Recently I have been able to attend some trainings on perinatal mental health issues.  I have learned a lot in those trainings, but I wanted more than an "academic" understanding of what a mom may experience, I wanted an up close and intimate understanding.

Brooke Shields wrote about her personal experience with postpartum depression in her book Down Came the Rain.  The book was first published in 2005, and helped focus attention on something that was more on the back burner in maternity care.

As I read Brooke's book,  I could see all the red flags that indicated she was at increased risk of postpartum depression.  It was her intimate description of her feelings and thoughts during this time of her life that really touched my heart.  Her emotional journey into depression was raw and heartrending to read.  It brought the abstract learning I have to life.

Mental health issues can come up at anytime during pregnancy and the postpartum period.  It is now recognized that postpartum mental health issues can occur up to a year after birth.  In my practice, I do my best to support Moms in all aspects of pregnancy, birth and postpartum.  I watch for red flags such as overtiredness bordering on exhaustion, concerning mood fluctuations , lack of appetite and other possible signs that may indicate Mom is heading towards having issues.  If I have concerns, I will discuss them and may suggest my client have an evaluation with a mental health professional who specializes in postpartum mental health issues.  There are so many tools and ways to manage postpartum depression that just don't let mothers cope, but help them thrive that there is no reason to suffer.  In an ideal world, no mother would experience postpartum mental health issues, but if I notice something concerning, I will support my client and ensure she gets the help she needs.

Scale and sling: At every postpartum, I will weigh baby to monitor weight.  Babies typically lose weight in the first few days after birth and I want to track this.  It is normal for a baby to lose up to 10% of birth weight.  I like to see that baby is gaining weight and is close to or back at birth weight at the two week visit. 
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Stethoscope and blood pressure cuff: I also take Mom's blood pressure at each postpartum. Blood pressure numbers can tell me how well the body is handling birth related blood loss and helps me monitor for postpartum preeclampsia.

Pulse-oximeter: I carry a pulse-oximeter to use on baby to check for critical congenital heart dieases if parents want the check completed.

Newborn heel lancet and Kansas newborn metabolic screening collection form: I use these to collect five blood drops for the state to complete the metabolic disease screening.  Parents can decide if they want ths screening completed.

My hands: I like to palpate the uterus at the first 2 or three postpartums to check how quickly it is going back to pre-pregnancy size.

Questions: I ask lots of questions.  I'll ask about nursing, Mom's sleep and appetite, how everyone is adapting to baby and many more questions.  Questions help me assess how things are going and give me the opportunity to help everyone navigate any issues that may come up.  

My most important tools:  I feel my most important tools are asking questions and listening well and trusting parental intuition. 

Postpartum is wonderful and exhausting at the same time. Rest, good support and evidence based information can all contribute to a wonderful postpartum period. My goal in the postpartum period is to work together with parents and baby to help them have the best postpartum time they possibly can have.  

My birth bag is stocked with everything I use at births.

Gloves: I use a lot of gloves at birth. I use nitrile gloves so I don't have to worry about any latex allergies.  I also use sterile nitrile gloves.  Sterile gloves are used if an internal check is done after membranes are ruptured and for perineal checks after the birth.  If it is a water birth, I will use shoulder length gloves if I put my hands in the birth tub while Mom is in the water.

Blood pressure cuff and stethoscope: Just like in prenatals,  I want to check blood pressure to be sure it is in a healthy range during labor and after birth. 

Pulse-ox sensor: I like using this to get pulse and it is a good tool to have to know how well oxygenated mother's blood is.

Thermometer: Another tool to ensure mother's temperature is within normal range, and to check the newborn's temperature after birth.

Urine sticks: During labor, mom is working hard.  A urine dip can tell me if she has ketones, which are a by product of burning fat.  If ketones are present, I will encourage mom to eat to provide more energy for her body to use.

​Cotton Root Bark Tincture: I would use this if mother's bleeding is concerning or if her uterus is not firm.  It is very effective at causing the uterus to contract.  The mother would have 1 dropperful placed under her tongue and she would hold it there as long as she could, then swallow it. 

Hemostats and scissors: I carry a sterilization pack with sterilized hemostats and scissors in the rare situation where I would want to clamp and cut baby's cord after the head is born but before the body.  Thankfully there are simple things I can do to help baby be born without cutting the cord.  I have never had to use the hemostats or scissors.

Doppler:  During labor, it is challenging to hear fetal heart sounds with a fetoscope.  As baby descends lower into the pelvis, it gets even harder.  The doppler makes it much easier to find the heart sounds.  I like to listen shortly before a contraction starts, during the contraction and shortly after.  Listening in this way gives me a complete picture of how baby is handling contractions.  Baby will react to contractions and there are heart sound changes that can indicate the baby is getting closer to be being born.  If the heart rate drops at the beginning of the contraction, that can indicate that the baby's head is shaping to come through the pelvis. I try to listen every 30 minutes or so.  

Heating pad:  I use this to keep towels warm and to warm up my weighing sling for baby.  Who doesn't like having a fresh, warm towel?!
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Umbilical scissors and cord ties: I carry sterilized umbilical scissors for cutting the cord and sterilized cord ties. I crochet the ties.  I like using them because they are soft and less likely to rub on baby's stomach than the plastic clamps used by hospitals.

Ambubag:  This is a self inflating bag and mask I can use it if baby needs extra help to start breathing.  

Newborn stethoscope:  I use this to check how well baby's lungs are clearing, and also to count respirations and heart rate.

Scale and weighing sling:  I weigh baby as part of the newborn exam I do after birth. 

Measuring mat:  As part of the newborn exam,  I measure baby's length, head, chest and abdominal circumference.  I tried using paper measuring tapes but repositioning baby for each measurement, not to mention the fact that I routinely tore the tapes made my decision to use a measuring mat instead a very easy one.  

My most important tools: My most important tools for baby at birth are observation and intuition.  I observe what is normal and watch to ensure that things stay within normal during birth. Intuition plays a huge part in birth, both Mom's intuition and mine.  It is amazing to me when my intuition lets me tune into the "dance" of birth between baby and Mom.  Intuition helps me prepare for the uniqueness of each birth situation and helps me to support the birth process for both Mom and baby.