#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 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

Sasha Anne Mayer

Erin and I are so happy to announce that Sasha Anne Mayer made a slightly early arrival earth-side. She was plucked a bit early due to mom’s gestational hypertension (and an attempt to avoid a repeat of the severe preeclampsia from last time). She was born at a bit over 38 weeks and weighed 5lbs, 6oz and measured 18 inches.

So far the experience has gone much more smoothly than the last time. Everyone is doing well happy and healthy.

We are currently working on the name for Sasha’s chicken-shaped nursing pillow, Theo’s eventually was called “buck buck”. And yes, we had to get a second $50 nursing pillow because as soon as his mom suggested that his new sister would need his, Theo started sleeping with his pillow every night… Names currently in the running:

a_chicken_pillow

  • Cuckoo
  • ChaChaCha
  • Clucky
  • Kikiriki (The Spanish word for a chickens sound)
  • Spark Plug