Posptartum is, in my opinion, the most important and overlooked time in maternity care in the United States.  Medical care has made great strides in taking care of newborns, but taking mare of Moms seems to be an afterthought.  I have seen this play out time and again with friends and family.  Baby comes, they have all the newborn appointments, but not a single check on Mom until the 6 week visit with the OB.  We can do better for families, we need to do better for families, we HAVE TO do better for families.

The American College of Obstetrics and Gynecology updated postpartum care recommendations in 2018.  They now recommend that women be seen by a provider at 3 weeks postpartum in addition to the 6 week postpartum.  Why the change?  Well, they are finally acknowledging that too many mothers are dying in the postpartum period from childbirth related issues, 50% or more of all maternal deaths in the US occur in the  postpartum period.  The hope is that by checking on mothers at 3 weeks, more issues will be caught sooner, and mothers can get vital help sooner.  Whie this recommendation has been out for a few years,  women in the areas I serve are still not being seen before 6 weeks.   Being seen once at the 6 week postpartum is even the practice at teaching hospitals which I would expect to be implementing the latest recommendations as soon as they come out. 

In my midwifery practice, I see clients in person 4 times in the 6 weeks after birth.  The first two visits are at the client's home because I want the client to be able to rest and focus on recovery in the first few days after birth instead of dragging themselves and a newborn out to get care.  By seeing my client so soon after birth, I am able to help with any nursing issues, assess bleeding, and be sure my client isn't going into preeclampsia in the postpartum period.  I have a better sense of how my client's recovery is going with those visits than if I waited to see them at three weeks after birth.  

I want my clients to thrive during the postpartum period.  For me, that means seeing them twice in the first week after birth, as well as two more visits in the first 6 weeks postpartum and making myself available by phone to them.  I feel strongly that mainstream medical care is failing women in the postpartum period, and it shows in the maternal mortality rate.  I can make a difference, one client at a time.​ 

What is jaundice?  
Bilirubin is a yellowish substance that is a byproduct when red blood cells are broken down. Red blood cells are always being broken down and replaced by the body. Bilirubin is normally broken down by the liver.  Jaundice occurs when bilirubin builds up faster than the liver can break it down and eliminate it from the body. Newborns have more red blood cells than adults and they begin transitioning from fetal red blood cells which have a unique hemoblogin to regular red blood cells after birth.

How common is jaundice in a newborn?
It is pretty common, 60-84% of  newborns born at term will experience some level of jaundice in the first week of life. It even has a name, physiologic jaundice because it is considered normal.
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How will I know if my baby has jaundice?
The newborn will start to get a yellowish tinge to the skin. It starts at the top of baby’s head and travels down the body through the torso. The whites of baby’s eyes may also start to take on a yellowish tinge.  Jaundice usually peaks between 2-5 days after birth, and  lasts 1-2 weeks.

Can jaundice become a problem?
Yes, in a small amount of cases, jaundice can be a problem.  Jaundice can be a sign of blood type incompatibility, whether due to rH factors, or blood type. If bilirubin levels get high enough, brain damage can occur. Thankfully, jaundice induced brain damage is rare.

What can I do to minimize jaundice?
Bilirubin is eliminated through the digestive system. The single most helpful thing you can do to minimize jaundice is to nurse baby frequently. I prefer that baby is nursed every two hours. Light therapy can also be helpful since sunlight breaks down bilirubin. Place baby where natural sunlight will shine with just a diaper on, or completely naked. Do this for 45-60 minutes 3 times a day. You could also consider having baby under a SAD (seasonal affective disorder) light if there isn’t a lot of direct sunlight in your home. 

New perspectives and understanding of jaundice  
In the past, blood serum levels of bilirubin were used to determine whether treatments were necessary, regardless of the age of the newborn. As the understanding of the normal trajectory of newborn jaundice has expanded, blood serum levels of bilirubin based on how old the newborn is should be used to determine if treatment is needed. Results from recent studies show that jaundice may be beneficial to the newborn, acting as an antioxidant and preventing illness from Group B Strep. As a midwife, I find it reassuring that the research is showing increasing evidence that physiological processes after birth may not be harmful but actually serve a beneficial purpose.

We have a lot of myths about postpartum which are perpetuated by many sources: TV, movies, social media posts, etc. Myths that Mom is going to have the time to get dressed and put on makeup, myths that life instantly goes back to "normal". Myths are interesting, but they are nowhere close to reality. It's time to talk about the reality of the first few days (think 5-7 days) postpartum.

In the first week postpartum, things to expect include:

• bleeding: this will be like a heavy period the first few days and will gradually begin to decrease
• sore bottom: Mom has just pushed out a human being, things are going to be a little tender to downright sore down there
• swelling: the tissues in your nether regions have been through a lot! Swelling is normal, it may take up to 24 hours to peak and should start to go down on day two or three.  
• moving around like a Great-Grandma: it is normal to feel the need too move very slowly as you get around. Mom may have sore muscles all over, like she just did a marathon and then climbed Mt. Everest.
• still looking pregnant: yes, baby is out but your body needs time to go back to your pre pregnancy state. Your uterus is slowly shrinking, organs are shifting back into pre pregnancy positions, and your stomach muscles are recovering from stretching out to support your belly in pregnancy
• tiredness: this is the one thing that the myths get right. Expect to be tired.  You will be waking up every 1 to 3 hours to feed baby around the clock. That will tire anyone out!
• heavy and leaking breasts: as your milk comes in, your breasts may start feeling like they weigh a ton. Leaking like anything between a faucet trickling and a fire hydrant when your baby cries is perfectly normal
• new fashion accessories: breast pads, diapers, belly support wraps or belts, nursing tops, or going topless are all going to be options Mom may want to try out in the first few days postpartum.

I share all this to prepare families. We glamorize pregnancy as a society, having gender reveal parties and pregnancy photo shoots. Pregnancy is beautiful and I don't want to discount that but...I feel postpartum is even more beautiful. Mom has given birth, an act that requires digging deep into strengths she has never tapped into before. Baby has arrived, and the same body that sustained the baby in pregnancy is sustaining the baby after birth, and doing all the things it has to do to shift out of pregnancy mode. That is absolutely amazing to me.   

Let's celebrate just how amazing Mom's body is after birth. Let's start having postpartum photo shoots, just like we do during pregnancy.  Slip into that adult diaper, grab your camera and take some pictures.  It's time to normalize, document and celebrate every aspect of postpartum!
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How does a parent get sleep with a newborn?  How often should a newborn nurse?  Will this ever end?  I think every parent asks some version of these questions.  I know I did when I had babies.  I learned so much about navigating that time that I thought it might be helpful if I shared my knowledge.

To answer the last question first, yes this season ends.  It's not the end though.  Babies eventually turn into teenagers who will again keep you up at night like when they were newborns but this time you are wondering if they are ok, and when they will come home from an evening with friends.  But I digress....

How often should a newborn nurse?  My answer is as often as they want.  It can be 30 minutes after they just finished nursing, or a few hours after.  I'm not a fan of putting newborns on a schedule for many reasons.  They are learning to eat so they need lots of practice.  The digestive system is also learning how to process what they eat.  They are growing so fast that they need to eat a lot and that is normal.  Nursing when they want helps encourage and establish a good breast milk supply.  I prefer that newborns don't go longer than 3 hours between nursing sessions.  It's something I ask about at postpartum visits and we discuss what your baby's nursing pattern is, how well they are growing, and if anything needs to be tweaked.  Also, be aware that the longer baby goes between nursing sessions at nights, the sooner your cycle will return (if you are one of those lucky women for whom nursing keeps periods at bay), so there is a small benefit to waking up often to nurse baby.

How does a parent with a newborn get sleep?  I have lots of suggestions for this based on what I did wrong with my first child.  Baby should be in the same room as Mom, next to the bed if you are not comfortable with bed sharing.  As soon as you hear baby waking up, that's the time to gather up the pillows on the bed, and create a nest with any support you might need and start nursing baby.  You may drowse while baby is nursing, and when they are done everyone can reposition for more sleep. That is so much more restful than getting up to get baby from another room and then nursing them in a room other than your bedroom, hoping they will settle and go back to sleep in their own bed and then trying to get back to sleep yourself before baby wakes to nurse again. When baby naps, you should nap.  It's tempting to want to try to get a few things on your to do list done, but you and your family will benefit more if you get in a nap or two during the day than if you run yourself ragged trying to complete your to do list.  Enlist the help of friends and family, or hire a postpartum doula to help keep up with basic household tasks.  If you are a regular blog reader, you know I am a huge proponent of having a postpartum plan.  Planning can go a long way towards setting life up so you can sleep and rest more. 

The sleep deprivation that comes from caring for a newborn can feel like it will last forever, but it is a short season in your parenting journey. Sleep is vital for your recovery and health, so be strategic and proactive to create space for sleep. In my midwifery practice, I try to help clients think through what they might want or need before baby arrives.  I want my clients to be prepared, and equipped for a postpartum that supports rest and recovery and meets their wants and needs, including sleep.

When I had my sons, we did not have family close by and had a handful of friends we had made between births that we had just moved 40 minutes away from.  I had no posptartum support after my first child.  Postpartum support after my second child consisted of a friend providing one meal and another friend sending a balloon bouquet to big brother.  I've thought a lot about those days and ways family and friends who are far away can help with supporting the family in the postpartum period. In serving Manhattan KS and surrounding areas with a highly mobile military and student population, I want to share my ideas so family and friends who aren't local can help provide some postpartum support.  

• Give gift cards for restaurants.
• Give gift cards for Ubereats, Doordash or other delivery services.
  • Helpful for those times when making a meal is just too much to manage.
• Pay for a meal service like HelloFresh or Freshly.
  • Some services offer allergy free options which is great for families with food allergies/sensitivities.
• Pay for lawn mowing services.
• Pay for a few sessions or a few months of housecleaning.
• Mail a package for siblings with books, snacks, toys etc.
  • Not only will big brother or sister be excited to get a package, having something new will keep them occupied, hopefully for a few days.
• Check in on a regular basis to see how Mom, Dad and family are doing.
  • Be mindful to listen well and not be judgemental or offer advice unless asked.
• Be available whenever Mom or Dad needs to vent by phone or video chat.
  • Sometimes we just need someone to listen and acknowledge they heard us.
• Be available for a video call or phone call when Mom is nursing, or parents need a break/distraction for siblings.
  • I once desperately needed a break so I called my husband on his lunch break at work. He was not in but his coworker who answered the phone was willing to sing the ABC song with my toddler for 10 minutes which gave me a much needed chance to step away and take a few deep breaths.
• Consider asking local friends in the area to join a meal train, or schedule a time to stop by and do a quick chore like starting laundry or loading the dishwasher.
• Offer to read a story over the phone or  by video call to baby and/or siblings.
  • This could become a regular thing that everyone looks forward to.

I hope these ideas help friends and family who aren't close by to be able to share in the joys and work of the postpartum period.  I know how hard it is to be far away from loved ones and how nice it is to be able to do something to help.  Being able to help will let you be more connected with the postpartum family and believe me, every bit of help is deeply appreciated.  I will never forget Brett's kindness in singing with my toddler, or how excited my son got when packages from Grandma who lived accross the country arrived.   

Let me know what ideas you have in the comments below and I'll be sure to add them to my list.   Here's a printable version to share with friends and family.