the tissues and organs go back in alignment. As Jenny Allison says in Golden Month "massage is very valuable as a passive form of exercise without the mother using any of her own energy, her circulation is stimulated and she gets the pleasure and sense of wellbeing that comes with exercise" (Allison 2012). Similarly, using a cloth to wrap the new mother appears to be a universal practise around the world, and still used in the UK at the end of the 19th Century.

Preparing for, and asking for a nurturing postpartum is the opposite of a selfish act, it is one that has the power to positively impact the experience and wellbeing of both the new mother, and beyond this, has the power to change society as a whole.

Sophie Messager is the author of Why Postnatal Recovery Matters (Pinter & Martin):

Further reading

Maternal isolation: it takes a village to support a mother

The supermum myth: why good enough should be the goal

How to help a friend with postnatal depression

Birth trauma: new mothers with PTSD