Return to You

A Postpartum Plan for New Moms

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• Publisher: American Academy of Pediatrics
• Year: 2022
• ISBN:
  9781610025959
• Edition: 1
• Topic: Medicine
• Subtopic: Gynecology, Obstetrics & Midwifery

Having a baby is supposed to be the happiest time of a woman's life, but for some it isn't. And for many, it is the most challenging. As they learn to care for their newborns, many new mothers often face physical challenges with breastfeeding, sleep, and nutrition, and struggle with feelings of isolation, sadness, and guilt. Dr. Sriraman shares practical professional advice along with her own personal experiences and those of other mothers to help 4th trimester moms know they are not alone. From pelvic floor issues to postpartum depression, no topic is taboo. Return to You will help new moms restore themselves physically and encourage them to ask for help and give themselves the time they need to rest, recover, and heal emotionally.

CHAPTER 1

History of Postpartum Care

HISTORY/noun/ˈhist(ə)rē/: the study of past events

When I was a pediatric resident, I knew that I wanted to wait to have a family, even though I was married, because my grueling call schedule made it too difficult to manage a new baby while taking care of my professional responsibilities. During my month in the neonatal intensive care unit, I remember working with a younger resident, also married, who was from a European country. She told me, “I’m not having a baby until I’m done with residency and I can move back home. I will have a lot more help and time off after delivering over there.” Back then, even though I didn’t know the significance of what she told me, I still remember it clearly.

POSTPARTUM PERIOD

First of all, let’s define the postpartum period. While it means after childbirth, whether we discuss it within a medical context (your postpartum visit with the obstetrician) or a personal context (postpartum leave), many people, including me, define the immediate postpartum period as that 3-month period after the birth of your baby—in other words, your fourth trimester.

What did my colleague mean when she said that? After I had my baby, why was it that my relatives from India were shocked at what my postpartum period looked like?

Why do so many of my patients from other countries tell me it’s harder to have a baby in this country?

When thinking about this book, I felt it was important to talk about what postpartum looks like, not just in the United States, but also in different parts of the world. The United States spends more money per person on health care than other developed countries, but our health outcomes for mothers and babies rank much lower than those of other wealthy nations. Why is that? One major reason is that postpartum care in the United States is, frankly, disgraceful.

Birth may signal the end of a woman’s pregnancy, but it is only the beginning of so much more. The postpartum period is often not recognized as being vital to the health and well-being of both mom and baby.

When I spoke at a conference in the Philippines in 2019 about breastfeeding and postpartum depression, the audience, composed of physicians, nurses, and other health care providers who worked with mama-baby dyads, was shocked to hear that new mothers in the United States have their first obstetrician postpartum visit 6 weeks after delivery. Honestly, there was a collective gasp in that room of around 1,000 people.

On a professional level, I see a vast difference for my mothers who have had children in their native countries as well as in the United States. For instance, the level of support from family members and the community is different from the pressures placed on mothers in the United States. Every day I see mothers who, for financial and familial reasons, are going back to work or school within 6 weeks after delivery; I’ve actually seen mothers going back to work within 2 weeks. On a personal level, I witnessed the differences for my family and friends who had babies in India versus the United States and their expectations as to the amount of help they would receive on arriving home with their newborn. In many countries and societies around the world, it truly is a village that helps mom when she returns home with her newborn.

TRADITIONS IN OTHER COUNTRIES

What do other countries do to help their mothers during the fourth trimester?

One of the most common traditions in countries around the world is something called the 40-day lying in period. This has also been referred to as postpartum confinement. Before thinking this is crazy or not for you, let me explain how this helps moms and their babies during this particularly stressful time.

In India, the 40- to 60-day period, known as jaappa in Hindi, allows mom to stay home and rest while preventing her and the baby from being exposed to any type of infection. In Pakistan, this postpartum tradition is known as sawa mahina, meaning 5 weeks. The only thing for mom to do is rest and nourish (breastfeed) the baby. Mom is fed nourishing foods, cooked by family members, that are easily digestible and meant to keep her body warm. After having my second child, our nanny, who had emigrated from India many years earlier, was with me during those early weeks helping care for my oldest child (a toddler in diapers). She just could not understand why I was still doing things around the house; my husband was back to work within a week and we had no help from our families. Regardless of what she was doing to keep my toddler occupied, she tried to get me to eat well instead of snacking when I had time. I still remember the protein-rich dish she gave me made with herbs that not only nourished me but actually helped increase my breast milk. Ironically, as I learned later on while studying to become an IBCLC (International Board Certified Lactation Consultant) and starting my own breastfeeding medicine practice, I realized that the herb she used, methi—known in Western countries as fenugreek—is a common galactogogue that mothers can take to help increase breast milk production.

In China, the postpartum recovery period is sometimes referred to as sitting the month; during this time, new mothers are advised to stay inside to recover and focus on feeding their newborn. Aspects of Chinese medicine are included to nourish mom while increasing her breast milk supply. In some areas, visitors are not allowed for the first 12 days. Mothers are also discouraged from bathing, washing their hair, or having any contact with cold weather as this may increase their risk of catching a cold. In some, more modern areas, after mothers shower, they must dry off immediately and can use a hair dryer to help keep warm. Similar to other cultures, preparation of food in China is an important aspect of postpartum healing. Mothers are given easily digestible foods rich in protein that are prepared by female family members. These foods give mom energy while helping to shrink the uterus and facilitating physical healing.

In Korea, postpartum confinement is known as sanhujori, which can last from 1 week to 1 month. Mothers eat healthy food and perform easy exercises that help warm the body, which allows for physical recovery. While these services were previously provided by family members, they are now provided by various postpartum centers and workers who can come into the home. Services include anything from skin therapy and body massage to full-time help caring for the newborn. The goal is to help mom heal completely, both physically and mentally, not only to help her prepare for any future pregnancies, but also to prevent health conditions that can negatively affect her later in life, such as joint issues, incontinence, and depression. Clearly, the need is there, as more than 50% of mothers in Korea use these services.

Among many Latina mothers, la cuarentena helps them ease into the transition of motherhood. Cuarentena lasts about 40 days or 6 weeks (do you see the pattern?) during which she focuses on her physical healing and caring for and nourishing her newborn by breastfeeding. Members of the extended family take care of cooking, cleaning, and caring for any older children. Depending on the family, the type and consistency of foods are a central part of the mother’s postpartum healing process.

So while we focus on birth plans, baby showers, and gender reveals in the United States, other countries start discussing and teaching about postpartum care to help women while they are still pregnant. For example, in the Netherlands, mothers begin planning for their postpartum period at 33 weeks’ gestation. In Spain, pregnant women receive their own mother’s passport called the cartilla de embarazo. They take this passport with them as they are tended to by a community midwife each month, not just for prenatal baby care, but also to start planning for the immediate postpartum period.

In Germany, a woman receives a booklet called a mutterpass at her first prenatal appointment. Not only does it track her prenatal visits, but mom continues to present it at all her postpartum visits so that all health issues, for both mom and baby, can be tracked and followed during pregnancy and the postpartum period. This eases the transition into the fourth trimester, allowing care for mom to continue and remain consistent.

Probably the best known maternity package around the world comes from Finland. Remember when Kate, Duchess of Cambridge, received a gift from the Finnish Government? What was in this special package? Once mothers are 154 days into their pregnancy (approximately 22 weeks’ gestation), they can apply for a free baby box through the country’s social security system. This box is available to all mothers, regardless of financial or employment status. Although the colorful box is filled with essentials for the baby, such as diapers, baby toiletries, clothing, and a book, it also contains a small mattress, so it can double as an initial bed for the baby, almost like a bassinette. Not only is this helpful to many moms, but this baby box emphasizes the importance of placing the newborn on a flat surface to sleep. This practice has also been shown to be effective in lowering infant mortality rates in Finland.

As these examples illustrate, postpartum care around the world varies greatly, but one common theme exists. Mothers are taken care of not only during their pregnancy, but also after delivery as they enter the postpartum period. While babies are being cared for by their mothers, family members and others in the community are focused on caring for mom’s physical and mental well-being.

To all the mothers who are reading this book, postpartum practices from different areas of the world do impact us directly in the United States. Whether you emigrated from another country or have family members in other parts of the world who come here to help once the baby is born, we will see an overlap of these various postpartum practices that will impact what the fourth trimester looks like for you and your baby.

And to my mothers from the United States or other Western societies who may not have postpartum cultural or familial practices, perhaps the information in this book will help you start to construct the ideal postpartum journey based on what you need.

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One of my friends who lives in the United States told me, “My parents came from India and stayed with me for 6 months, and after that my in-laws came to stay for another 6 months. I have never taken care of my kids alone. After everyone left, and I was taking care of my baby and toddler alone, I fell into a deep depression. I felt so helpless.”

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In the next chapter, I will explore postpartum care in the United States and how it affects mom and baby. My hope is that you, whether pregnant or a new mom, will gain the information you need to move into your fourth trimester feeling empowered and confident.

CHAPTER 2

Current State of Postpartum Care

POSTPARTUM/adjective/pōs(t)-ˈpär-təm: occurring in or being the period following childbirth

Now that we have taken a glimpse into what postpartum care looks like in other parts of the world, let’s take a closer look at postpartum practices here in the United States.

As a pediatrician for the past 20 plus years and a mom for the past 19 plus years, it has become clear to me that postpartum care in this country does not take care of the mother. The postpartum period focuses on the health and safety of the newborn, but it lacks support for the woman who just gave birth.

Let’s Do Some Math … Promise, No Calculus

During a normal pregnancy (with no complications or need for extra visits), a woman is seen at least 10 to 15 times by her obstetrician. Within the first year after delivery, pediatricians see the baby between 7 and 9 times, and this does not include any sick visits. What about after the baby is born? When is mom seen again after this miraculous task of childbirth?

If mom has a cesarean delivery, she will be seen in 2 weeks for an incision check. At this visit, mom usually will be given clearance for small tasks or activities. For me, being able to drive was a big one. Mothers who have had a regular vaginal delivery may not be seen until 6 weeks afterward.

Yes, you heard that correctly. Six weeks! I always find it crazy that after such close follow-up of a mom’s physical and mental health during the pregnancy that after giving birth, she is left to figure it out and fend for herself until the 6-week visit.

It has always been interesting to me that when a mom brings her baby to me for those frequent newborn visits and weight checks, they often ask what they should do about their episiotomy pain, leg swelling, or overwhelming anxiety … just to name a few concerns.

The American College of Obstetricians and Gynecologists (ACOG) addressed this issue by stressing the importance of tailoring the postpartum plan to each mom. Moms need to be seen sooner than 6 weeks’ postpartum and more frequently. One size does not fit all. The ACOG statement, “Optimizing Postpartum Care,” was developed as a result of concerns a...

Table of contents

• Cover
• Title Page
• Copyright
• Dedication
• Contents
• Acknowledgments
• Introduction
• Chapter 1: History of Postpartum Care
• Chapter 2: Current State of Postpartum Care
• Chapter 3: You’re Pregnant…Now What?
• Chapter 4: Your Postpartum Plan
• Chapter 5: Role of the Father/Partner
• Chapter 6: Visitors/Boundaries
• Chapter 7: Infant Nutrition
• Chapter 8: Postpartum Nutrition and Exercise
• Chapter 9: Postpartum Depression and Anxiety
• Chapter 10: Return to You
• Chapter 11: Ease the Stress of Returning to Work
• Chapter 12: Reconnecting With Your Partner
• Chapter 13: Role of Social Media
• Chapter 14: Mommy Guilt: It’s Real Folks
• Chapter 15: Maximizing Sleep as a New Mommy: Really, It’s Not a Myth!