If feelings of depression persist (lasting more than two weeks) or worsen, and start interfering with your functioning, call your practitioner right away and see the next column.

"I feel amazing and have since the moment I delivered three weeks ago. Is all this good feeling building up to one amazing case of letdown?"

Baby blues are common, but they're by no means on every newly delivered mom's to-do list. In fact, there's no reason to believe you're in for an emotional crash just because you've been feeling upbeat. Since baby blues usually occur within the first or second postpartum week, it's pretty safe to assume you've escaped them.

The fact that you're not feeling down, however, doesn't necessarily mean that everybody in your house has escaped the blues. Studies show that while new fathers (who, believe it or not, also go through hormonal changes postpartum) are unlikely to be depressed when their wives are, their risk of falling into a postpartum slump increases dramatically when the new mother is feeling great. So be sure your spouse isn't down with the baby blues; some new dads try to hide such feelings to avoid dumping on their spouses.

Postpartum Depression "My baby is over a month old, and I still can't stop feeling depressed. Shouldn't I be feeling better by now?"

When the blues just won't fade, chances are postpartum depression is the reason why. Though "baby blues" and "postpartum depression" are often used interchangeably, they're actually two very different conditions. True postpartum depression (PPD) is less common (affecting about 15 percent of women) and much more enduring (lasting anywhere from a few weeks to a year or more). It may begin at delivery, but more often not until a month or two later. Sometimes PPD is late onset; it doesn't start until a woman gets her first postpartum period or until she weans her nursing baby (possibly because of fluctuating hormones). More susceptible to PPD are women who have had it before, have a personal or family history of depression or severe PMS, spent a lot of time feeling down during pregnancy, had a complicated pregnancy or delivery, or have a sick baby.

The symptoms of PPD are similar to those of baby blues, though much more pronounced. They include crying and irritability; sleep problems (not being able to sleep or wanting to sleep the day away); eating problems (having no appetite or an excessive one); persistent feelings of sadness, hopelessness, and helplessness; an inability (or lack of desire) to take care of yourself or your newborn; social withdrawal; excessive worry; aversion to your newborn; feeling all alone; and memory loss.

Getting Help for Postpartum Depression No new mother should have to suffer from postpartum depression (PPD). Sadly, too many do, either because they believe it's normal and inevitable after delivery (it isn't) or because they're ashamed to ask for help (they shouldn't be).Public education campaigns are under way to spread the word about PPD, to make sure that a woman who needs help gets it as quickly as she can-so she can start enjoying her new baby as soon as possible. Hospitals are, or will be, required to send new mothers home with educational materials about PPD, so that they (and their spouses) will be more likely to spot the symptoms early and seek treatment. Practitioners are becoming better educated, too-learning how to look for risk factors during pregnancy that might predispose a woman to PPD, to screen routinely for the illness postpartum, and to treat it quickly, safely, and successfully. Several standardized tests (Edinburgh Postnatal Depression Scale and Cheryl Beck's Postpartum Depression Screening Scale) are effective in screening for PPD.PPD is one of the most treatable forms of depression. So if it strikes you, don't suffer with it any longer than you have to. Speak up-and get the help you need now. For more help, contact Postpartum Support International, (800) 944-4PPD (4773); postpartum.net.

If you haven't already tried the tips for fading the baby blues (see page 456 page 456), do try them now. Some of them may be helpful in easing postpartum depression, too. But if your symptoms have persisted for more than two weeks without any noticeable improvement or if you're having more serious symptoms for more than a few days, chances are your PPD won't go away without professional attention. Don't wait to see if it does. First, call your practitioner and be up-front about how you're feeling. He or she may run a thyroid test; because irregularities in thyroid hormone levels can lead to emotional instability, this is often one of the first steps taken when evaluating postpartum depression (see next page). If your thyroid levels check out normally, ask for a referral to a therapist who has a clinical background in the treatment of postpartum depression and make an appointment promptly. Antidepressants (several are safe even if you're breastfeeding), combined with counseling, can help you feel better fast. Some physicians prescribe low doses of antidepressants during the last trimester of pregnancy to women with a history of depression; others recommend that women who are at high risk take antidepressants right after delivery to prevent postpartum depression. Bright light therapy may also bring relief from the symptoms of PPD. (In light therapy, you sit with your eyes open in front of a box that emits a type of light that mimics daylight, causing a positive biochemical change in your brain that can cheer you up.) Whichever treatment (or combination of treatments) you and your therapist decide is right for you, keep in mind that swift intervention is critical. Without it, depression can prevent you from bonding with, caring for, and enjoying your baby. It can also have a devastating effect on the other relationships in your life (with your spouse, with other children), as well as on your own health and well-being.

Thyroiditis Got You Down?

Nearly all new mothers feel run-down and tired. Most have trouble losing weight. Many suffer from some degree of depression and a certain amount of hair loss. It may not be a pretty picture, but for the majority of moms, it's a completely normal one in the postpartum period-and one that gradually begins to look better as the weeks pass. For the estimated 5 to 9 percent of women who suffer from postpartum thyroiditis (PPT), however, this picture may not improve with time. And, because the symptoms of PPT are so similar to those weathered by all new mothers, the condition may go undiagnosed and untreated.PPT may start anywhere from one to three months after delivery with a brief episode of hyperthyroidism (too much thyroid hormone). This period of excess thyroid hormone circulating in the bloodstream may last a few weeks or longer. During this hyperthyroid period, a woman may be tired, irritable, and nervous; feel very warm; and experience increased sweating and insomnia-all of which are common in the immediate postpartum period anyway, making an easy diagnosis more elusive. Treatment isn't usually needed for this phase.This period will typically (but not always) be followed by one of hypothyroidism (too little thyroid hormone). With hypothyroidism, fatigue continues, along with depression (longer lasting and often more severe than typical baby blues), muscle aches, excessive hair loss, dry skin, cold intolerance, poor memory, and an inability to lose weight.If your postpartum symptoms seem to be more pronounced and persistent than you would have expected, and especially if they are preventing you from eating, sleeping, and enjoying your new baby, check with your practitioner. Tests can determine whether PPT is the cause of your troubles. Be sure to mention any history of thyroid problems in your family, since there is a very strong genetic link.Most women recover from PPT within a year after delivery. In the meantime, treatment with supplementary thyroid hormone can help them feel much better much faster. About 25 percent of women who have the condition, however, remain hypothyroid, requiring lifetime treatment (which is as easy as taking a pill every day and having a yearly blood test). Even in those who recover spontaneously, thyroiditis is likely to recur during or after subsequent pregnancies. Some may develop hypothyroidism or Graves disease (hyperthyroidism) later in life. For this reason, it makes sense for women who have had PPT to have a yearly thyroid screening and, if they are planning another pregnancy, to be screened in the preconception period and during pregnancy (because an untreated thyroid condition can interfere with conception and cause problems during pregnancy).

Some women, instead of (or in addition to) feeling depressed postpartum, feel extremely anxious or fearful, sometimes experiencing panic attacks that include rapid heartbeat and breathing, hot or cold flashes, chest pain, dizziness, and shaking. These symptoms also require prompt treatment by a qualified therapist, which may include medication.

About 30 percent of women suffering from PPD also exhibit signs of postpartum obsessive-compulsive disorder (PPOCD), though PPOCD can also occur by itself. Symptoms of PPOCD include obsessive-compulsive behaviors, such as waking up every 15 minutes to make sure the baby is still breathing, furious housecleaning, or having obsessive thoughts about harming the newborn (such as throwing the baby out the window or dropping him or her down the stairs). Women suffering from PPOCD are appalled by their gruesome and violent thoughts, though they won't act on them (only those suffering from postpartum psychosis might; see below). Still, they can be so afraid of losing control and following through with these impulses that they may end up neglecting their babies. Like PPD, treatment for PPOCD includes a combination of antidepressants and therapy. If you're having obsessive thoughts and/or behaviors, be sure to get help by telling your practitioner about your symptoms.

Much more rare and much more serious than PPD is postpartum psychosis. Its symptoms include loss of reality, hallucinations, and/or delusions. If you're experiencing suicidal, violent, or aggressive feelings, are hearing voices or seeing things, or have other signs of psychosis, call your doctor and go to the emergency room immediately. Don't underplay what you're feeling, and don't be put off by reassurances that such feelings are normal during the postpartum period-they're not. To be sure you don't act out any dangerous feelings while you're waiting for help, try to get a neighbor, relative, or friend to stay with you or put your baby in a safe place (such as the crib).

Losing Weight Postpartum "I knew I wouldn't be ready for a bikini right after delivery, but I still look six months pregnant two weeks later."

Though childbirth produces more rapid weight loss than any diet you'll find on the bestseller lists (an average of 12 pounds overnight), most women don't find it quite rapid enough. Particularly after they catch a glimpse of their paunchy postpartum profiles in the mirror.

The fact is, no one comes out of the delivery room looking much slimmer than when they went in. Part of the reason for that protruding postpartum abdomen is your still-enlarged uterus, which will be reduced to prepregnancy size by the end of six weeks, reducing your girth in the process. Another reason for your belly bloat might be leftover fluids, which should be flushing out soon. But the rest of the problem lies in those stretched-out abdominal muscles and skin, which will likely take some effort to tone up. (See Getting Back into Shape, page 465 page 465.) As hard as it might be to put it out of your mind, don't even think about the shape your body's in during the first six weeks postpartum, especially if you're breastfeeding. This is a recovery period, during which ample nutrition (and rest) is important for both energy and resistance to infection. Sticking to a healthy postpartum diet should start you on the way to slow, steady weight loss. If, after six weeks, you aren't losing any weight, you can start cutting back somewhat on calories. If you're nursing, don't go overboard. Eating too few calories can reduce milk production, and burning fat too quickly can release toxins into the blood, which can end up in your breast milk. If you're not nursing, you can go on a sensible, well-balanced weight-loss diet six weeks postpartum.

Some women find that the extra pounds melt off while they're breastfeeding; others are dismayed to find the scale doesn't budge. If the latter turns out to be the case with you, don't despair; you'll be able to shed any remaining excess poundage once you've weaned your baby.

How quickly you return to your prepregnant weight will also depend on how many pounds you put on during pregnancy. If you didn't gain much more than 25 to 35 pounds, you'll likely be able to pack away those pregnancy jeans in a few months, without strenuous dieting. If you gained 35 or more pounds, you may find it takes more effort and more time-anywhere from 10 months to 2 years-to return to prepregnancy weight and your skinny jeans.

Either way, give yourself a break-and give yourself some time. Remember, it took you nine months to gain that pregnancy weight, and it may take at least that long to take it off.

Long-Term C-Section Recovery "It's been a week since my C-section. What can I expect now?"

While you've definitely come a long way since you were wheeled into recovery, like every new mom you still have some recuperation ahead of you in the next few weeks. Keep in mind that the more conscientious you are about getting the rest you need now-as well as about following your practitioner's instructions-the shorter that recuperation time will ultimately be. In the meantime, you can expect: Little or no pain. Most of it should have dissipated by now. But if you do hurt, some acetaminophen (Tylenol) should do the trick. Most of it should have dissipated by now. But if you do hurt, some acetaminophen (Tylenol) should do the trick.

Progressive improvement. Your scar will be sore and sensitive for a few weeks, but it will improve steadily. A light dressing may protect it from irritation, and you will probably be more comfortable wearing loose clothing that doesn't rub. Occasional sensations of pulling or twitching and other brief pains around the incision site are a normal part of healing and eventually subside. Itchiness may follow-ask your practitioner to recommend an anti-itch ointment that you can apply. The numbness surrounding the scar will last longer, possibly several months. Lumpiness in the scar tissue will probably diminish, and the scar may turn pink or purple before it finally fades. Your scar will be sore and sensitive for a few weeks, but it will improve steadily. A light dressing may protect it from irritation, and you will probably be more comfortable wearing loose clothing that doesn't rub. Occasional sensations of pulling or twitching and other brief pains around the incision site are a normal part of healing and eventually subside. Itchiness may follow-ask your practitioner to recommend an anti-itch ointment that you can apply. The numbness surrounding the scar will last longer, possibly several months. Lumpiness in the scar tissue will probably diminish, and the scar may turn pink or purple before it finally fades.

If pain becomes persistent, if the area around the incision turns an angry red, or if a brown, gray, green, or yellow discharge oozes from the wound, call your doctor. The incision may have become infected. (A small amount of clear fluid discharge is usually normal, but report it to your physician anyway.) A four-week wait (at least) for sex. The guidelines are pretty much the same as they are for those who've delivered vaginally, though how well your incision is healing may also be factored into how long you'll need to wait. See the next question for more. The guidelines are pretty much the same as they are for those who've delivered vaginally, though how well your incision is healing may also be factored into how long you'll need to wait. See the next question for more.

To get moving. Once you're free of pain, you'll be able to begin exercising. Kegel exercises are still important even if you delivered with your perineum intact, because pregnancy took its toll on those pelvic floor muscles. Concentrate, too, on exercises that tighten the abdominal muscles. (See Getting Back into Shape, Once you're free of pain, you'll be able to begin exercising. Kegel exercises are still important even if you delivered with your perineum intact, because pregnancy took its toll on those pelvic floor muscles. Concentrate, too, on exercises that tighten the abdominal muscles. (See Getting Back into Shape, page 465 page 465.) Make "slow and steady" your motto; get into a program gradually and continue it daily. Expect it to take several months before you're back to your old self.

Resuming Sex "When can we start having sex again?"

That's at least partly up to you, though you'll also want to include your practitioner in the decision (probably not in the heat of the moment). Couples are typically advised to pick up where they left off whenever the woman feels physically ready-usually around four weeks postpartum, though some practitioners give the green light to sex as early as two weeks postpartum, and others still follow the old six-week rule routinely. In certain circumstances (for instance, if healing has been slow or you had an infection), your practitioner may recommend waiting longer. If your practitioner still has you in a holding pattern, but you think you're ready to move forward, ask if there's a reason why you shouldn't. If there isn't, ask your practitioner if you can get busy earlier. If it turns out there is a reason why sex might not be safe yet, hit the cold shower-though maybe together-and wait for clearance. Keep in mind that time will fly when you're caring for a newborn. In the meantime, satisfy each other with lovemaking that doesn't involve penetration.

"My midwife told me I can start having sex, but I'm afraid it's going to hurt. Plus, to be honest, I'm really not in the mood."

Doing "it" isn't topping your to-do list these days-or, more likely, isn't even making the top 20? No surprise there (or down there). Most women lose that loving feeling during the postpartum period-and beyond-for a variety of reasons. First, as you already suspect, postpartum sex can be more pain than pleasure-especially if you delivered vaginally, but, surprisingly, even if you labored and then had a C-section. After all, your vagina has just been stretched to its earthly limits, and possibly torn or surgically cut and sutured to boot-leaving you too sore to sit, never mind contemplate sex. Your natural lubrications haven't turned on yet, making you feel uncomfortably dry where you'd rather be moist-especially if you're breastfeeding. Adding to the pain potential: Low levels of estrogen cause the vaginal tissue to remain thin, and thin is not in as far as vaginas are concerned.

But your libido has other problems to contend with postpartum besides the physical ones: Your understandable preoccupation with a very little and very needy person, who is given to waking up with a full diaper and an empty tummy at the least opportune times. Not to mention a number of other very effective mood killers (the pungent smell of day-old spit-up on your sheets, the pile of dirty baby clothes at the foot of your bed, the baby oil on your nightstand where there used to be massage oil, the fact that you can't remember when you had your last shower). It's no wonder sex isn't on the schedule.

Will you ever live to make love again? Absolutely. Like everything else in your new and often overwhelming life, it'll just take time and patience (especially from your partner, who's almost certainly ready for this dry spell to end). So wait until you're feeling ready, or help yourself get ready with the following tips: Lubricate. Using K-Y jelly, Astroglide, or another lubricant until your own natural secretions return can reduce pain and, ideally, increase pleasure. Buy them in economy sizes, so you'll be more likely to use them liberally-on both of you. Using K-Y jelly, Astroglide, or another lubricant until your own natural secretions return can reduce pain and, ideally, increase pleasure. Buy them in economy sizes, so you'll be more likely to use them liberally-on both of you.

Loosen up. Speaking of lubrication, drinking a small glass of wine can also help you unwind-and keep you from tensing up and experiencing pain during intercourse (just make sure you drink it right after a feeding if you're nursing). Another great way to loosen up is massage, so request one prior to closing the deal. Speaking of lubrication, drinking a small glass of wine can also help you unwind-and keep you from tensing up and experiencing pain during intercourse (just make sure you drink it right after a feeding if you're nursing). Another great way to loosen up is massage, so request one prior to closing the deal.

Craving More?

For much more information on easing back into sex, birth control, and enjoying the first year, see What to Expect the First Year. What to Expect the First Year.

Warm up. Of course, your partner's probably as eager as he's ever been to get down to business. But though he may not need much-if any-foreplay, you definitely do. So ask for it. And then ask for some more. The greater the effort he puts into warming you up (time permitting before baby wakes up again, of course), the better the main event will be for both of you. Of course, your partner's probably as eager as he's ever been to get down to business. But though he may not need much-if any-foreplay, you definitely do. So ask for it. And then ask for some more. The greater the effort he puts into warming you up (time permitting before baby wakes up again, of course), the better the main event will be for both of you.

Tell it like it is. You know what hurts and what feels good, but your partner doesn't unless you provide him a clearly marked map ("Turn left ... no, right ... no, down ... up just a smidge-there, perfect!"). So speak up when you'd like things to heat up. You know what hurts and what feels good, but your partner doesn't unless you provide him a clearly marked map ("Turn left ... no, right ... no, down ... up just a smidge-there, perfect!"). So speak up when you'd like things to heat up.

Position properly. Experiment and find a position that puts less pressure on any tender areas and gives you control over the depth of penetration (this is one time when deeper will definitely not be better). Woman-on-top (if you have the energy) or side-to-side positions are both great postpartum picks for those reasons. Whoever's in charge of the strides, make sure they're performed at a comfortably slow speed. Experiment and find a position that puts less pressure on any tender areas and gives you control over the depth of penetration (this is one time when deeper will definitely not be better). Woman-on-top (if you have the energy) or side-to-side positions are both great postpartum picks for those reasons. Whoever's in charge of the strides, make sure they're performed at a comfortably slow speed.

Pump it up. No, not that kind of pumping. Pump blood and restore muscle tone to your vagina by doing the exercise you're probably sick of hearing about (but should keep doing anyway): Kegels. Do them day and night (and don't forget to do them when you're doing "it," too, since that squeeze will please you both). No, not that kind of pumping. Pump blood and restore muscle tone to your vagina by doing the exercise you're probably sick of hearing about (but should keep doing anyway): Kegels. Do them day and night (and don't forget to do them when you're doing "it," too, since that squeeze will please you both).

Find alternative means of gratification. If you're not having fun yet through intercourse, seek sexual satisfaction through mutual masturbation or oral sex. Or if you're both too pooped to pop, find pleasure in just being together. There's absolutely nothing wrong (and everything right) about lying in bed together, cuddling, kissing, and swapping baby stories. If you're not having fun yet through intercourse, seek sexual satisfaction through mutual masturbation or oral sex. Or if you're both too pooped to pop, find pleasure in just being together. There's absolutely nothing wrong (and everything right) about lying in bed together, cuddling, kissing, and swapping baby stories.

Bottom line on your bottom line: Even if sex does hurt a bit the first time (and second and third time), don't write it off-or give it up. It won't be long (though it may seem that way) before the pleasure will be all yours-and your partner's-again.

Becoming Pregnant Again "I thought that breastfeeding was a form of birth control. Now I hear you can get pregnant while nursing, even before you get your period."

Unless you don't mind becoming pregnant again soon, don't even think about relying on breastfeeding for contraception.

It's true that, on average, women who nurse resume normal cycles later than those who don't. In mothers who aren't nursing, periods usually kick in again somewhere between 6 and 12 weeks after delivery, whereas in nursing mothers the average is somewhere between 4 and 6 months. As usual, however, averages are deceptive. Nursing moms have been known to begin their periods as early as 6 weeks and later than 18 months postpartum. The problem is, there's no sure way to predict when you will get your first postbaby period, though several variables can influence the timing: for example, frequency of nursing (more than three times a day seems to suppress ovulation better), duration of nursing (the longer you nurse, the greater the delay in ovulation), and whether or not feedings are being supplemented (your baby's taking formula, solids, even water can interfere with the ovulation-suppressing effect of nursing).

Why worry about birth control before that first postpartum visit from Aunt Flo? Because the point at which you ovulate for the first time after delivery is as unpredictable as when you menstruate. Some women have a sterile first period; that is, they don't ovulate during that initial cycle. Others ovulate before the period, and therefore they can go from pregnancy to pregnancy without ever having had a period. Since you don't know which will come first, the period or the egg, contraceptive caution is highly advisable.

Of course, accidents can happen. So even if you've been using contraception-and especially if you haven't been-pregnancy is still a possibility. If you do have any suspicion that you might be expecting again, the best thing to do is take a pregnancy test. See page 42 page 42 for information on back-to-back pregnancies. for information on back-to-back pregnancies.

Getting Back into Shape It's one thing to look six months pregnant when, in fact, you are six months pregnant, and quite another to look it when you've already delivered. Yet most women can expect to come out of the birthing room not much trimmer than when they went in-with a little bundle in their arms and a sizable one still around their middles. As for the zip-up jeans optimistically packed for the going-home trip, they're likely to stay packed, with baggy sweats the comfortable substitute.

How soon after you become a new mother will you stop looking like a mother-to-be? The answer will depend primarily on four factors: how much weight you gained during pregnancy, how well you control your intake of calories, how much exercise you get, and your metabolism and your genes.

"Who needs exercise?" you may wonder. "I haven't stopped moving since I got home from the hospital. Doesn't that count?" Unfortunately, not much. Exhausting as it is caring for a newborn, that kind of activity won't tighten up the perineal and abdominal muscles that have been stretched and left saggy by pregnancy and childbirth-only an exercise program will. And the right kind of postpartum exercise will do more than tone you up. It will help keep baby-toting backaches at bay, promote healing and hasten recovery from labor and delivery, help pregnancy-loosened joints tighten up, improve circulation, and reduce the risk of a variety of other unpleasant postpartum symptoms, from varicose veins to leg cramps. Kegel exercises, which target the perineal muscles, will help you avoid stress and urinary incontinence and postpartum sexual problems. Finally, exercise can make you happier. As exercise-released endorphins circulate in your system, boosting your mood and your ability to cope, you'll find yourself much better equipped to handle the stresses of new parenthood. In fact, research shows that moms who resume exercising within six weeks of delivery feel better about themselves-and just plain feel better.

Basic Position Lie on your back, knees bent, soles flat on the floor. Support your head and shoulders with cushions, and rest your arms flat at your sides.

Pelvic Tilt Lie on your back in the basic position. Take a breath. Then exhale as you press the small of your back against the floor for 10 seconds. Then relax. Repeat three or four times to start, increasing gradually to 12, and then 24.

Leg Slides Assume the Basic Position. Slowly extend both legs until they are flat on the floor. Slide your right foot, flat on the floor, back toward your buttocks, inhaling as you go. Keep the small of your back against the floor. Exhale as you slide your leg back down. Repeat with your left foot. Start with three or four slides per side, and increase gradually until you can do a dozen or more comfortably. After three weeks, move to a modified leg lift (lifting one leg at a time slightly off the floor and lowering it again very slowly), if it is comfortable.

Head/Shoulder Lift Assume the Basic Position. Take a deep relaxing breath; then raise your head very slightly and stretch your arms out, exhaling as you do. Lower your head slowly and inhale. Raise your head a little more each day, gradually working up to lifting your shoulders slightly off the floor. Don't try full sit-ups during the first six weeks-and then only if you have always had very good abdominal muscle tone. Check first, too, for an abdominal separation (see page 469 page 469).

And you can probably start sooner than you think. If your delivery was vaginal and uncomplicated and you don't have any other major health issue that might slow you down, you can begin your postpartum exercise program as early as 24 hours after delivery. (If you've had a surgical or a traumatic delivery, check with your doctor first.) Don't even think about starting off with a bang, however; your recovering body needs to take it slowly and carefully. The following three-phase program will help guide you. You can supplement it by using a postpartum exercise book or DVD, joining a class for new mothers (the camaraderie helps with motivation, and many include infants in the routines), and making daily strolls with baby a part of your routine.

Workout Rules for the First Six Weeks [image] Wear a supportive bra and comfortable clothing. Wear a supportive bra and comfortable clothing.[image] Try to divide your exercise schedule into two or three brief sessions rather than doing one long session a day (this tones muscles better and will be easier on your recovering body-plus you're more likely to be able to fit it in). Try to divide your exercise schedule into two or three brief sessions rather than doing one long session a day (this tones muscles better and will be easier on your recovering body-plus you're more likely to be able to fit it in).[image] Start each session with the exercise you find least strenuous. Start each session with the exercise you find least strenuous.[image] Do exercises slowly, and don't do a rapid series of repetitions. Instead, rest briefly between movements (the muscle buildup occurs then, not while you are in motion). Do exercises slowly, and don't do a rapid series of repetitions. Instead, rest briefly between movements (the muscle buildup occurs then, not while you are in motion).[image] As during pregnancy, avoid jerky, bouncy, erratic motions during the first six weeks postpartum, while your ligaments are still loose. Also avoid knee-to-chest exercises, full sit-ups, and double leg lifts during this period. As during pregnancy, avoid jerky, bouncy, erratic motions during the first six weeks postpartum, while your ligaments are still loose. Also avoid knee-to-chest exercises, full sit-ups, and double leg lifts during this period.[image] Be sure to replenish fluids lost during exercise. Keep a water bottle next to you during your workouts and sip often. Aim for an extra cup or two of fluids for short bouts of exercise (more if your workouts are longer or more strenuous). Be sure to replenish fluids lost during exercise. Keep a water bottle next to you during your workouts and sip often. Aim for an extra cup or two of fluids for short bouts of exercise (more if your workouts are longer or more strenuous).[image] Take it slowly and sensibly. "No pain, no gain" wasn't a motto created with new moms in mind. Don't do more than recommended, even if you feel you can, and stop before you feel tired. If you overdo it, you probably won't feel it until the next day, by which time you may be so exhausted and achy that you won't be able to exercise at all. Take it slowly and sensibly. "No pain, no gain" wasn't a motto created with new moms in mind. Don't do more than recommended, even if you feel you can, and stop before you feel tired. If you overdo it, you probably won't feel it until the next day, by which time you may be so exhausted and achy that you won't be able to exercise at all.[image] Don't let taking care of your baby stop you from taking care of yourself. Your baby will love lying on your chest as you go through your exercise routine. Don't let taking care of your baby stop you from taking care of yourself. Your baby will love lying on your chest as you go through your exercise routine.

Phase 1: Twenty-Four Hours After Delivery Can't wait to get back on the workout wagon? Easy does it, starting with: Kegels. You can really start your Kegels as soon as you've delivered (see You can really start your Kegels as soon as you've delivered (see page 295 page 295 for directions if you haven't done them before), though you probably won't be able to feel yourself doing them at first, thanks to perineal numbness. Kegels can be done in any comfortable position, and comfort is key when you've just delivered a baby. Any time is a good time for Kegels, but try to get in the habit of doing them while you're feeding your baby-which you'll be doing a lot in the months to come. Work up to 25 repetitions four to six times a day, and continue for the rest of your life for good pelvic health (and increased sexual pleasure). for directions if you haven't done them before), though you probably won't be able to feel yourself doing them at first, thanks to perineal numbness. Kegels can be done in any comfortable position, and comfort is key when you've just delivered a baby. Any time is a good time for Kegels, but try to get in the habit of doing them while you're feeding your baby-which you'll be doing a lot in the months to come. Work up to 25 repetitions four to six times a day, and continue for the rest of your life for good pelvic health (and increased sexual pleasure).

Deep diaphragmatic breathing. In the Basic Position (see box, In the Basic Position (see box, page 466 page 466), place your hands on your abdomen so you can feel it rise as you inhale slowly through your nose; tighten the abdominal muscles as you exhale slowly through your mouth. Start with just two or three deep breaths at a time, to prevent hyperventilating, and work up gradually. (Signs that you've overdone it are dizziness or faintness, tingling, or blurred vision.) Phase 2: Three Days After Delivery Anxious to get that pre-baby body back? Then you'll be happy to hear that it's time to move up another rung on the exercise ladder. But before you take that step, make sure the pair of vertical muscles that form your abdominal wall have not separated during pregnancy. If they have, you'll have to close them up before the workouts start heating up (see box below). Once the separation has closed, or if you've never had one, move on to Head/Shoulder Lifts, Leg Slides, and Pelvic Tilts (see illustrations on pages 466 pages 466 and and 467 467).

All these exercises should be done in the Basic Position. At first, do them in bed, then move on to a well-cushioned floor. (An exercise mat is a good investment, not only because it makes these exercises easier and more comfortable to do now, but because your baby can practice rolling over and try his or her first tentative crawls on it later on in the year.)

Close the Gap Don't look now, but there's probably a hole in the middle of your belly (and it's not your navel). A very common pregnancy condition known in obstetrical circles as diastasis, it's a gap in your abdominal muscles that can develop as the abdomen expands. It can take a month or two after delivery for this gap to close, and you'll have to wait until it does before you start those crunches and other abdominal exercises or you'll risk an injury. To determine if you have a separation, examine yourself this way: As you lie in the Basic Position, raise your head slightly with your arms extended forward; then feel for a soft lump above your navel. Such a lump indicates a separation.If you do have a separation, you may be able to help correct it more quickly with this exercise: Assume the Basic Position and inhale. Now cross your hands over your abdomen, using your fingers to draw the sides of your abdominal muscles together as you breathe out, pulling your belly button inward toward the spine while raising your head slowly. Exhale as you lower your head slowly. Repeat three or four times, twice a day.

Phase 3: After Your Postpartum Checkup Now, with your practitioner's go-ahead, you can gradually graduate to a more active workout program that includes walking, running, bicycling, swimming, water workouts, aerobics, yoga, Pilates, weight training, or similar routines. Or sign up for a postpartum exercise class. But don't try to do too much too soon. As always, let your body be your guide.

Milk It Good news for nursing moms who want to exercise their right to work out. Exercise-even the high-intensity type-doesn't turn your breast milk sour, as you might have heard. Salty, maybe, from the sweat on your nipples-but your baby might actually enjoy that added tang. So go ahead (when your practitioner's given the go-ahead) and exercise to your body's content. Feeding your baby before a workout (or pumping) might make you more comfortable (since your breasts won't be as full), but it isn't necessary. And don't forget to wear a bra that offers you plenty of support-you need it more than ever.

PART 5.

For Dads

CHAPTER 19.

Fathers Are Expectant, Too.

THOUGH IT'S CERTAINLY TRUE-future medical breakthroughs and Hollywood movies notwithstanding-that only women can become pregnant, it's just as true that fathers are expectant, too. As a dad, you're not only an essential member of your baby-making team, but an invaluable nurturer of both your pregnant spouse and your unborn offspring. In the months to come, you'll participate fully in the amazing process of pregnancy-in the excitement, in the responsibility, and, of course, in the worry. Some of your concerns will overlap those of mom-to-be; others will be uniquely yours. And just like your mate, you're entitled to your share of reassurance, not just during the pregnancy and the birth, but during the postpartum period as well.

And so this chapter is dedicated to the equal, but sometimes neglected, partner-in-reproduction. Keep in mind, however, that the pages that follow aren't intended for your eyes only, any more than the rest of the book is intended only for the mother-to-be. Your spouse can gain some valuable insights into what you're feeling, wondering about, and hoping by reading this chapter; you can better understand the physical and emotional challenges she'll be facing during pregnancy, childbirth, and postpartum-and at the same time better prepare yourself for your own role in this adventure-by reading the rest of this book.

Get Ready, Get Set ... Then Go Giving your baby the best start in life can start even before sperm meets egg. If your partner isn't yet pregnant, you both have time to get yourselves into tip-top baby-making shape first. Read Chapter 1, and follow the suggestions for the preconception period. If you're already expecting, no problem. Just start taking good care of yourselves and each other now.

What You May Be Wondering About Dealing with Her Symptoms "My wife is having every symptom in the book, literally: nausea and cravings and peeing all the time. I'm not sure what to do-I feel so helpless."

Seem like the woman in your life has been taken over by aliens? Close-she's been taken over by pregnancy hormones (which can sometimes make an alien invasion seem like a walk in the park). These hormones, vital to baby production, can also produce a wide variety of uncomfortable (and sometimes bewildering) symptoms: hard for her to cope with and hard for you to stand by helplessly and watch.

Fortunately, you don't have to just stand there-you can actually do something. To help your pregnant partner feel better while helping yourself feel less helpless, read about the symptoms individually in this book, plus try some of the following father-focused symptom- fighting strategies: Morning sickness. Morning sickness is one pregnancy symptom that definitely doesn't live up to its name. It's a 24/7 experience that can send your spouse running to the bathroom morning, noon, and night-and hugging the toilet far more than she'll be hugging you. So take steps to help her feel better-or at least not worse. Lose the aftershave that she suddenly finds repulsive and get your onion ring fix out of her sniffing range (her sense of smell is in overdrive). Fill her gas tank so she doesn't have to come nose-to-nozzle with the fumes at the pump. Fetch her foods that quell her queasies and don't provoke another run to the toilet-ginger ale, soothing smoothies, crackers (but ask first-what spells r-e-l-i-e-f for one queasy woman spells v-o-m-i-t to another). Be there for support when she's throwing up-hold back her hair, bring her some ice water, rub her back. Encourage her to eat small meals throughout the day instead of three large ones (spreading out the load and keeping her tummy filled may ease her nausea). And remember, no jokes. If you'd been throwing up for 10 straight weeks, you wouldn't find it amusing. Neither does she. Morning sickness is one pregnancy symptom that definitely doesn't live up to its name. It's a 24/7 experience that can send your spouse running to the bathroom morning, noon, and night-and hugging the toilet far more than she'll be hugging you. So take steps to help her feel better-or at least not worse. Lose the aftershave that she suddenly finds repulsive and get your onion ring fix out of her sniffing range (her sense of smell is in overdrive). Fill her gas tank so she doesn't have to come nose-to-nozzle with the fumes at the pump. Fetch her foods that quell her queasies and don't provoke another run to the toilet-ginger ale, soothing smoothies, crackers (but ask first-what spells r-e-l-i-e-f for one queasy woman spells v-o-m-i-t to another). Be there for support when she's throwing up-hold back her hair, bring her some ice water, rub her back. Encourage her to eat small meals throughout the day instead of three large ones (spreading out the load and keeping her tummy filled may ease her nausea). And remember, no jokes. If you'd been throwing up for 10 straight weeks, you wouldn't find it amusing. Neither does she.

Cravings and aversions. Have you noticed that she's gagging over foods she used to love-or going gaga over foods she's never eaten before (or eaten in such peculiar combinations)? Don't tease her about these cravings and aversions-she's as powerless to control them as you are to understand them. Instead, indulge her by keeping the offending foods out of smelling distance. (Love chicken wings? Love them somewhere else.) Surprise her with the pickle-melon-and-Swiss sandwich she suddenly can't live without. Go the extra mile-or two miles-to the all-night mart for that midnight pint of triple fudge brownie, and you'll both feel better. Have you noticed that she's gagging over foods she used to love-or going gaga over foods she's never eaten before (or eaten in such peculiar combinations)? Don't tease her about these cravings and aversions-she's as powerless to control them as you are to understand them. Instead, indulge her by keeping the offending foods out of smelling distance. (Love chicken wings? Love them somewhere else.) Surprise her with the pickle-melon-and-Swiss sandwich she suddenly can't live without. Go the extra mile-or two miles-to the all-night mart for that midnight pint of triple fudge brownie, and you'll both feel better.

A Partner in Parenting by Any Name Most of the tips in this chapter also apply to the partner in a nontraditional family. Pick and choose questions and answers that fit your situation or can be applied to it.

Exhaustion. If you think If you think you're you're tired at the end of the day, think about this: Your spouse expends more energy lying down on the sofa building a baby than you do bodybuilding at the gym. Which makes her a lot more tired than you've ever known her to be-and a lot more tired than you can even imagine. So pick up the slack. And your slacks. And the trail of socks and sneakers in the hallway. Beat her to the vacuuming and the dusting and the laundry and the toilet cleaning. (The fumes from the cleaning products will make her feel sicker anyway.) Encourage her to watch your cleanup routine from a fully reclining position on the sofa (even if that's always been your favorite position). tired at the end of the day, think about this: Your spouse expends more energy lying down on the sofa building a baby than you do bodybuilding at the gym. Which makes her a lot more tired than you've ever known her to be-and a lot more tired than you can even imagine. So pick up the slack. And your slacks. And the trail of socks and sneakers in the hallway. Beat her to the vacuuming and the dusting and the laundry and the toilet cleaning. (The fumes from the cleaning products will make her feel sicker anyway.) Encourage her to watch your cleanup routine from a fully reclining position on the sofa (even if that's always been your favorite position).

Trouble sleeping. She's making a baby, but chances are she isn't sleeping like one. So instead of snoring up a storm next time her pregnancy insomnia strikes, keep your spouse company while she waits for the sandman to show up. Buy her a body pillow to help get her comfy or build her a cozy fort of support with your extra pillows. Relax her with a backrub, run her a bath, bring her a warm cup of milk and a muffin. Do a little pillow talking. Cuddle as needed and as wanted. And if one thing leads to another, you might both sleep better. (Don't expect a sexual nightcap for your efforts, though-there are plenty of reasons why she might not be in the mood these days.) She's making a baby, but chances are she isn't sleeping like one. So instead of snoring up a storm next time her pregnancy insomnia strikes, keep your spouse company while she waits for the sandman to show up. Buy her a body pillow to help get her comfy or build her a cozy fort of support with your extra pillows. Relax her with a backrub, run her a bath, bring her a warm cup of milk and a muffin. Do a little pillow talking. Cuddle as needed and as wanted. And if one thing leads to another, you might both sleep better. (Don't expect a sexual nightcap for your efforts, though-there are plenty of reasons why she might not be in the mood these days.) Frequent urination. There she goes-again. Urinary frequency will be your spouse's constant companion in her first trimester, and it'll come back with a vengeance in the last trimester, too. So try not to hog the bathroom, and always leave it ready for her use. Remember to put the seat down after every use (especially at night), and keep the hallway free of obstacles (your briefcase, your sneakers, that magazine) and lit by a night-light so she won't trip on her way to the toilet. And be as understanding as you can when she has to get up three times during the movie or stop six times on the way to your parents' house. There she goes-again. Urinary frequency will be your spouse's constant companion in her first trimester, and it'll come back with a vengeance in the last trimester, too. So try not to hog the bathroom, and always leave it ready for her use. Remember to put the seat down after every use (especially at night), and keep the hallway free of obstacles (your briefcase, your sneakers, that magazine) and lit by a night-light so she won't trip on her way to the toilet. And be as understanding as you can when she has to get up three times during the movie or stop six times on the way to your parents' house.

Sympathy Symptoms "It's my wife who's pregnant, so why am I having morning sickness?"

Feeling curiously ... pregnant? Women may have a corner on the pregnancy market but not on pregnancy symptoms. As many as half, or even more (depending on the study), of expectant fathers suffer from some degree of couvade syndrome, or "sympathetic pregnancy," during their wives' gestation. The symptoms of couvade can mimic virtually all the normal symptoms of pregnancy, including nausea and vomiting, abdominal pain, appetite changes, weight gain, food cravings, constipation, leg cramps, dizziness, fatigue, and mood swings.

Any number of emotions that have settled down in your psyche these days could trigger these symptoms, from sympathy (you wish you could feel her pain, and so you do), to anxiety (you're stressed about the pregnancy or about becoming a father), to jealousy (she's getting center stage; you'd like to share it). But there's more to sympathy symptoms than just sympathy (and other normal father-to-be feelings). In fact, there are actually physical factors in play. Believe it or not, your wife's female hormones aren't the only ones surging these days. Research shows that pregnancy and the postpartum period step up dad's supply, too. Though you (and your fellow fathers-to-be) won't be churning out enough female hormones to grow breasts, you might produce enough to grow a little belly, or send you heaving at the sight of your favorite burger, or running to the fridge for a midnight pickle fest (or all three). And these hormonal fluctuations aren't random or a sign of Mother Nature's twisted sense of humor. They're designed to get you in touch with your nurturing side-nature's way of bringing out the parent in you. Which doesn't only prepare you for the diaper-changing ahead, but helps you cope with the changes you're both facing now. These hormone shifts also make it easier for you to channel those sometimes uncomfortable feelings into productive pursuits. Apply your sympathy to cooking dinner and scrubbing the toilet; work through those anxieties by talking them out with your spouse and with friends who are already dads; feel less left out by becoming more involved in the pregnancy and baby prep.