Postpartum Survival Tips

“In western society, the baby gets attention while the mother is given lectures. Pregnancy is considered an illness; once the ‘illness’ is over, interest in her wanes. Mothers in ‘civilized’ countries often have no or very little help with a new baby. Women tend to be home alone to fend for themselves and the children. They are typically isolated socially & expected to complete their usual chores…while being the sole person to care for the infant…” –Milk, Money, & Madness

I recently shared this quote on my Facebook page and a reader responded expressing her fear at preparing to face this exact situation. I responded that it is an unfortunately realistic fear and suggested she check out some resources for postpartum planning that might help work through the fear as well as plan for a nurturing postpartum instead of a stressful one. She then responded that she has a very minimal local support system and that got me thinking about postpartum survival tips for when one’s local support system is limited…

My ideas:

•  Suggest to your out of town friends and family that they contribute to a “babymoon” for you and all pitch in to hire a postpartum doula.
• Tactfully remind people that even if they’re too far away to bring you a meal, they can certainly call up a local restaurant and order a delivery for you! I think a lot of us forget that is an option for a long distance family member (that we would bring food to if they were local). In my experience, getting enough food is a huge issue postpartum! I remember long distance friends having babies a variety of times and wishing I was close enough to bring them dinner. Duh. Many restaurants do, in fact, deliver food!
• Be your own “best friend” by preparing and freezing meals and snacks now. I know I sound obsessed with food, but it is totally one the hardest things to take care of postpartum, but so important!
• Put together a mama survival kit for yourself that you can then open up when you need it. Some ideas here and more ideas of variable quality here.
• If you don’t have a sense of community work, actively work on building one—go to La Leche League meetings, Holistic Moms Network, Mothers of Preschoolers, Attachment Parenting International, or other mothers’ groups. Go BEFORE you have your baby if you can.

Other ideas for helpers:

• In addition to my idea of ordering delivery for a postpartum family as a way of bringing them dinner long distance, is to order a dinner through the mail via the business Spoonful of Comfort. They will send fresh chicken soup, rolls, cookies, and a baby present via Priority Mail (packed with freezer packs). I send it with a note saying, “this is me, bringing you dinner!” Friendly tip from unfortunate personal experience: if you are doing this for a friend make SURE you enter THEIR address as the shipping address and not your OWN address, or you will then be forced to enjoy their postpartum meal and feel like a total idiot at the same time.
• Don’t forget about other meals—breakfast = awesome. Muffins = awesome.
• Pay it forward–I think sometimes people feel like they don’t know someone well enough to bring them food, or maybe they even do a mental “tally” and think, “well, she won’t be bringing me food ever, so why should I take time to bring it to her” or, “she didn’t make anything for me when I had my last baby, so I’m off the hook on this one.” When I had Alaina, a mother who had literally JUST moved to town and that I had not yet met, sent a hot breakfast casserole to me (that my lovely doula delivered to my lovely mother at the snowy end of my gravel road).  I think of that generosity when I bring a postpartum meal to a mama from whom I will never end up getting a reciprocal meal. Who cares. She needs it. You can do it!
• Another doula commented on my post: “Do you know a mom that is about to have a baby? Or maybe a momma who just gave birth recently? Don’t even ‘offer’ just show up with a bucket of cleaning supplies, a bag of healthy food, and maybe something nice for her. Go tuck her in bed with baby, and get to work on her home.. When she wakes, she has nothing to do but nurse that baby. (If she has other kids, delegate chores with them, if to young, call mutual friends to sit for them! Our Mom’s need this, up through 6-9weeks pp, Mom’s need help, even longer for some. There is a reason the US has the highest Post Partum Depression issues in the developed world… Create your community! DO IT!” I would add that if you do not know mom well, do not plan to engage in a deep cleaning project and stay for a long time doing such project.

I also posted to the Citizens for Midwifery Facebook page asking for contributions for postpartum survival tips when your local support system is limited. What beautiful, helpful women we have on that page! While I didn’t get many suggestions specifically for minimal local support systems, I did get a nice collection of survival tip ideas:

• Trust your own instincts. Many women have great advice but if your heart is telling you something else, go with it.
• Craniosacral therapy… one session for you and one for the baby.
• In addition to lots of suggestions to hire a postpartum doula, there were lots and lots and lots of shout-outs for placenta encapsulation. I echo it myself.
• Get out of the house alone! For me, it’s been crucial to my sanity to leave my home, by myself, even if only for an hour or two between nursings. Just a Target run was therapeutic!
• Kangaroo care for high needs babies.
• Lots of mentions of it being okay to accept help and okay to ask for help.
• A lot of new moms get really overwhelmed by family and friends coming by to see baby, and it’s important for them to remember that they can always put out a sign that says “mom and baby sleeping!” (even if they aren’t) anytime they need a break.
• Watch only positive stuff without violence on TV (cooking shows, home improvement) as regular TV is really violent for new mamas and she may be watching more with all the nursing/healing.
• Have homemade high protein frozen meals (and snacks) in the freezer before birth so anyone can warm them up for the household after birth. If breastfeeding, get much more rest than you think you need from day one to ensure an abundant milk supply (*note from Molly: it is true that prolactin receptors are “laid down” during the first days of breastfeeding. Breastfeeding “early and often” makes sure that there are an ample supply of receptors in your brain.)
• Have a sign up sheet for family and friends to choose which chores to help with, gift certificates to a cleaning service, stocking up on disposable plates and dinnerware…
• A new mommy group can be a life saver. Just knowing that other mommies are going through the same thing help
• Food registries such as mealtrain and mealbaby. Not enough families know about these amazing and free services. (*note from Molly: we often use Care Calendar locally.)
• Plan ahead and freeze several of your favorite freeze-able meals. Let the clothes be a little wrinkled. Use paper and plastic ware instead of worrying over dishes. Stay laying down first 3 days postpartum (preferably naked: it gives a certain message and is better for baby anyway) and the first week stay in pajamas. Enjoy frequent rest times, even if you can’t sleep.
• Baby wearing….lots of time in bed, sleeping cuddling and feeding babe skin to skin…brest friend nursing pillow
• Send a subliminal message to the limited visitors you’ll have (set limits early with partner) by wearing your robe for several weeks
• Eat well, accept all offers of help and food, get out of the house alone!
• I loved getting meals brought by friends, but I didn’t always want to socialize. So, someone to run interference, or maybe a drop-off location for leaving food. (*note from Molly: my doula was the perfect person for this job.)
• Ask for help! No one will know what you need if you don’t speak up.
• Don’t go without showering for more than four or five days. Brush your teeth once a day no matter what, even if it ends up being at a weird time. Take your vitamins/ herbal supplements/tea. HYDRATE! Nap with baby if you need to, arrange childcare for older siblings sometimes, but also listen to your instincts—one of my worst baby blues moments was with my third when my older two were gone and I wanted them home!
• LOVE yourself, nap when you can , Yes you are doing it right, No it’s no ones business (breastfeeding/cosleeping/pumping etc.) allow opinions and advice to slide off, drink lots of water , eat small snacks/meals, love your baby look into their beautiful eyes and connect, skin to skin whenever even with dad or siblings (safely) cherish these moments they don’t last forever, the laundry will get done, the dishes will be get cleaned …
• Take a “babymoon”. Put on a robe when someone comes to the door–even if you have real clothes underneath. Sleep when the baby sleeps. Don’t answer the phone. Remember, self-care is essential for you to be able to care for your baby.
• I loved having herbal soaked pad (frozen) to wear afterwards, felt soooo good. Have easy one-handed snacks available and a BIG water bottle.
• In those last few months of pregnancy I prepare meals to freeze (I start about month 5 or 6). I make up 6 weeks worth of dinners (they always last longer since we have a great church family and friends that bring us meals). After baby is born I can put 2-3 dinners in the refrigerator (to thaw) a few days before I need them. Then all I have to do is pop one in the oven and BAM….dinner’s ready. I love “Don’t Panic, Dinner’s In The Freezer” I & II. The recipes are amazing and all freeze well. Hope that helps!
• Skin-to-skin in bed for as long as possible; 40 days of rest, recuperation, establishing breastfeeding, bonding, limited visitors, and limited activity; drink when the baby nurses; sleep when the baby sleeps; nurse on demand; learn to wear your baby; and use a peri bottle when peeing! A postpartum herb bath and massage are nice, too.
• Hot water bottle for afterpains
• Placenta encapsulation and WishGarden Herbs ReBalance tincture!
• Chiropractic adjustments, ASAP
• Call in your mom. My mom’s job after my second was born was to keep me fed and to spend some quality time with my older child.
• Drag oneself outside and BREATHE!
• Water…..hot tub, shower, steam, pool, raindrops, snow, sauna, bath, river, stream, ocean, lake! If you can, immerse yourself, if you cannot, imagine yourself floating
• Lots of water, lots of protein and healthy fats, placenta encapsulation and low expectations of anything other than bonding time with baby.
• Don’t try to impress others with how quickly you can get up and going, even if you can, just take it easy!!!!
• It’s not in the asking for help; its in the accepting…

Surround her with support!

Check out these previous posts:

Mothers Matter–Creating a Postpartum Plan

Planning for Postpartum

Some reminders for postpartum mamas & those who love them

and a great one for helpers written by my own doula:

The Incredible Importance of Postpartum Support

And, remember…

“The first few months after a baby comes can be a lot like floating in a jar of honey—very sweet and golden, but very sticky too.”

–American College of Nurse-Midwives

This post is crossposted at Talk Birth.

Birth Plan Item #1: Leave My Cervix Inside My Body!

Last night I finished reading several articles in Midwifery Today about birth in the Ukraine. Apparently, it is a routine practice immediately postpartum to use two "shoe horn" shaped devices to pull the cervix out of the woman's body to examine. Yes, I think that warrants repeating--manually pulling out the cervix to look at! (no pain medications). This is so patently horrible and unnecessary that I had a visceral response to reading about it--my uterus hurt.

However, as I reflected on my reaction, I began to wonder if the practice is any more strange or disturbing that some U.S. maternity care routines? I still feel like cervix-pulling-out ranks pretty high on the horrible factor, but I also recognize that is is filtered through my cultural lens of what I'm used to--"normal" (i.e. culturally acceptable) birth practices in the U.S. (such as Pitocin injection immediately following most normal births regardless of indication and so on and so forth). We have any number of questionnable medical care practices in this country too, but because I'm used to them they register as "normal." Of course, this doesn't mean I approve of them or fail to notice that they are not evidence-based, but I accept them as possible occurrences and I'm certainly not surprised to read about them over and over again.

One of the articles was about birth in a Ukrainian "birth house" and the other was a composite of observations about birth in the Ukraine in general. Sometimes there is a tendency amongst midwifery supporters to romanticize birth and midwifery care in other countries and to vilify the U.S.--if you are a Ukrainian woman, this is clearly misplaced!

My first thought when reading the essays was, "Wow! The U.S. system isn't so terrible after all!" But then, I tried to imagine the U.S. birth culture seen through completely fresh eyes, as I had just viewed the cervix-pulling technique. How would facets of hospital birth care in the U.S. appear to me if I was just hearing about them for the first time? As gross human rights violations?

Though I cannot make it have the same raw emotional and physical shock to me as cervix-pulling-out, I can only imagine how an episiotomy might sound to my imaginary fresh eyes: "then the doctor took some scissors and cut through the skin and muscles at the base of the woman's vagina." Or, the same with the not uncommon addition of, "as she begged 'please don't cut me! No!'"

I also read with sadness and dismay about the emotional maltreatment of Ukrainian women in labor and how (in hospitals) they are frequently denied the companionship of their husbands. Is this really more awful than women being coerced into unnecessary cesareans or even more basic, being denied food and drink throughout their labors? No, not really, just less familiar.

While it is nice to recognize that there are things that women birthing in U.S. hospitals can be very grateful for, there is not an official continuum or hierarchy of "better" bad things to happen to birthing women regardless of country of residence. Humanized care is humanized care. Women worldwide deserve a safe environment, a respectful caregiver, continuous emotional support, physically responsive care, evidence-based medicine, and to have their cervixes and uteruses left inside their bodies.

--
Molly
CfM Blogger

P.S. In case anyone is interested, "cervices" or "cervixes" and "uteri" or "uteruses" are both acceptable plurals ;-)

Birth-Day Giveaway!

I've set this post to publish at 2:45 a.m. on May 29th to commemorate that three years ago exactly I had just given birth to my second baby boy on the floor of my living room! He was received by the caring hands of my midwife, who was present for exactly 5 minutes of the birth. I didn't actually feel like I needed a midwife in labor or during birth, but I was profoundly grateful for her presence postpartum and also for her time and care during prenatal visits. She always spent at least an hour with me during prenatal visits and I had so much fun spending that time with someone who was interested in me, my pregnancy, and my baby. She treated me with such love and respect and much like a colleague, instead of a "patient." Then, postpartum, she helped me stand and carry my new baby to the bed. She perked me back up with smelling salts when I started to faint (I have a little "issue" with seeing blood). She lovingly sponge-bathed my arms and legs (this birth was triumphant and transformative, though also particularly bloody!). When I started to "slip" emotionally in the early days postpartum (baby blues), she offered me words of encouragement, kindness, and inspiration as well as her presence. She also thoughtfully helped me make an important decision about whether to visit my family physician regarding my physical recovery following the birth. These things were such gifts and were irreplaceable!

In honor of my son's third birthday and the anniversary of my swift and special homebirth with him, I'd like to offer a book giveaway (the first on this blog!). When I was pregnant, I was already very informed about pregnancy and birth (I became a certified childbirth educator in 2005) and I felt a need to seek out books that "went beyond" the average pregnancy and birth books. One such book is Rediscovering Birth by Sheila Kitzinger. To enter to win a hardback copy of this book just leave a comment on this post by midnight on June 9th letting me know something special that you valued about your midwife (or other birth caregiver). You can gain an additional entry to win by posting a link to this giveaway on your own blog (and posting to let me know about it).

Happy Birthday Zander!

(his complete birth story is posted here)

--
Molly
CfM Blogger

Articles About Midwives, Postpartum, & Breastfeeding

Earlier this week, an article came to my attention on the USPharmD website (for people interested in earning their Doctor of Pharmacology degree). The article is called "100+ Essential Online Resources for Midwives" and is a really comprehensive listing! I was pleased to see Citizens for Midwifery on the list :)

Speaking of interesting articles, I also read a very good one called "Mothering Our Mothers." The focus is on caring for women postpartum and what women need during that vulnerable time (to be "mothered" as they learn to mother).

As a related side note, I read in Leaven (LLL Leader journal) this month that in Russia, the law is that children can be brought to their mothers in the workplace to breastfeed every three hours until they are three years old! Fantastic. I could hardly believe it. The article went on to say that many women do not have anyone available to bring their child to them every three hours though and so most wean when going back to work. In another contrast to the US, the article also said that Russian doctors to not allow the distribution of free formula packs in hospitals.

Postpartum

I am leaving shortly for the Friends of Missouri Midwives annual retreat this weekend. I'm presenting two sessions--one on "Birthing Room Yoga" and the other on "Planning for Postpartum." I have a special interest in postpartum and encourage people to plan for a special time of "cocooning" with their newborn, rather than rushing to rejoin "normal" life. A vital part of making cocooning possible, is having a good support network. I think back to the care I received from my midwife postpartum--it really mattered to me. The time she spent gently sponge bathing off my arms and legs, cleaning the living room rug, doing laundry. The fact that she returned (20 mile drive for her) at about 12 hours postpartum, 2 days postpartum, and a few more times thereafter (plus phone calls!), to check on us and to offer her support and encouragement. This kind of care is irreplaceable and not the kind of care that you can ever expect from an OB or for an out-of-home birthing environment. Many midwives return at 1 day, 3 days, 5, days, and one week postpartum!

An element I also emphasize is the importance of making a written postpartum support plan. DONA has a great example on their website and there is a good handout about postpartum planning on this site (I especially like the final page in the document that is "A Request for Help After Baby is Born" with accompanying "tear-off" section for people to fill out and give back to with the things they are willing to do for you postpartum).

Postpartum is a time for you to reach out for support and to let others "mother" you for a change. Though of course you could do it all alone if you had to, now is not the time to be "superwoman" or to prove how competent and independent you are. You and your baby will both benefit from an extended period of rest and recuperation, nuzzled up together in your own bed, marveling at what has just happened.

Thin Air Media's BORN

A little while ago I learned that Thin Air Media has produced a new radio documentary called BORN--a one hour public radio journey about the postpartum experience in America. The show will be distributed by Public Radio International in Sept. 2008. Please call you local public radio station to request that BORN be aired in your local community!

Last year, my local public radio station aired The Birth Tour ("part one" of sorts of this series from Thin Air Media). I got to hear it and it was quite interesting. I'm thrilled to see them address postpartum, because this is often overlooked transition point in our society. From my vantage point, postpartum is even more neglected than birth is in mainstream media and American culture.