Postpartum Recovery

Recovery timeline, breastfeeding, postpartum depression screening and treatment, cord blood banking, newborn procedures, and visit timing.

Recovery Timeline

Period	Physical	Emotional
Day 1-3	Lochia (heavy bleeding), uterine cramping, breast engorgement begins. C-section: incision pain.	Hormonal crash. "Baby blues" in up to 80% — mood swings, tearfulness. Normal and temporary.
Week 1-2	Lochia decreasing. Night sweats. Breast milk establishing. Hemorrhoids.	Sleep deprivation compounds. Baby blues resolve by 2 weeks. If worsening, screen for PPD.
Week 3-6	Lochia stops. Uterus returning to pre-pregnancy size. Perineal healing mostly complete.	If depression persisting beyond 2 weeks = PPD, not blues. Seek evaluation.
Month 2-3	Hair loss peaks (telogen effluvium, temporary). Periods may return.	Finding new routine. PPD can present up to 12 months postpartum.
Month 3-6	Most women feel physically recovered. Core strength rebuilding.	Return to work stress. Relationship adjustment.
Month 6-12	Full physical recovery. Hair regrowth. Pelvic floor rehabilitation if needed.	PPD can still develop or persist. Annual screening recommended.

Tool	Scoring
EPDS (Edinburgh Postnatal Depression Scale)	Score >= 13 = probable depression. >= 10 = possible. >= 20 = severe.
PHQ-9 (Patient Health Questionnaire)	5-9 mild, 10-14 moderate, 15-19 moderately severe, 20-27 severe.
GAD-7 (Generalized Anxiety Disorder)	5-9 mild, 10-14 moderate, >= 15 severe anxiety.

Treatment	Onset	Notes
Therapy (CBT/IPT)	4-8 weeks	First-line for mild-moderate. Can combine with medication.
Sertraline (Zoloft)	2-4 weeks	Most studied SSRI in breastfeeding. Minimal infant exposure. First-line medication.
Zuranolone (Zurzuvae)	As early as day 3	First oral medication specifically for PPD. FDA approved 2023. 14-day course.
Brexanolone (Zulresso)	24-48 hours	IV infusion, inpatient only. For severe PPD. First FDA-approved PPD treatment (2019).