Before Bri Adams, 33, had her first child, in the spring of 2022, she recalls being briefed on the series of pediatrician appointments that would follow delivery—check-ins at day three, week two, and at months one, two, and beyond to ensure her newborn was thriving. Just a single visit was booked with her ob-gyn, for the six-week mark, “so I honestly assumed that by then, I’d be healed and out of diapers. I knew I might not be sleeping through the night, but I thought I’d have things together emotionally and hormonally and physically,” Adams tells SELF. “When that was blatantly not the case, I felt completely blindsided.”
As Adams would come to learn, plenty of societal norms surrounding childbirth mask the realities of postpartum or delegitimize the recovery it entails. “The idea of bouncing back is pervasive in our culture, and the lack of federal paid leave means people are often forced to get back to their normal life whether or not they’re healed,” Rachel Blake, MD, an ob-gyn in New York and Chamber of Mothers board member, tells SELF. The fact that you may only see your ob-gyn once or twice postpartum further minimizes the gravity of this period, Dr. Blake says, as does the long-ingrained idea of the six-week checkpoint being an “all-clear” for sex and exercise. Adams, for one, was shocked to be given the go-ahead for sex at her own such appointment, despite reporting anxious feelings and having still-healing stitches.
In recent years, recognition has grown among experts of the unique tribulations of the postpartum phase—a time during which nearly two-thirds of maternal deaths occur—and the insufficiency of a single health-care encounter; in 2018, the American College of Obstetrics and Gynecology (ACOG) recommended an “ongoing approach,” beginning within the first three weeks postpartum and wrapping up by week 12, reflecting a “fourth trimester.” But even as this concept has trickled into the mainstream, health care has been slow to change, and plenty of moms, like Adams, are caught off-guard by just how long it takes to feel normal again amid the postpartum onslaught. And the truth is, even an extra “trimester” can be a vast underestimate when you consider all the variables in flux.
It may be around 12 to 18 months post-birth until the biological shifts of postpartum settle, depending on factors like how your pregnancy unfolded and whether you breastfeed. But how long it takes to feel like yourself again is also complicated by the challenges of becoming a mom in a society where support for parents is increasingly lacking. Read on to get the lay of the postpartum land, according to science, doctors, and moms themselves.
Hormone changes trigger symptoms that can outlast the fourth trimester.
Pregnancy is, famously, a hormonal rollercoaster, and the ride doesn’t just stop when the baby arrives. At delivery, levels of estrogen and progesterone plummet from their pregnancy peak, which is the culprit behind the “baby blues” in some women, or a period of mood swings lasting a couple weeks, Sarah Oreck, MD, MS, a Los Angeles-based reproductive psychiatrist and founder of maternal mental health platform Mavida Health, tells SELF. That might look like feeling tearful or weepy at any given moment, yet overjoyed the next. (In certain women who may be more sensitive to rapid hormone changes, this shift can also be the “origin story” for postpartum depression, Dr. Oreck points out.)
