Holistic Postpartum Care
Catherine Mcleod-Moya BSN, RN
So You Just Had a Baby…
If you’re a mom-to-be or a new mom, you may be aware of the 6-week postpartum checkup. Your body prepares a baby for about 9 months, you deliver at home, birth center, or the hospital, and are then discharged by your provider.
If you deliver at a birth center or hospital, you will likely see your provider again around that 6-week mark, depending on the type of delivery you had and whether there were any complications.
The weeks following birth, commonly referred to as the “fourth trimester” mark a transformational period for you.
Not only are you recovering from the event of childbirth, but you are also caring for a brand new life. Your body is going through rapid hormonal shifts, which means you are adapting to new physical, social and psychological changes.
For the most part, you are doing this on your own alongside your support team at home.
While you are able to call your provider regarding any concerns and complications, access is limited and often, women believe they must wait until that 6-week mark in order to address their concerns.
This lack of support potentially puts women at risk during these critical first few weeks, which may have a long-term effect on their well-being.
In 2018, the American College of Obstetricians and Gynecologists (ACOG) introduced a revised Committee Opinion on access to postpartum care during the fourth trimester.
They proposed that women should have ongoing contact and support from their providers within the first 3 weeks, and follow up care up to 12 weeks following birth.
Instead of a one-size fits all approach to postpartum care, services and support should be individualized according to the woman’s individual needs. Providers should be available to address any concerns and to support women as they discover new changes and challenges.
Woman-centered, holistic postpartum care and assessment should address the following categories:
Mood and emotional wellbeing
Infant care and feeding
Sexuality, contraception, and birth spacing
Sleep and fatigue
Physical recovery from birth
Chronic disease management
Health maintenance
Often, women and moms are their own self-advocates and find themselves demanding patient-centered care. This should never be the standard, and women need to feel empowered by their providers to collaborate on issues regarding their own health care.
What kind of questions should you ask during these first few postpartum visits? You may be feeling totally overwhelmed and depleted, and it helps to have some talking points:
Delivery and birth — Were there any issues? Expectations for recovery from laceration/episiotomy/cesarean?
Bleeding — What’s normal and what isn’t?
Pain — What’s normal and what isn’t? Any pain management medications and supplements? What’s safe for breastfeeding?
Adjustment — How are you dealing with the new demands of motherhood? How are dad and siblings adapting? Has the family noticed any changes? What are the difference between baby blues vs. PP depression?
Support system — Is the family involved in caring for the infant? Verbalize whether you feel like you need more support.
Breastfeeding — Address feedings and infant’s growth. Pain with latch, nipple care, engorgement, mastitis. How can I find an IBCLC lactation consultant?
Digestion and bladder/bowel movements — What can I do for constipation? Hemorrhoids? Perineal pain? Urine leakage? What’s normal and what isn’t?
Nutrition — How many more calories do I need? Adequately hydrating? What are some nutrient-dense foods to include? What’s safe for breastfeeding? Can I have alcohol?
Exercise and physical therapy — What kind of exercises are safe? What’s pelvic floor therapy and how can it help me? What’s a pelvic floor?
Sex and family planning — When can I have sex again? Can we talk about the symptothermal method, copper IUD, and barrier methods of contraception vs. hormonal methods?
Hormonal changes — Have I been screened for thyroid disease? What about iron, zinc, and B12 levels?
Ideally, you and your provider would have been preparing for the fourth trimester and have discussed expectations. Remember, your postpartum visits are just as important as your prenatal appointments were!
Reference
The American College of Obstetricians and Gynecologists (ACOG). (2018). ACOG Postpartum Toolkit. ACOG Toolkits for Healthcare Providers. Retrieved from https://www.acog.org/-/media/Departments/Toolkits-for-Health-Care-Providers/Postpartum-Toolkit/2018-Postpartum-Toolkit.pdf?dmc=1&ts=20190828T0411195562
