Postpartum Fatigue and Ways to Overcome It

One of the most challenging and often under-recognized aspects of giving birth to a child is Postpartum fatigue. It is often dismissed as an expected consequence of childbirth and newborn care, but postpartum fatigue can have far-reaching effects on physical recovery, emotional well-being, infant bonding, and overall family functioning. In this article, first, we explore the physiological, psychological, and situational causes of postpartum fatigue and why it’s so important, then we discuss evidence-based strategies for its management.

Understanding Postpartum Fatigue

Fatigue in the postpartum period is caused by several factors, and it may persist for weeks or months after childbirth, depending on the causing factors. Postpartum fatigue is different from general tiredness that one might experience at any given moment. Postpartum fatigue often includes physical exhaustion, cognitive dulling, emotional depletion, and sleep fragmentation.

According to Williams Obstetrics, "The early puerperium is a time of considerable maternal physiologic adjustment, and it is influenced by emotional and psychological factors". This postpartum period demands recovery from labor and delivery while simultaneously initiating the responsibilities of infant care, causing limited sleep, heavy work, and insufficient support.

Physiological Contributors of Postpartum Fatigue

Hormonal Changes: A dramatic hormonal shift occurs in the hours and days after childbirth. Estrogen and progesterone levels plummet following placental delivery, leading to neurochemical changes that can influence mood, energy levels, and sleep regulation. Hormonal imbalance is a major factor for fatigue, as it is often observed in PMS. Williams describes: "Profound drops in estrogen levels follow removal of the placenta... postpartum women may experience hot flushes, especially at night.” These vasomotor symptoms disrupt sleep, compounding exhaustion.

Hemodynamic and Hematologic Shifts:  Significant blood loss during delivery can contribute to anemia, which is a well-established cause of fatigue. “Blood volume declines 10 to 15 percent within the first week postpartum, and hemoglobin levels may not return to pre-pregnancy levels for weeks,” according to Williams' textbook.

Mothers with operative deliveries or peripartum complications are particularly at this risk. Anemia impairs the delivery of oxygen to the brain and other organs, resulting in persistent tiredness, weakness, and exertional intolerance.

Musculoskeletal and Pelvic Floor Recovery: childbirth involves intense muscular exertion. Prolonged pushing, perineal trauma, and cesarean recovery further challenge the musculoskeletal system. As Williams notes: “Complete uterine involution requires approximately 6 weeks... concurrent with repair and healing of lacerations or surgical incisions”. This tissue healing and remodeling consume metabolic energy, contributing to maternal fatigue.

Psychological and Lifestyle Factors

Sleep Deprivation: Sleep disruption is universal after birthgiving, particularly with breastfeeding every 2–3 hours and infant circadian immaturity. Studies have shown that postpartum women experience significant decreases in both REM and non-REM restorative sleep stages. Williams' textbook mentions “Fatigue from sleep deprivation is a core component of postpartum distress.” Fragmented sleep not only impairs cognition and mood but also slows physical recovery and worsens pain perception. 

Emotional and Cognitive Load:  The transition to motherhood entails a steep learning curve, especially for first-time mothers. There are frequent decisions to make, concerns about the infant’s health, and a constant mental vigilance that often prevents true rest. As mentioned in Williams' textbook, “Anxiety over the ability to provide appropriate newborn care is a contributing factor to maternal emotional distress and fatigue”. This anticipatory anxiety drains mental resources and contributes to feelings of overwhelm.

Lack of Support and Unrealistic Expectations: Social support, both emotional and practical, is a key determinant of how fatigued a mother feels. Lack of help with household duties, childcare, or emotional reassurance increases the mother's workload and reduces opportunities for rest.

Cultural messages that glorify self-sacrifice or minimize postpartum recovery can delay help-seeking. As Williams emphasizes, comprehensive postpartum care should “include a full assessment of physical, social, and psychological well-being,” suggesting that the healthcare system has a role in recognizing and addressing maternal fatigue.

When post-partum Fatigue becomes a Concern and when to seek help?

While some tiredness is expected after delivery, persistent or disabling fatigue may indicate an underlying problem such as Postpartum depression (we discussed in another article and how it differs from post-partum blues), Anemia, Thyroid dysfunction, Infection, Sleep disorder, and Nutritional deficiency.

It is recommended by health care professionals that mothers should seek help if they experience post-partum fatigue

Interferes with daily functioning or infant care, persists beyond 6–8 weeks postpartum without improvement, and is accompanied by mood changes, palpitations, dizziness, or shortness of breath.

Evidence-Based Strategies to Overcome Postpartum Fatigue

Normalize Rest and Recovery: mothers often need to be reassured that rest is not a luxury — it is a medical necessity during the postpartum period. Encouraging women to rest when the baby sleeps and to reduce nonessential tasks can facilitate recovery.

In Williams Obstetrics, the importance of the fourth trimester is emphasized: “The American College of Obstetricians and Gynecologists (2018a) promulgated the concept of a 'fourth trimester' to underscore the medical importance of the postpartum period”. Rest and recuperation should be institutionalized into postpartum planning, not left to chance. 

Screen and Treat Anemia: Postpartum hemoglobin should be assessed if a woman reports significant fatigue, particularly after operative deliveries or heavy bleeding. Iron supplementation should be provided if indicated.

Williams confirms that “iron and folate reserves are likely depleted at the time of delivery”. Restoring hematologic balance can make a measurable difference in energy levels.

Support Breastfeeding While Promoting Sleep: Night feedings are disruptive, but support strategies can improve maternal sleep. These include:

• Partner assistance with burping or diapering after feeds
• Using side-lying or laid-back breastfeeding positions to allow dozing
• Expressing milk for occasional bottle feeds to enable a longer sleep stretch

Although breastfeeding has immunological and bonding benefits, it should not come at the cost of maternal burnout. Williams' textbook mentions: “Breastfeeding benefits are dose dependent... exclusive breastfeeding confers maximum benefit, but partial breastfeeding still offers advantages”.

This flexibility allows mothers to prioritize both infant and maternal well-being.

Improve Nutrition and Hydration: Caloric needs remain elevated postpartum, particularly during breastfeeding, and at the same time, most mothers are also concerned about how they look. Women should aim for nutrient-dense foods rich in protein, iron, and B vitamins. Hydration is also critical, especially during lactation, and do not worry about visuals for a little while.

It’s been shown that low glycemic load diets can help stabilize energy and mood. Snacking on nuts, yogurt, fruits, and whole grains between meals prevents hypoglycemia-induced fatigue.

Gentle Physical Activity: Once medically cleared, light physical activity can combat fatigue, enhance mood, and improve sleep quality. Walking, stretching, and postpartum yoga are appropriate in the early weeks.

Williams encourages return to physical function: “Resumption of activity, including exercise, should be gradual, but early ambulation is recommended to reduce thromboembolic risk and support recovery”.

Activity also enhances endorphin release, helping to counteract both physical and emotional fatigue.

Psychological Support and Emotional Validation: Mothers benefit from reassurance that postpartum fatigue is real and valid. Peer support, postpartum doulas, or mental health professionals can assist in processing emotional overload and developing coping strategies. Mothers with coexisting depression should receive tailored treatment, including psychotherapy or medication where appropriate. As stated in Williams' textbook: “It is important to screen the postpartum woman for depression”.

Authored by:
Dr. Alireza Sarmadi
Family Physician

References:

Williams textbook of obstetrics 26e