Pregnancy, labor, and delivery bring myriad physiological and psychological changes. A giant surge and depletion of hormones accompanies mental and emotional swings, as well as sleep deprivation. Adjusting to the “new normal” often drains every bit of new-parent energy—already in short supply.

Because many of these adjustments are not regularly or openly discussed, new parents are often “caught off guard” by them, says Emily Guarnotta, a licensed clinical psychologist. “As a society, we have made some progress in talking more openly about the physical and emotional struggles during pregnancy and postpartum, but there is still much stigma and silence surrounding this topic.”

The most important thing to remember about these postpartum changes is that many of them are widely experienced, and you are not alone. Here, we break down what you need to know about some of the major physiological and psychological changes that come with the postpartum package.

Physiological

Blood loss

One of the first things you’ll experience—regardless of your type of delivery—is bleeding. Your blood volume doubles in pregnancy, so your body can tolerate a lot of blood loss after birth.

At first, the bleeding is the result of the birth itself. The average amount of blood loss for a woman who has a vaginal delivery is about half a quart, while the average for a women who has had a C-section is about a single quart¹.

“The significant bleeding that occurs is surprising and distressing to many women, because it is rarely spoken about as a change that women should expect after giving birth,” Dr. Guarnotta says. Another physical change that may take new moms by surprise: the bleeding that continues for up to six weeks postpartum, known as lochia discharge. Lochia is a combination of blood, mucus, and tissue that helps sustain a pregnancy. The color and flow of the vaginal discharge will respectively be darkest and heaviest at first, and should slowly taper off over the next six weeks. Tampons are off-limits until your doctor gives you the green light; you’ll likely wear maxi pads until your six-week postpartum check-in.

If you were anemic prior to giving birth—and many pregnant people are anemic—you may end up more so after delivery. Additionally, if you’ve had a postpartum hemorrhage, you are also more likely to become anemic. Common symptoms of anemia include fatigue and getting more tired than normal with activities you used to be able to tolerate. Discuss with your provider how you can replenish your blood stores.

Hormonal changes

Delivery of the placenta triggers a series of hormonal changes in your body. Your estrogen, progesterone, and cortisol levels dramatically fall, likely impacting your mood and physical abilities. Extreme highs and lows during pregnancy and the postpartum period are common, and these changes can be challenging to navigate, notes Saba Harouni Lurie, a licensed marriage and family therapist. The drop in estrogen, in particular, can offer a sneak peek into how menopause can impact you, as it is not uncommon to experience hot flashes in these first few postpartum weeks.

Vaginal dryness

One lesser-known effect of the hormonal changes is the impact of estrogen on the vagina. “The decrease in estrogen levels during and after birth—and the additional decrease, if one is breastfeeding—can mean vaginal dryness. And for [many] couples, that can impact intimacy and expectations around sexual penetration,” Lurie explains. “Even though your OB may give you the green light on penetrative sex, your body may not be receptive for a long while.” Lubricants and vaginal estrogen cream can help fight vaginal dryness, particularly if you plan to breastfeed for more than a couple of months.

Psychological

Perinatal mood and anxiety disorders (PMADs)

Roughly 80 percent of women experience the baby blues in the first two weeks after delivery, as a result of the massive shift in hormone levels. During this time, it is common to feel irritable, overwhelmed, and anxious. You may swing between feeling happy and proud to crying and upset. If you have feelings of sadness, hopelessness, detachment from your baby, or difficulty caring for your baby that either persist or get worse after the first two postpartum weeks, reach out to your doctor to get more help. You may be experiencing a PMAD, or postpartum mood and anxiety disorder.

Postpartum anxiety

Many people are familiar with the concept of postpartum depression, which affects an estimated 10 percent of U.S. women who have given birth². Postpartum anxiety is a different condition altogether—and although it’s lesser known, it may actually be even more common than postpartum depression. One study found that one in three women report postpartum anxiety³.

These higher levels of anxiety can come in the form of intrusive thoughts, such as fear of dropping the baby, Dr. Guarnotta warns. “These feelings are distressing, but some heightened anxiety is actually adaptive and causes you to be more on alert to threats to your new baby’s well-being,” she says, “so you’re more likely to keep a close eye.”

Sleep deprivation

While it’s true that sleep is hard to come by in the postpartum period, it’s not exactly something you can save up on prior to your baby’s arrival and cash in on later. Sleep deprivation affects an estimated 8 percent to 13 percent of new moms⁴ not only due to having to care for and feed their newborn every few hours, but also as a result of increased anxiety and hormonal shifts, according to Dr. Guarnotta.

“This change is normal and may improve with self-care and lifestyle changes,” she says, “but if not, therapy and medication can help.”