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Postpartum planning: Updated

** This post contains affiliate links. If you purchase from one of these links I receive a small commission at no charge to you. It helps to support my doula work.

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The postpartum period is a subject close to my heart. It's such a crazy time. Mom is trying to heal and figure out nursing, while bonding with baby and trying to stay present for any older siblings. Dad is figuring out his role and is still reeling from the birth as well. All the while everyone is exhausted, but people want to visit the new baby and help out the family. While it feels like life should pause for a while it seems to do the opposite. 

One of the most visited posts I have here at the Living Heart Doula blog is A Postpartum Checklist, and dives in to some facets of planning for postpartum. It also includes some really great slides on new babies and their families. 

Having a few things prepared, friends signed up for meals, and extended family ready to serve can make a huge difference for a new family. I’m updating the list to share new products, as well as services that can help a postpartum family.

1) Postpartum Doula Services- Having a postpartum doula is indispensable. They can start as early as the day you get home from the hospital or birth center, or you can hold off until your partner has returned to work. A postpartum doula can also do an overnight shift, so mom and partner can sleep. She can bring baby to mom for feedings, or bottle feed based on your preferences. The doula also helps with house hold chores like laundry, dishes, vacuuming, and helping older siblings. Their knowledge of breastfeeding, newborn care, and postpartum healing can be a huge help. Service prices can vary, and may be billed as hourly or as packages. Add services to your registry and have friends and family chip in! Living Heart Doula will be adding postpartum services this spring. Be on the watch for more news!

2) Earth Mama Organics- I love their products, and their postpartum items saved me with my last birth. Some must haves include perineal spray, perineal herbal packs, and organic nipple butter. They also have their own Lying-In plan for postpartum families you can find here:

Earth Mama Organics Cyber Monday

3) Takethemameal.com - Free sign up service to organize having meals brought to the family. Super easy to use and share over email and social media. The service also has a function where friends can order a meal to be delivered if they are unable to cook. Having meals covered takes the burden and logistics of food preparation away from the recuperating family.

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4) Depends - An option aside from typical menstrual pads. Wearing Depends during the first heavy days of lochia can be helpful, because the whole thing acts as a pad. No more worrying about leaking on to undies or sheets.

5) Natracare Wipes and Pads- An all natural organic option, wipes can be used for both mom and baby. The organic pads are super absorbent and keep the skin feeling dry instead of sticky like with plastic pads. However, they are not especially large. Save them for when bleeding has become more manageable.

6) Boobytubes - Awesome product by Bamboobies, these beaded tubes can be put in the freezer to help with engorgement, or in the microwave to help with a clogged duct. Can also go along the neck and shoulders to help with aches and stiffness.

7.) Ecocentric Mom Box- You can check out all the goodies I got from my subscription box here. Receive a box full of natural goodies for mom and baby, ranging from snacks to awesome hair care products. Subscriptions can vary from one time to a full year, and make a great gift for new moms. Ecocentric Mom offers a nice self-care pick me up, and a way to find some new clean products.

Ecocentric Mom box

8.) Pelvic Floor Physical Therapy - This subject really needs its own post, but I’ll give you an introduction here. In other countries, especially Europe, women receive physical therapy after they have a baby. Your back, hips, pelvis, vagina, perineum, core and bladder can all be affected by pregnancy and birth. This includes both vaginal and cesarean births. Experiencing pain, incontinence (snissing, anyone?) or diastasis recti is common, but is NOT NORMAL, and can be corrected by physical therapy. What makes it different than just doing kegels until you’re cross eyed, is that the specific muscles and tendons that are strained, weakened, and overcompensating can be identified, and you are taught how to properly release and strengthen the affected areas. Body mechanics are applied to help correct diastasis recti and ease pain as muscles recover. It can be life changing. With 50% of women experiencing prolapse in their lifetime, it’s worth the investment.

9.) Get a baby carrier- Baby wearing was how I managed to do life with both my girls. Babies want to be held and snuggled. This allows you to keep baby close, get breakfast made, and the dog walked. Moby and Boba wraps are great for newborns, and as baby grows soft structured carriers like Boba are great for getting baby on and off easily, as well as place in a back carry. You can learn more about carriers here.

10.) Sitz Bath and accessories- I’m a little bitter no one taught how to do a sitz bath when I had my girls. Available at drug stores like Rite Aid or CVS, it’s essentially a large basin that fits in the toilet. Fill with warm water, Epsom salt, or herbs. Place in your toilet, and simply soak. It’s great for hemorrhoids and perineal tearing. It also relaxes the pelvic floor muscles so you can actually go #2. No one said postpartum was glamorous.

11.) K-Tape Services Frederick Birth Center- K-Tape is a cotton elastic adhesive, with therapeutic properties that can be applied to ligament function, muscle applications, corrective postures, and lymphatic drainage. During the postpartum period, K-tape can help with numerous issues, including swelling, engorgement, diastasis recti, and mastitis. Mom’s who have had a cesarean birth can benefit from lymphatic drainage. The scar tissue can disrupt neurological pathways and the drainage of lymph in the lower body. K-tape can support the return of menstruation, and can ease uterine cramping. Gynecological issues like prolapse and incontinence can benefit from K-Tape. While I’ve focused on the benefits of K-Taping for women, anyone can come and get taping at the Frederick Birth Center! Contact the staff at FBC for an appointment.

12.) Like Neighbors- This is a service that allows friends, families, and neighbors to help in your time of need while being across the country. Services like lawn mowing, house cleaning, dog walking, gift cards and meal delivery can all be added. It’s a great way to have support and let people know what your family’s needs are.

13.) Postpartum belly binding- Beng Kung belly wraps, Mama Strut, and Velcro girdles are all ways to support your core and back after birth. Your muscles have taken a vacation for at least six months, and having the support helps to engage them and maintain proper posture. This helps to prevent and correct diastasis recti, as well as the aches and pains we often feel while nursing for long periods and carrying carseats.

14.) Strong as a Mother: How to Stay Healthy, Happy, and (Most Importantly) Sane from Pregnancy to Parenthood: The Only Guide to Taking Care of YOU! by Katie Rope- This book breaks down all things postpartum, from healing, birth recovery, and mental health. Author Katie Rope shares stories from a wide variety of mothers, breaking down the mommy traps we can get sucked into. It’s one of the few books out there talking about postpartum in an open way, while not beating around the bush of how hard modern moms have it.

15) Placenta Encapsulation - Encapsulation is the process of steaming, dehydrating, grinding, and putting a placenta into pill form. Benefits include a boost in hormones, increased milk production, and faster recovery. The evidence is still anecdotal at this point, but you only have one shot at preserving the placenta to try. If you plan on having your placenta encapsulated, please use a professional encapsulator that is blood borne pathogen certified. I recommend Deborah Bailey of Doulas of Central Maryland.



What have I missed? What really helped your family in the postpartum period?







 

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Jacob's Birth Story: A fast breech vaginal birth

Before I begin my most recent birth story, I need to give some background information about myself. I am a Neonatal Nurse Practitioner and work at the same hospital that I receive my OB care; therefore, I have a close professional relationship with my OB providers. I also have a uterine anomaly called a bicornuate uterus. This means that my uterus is divided into two sections. This was discovered at my 13 week nuchal transluceny ultrasound with my first pregnancy. The complications associated with this anomaly are cervical insufficiency, preterm labor, preterm delivery, growth restriction, and breech presentation. The risk of breech presentation is due to the limited space for the baby to turn. Because of this anomaly, I was followed very closely by the high risk OB and had approximately 13 ultrasounds with my first pregnancy. My son was born by vaginal delivery after spontaneous labor at 37 weeks and 2 days. At every ultrasound he was head down.

With my second pregnancy, my son was in breech presentation at every ultrasound. I really became concerned about this around 26-28 weeks, given the limited uterine space and that my first son was always head down and this time my son was always breech. Everyone (both medical and non-medical) tried to reassure me that “there’s plenty of time for him to flip.” It was at this point that I began my research on getting a baby to turn. I googled, youtubed, and read a lot of articles and blogs. I tried anything and everything to get my baby to turn, with no avail. At 34 weeks I had a discussion with my OB about attempting an external cephalic version (ECV); however, I am not a candidate for this procedure given my uterine anomaly. It finally started to sink in that I was going to have a c-section. My OB decided not to schedule me for a c-section, rather we would wait until I went into labor in order to give me every opportunity for the baby to flip.

Breech presentations include:

  • Frank Breech (Bottom down, feet are up by the head)
  • Footling breech (One or both feet are by down)
  • Complete breech (Bottom is down and legs are crossed. Imagine baby sitting Indian style.)

During a casual conversation one day at work with the high risk OB director, I expressed my concern for having a c-section and how much I did not want to have one. He agreed that I was not a candidate for an ECV and what I thought was jokingly, he said,“Well you could always do a breech vaginal, the only problem is I would have to be at your delivery, and that might be uncomfortable for you.” My response was that I would not have a breech vaginal because of the risks associated with it. That was the extent of our conversation. I did not have any conversation with my primary OB about a breech vaginal delivery.

So what are the risks with breech birth?
- Placenta being compressed
- Head getting stuck
- Some incidence of large limb fractures
Biggest issue currently is finding a provider who is experienced and educated in delivering a breech!

At 37 weeks I went to my routine OB appointment, and again had a discussion with my OB about a C-section, and again expressed my feelings and anxiety about it. She was very empathetic, but tried to reassure me that it wouldn’t be as bad as I thought and also gently brought me to reality that this baby would most likely not flip at this point. I was 1 cm dilated and 50% effaced at this appointment and not having any significant contractions.

The next morning, at 37 weeks and 1 day, I woke up with some intermittent cramping back pain. It wasn’t very painful, but it was certainly noticeable. Shortly thereafter I began to have some lower abdominal cramping similar to that of a period. I didn’t time the cramping but thought something might be happening given that it was intermittent and not a consistent discomfort. At this point I didn’t want to call my OB, because I knew she would want me to come in right away given the breech presentation and I didn’t want to have my husband come home from work and call my childcare if this wasn’t, “the real thing.” But, I did get my (almost) 2 year old set up with breakfast and hopped in the shower, did my hair and makeup, and got myself all ready “just in case” this was it. I packed the car with our bags before heading out with my son. Throughout the pregnancy I constantly thought about the, “last day” that it would be just, “us.” My son loves ice cream, so I wanted to take him out on an ice cream date. We got to the ice cream parlor a little before noon just to find out they didn’t open until noon. We went next door to the grocery store to kill a little time. By this point the cramping was occurring more frequently, but not necessarily with more intensity. I stopped in the bathroom on our way out and that’s when I had my bloody mucousy show. It finally sunk in at that time that I was in early labor. We got our ice cream and I just sat and enjoyed those last minutes with my son before my attention was going to have to be shared.

Megan the morning of Jacob's birth.

Megan the morning of Jacob's birth.

We got out to the car around 12:15 and I called my OB to report my symptoms. As I expected, she told me to come to the hospital to get evaluated. I called my husband who was working an hour away and my sister who was going to watch my son. By the time my husband got home and we got out the door it was around 1:30. We weren’t in the car more than 5 minutes when the intensity of my contractions increased and I was unable to talk during them. The ride to where we were meeting my sister was about 25 minutes. Just as we pulled up my water broke. I called my OB again to give her an update and that we were about 20 minutes away. By the time we arrived to the hospital I could barely think or talk due to the pain of the contractions which were now about a minute apart.

I was immediately taken into a room (the PACU was full) and my OB checked me and said I was 6 cms. There were so many medical professionals in my room working diligently to get me prepared for my c-section since I had progressed into labor so quickly and was continuing to have very strong contractions every minute. That was when my OB told me that the hospitalist was on service and she has experience with breech vaginal deliveries and asked if that was something I wanted to consider. I could barely focus on her words so she decided to get me my epidural and get me comfortable before we had any further conversation. As soon as I got my epidural she checked me again and I was 9 cms (that was about 30 minutes after the first time she checked me). I had to make my decision very quickly after having a brief but serious conversation with the hospitalist. I knew in my heart that this was the right decision for me. My husband was against it, but said he trusted me and my OB and knew that I was very aware of the risks associated with this type of delivery given my medical background.

So we moved into the OR, which is where I had to deliver in case they had to do an emergency c-section. As was explained to me before making my decision, I labored down for about an hour before I started pushing in order for the baby to optimally move into the birth canal vs pushing him into position. I pushed for 18 minutes until I heard the most beautiful sound in the world which was that of my baby crying. He was placed skin to skin with me and I just cried tears of joy and relief. He weighed exactly the same as my first son, which was 6 lbs 13 oz. I had no tears and felt so wonderful during my recovery. Every day I thought about how different my recovery would have been if I had a c-section.

On the way to the hospital when I was contracting so painfully I thought to myself, “Why did I wait so long to call my OB? I should have called this morning! This pain is so unbearable I could have avoided this if I hadn’t waited!” Afterwards, I was so thankful that I did wait to call, because my delivery experience would have been so different. Everything happened to just fall into place to make this all possible. The OB that I had such extensive conversations with was on service at the hospital so she knew my anxiety about having a c-section, the hospitalist who will do the breech vaginal delivery was on service, I was in spontaneous labor with contractions every minute with very fast cervical dilation, and my baby was tolerating the labor. Had any one of these factors been missing or different, I would have had a c-section. I absolutely love my birth story and I hope you enjoyed reading it!

Jacob meets his big brother.

Jacob meets his big brother.

 

 

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Pregnant in Sumatra

Being pregnant brought lots of joy and excitement to my life. Living in Sumatra with my Indonesian husband while pregnant brought some worry and fear as well. Fear of a serious medical complication in a developing country, fear of being far from my own mom and loving family members, fear of not being able to stick to my guns about what I wanted and knew was best for my pregnancy and son’s birth in a completely different culture and environment. In spite of the fear and the unknown, I tried to focus on the positive and the potential for amazing things to happen.

My mom shipped What to Expect When You’re Expecting and Ina May Gaskin’s Guide to Breastfeeding halfway across the world and I scoured the internet for what American mommies were doing so that I could try and blend as best as I could the two distinct cultures that my baby would be born into.

I loved the way many Indonesian moms practice attachment parenting simply because there is no alternative. Who would leave their infant in another room of the house to sleep? A centipede or snake could bite it! Or a tiger could attack! (Just kidding….mostly). Also, most houses simply don’t have another room in the house to make into a nursery nor do they have money to buy a crib. So we bought a baby hammock instead of a crib. Car seat? More babies are used to riding on motor bikes. Diapers? The hot, humid weather plus the cost mean that these are usually a luxury item that not all babies wear but that are becoming more common now especially in cities. Slings and baby carriers? Indonesian moms have been strapping their babies to ‘em in Batik sarongs and going about their day since forever. Breastfeeding? Again, a lot of women in villages usually do not work outside of the house nor are they able to spend money on formula so nursing is the best option for them. Natural childbirth? My mother-in-law delivered six children in her house with a midwife. No pitocin or epidurals available! Cry it out? I am not exaggerating when I say that the entire Indonesian family will do anything – anything – to comfort a baby at the first whimper or sign of discontent. While times are also changing here and all mother and baby stories are different, these were the impressions of labor and infant care that I witnessed and saw as common.

 

34 Weeks

Thankfully, I had an incredibly easy and manageable nine months with just one bout of morning sickness. My baby boy grew and kicked while I practiced yoga, deep breathing, Kegels, everything I could think of to stay calm, relaxed and prepared in order to envision a healthy, natural birth. My mantra was “I am a flower, I am a fountain.” I would say it every time I worried that my body would not open to push the baby out or that my breasts would not produce milk to nurture him.

Throughout my pregnancy, I had deep concerns about being pressured into a C-section here as the modern hospital where I received prenatal care seemed to have so many. I received an ultrasound at every monthly visit, which seemed so unusual and unnecessary. I was told I had low amniotic fluid and should take strange medicine not approved by the FDA along with placental extract thought to prevent miscarriage. All the medicine my OB-GYN tried to get me to take was discarded and I trusted my gut and stuck with my prenatal vitamin. I asked if I could try different labor positions and he was totally against it saying that I needed to stay attached to a monitor. While I stayed with this doctor, part of me wished I was in the middle of our house in the village with a bidan (trained midwife) so that I could avoid all of the interventions. But I knew that my family in America and my husband here trusted the hospital and wanted the security and safety assumed to be had there.

My due date was March 19th, 2015. The doctor wanted to induce the very night of my due date without waiting at all (this after being told earlier in my pregnancy inexplicably that my due date was 4 days earlier than the one previously given). I refused and went home resolved to wait a week before going back to the doctor. I walked around the neighborhood endlessly, ate all kinds of spicy food like curries and sambal (chili sauce - unavoidable in Indonesia!), and did squats and meditation. I began doubting myself and of course just wanted what was best for the baby. I knew that his movement could slow down as the time approached but I went to the doctor on the night of March 25th to check that everything was ok. They admitted me, hooked me up to the monitor and it felt like there was no going back. I wanted to move and walk like I read about. I wanted to get on all fours and stretch. I wanted to go in the water and take a bath. I was repeatedly told in a language not my own that I could not. I was scared and if not for my husband’s presence and support, I would have felt hopeless and entirely alone. I had brought prayer cards and a rosary and listened to Christian music on my phone while praying that he was safe and all would be well. They started me on a pitocin drip after an invasive internal examination from the doctor. I experienced mild pressure but no contractions all night and tried to rest.

The morning of the 26th, they increased the pitocin and the contractions came fast and strong. They felt erratic and unstoppable with no rhythm. I had been offered no pain medicine and was forced to stay in bed with no ability to change positions. I was even ridiculously told to keep my legs closed! At one point during the four hours of endless contractions with absolutely no progress or relief, a complete stranger, the mom of another laboring woman from the room across the hall, came into my room to stare at me as a strange foreign woman and talk to my mother-in-law. I wanted to scream “Get out!” but settled on telling my husband that I was in no way comfortable with random people in my room.

In the end, at noon after not even dilating one centimeter on the pitocin, the doctor suggested that I go for a C-section, which I firmly believe was his desired route all along. But by that time, I could not handle the rigid rules, the pain or the hopelessness of the situation anymore and just sought relief and the certainty that I would meet my baby boy soon. The five minutes in the Operating Room leading up to the procedure was the sweetest and most meaningful time of the whole labor. My husband bravely came into the room with me (something that I think not many Indonesian husbands do!) and we talked about seeing our son. He smoothed my hair, held my hand, kissed my cheek and I could not believe how calm and reassured I felt after the trauma of the night and morning before.

 

Sweetest Moment

Upon waking from a nap after the procedure, I had found my voice and my conviction that baby was not allowed to be far from me or receive any unnecessary treatment. I found it difficult to speak up for myself but had absolutely no qualms about speaking up for my son. My postpartum experience was extraordinary and even better than I could have anticipated. As soon as he was brought to me, he nursed and we were skin-to-skin. I breathed and soaked in every moment. We shared a surprisingly spacious and luxurious family room; he did not go to the nursery except for his bath and hospital photos. When I felt he had been gone too long, I immediately called for him to be brought back. The nurses and my experienced mother-in-law helped him latch and brought him to my bed every time they thought he was hungry. He received no supplementary sugar water, formula or pacifier as per my express instructions. When I had slightly high blood pressure and seemed tired, the nurses suggested he stay in the nursery but I refused to let them take him away and he slept by me instead. The second day in the hospital during my recovery, they brought a complimentary massage therapist to give me an hour massage. Absolutely heavenly! I was fed such nutritious fish, veggies, rice, broth, porridge and fruit. By the time we were released from the hospital, I was confidently nursing him.

We brought him home and I had the whole “it takes a village” experience with my in-laws staying with us to cook and clean. Our sweet baby boy slept between my husband and I, and I nursed and changed wet diapers in bed throughout the night – as we still do! And he takes his naps in his hammock. The all-in-one changing table, bassinet and play pen is still collecting dust in storage.

 

Baby in a Hammock

Although the birth experience was incredibly different than expected and I did not have a doula with me, Jessica’s constant support and advice via messages and care packages kept me sane, grounded and feeling more in control and knowledgeable. I can’t even imagine how helpful she would have been if she were actually by my side!

 

Indonesian-style Baby Wearing

By: Kristin Abt

 

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