Coping with hormonal shifts

Adequate rest, compassionate care, and steering clear of stress ensure that cortisol and prolactin levels are in harmony during postpartum recovery, writes Dr Ashwini Anil Kumar Sirapanasetty.

Childbirth does not end with delivery of the baby; in many ways, it marks the beginning of one of the most complex hormonal transitions in a woman’s life. While much attention is given to physical recovery after delivery, the invisible hormonal shifts—particularly involving cortisol and prolactin—play a decisive role in postpartum healing, emotional balance, and a mother’s ability to nurture her newborn. Understanding this delicate hormonal interplay is essential, not only for mothers but also for families and caregivers who often underestimate the biological intensity of the postpartum period.

Stress hormone

Cortisol is widely known as the “stress hormone.” During pregnancy, cortisol levels naturally rise to support foetal development and prepare the body for labour. After delivery, these levels are expected to gradually normalise. However, in modern postpartum life — marked by sleep deprivation, emotional vulnerability, social pressure, and lack of adequate rest —cortisol often remains persistently elevated. Mothers may experience profound fatigue despite rest, anxiety, irritability, difficulty sleeping even when the baby sleeps, and delayed physical healing. Elevated cortisol also interferes with immune function, making women more susceptible to infections and prolonged inflammatory states after childbirth. Cortisol also directly affects breastfeeding. When stress dominates the postpartum environment, cortisol can suppress the hormonal pathways required for smooth lactation, leading to delayed milk let-down and reduced milk supply. This often results in unnecessary guilt and self-blame for mothers, when the root cause is physiological stress rather than maternal inadequacy.

Hormone of nurture 

Released from the pituitary gland, prolactin stimulates milk production and promotes maternal behaviours such as nurturing, attachment, and emotional attunement to the baby. Its levels rise significantly with nipple stimulation, particularly during night feeds. Prolactin also has a calming effect on the maternal brain. It encourages rest, emotional sensitivity, and bonding, helping mothers adapt to their new role. In a biologically supportive environment, prolactin counterbalances stress hormones and promotes recovery. However, prolactin is highly sensitive to cortisol. Chronic stress, anxiety, fear, or pressure — common experiences for many new mothers can blunt prolactin release. This creates a vicious cycle: stress reduces milk supply, feeding difficulties increase anxiety, and cortisol rises further.

Cortisol–prolactin balance

Postpartum recovery depends not on the dominance of one hormone, but on balance. Cortisol is necessary in small amounts to help mothers stay alert and responsive to their newborn. Prolactin ensures nourishment, bonding, and emotional stability. When cortisol overwhelms prolactin, recovery becomes slower and complicated. This imbalance may contribute to postpartum mood disorders, including postpartum blues, anxiety, and depression. It may also affect uterine involution, wound healing after episiotomy or cesarean section, and overall energy levels.

Why modern mothers struggle more

Traditionally, postpartum care emphasised rest, nourishment, warmth, and emotional protection. In many cultures, new mothers were shielded from stressors and household responsibilities for weeks. Today, expectations of rapid “bounce-back,” early social engagement, and minimal support disrupt this biological need for recovery. Sleep deprivation, constant external opinions, fear-based information from social media, and pressure to perform motherhood perfectly all drive cortisol upward. Unfortunately, hormonal biology does not adapt to societal expectations — it responds only to safety, rest, and support.

Recovery after childbirth

Postpartum hormonal healing is not a luxury; it is a medical and emotional necessity. Adequate rest, skin-to-skin contact, gentle breastfeeding support, nutritious meals, and emotional reassurance significantly lower cortisol and enhance prolactin release. Reducing unnecessary visitors, limiting external stressors, and validating a mother’s emotional experiences are equally important. Medical professionals must recognise that postpartum symptoms are often hormonal signals rather than weakness or poor coping. When extreme anxiety, persistent sadness, severe sleep disturbance, or breastfeeding difficulties persist, timely medical evaluation is crucial. Early support can prevent long-term complications for both mother and child.

Postpartum recovery is a hormonally sensitive phase that deserves respect, patience, and structured support. Shifting the narrative from “quick recovery” to “protected healing” can transform maternal health outcomes. 

(The author is an obstetrics and gynaecology surgeon, and senior counsellor of Army Wives Welfare Association.)