Baby Theo, Feb. 2017

Baby Sasha, June 2019

So, obviously, if you are pregnant, you’re going to deliver– one way or another. And if you are far enough along to be thinking through planning for your birth, congratulations!! I know that the road to this place for many families is long and paved with heartache. Know that I am cheering you on.

This guide is imperfect and, by its nature, anecdotal. It’s based on my experience having two kids at two different hospitals with two different providers. But it’s also informed by my expertise and advocacy in maternal and child health policy. 

My first birth (in February 2017) was a spontaneous vaginal delivery in a hospital, performed by a Kaiser physician who I had not met where lots of things went wrong. My blood pressure spiked, but the diagnosis of preeclampsia was missed until I was readmitted with severe symptoms 5 days postpartum. The delivery room was chaotic, communication was abysmal, and in the end, an uncontested episiotomy was performed that led to a 4th degree perineal laceration. My baby boy was born small for gestational age, but healthy and vigorous. 

My second birth (in June 2019) was a planned cesarean, due to ongoing pain and functional issues from the 4th degree tear — 4th degree tears rarely fully heal (unlike lesser tears) and can lead to long-term complications. My c-section was performed early, around 38 weeks, because I developed pregnancy-induced hypertension and my physician wanted to do everything possible to avoid risk factors for preeclampsia this time (being readmitted to the hospital and the treatment for preeclampsia are both miserable). My baby girl was also born small for gestational age, but healthy and vigorous. 

This guide is designed to be action oriented and covers what I think are the most important pieces of preparing to welcome a baby to your family. There are book recommendations (item #7) that contain tons of great additional information. 

Looking through this list, it’s a lot. Pregnant and stressed — no wonder! Check out this mental load!  Yes, it’s true that you’ll be busy too when the baby comes, but this stuff is planning, it’s academic, it’s cerebral. And on top of all of this, the majority of pregnant women in the United States are working full-time without fully-paid maternity leave, so you are also planning your maternity leave from work and your family finances. In some ways, taking care of newborn is primal, it’s hard and overwhelming in a completely different way, and a welcome break from this type of thinking. 

So, here’s my advice, YMMV. The items below are listed roughly in their order of operation. If you disagree or have other tips, PLEASE leave feedback in the comments.

1. Interview providers and find one who you love and trust 
2. Decide where you will have your baby
3. Figure out how you will get help with breastfeeding
4. Write a specific birth and postpartum hospital plan, print it out (3 copies each), and put it in your hospital bag, now.
5. One last plan — your postpartum support plan
6. Things to buy
7. Books to read
8. Take the mesh underwear and EVERYTHING ELSE not nailed down in your hospital room
9. Find a good postpartum recovery program online and do the exercises
10. Pull a onesie DOWN in the event of a blowout

Welcome to my birth and postpartum guide, item #10. Congrats on the upcoming addition to your family! Please take care of yourself and best of luck with your preparations. This is one piece of a 10-part guide. Feel free to explore the other pieces from the introduction page.

************
Given the breadth of the rest of this guide, it may seem odd for this last tip to be so very specific. But we are in this phase right now — blowouts happen, several times a week. With our first kid, it was winter and so he was dressed mostly in footed pajamas, which are very easy to change (especially those with zippers — always get zippers, not snaps). But it’s summer now with our second kiddo and footed jammies are an impractical choice for all-day use. And I realized that my husband got through most of our first kid’s early months without understanding why onesies have those folds at the shoulders — it’s so that you can pull them down, and don’t have to pull a poop-soaked onesie over your baby’s precious little head.

Welcome to my birth and postpartum guide, item #9. Congrats on the upcoming addition to your family! Please take care of yourself and best of luck with your preparations. This is one piece of a 10-part guide. Feel free to explore the other pieces from the introduction page.

************

These exercises should be able to be done at home (you’re not going anywhere for awhile), start very slow and easy and gradually build-up. It’s great to have a plan to follow to rebuild your confidence in your body.

I found this great blog for c-section recovery with my second.

And I’ve heard good things about the Mutu System for all types of childbirth recovery (but it is costly — perhaps a good baby shower registry item).

Welcome to my birth and postpartum guide, item #8. Congrats on the upcoming addition to your family! Please take care of yourself and best of luck with your preparations. This is one piece of a 10-part guide. Feel free to explore the other pieces from the introduction page.

************

Even in the United States, I have not been charged for taking all of the baby supplies in our recovery room upon discharge. Or perhaps, it’s more accurate to say that you have already been charged for it, so take it. You can sometimes even ask for extras of things right before discharge so you can take home more. Some personal highlights:

• The mesh underwear (obviously)
• The receiving blankets (as many as you can get your hands on) — they are made by Medline and ubiquitous across the world. Much of the U.S. uses a blue and pink stripe pattern, but both hospitals I delivered at have opted for the slightly-more-expensive foot-print pattern. Watch the nurses use these blankets — they use them for everything, they are so absorbent that nurses use them as towels after a baby’s first bath, they line the crib. And they are still soft enough to use for a swaddle. At home we’ve used them as a way to line a counter for the baby’s sponge bath before her umbilical cord falls off and to line changing tables.

• The little newborn hats (also in the picture above). Our kiddos were born small and almost no purchased hats were small enough for their heads. It’s key to have some hats at home to throw on after baby baths for the first few weeks.
• All the diapers and wipes you can find — those have been donated to the hospital for marketing purposes, so get ‘em while you can.

But seriously, take anything and everything you like — like the plastic cup? Take it. Like the pads, take those too. Got a tube of Benadryl for an allergic reaction? It’s yours now.

Welcome to my birth and postpartum guide, item #7. Congrats on the upcoming addition to your family! Please take care of yourself and best of luck with your preparations. This is one piece of a 10-part guide. Feel free to explore the other pieces from the introduction page.

************

Before baby arrives:

• Expecting Better: Why the Conventional Pregnancy Wisdom Is Wrong–and What You Really Need to Know 
• Be Prepared: A Practical Handbook for New Dads
• The Anthropology of Childhood:  Cherubs, Chattel, Changelings: (this is a TEXTbook, so order only on Kindle) but it is great at providing perspective about what infant and childhood looks like around the world — are you and kiddo still alive at the end of the day — Congrats! Gold star day for you! 🙂

For just-in-time training as baby grows:

• Cribsheet: A Data-Driven Guide to Better, More Relaxed Parenting, from Birth to Preschool
• The Fifth Trimester: The Working Mom’s Guide to Style, Sanity, and Success After Baby
• Wonder Weeks: How to stimulate the most important developmental weeks in your baby’s first 20 months and turn these 10 predictable, great, fussy phases into magical leaps forward.  (Also a helpful app for understanding your kiddo’s developmental phases)
• Touchpoints-Birth to Three

(A note about these last two is that I do think these are some of the best in their class — but you will still have to get over a slightly sexist and condescending tone.)

Welcome to my birth and postpartum guide, item #6. Congrats on the upcoming addition to your family! Please take care of yourself and best of luck with your preparations. This is one piece of a 10-part guide. Feel free to explore the other pieces from the introduction page.

************

It’s true that newborns don’t need much other than a functioning caregiver and a place to sleep in those early days…but before I had my first babe I crowdsourced all the advice I could on what exactly we needed to care for a new baby. And I have since answered this question for a number of friends. One of my friends told me the only thing you needed for a new baby is to live somewhere with Amazon Now — that is, Amazon’s two-hour delivery. This is excellent advice — impractical, but excellent. If your area does have Amazon Now, be sure you are familiar with how it works — forget infant (or adult) Tylenol, you can order it — need formula or diapers TONIGHT, you can order it.

The things you should buy:

For you — all kiddo will need for the first few days is food and diapers and wipes and you — and so you need to be well-cared for:

• Perineal ice packs — you will need them and love them. These were my favorite and they worked well on my incision after a c-section too.
• Small Depends diapers, yes, for YOU — more comfortable in the early days than trying to stick giants pads on your mesh underwear with tiny little dainty “wings.” Bring them to the hospital.
• Good coffee — if you are not well-slept, be well-caffeinated. No, caffeine does not pass through your breastmilk in any appreciable way.
• If you are going to breastfeed, clip-down nursing tanks are the easiest way to go in the early days — great access for the babe while you are figuring everything out.
• Audio books — the trick with the early morning feeds is for you to be awake enough to take care of kiddo but stay asleep enough that you don’t have trouble getting back to sleep once the kid is down — I find audio books really helpful for this — they keep your brain at just the right level and then help you fall back to sleep — any good audio book will do — we really enjoyed Trevor Noah’s Born a Crime — if you haven’t read the Harry Potter series, I hear it is great for this too. We’ve also had fun with Guns, Germs, and Steel (kind of like a good college lecture) and Becoming by Michelle Obama. Also, both or all 4 of your hands will be full a surprising amount with one kid early on, so if you have an Alexa or some such, it’s great to get the audio book hooked up to it so that you can tell it to play once you get the kiddo latched (see HOW TO LATCH YOUR BABY TO YOUR LEFT BREAST IN A CROSS CRADLE HOLD IN 33 EASY-TO-MASTER STEPS)
• Larabars — put them in your nightstand now. I was completely caught off guard by how much HUNGRIER I was in the early weeks postpartum than when I was pregnant, I hammered snacks all night. Larabars will also help with that all-important postpartum poop.
• Also — get a huge water cup with a lid and a straw for your nightstand. Breastfeeding makes you sooo thirsty and you will not have the patience for a midnight spill.

For babe:

• Forehead baby thermometer — it’s unlikely that kiddo will get sick in the early months, but this way, if you are worried, you can check.
• This baby carrier is the way to go — super easy to use and lasts a long time.
• A travel crib — do it, travel with your babe. We liked this one.  
• A bassinet for your room for the early months. (Side note, pro-tip from one of my friends —  once the kiddo is in a full crib, layer the sheets like this — waterproof cover, sheet, waterproof cover, sheet. This way, if the kid has a blow-out in the middle of the night you can just rip off the top two layers and put the kid back down.) 
• Our favorite baby towel 
• One trillion cheap wash clothes — if/when kiddo gets a diaper rash, one of the best ways to help treat it is to stop using wipes, so you will need a lot of water and a lot of wash clothes. 🙂
• Good diapers and wipes — we like Huggies Little Snugglers and Pampers Swaddlers for the early months
• Lots of burp cloths — we liked these for all around use. The method we copied from our friends and used for both kids was to just scatter them around the house on the furniture and throw them onto the floor once they couldn’t be used anymore — a signal that they need to be tossed into the laundry.
• At least a couple good kids books. Read to your babe. Goodnight Moon and Little Blue Truck are my favorites.
• A stroller — we love our City Mini GT around town — the wheels don’t inflate so they can’t pop — a sunshade, recline, and basket storage are important.
• A nursing pillow — This one!! THE BEST. It pulls right up to your chest, whereas I found that the boppy left this weird gap for me and wasn’t nearly as comfortable. 
• Disposable changing pads/chuck pads — so helpful for babies. Use them to give the baby a sponge bath, or to line the bassinet for midnight diaper changes. If your kid gets a diaper rash and needs to spend time without a diaper on, put them on one of these. There are a million ways they can make your life easier. 
• A diaper bag — I would truly not bother. Buy a portable changing station and put it into a day-hiker backpack that fits you well (I like my CamelBak Sundowner Lowrider 22). Throw in some toys for any older kids, a change of clothes for each kid, snacks for you and any older kids, a giant water bottle and some back up formula in case of an emergency and you are GTG.

Welcome to my birth and postpartum guide, item #5. Congrats on the upcoming addition to your family! Please take care of yourself and best of luck with your preparations. This is one piece of a 10-part guide. Feel free to explore the other pieces from the introduction page.

************

Baby love

Check out this team!

Breakfast in bed from my sister

The best ways to avoid pregnancy-related depression (as we noted, it’s the most common complication of pregnancy) are the 3 Ss — sleep, sunshine, and support. You will need support. New moms should not be required to do anything other than soak up baby love while dropping crumbs on their new baby’s head from food brought from loving friends and family members (or ordered from Grubhub) for at least two weeks. You’ll likely be told not to lift anything heavier than your new baby for those two weeks anyway. Limit your stairs, do no laundry, soak up that baby. In order to have any hope of this, you’ll need support. As I approached the end of my second pregnancy, my sister told me that everyone wanted to help, but just needed to know how. I said that I hoped she was serious and drew up a postpartum support plan. And honestly, everyone did their part, if not even more than they were assigned. I had everything I needed at every moment and often wondered, “how is it that everyone knows EXACTLY what I need right now?” — Oh yeah — I told them, and it worked. Write up a plan and share it with your support team, which can be family or friends or a mix of folks.

Things to include:

• Help with childcare or childcare drop-off and pick up if you have an older kiddo. (If your older child is in childcare, I strongly recommend keeping that going during at least the beginning of your leave — no need to disrupt their routine any more than necessary, and it will be great for you.)
• Someone to bring you food at the hospital — many hospitals do not have a way to get food 24 hours a day and you don’t know when you will go into labor or when you will be hungry. Also, having snacks in your postpartum room is great for guests.
• Help with food prep and dishes when you get home
• Help with house cleaning/keeping so that you are not tempted to do it when you should be soaking up baby love
• Help with laundry (you will go through outfits for you and the babe, blankets and burp clothes at an alarming rate for weeks months.)
• Help with any routine outdoor chores — e.g. shoveling, mowing

Here is my postpartum support plan as an example.

Welcome to my birth and postpartum guide, item #4. Congrats on the upcoming addition to your family! Please take care of yourself and best of luck with your preparations. This is one piece of a 10-part guide. Feel free to explore the other pieces from the introduction page.

************

This felt a bit awkward to me the first time — it sort of feels like you are telling other people how to do their jobs. However, I learned from that experience and was much more specific the second time around. First, many nurses and physicians want to meet your needs and respect your wishes, but genuinely won’t know how to do that unless you are specific. Second, sometimes there are hospital policies that are not always the most family friendly, and if you express your wishes clearly, the nurses can respect those wishes against hospital policy. For example, many hospitals require nurses to check on patients every hour. Do you really want a check at 1AM, 2AM, 3AM and 4AM? Or, if your baby happens to blessedly sleep for more than an hour, do you want a chance to get some shut-eye too? 

The care teams for your delivery and your postpartum stay will be different, so I recommend having different plans for the two events. Give both plans to your provider as soon as you make them (you can always change it and update it as your pregnancy progresses). When you get to the hospital, give a copy of your birth plan to the first nurse you meet and give one to the anesthesiologist or another provider in your room. Give a copy of your postpartum plan to the nurse that takes you to your postpartum room.

Keep your plan short and to-the-point and remember that busy people will be reading it.

Things to include:

• A tiny bit about you, your medical history, your concerns and goals for your birth
• The specifics of your plan, including what you want to do about the vitamin K shot, Hepatitis B shot, and antibacterial eye ointment. I consented to all of this with both kids and think these things generally make sense. But however you feel, be sure you have thought through them before you are in active labor.
• A request for warm liquids as soon as possible. Postpartum constipation is real. And for a surprising number of women, it becomes almost as big a deal as the initial birth. You want to avoid it. Be well hydrated going in. Continue to hydrate well. Warm liquids and chewing gum both help “wake up” your intestines and get things moving. Eat foods that promote regularity too. And take the stool softeners when they are offered.
• Any questions that you have
• Your pre-discharge goals

You can view my c-section birth plan as an example. Most of this would make sense in other births as well, the pieces most-specific to a c-section have been italicized. 

You can also take a look at my postpartum recovery example plan.

Welcome to my birth and postpartum guide, item #1. Congrats on the upcoming addition to your family! Please take care of yourself and best of luck with your preparations. This is one piece of a 10-part guide. Feel free to explore the other pieces from the introduction page.

************

You should love and trust the health care provider that is going to deliver your baby. As I recently told a friend — this is not like a dermatologist — life gets very real. Unfortunately, few OBGYNs are used to being “interviewed” in this way and some are resistant to the idea. Whereas its normal for expecting parents to check out pediatricians and interview them before making the choice of who will care for their child, this is fairly unusual when it comes to choosing the person who will help you birth your baby, and it shouldn’t be. I probably interviewed 10 OBGYNs in Denver to find one that I LOVED for the birth of my second kid. From my narrow experience, I can say that universally the best providers were open to this interview approach, but it sometimes did require scheduling a first prenatal appointment, and insisting that it be with the physician in order to have the time to chat with them and get to know them. If you get a lot of resistance to the idea of an “interview” appointment, I’d look for another provider. You should ask questions at that appointment that address any concerns that you have, here are some ideas:

• What percent of your patients’ babies do you deliver? (The whole idea of finding a great provider is to ensure that there is a great provider actually present at your birth.)
• Will you be in town around my due date?
• If you cannot attend my birth, what steps do you take to make sure that I know and trust the provider(s) who back you up? And to make sure that they know my history and trust me?
• How do you advocate for your patients? That is, how do you help make sure that this birth goes according to my plan? (Whether that is preventing an episiotomy, ensuring delayed cord clamping or making sure you can have two support people in the room if you need a cesarean.)
• How do you help your patients if they need to be readmitted following a birth? 
• How do you look out for your patients’ mental health? (Remember that depression and anxiety is THE MOST COMMON complication of pregnancy.)
• What brought you to OBGYN as a specialty?