Friday, January 7, 2011

Postpartum Care Reflections

I found this article online that does a really nice job outlining a few points on postpartum care.  From recent experience, I found I could relate directly to a couple of points. 
If you want, please read...I've put my comments on my own experience at the end of this post.

The Void that is Postpartum Care in America

I just started reading a most phenomenal jewel of a book called After the Baby's Birth by Robin Lim. Two quotes just from the preface and opening chapter have struck me:

"...I came to see more clear how my sisters in the West could expect little or no postpartum care or support, either from health-care providers or from friends and family. The modern lifestyle, embraced by the West, sought after and imitated all over the world, has so fractured families that 
postpartum women today accept and expect to be isolated. [bolding mine] I wonder at a culture that decades ago put men on the moon, yet chooses to ignore the most significant life passage of women." (xi)

"All too often, the only postpartum care an American woman can count on is one fifteen minute appointment with her doctor, six weeks after she has given birth. This six week marker ends an arbitrary period within which she is supposed to have worked out most postpartum questions for herself. 
This neglect of postpartum women is not just poor healthcare, it is abusive--[bolding mine]particularly to women suffering from painful physical and/or psychological disorders following childbirth." (4-5)

In cultures across the world, newborns and postpartum mothers are viewed as sacred and in a vulnerable state of being of both body and spirit. As such, they are nurtured and cared for. I suspect that now that puerperal fever is largely a thing of the past due to a better understanding of germ theory, more sanitary practices, and antibiotics, that as we lost some of the physical vulnerability of this time period (mercifully, the vast, vast majority of women in the West survive postpartum), we also lost respect for the spiritual and emotional vulnerability.

There are many interesting, beautiful traditions for postpartum women across the world. "Warming" the mother is common to many cultures. Some bury warm coals under the postpartum woman's bed. Some women are to sit on a fire warmed rock every morning, and it is also common to place a warmed rock on the woman's abdomen. There are taboos revolving around certain foods, and it often requires that the mother consume only warm liquids like tea and soup. These practices not only warm the body, but the soul. Touch is also a familiar component to these rituals. In some cultures the responsibility falls to the midwife to come give the mother a massage or rebozo treatment designed to "bring the bones back together." In others, the mothers or grandmothers of the postpartum woman provide this life affirming touch. In America, we too have our warming ritual, if you are lucky enough for someone to bring you a warm blanket after birth. The difference is, whereas the aforementioned traditions go on for weeks, women in our culture are "cared for" (and I use that term very loosely) for a few days or less.

Today I was reading a post on a message board for moms from the mother of a 2.5 week old who was feeling overwhelmed, sleep deprived, and isolated, looking to reach out to other mothers. She got some wonderful suggestions, but what stood out to me was the comment from one poster that said "If you are feeling depressed, don't worry, there are many antidepressants compatible with breastfeeding." While this is certainly true, and I would never ever advise against someone going on such medications if they feel like they need them, it made me wonder if we are handing prescriptions out to women who are really seeking encouragement and camraderie. Much as a laboring woman asking for drugs is sometimes actually asking for more support from those around her, I can't help but feel like we are ignoring a mass of women when we hand them a pill instead of loving guidance and help.

I have been working as a hospital doula now for 2 weeks and have spent a few shifts shadowing another doula on the mother baby unit. What has been eye opening for me is how little rest these women are getting in their very brief stay at the hospital. I have seen mothers drifting off falling asleep while they try desperately to pay attention to the presentation of how to put together their breast pump. I have seen a mother who had a cesarean not 12 hours earlier whose hospital phone rang no less than 5 times in the 15 minutes we visited with her. This same mother was distraught and exhausted and told us she had had visitors all day long. These mothers are also struggling to get to know their baby, learn how to breastfeed and recover from birth which for many also means recovering from major surgery. What I have also noticed is while these rooms may be brimming with stuffed animals and flower arrangement, I have yet to see a care package for mom, a stack of magazines or her favorite food or drink. The focus is on coming to see the baby, and respect for the mother and her passage is lost. It is no wonder we have a whole generation of women suffering alone through isolation, a sudden, crushing loss of identity and postpartum depression.

What can we do to improve the state of postpartum care in America? I believe it's obvious we need better medical care including at least one home nurse visit in the first 2 weeks after birth. For a greater discussion of this, see Ina May Gaskin's article "Masking Maternal Mortality" in the March/April 2008 edition of 
Mothering magazine. But aside from that, what can we women, birth professionals, mothers, sisters, aunts, grandmothers, and friends of postpartum women do to help fill this void? And what can the postpartum woman herself do to create the support system that is so sorely lacking for them?

First, I believe we need to address the early visitor issue. Everyone loves to see and hold a new baby. But again, we are talking about women who are in the hospital for 24 hours, not getting to rest because the nurses are checking in on them and their babies every few hours, learning to breastfeed which can be highly challenging, and often recovering from surgery. We wouldn't expect to go see Aunt Sally 4 hours after her appendectomy, and the same respect should be given a woman who has had a cesarean. I propose that no visitors come to the hospital the first day, and if they do, be limited to immediate family and the closest friends for less than an hour. Remember, in most hospitals rooming in is standard, and these mothers are not going to get a full night of sleep. There will be plenty of time to meet and cuddle this wonderful new blessing once the new family is settled at home.

How can the postpartum mother enforce this? Some tips are quite simple. Don't call anyone while you are in labor except for those you want with you either at or immediately after the birth. When you do call to let family and friends know you've had the baby, tell them you will be happy to see them once you get home. This alerts them to the fact that you are not inviting them to the hospital. What about those who will show up anyway? Tell your nurses to mark you down as "do not announce" and they will not tell anyone you are there. Let them know you would like your visitors cleared through the nurse's station and have them place a sign on your door when you are resting/feeding and prefer not to have visitors. Please realize this is not a hardship for the nurses, they actually like to limit your visitors. It is their job for you to have a full, speedy recovery, and they realize that you resting is the best way to get that. They will not mind at all being your gatekeeper.

I realize this all probably sounds harsh. But I assure you that once you have given birth, you will understand more of what I am saying. And I will also tell you that the most crucial time to your postpartum healing is 8 days after birth. The more rest, relaxation, and general being taken care of you can arrange for, the quicker the rest of your recovery will go. You are not denying people access to your baby. You are ensuring that you are healthy enough to care for him/her in the very demanding weeks to come.

Birth professionals, I implore you to impress the importance of these 8 days on your clients prenatally and encourage them to set forth the rules I have suggested for postpartum visitors.

This post will continue with more tips on how to build your own network of postpartum care, but for now I must sign off!
First, I have not and probably will not read the book reference.  I just don't have time; what I was more touched by was the discussion that followed the quote.  My connections to this piece are on the emotional well-being of the new family, not the state of medical care.
I had a great birth experience.  I loved my group of midwives.  I loved having only my husband and my support person present for the birth.  I loved the hospital that we gave birth at.  Let me start there.  We had our daughter at the height of the H1N1 scare in California, so all local hospitals were closed to visitors before, during and after birth.  I LOVED THIS.  My husband, my baby and I were left in a little cocoon for 3 days (one day of birthing and two days after), where the fantastic nursing staff doted on us, anticipating our every need.  I felt so supported that I didn't really want to leave.  I felt like Travis and I were allowed a special bit of time to met our daughter and begin being a family.  We didn't have to worry about anything.  Then we came home and had the expected line of visitors.  I'm happy that everyone was excited to meet our daughter, but it's stinking exhausting having people in your home when all you want to do is curl up with your baby and get to know her.  
I love the tips the blogger listed.  Travis and I are already discussing what we will do after the birth of our next child (no, we're not pregnant), and I think we're going to use some of those tips.  One of my closest friends had a home birth almost two years ago.  I still think about how wonderful her postnatal experience was.  She and her husband told all friends that they were not accepting visitors, but they would let us know when they were.  They spent over a week tucked away in their bedroom with their baby, experiencing everything together.  No one was offended (or if they were, they were smart enough not to say anything!) and we all eventually met the baby.  It's not like the parents said, no one can come visit until the baby is one year old.  No, they were putting their needs as a family above the wants of other people, as they should have.  
The transition from married couple to family is difficult.  Not only did I have to learn how to be a mom, and my husband learn how to be a dad, but we had to accommodate visitors at the same time.  We said no when we needed to, and most people understood, but it was still hard to make the transition.  I know what we'll do differently next time, and I know people will understand.  Our friends and family love us and they want to support us, so they'll understand.  After many discussions with my mom, my sister, my husband and my midwife, I KNOW I did not experience postpartum depression; I can only imagine how hard it is for women who do.
I will make the distinction between the "isolation" the blogger writes about and the self-imposed isolation that I write about.  I'm interpreting the blogger's term isolation as neglect; the hardworking woman and her husband/support person being overlooked by medical staff or pushed aside by family and friends so people can met the baby.  I know that comes from love, but it can still be hurtful to the new family members, physically and emotionally.  
I write about a self-imposed isolation, not related to medical care.  I write about a voluntary bubble that the new family may enjoy, if they so choose.  I know it's not for everyone.  I know there are people out there that want others around because they feed off their energy.  Great!  It works for you and that's fantastic.  But it doesn't work for everyone.  But if your loved one or best friend says, give us some time.  Please listen to them and honor their wishes.  It's not about you.  It's about them.  Get over it :)

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