Category Archives: Baby

#5 One last plan — your postpartum support plan

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.

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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.

#4 Write a specific birth and postpartum hospital plan, print it out (3 copies each), and put it in your hospital bag, now. 

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.

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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.

 

#1 Interview providers and find one who you love and trust

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.

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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?

#3 Figure out how you will get help with breastfeeding

Welcome to my birth and postpartum guide, item #3. 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.

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If you are planning to breastfeed, and you can swing it financially in any way, I STRONGLY recommend finding a lactation consultant in your area who specializes in home visits. I recommend interviewing at least two of them and going with the one that you like best. This does sometimes require scheduling a first home consult for the interview. Arrange for your lactation consultant to be on call and ready to visit you in the day or two after you return home from the hospital to check-in and offer any tips. This will likely be expensive. Insurance companies are required to cover breastfeeding support under the Affordable Care Act, but they often make you jump through a TON of hoops, use their preferred provider (of which there is often only one in a metro area) and may not cover home visits (and you DO NOT want to be traveling ANYWHERE the first two weeks after birth, when you most need lactation support). If you cannot afford one out of pocket, I strongly recommend asking for this as a baby shower gift — even if your friends and family pool together to support the roughly $250 that it might cost to have a prenatal and two postnatal consults in the comfort of your home. If you cannot find a way to have someone visit you at home, then figure out where you will go if you need help before you need it (you will not be thinking clearly in the week after your baby is born). Look for hospitals and practices that specialize in lactation support. Insurance is more likely to cover a visit at a hospital. Alternatively, find a neighborhood support group at a store that specializes in maternity services, which will be less expensive.

Also, once you arrive at the hospital for your birth (if delivering in a hospital), ask about the lactation consultants, and the folks who keep donor breast milk around. The lactation consultants at the hospital are often very helpful. If the hospital has donor milk on hand, definitely scout out options for getting some, if you think your baby is hungrier than you can manage in the days after birth or losing weight too quickly (which is common). Using a bit of supplemental food in the days after birth is unlikely to impact long-term breastfeeding success. And donor milk has the added benefit of conferring a mixed microbiome onto your little babe. 

Also, read everything on McSweeney’s about breastfeeding — it’s everything you need to know 🙂 Good places to start — 

HOW TO LATCH YOUR BABY TO YOUR LEFT BREAST IN A CROSS CRADLE HOLD IN 33 EASY-TO-MASTER STEPS 

TEN MEETINGS WITH LACTATION CONSULTANTS

WELCOME TO BREASTFEEDING CLASS, SURRENDER ALL HOPE

MY BREASTS’ LIST OF GRIEVANCES AGAINST THE BABY

Lastly, remember that millions of women around the world are trying and struggling and failing and succeeding at nursing their little dictators at 3AM too — you are not alone.

#2. Decide where you will have your baby

Welcome to my birth and postpartum guide, item #2. 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.

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If you plan to birth in a hospital, this will be largely determined by where your provider has hospital privileges. If you live in a metro area, and have a choice between two or more hospitals, I find that Google and Yelp reviews are often the most informative — search for “birth.” 

There are also some more objective hospital quality reporting systems, however, these are often so objective as to be rendered meaningless and rarely show statistically significant differences. 

A Health Affairs article (free access) summarized the state of maternity quality reporting:

“Despite the substantial morbidity associated with childbirth in the United States, there is currently no national system for reporting maternal complications.The number of obstetrical deliveries far exceeds other common causes of hospitalizations for which performance reporting already exists, but the quality of obstetrical care is not systematically reported in the United States. The Joint Commission collects a small number of quality measures, but maternal outcomes are not publicly reported.30

And yet, quality varies dramatically, “Working with a large nationally representative sample of more than 750,000 obstetrical deliveries in 2010, we found substantial differences in rates of major complications in US hospitals. Women delivering vaginally in a low-performing hospital were twice as likely to experience a major complication, and those delivering by cesarean section were nearly five times more likely to experience a major complication, compared to women giving birth in a high-performing hospital.” 

The most widely-available “quality” measure is the rate of c-sections performed in first-time births. However, from the Health Affairs article, “Interestingly, we found that hospitals with higher cesarean delivery rates had lower complication rates for women having either a vaginal or a cesarean delivery, compared to hospitals with lower cesarean rates.” And as a mom who experienced both a 4th degree tear from a vaginal birth and planned c-section, healing from the c-section was a piece of cake compared to the botched vaginal birth. I was pretty much completely recovered from the C-section by 8 weeks postpartum, while I experience ongoing issues from my tear.

Here are a few other places to check:

This USA Today database contains data from a minority of states.

A minority of hospitals nationwide also provide data to Leapfrog, including some helpful maternal quality measures. 

Medicare Hospital Compare has data from all hospitals, but is limited around maternity data. Once you go to their website, you can choose hospitals in your area to compare.

You will also want to consider what makes sense for your baby. If you think you are likely to need NICU services, then find a hospital with a strong NICU offering all of the services you are likely to need. 

Lastly, if you think (or know) you might need a c-section, I strongly recommend finding a hospital that provides family-centered cesareans as policy.

All that said, my last piece of advice (again from VERY limited experience) is that I would be cautious about choosing a “baby friendly” hospital. These practices can be implemented poorly. For example, these hospitals sometimes push breastfeeding so hard as to make it impossible to get supplemental food for your baby, even if you think he is hungry and your milk hasn’t come in. I struggled to get supplemental food for my first child until he had lost 12 percent of his birth weight and was dropping quickly. There are stories of women sneaking in formula to feed their baby at these hospitals, even though formula use in the early days when a mother is also trying to breastfeed her infant does not appear to reduce long-term breastfeeding success

EDIT: Oh look, several smart folks have written about the downfalls of “baby-friendly” hospitals. See “No Nursery, No Formula, No Pacifier Are “baby-friendly” hospitals unfriendly to new mothers?” and “The Failure Of “Baby-Friendly” Initiatives.” An article in the Journal of Pediatrics found that “baby-friendly” hospitals do not increase breastfeeding rates. And a review in Pediatrics noted that some baby-friendly practices have been associated with “near fatal or fatal events related to sleep, suffocation, and falls from adult hospital beds.”

Our family is growing by one pair of shades this summer

Most folks already know, but Dan and I are happy to announce that we will be adding a new member to our family in June. I feel grateful, Dan is nervous, and Theo vacillates between being excited and not quite believing that there is really a baby inside of mama (which, admittedly, is kind of a hard thing to believe). He has slept with his old nursing pillow every night since I mentioned that we would need it for the new baby, which seems like an appropriate reaction.

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Oh yeah…we bought that sweet minivan in the background too
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Celebrating our birthdays

Home again, infant travel tips, pt. 2

We are home. Theo was a terrific traveler and now has two stamps in his passport. We loved Amsterdam and walking along the canals, meeting up with old friends who now live in Berlin, seeing the art museums, and Theo mostly loved his first boat ride. Despite arriving home with a teething and jet-lagged infant, the trip was definitely worth it and highly recommended for folks who have a long enough maternity leave for it to be plausible. I think that a lot of the beauty of traveling is the ability to be present and just enjoying your surroundings — whereas at home when I’m holding or feeding Theo, I feel pressure to be managing email or dealing with the yard, while traveling I just enjoyed hanging out with my new baby, so it was a great way to spend the last few weeks of my maternity leave. A few additional tips for those considering travel with their infants:

  • We arrived home with a teething (see below) and jet-lagged infant. I definitely underestimated the potential complication of a jet-lagged infant, mostly because Theo has always (knock on wood) been a pretty good sleeper. He adjusted to Paris time quickly (going east) but is really struggling with the return home (going west) — he is WIDE awake at 4AM. The first night I fought this for hours (nursing over and over, swaddling, noise machine…) before giving up and just reading about how Dragons Love Tacos and playing with teething toys. Last night we gave up after about 45 minutes and Dan helpfully got up and just hung out with him through the small morning hours. We are trying ample doses of morning and evening sunshine and hoping that it resolves in a few days — a good friend said to remember that this too will pass, which is true, but hard to remember at 4AM. I thought these blog posts on baby jet-lag were helpful, and it’s apparently common for babies to struggle more traveling west.
  • Theo started teething on this trip (a bit early, but he’s such a precocious kid 🙂 so, I definitely recommend bringing infant Tylenol, which was a life-saver on a couple of days (and nights). Also, it probably makes sense to bring your baby’s thermometer — we didn’t do this and before it became obvious that Theo was teething, we wondered briefly whether he was sick; it might have been nice to be able to check his temperature.
  • Theo went on a brief “nursing strike” during our last few days in Paris — he would arch his head back and scream when offered the breast.  What caused it? Too much travel and stimulation? The start of teething? No idea. But it was heartbreaking for me. Thankfully, we have been supplementing anyway due to my low milk supply, so we had bottles (another side tip — I found this travel bottle brush set very helpful — probably not necessary, but it saved us having to figure out how to clean the bottles every time we landed, tired, at an AirBnB with a whole bunch of very dirty bottles) and a breast pump with us. We stopped trying to force nursing when out and about for a couple of days and just offered him the bottle at restaurants and I kept up with pumping 3-6 times a day. After really just a couple of days, the issue went away — though I am still a bit nervous every time we go to nurse. No idea whether others have experienced something like this while traveling, but a couple of tips — the Medela Pump in Style Advanced worked great for keeping up my supply, even though I had been using a hospital-grade pump at home.  You can’t plug it in abroad (even with an adapter) and it takes 8 double-A batteries so we brought a TON of batteries. But one set of batteries really lasted a week of at least 3 pumping sessions a day. And this page from Kelly Mom was helpful and reassuring, especially the parts about starting with the nursing sessions when he was tired (about to go down or first to get up) and trying to nurse when we were back in the apartment in a calm and familiar-ish place.
  • Traveling with grandmas for the win (Thanks Elaine and Mom!). It was great to have their help and it is so much more pleasant to brave restaurant dinners and international flights with an infant if there are three people to do hand-offs.
  • All our friends who suggested bringing a nursing pillow were dead-on — great bring. Helpful for naps on the flights and feedings once we got to our apartments. There will definitely be a moment going through security when you wonder why you are carrying this huge pillow, but as soon as you sit down on the plane it will be so worth it. (Bonus tip — this is the best nursing pillow –more functional shape and smaller than the boppy.)
  • As I mentioned before, we really liked having our Babybjorn travel crib — it was nice for Theo to have a somewhat-familiar place to lie down. Also, before we left, Theo had gotten really into his baby gym mat and we wanted some way to recreate that while traveling, without, obviously, carting around a baby gym. So, we took a travel drying line (great travel gadget) and strung it across his crib and dangled some of his hanging toys from it — it bought us dozens of minutes of free time several times a day. IMG_20170521_142520
  • We brought a light-weight travel stroller — and I remain agnostic on whether we needed it. It was definitely helpful for carting around baby gear — especially through the airports, but Theo was happy to spend most of his time in the Babybjorn and probably slept a bit better in the Bjorn anyway. I’m definitely glad that we had the smaller, light-weight stroller rather than a full-size, full-weight American one, since most apartments in Europe are walk-ups. We stayed on the second floor both times, but still, the stairs would have been really tough with a full-size stroller. Paris is not designed well for strollers, especially the metro, so in that city I think folks really don’t need a stroller with a young infant (though it did allow us to skip some of the lines at the Louvre). Amsterdam has good bike and stroller infrastructure, so we used the stroller more in that city, but still, Theo often opted for the Bjorn. Most restaurants, in both cities, did not have space for the stroller inside. But one benefit of a stroller is the European tradition of allowing a sleeping baby to stay in their stroller parked outside the restaurant while the parents enjoy dinner inside, so that’s an option.IMG_20170513_161759
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    Theo in the Bjorn while we use the stroller for stuff
  • We still have a lot to learn about packing with a kid. Our carry-ons were large because we wanted to be sure to have enough burp clothes, outfits, diapers, and pumped milk/formula for supplemental feeds in case of multiple airport blow-outs or a missed connection that required us to overnight without our bags — that mostly worked out OK thanks to the airline tradition of allowing families with young kids to board first, but required a lot of airport schlepping