III. Postpartum

Nourishing my baby and myself, a complicated dichotomy

The care I received from the doctors, nurses, and hospital staff during labor, delivery, and postpartum period was excellent. I felt all the staff members explained all procedures for myself and the baby. The labor and delivery nurses were helpful and compassionate. They showed me how to breastfeed the baby, assisted me with skin to skin contact, and taught my husband and I how to care for the baby when we took her home. The birth center site at the hospital was amazing. I had an individual birthing suite with a bathroom, a television, a bathtub and a place for my husband to sleep. Health care for the baby and I following delivery continued to be excellent. I had a surgical follow up one week later with my doctor and another postpartum visit at 6 weeks. At each visit I was given The Edinburgh Postnatal Depression Scale (a scale to help identify postpartum depression) as well as educational pamphlets on self-care following a cesarean delivery. The only complaints I had that required assistance from a health care provider was with getting baby to latch with breast feeding and neck and shoulder pain from breast feeding the baby. I took it upon myself to work on core and hip exercises I would give a postpartum patient who had undergone a cesarean delivery and was working on my scar tissue to prevent problems with bladder, bowel, abdomen, and uterus. I sought some massage for my neck and shoulders and did my physical therapy exercises for my neck and shoulders. I sought a lactation consultant for the latching issues with breast feeding. Seeking care helped resolve these issues which reduced my neck and shoulder pain and helping me enjoy breastfeeding my baby.

Before having my daughter, I had preconceived notions about postpartum care. For the last ten years since I started working with women’s health patients I have heard repeatedly from my patients that they felt they did not receive comprehensive postpartum care. Many of these women hopped from health care provider to health care provider, sometimes taking years to resolve orthopedic or pelvic floor problems from their pregnancy or labor and delivery experience. Quality postpartum care was my soap box issue and still is. That being said, I was very satisfied with my postpartum health care experience. My experience revealed that support and education about postpartum problems as well as proactive healthcare for theses challenges is becoming mainstream. I have always felt that women in our country need better post-partum care and I am happy to see improvements being made. We may forget between the constant baby changing, soothing, and feedings that mom needs some care too. I am not sure that we always remember that there have been 9 months of physiologic changes occurring to a woman’s body. Additionally, physical trauma that occurs with caesarean or vaginal delivery. A mother may need physical therapy for exercises to strength abdominals or back, help for bowel or bladder problems, manual therapy for painful intercourse, or scar tissue work for abdominals or pelvic floor.

I think as a society we are getting more aware of the influence of hormones, crying babies, sleep deprivation, and a heavy work load can overwhelm a postpartum mother. Based on my experience only, I think we are doing a better job of monitoring postpartum depression, pain management, and pelvic floor problems. I was so pleased at the availability of information and counseling opportunities presented to me during my birthing and postpartum experience. I received so much encouragement and permission to seek help from others during my postpartum healing.

Now that patients are being routinely counseled on postpartum self-care for mind and body we need to help them achieve successful outcomes. As health care providers, we should help postpartum patients decide how to include self-care with their new routine with baby. Caring for a baby takes a lot of time! My postpartum experience was likely similar to other women, where I had very little time to do all the “things I should be doing.” (For me this included neck, shoulder, abdominal, back, and pelvic exercises. As well as attending pediatrician, massage therapy, and lactation appointments.) The baby needs to feed constantly. By the time you feed, change, and soothe the baby (and pump if needed) it is almost time to do it again. You may never have more than an hour to get things done or get some sleep. As a mother there are many novel challenges to face, skills to learn, and emotional stress from fatigue and hormones. On top of all that, oh yeah, you should exercise, eat healthy, and if you are lucky shower and sleep! The point is, being a mother is challenging and we are all doing the best job we can. It is difficult to care for your baby while taking care of yourself. Reflecting back on my “birth story” has helped me empathize with my patients but also helped me to see that as health care providers, we should continue to provide education to our patients on self-care and continue to encourage them to seek care for their problems. However, to really help our patients successfully heal, we need to help them figure out how postpartum self-care blends into their new life with baby.