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Postpartum

I have a birth plan… do I need a postnatal plan?

Mar 11, 2021
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BY
Sarah Gonzalez

How many times have you heard an exhausted parent lament the fact that parenting doesn’t come with a manual? This is particularly true during the postnatal period when our bodies are recovering, relationships with our partners are tested, and there is a new creature attached to our nipples 24/7.  We go from a cute Pinterest-worthy bump lavished with attention to an anti-climactic hot mess trying to keep a newborn alive while still completing our daily acts of living and possibly caring for other children. Many of us feel isolated and disenfranchised from our old life and self, routines and social life completely upended.

The good news is that much of this can be avoided with a little thought and proactive planning. The even better news is that, historically the United States has not placed much value on supporting women and families during this time, but the tides are slowly turning and the 4th trimester is finally getting the attention it deserves. This means there is a greater push for reimbursement policy change that supports postpartum care as an ongoing process and for paid parental leave [1].  

Services that were previously overlooked, such as pelvic floor therapists or postpartum doulas, while not all covered by insurance, are now readily available. We have a way to go, but the framework is in place for every woman to have a postpartum plan akin to the quality of care they received whilst pregnant. In this post we will outline how to build a solid plan, a manual of sorts, so that your mind, body and family can be nurtured along with your baby. It starts with determining your needs, and ideally building a village that will provide you well rounded support.

Here’s the village checklist:

  • Mental Health Therapist
  • Physical Therapist with pelvic floor training
  • Lactation Consultant
  • Postpartum Doula
  • Community of fellow parents, friends and family

I have great prenatal care, do I really need to worry now about what happens after?

The fervor with which women are monitored over ten prenatal visits comes to an abrupt halt after the baby is born with insurance typically covering one postnatal visit set at six weeks for vaginal deliveries and an additional two week appointment for cesarean deliveries. By this time most women have struggled, and googled their way through common issues such as tearing, hemorrhoids, breastfeeding challenges, baby blues and sleepless nights to name just a few [2]. Reserving more serious complications for your obstetrician or provider, there is not a new mom out there who wouldn’t benefit from comprehensive support structured in timely increments across the 12 weeks now known as the 4th trimester . Let’s take a closer look at what these support services are and the ideal timing of them.

Do I need a therapist if I don’t have a history of depression and anxiety?

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Transitioning to parenthood is hard, we put so much pressure on ourselves to be the perfect parent as evidenced by beautiful baby showers and magazine worthy nurseries. You don’t need an existing mental health condition to feel stressed and pushed to the max during this time. At baseline most people could benefit from extra support, a huge percentage of moms will experience “baby blues” and possibly even a perinatal mood disorder. By now most moms-to-be anticipate the baby blues, a term used to describe the temporary feelings of sadness, anxiety, stress and mood swings that afflict up to 80% of new mothers [3]. However, there is a fine line between these commonly experienced emotions and the more severe and persistent symptoms of perinatal mood disorders that affect 10 to 20% of postpartum women according to the Center for Disease Control (CDC) [4]. You may have the best healthcare and support that money can buy, but postpartum depression and anxiety is non-discriminating affecting women of any age, culture, income level and race. Think postpartum depression is limited to mothers? Not so, the CDC claims that up to 10% of partners suffer similar symptoms.  

Hormone fluctuations, sleepless nights, the pressure to get feeding off to a good start and caring for a tiny human, this is a time of stress for many moms and couples. Left undetected and untreated any brewing mental health issues can become serious quickly, to the detriment of the mother, infant and entire family.  If you don’t already have a therapist, we recommend at the very least an introductory call no later than your third trimester so that you have someone to go to if needed. Even better would be proactively setting up sessions when you know transition points are coming, for example, the two to three week mark when the "baby blues” are typically subsiding, midway through leave as fatigue sets in with most babies not yet sleeping through the night or in preparation for a return to work. By engaging a therapist early and establishing a relationship, they get to know you and any pre-existing risk factors.  It’s a really important resource whether you’re looking to adjust in a way that promotes emotional wellbeing or working through a more serious mental health issue. Proactive support means your therapist can be on top of it early with a therapeutic plan to lessen symptoms and potentially shorten the time to a full recovery. This is such an amazing and pivotal time in your life, you deserve to feel great and savor all the sweetness of your new baby!

Mental Health Need to Know:

  • Transitions in parenthood are hard - and mental health support can help
  • Perinatal mood and anxiety disorders can affect anyone, including partners
  • Set up an intro with a therapist during pregnancy so you have a go-to resource

Why would I need physical therapy after the birth of my baby?

The physical toll of pregnancy and childbirth is far reaching, affecting several parts of our anatomy both immediately and, in some unfortunate cases, for many years to come.  Whether dealing with minor and temporary annoyances like constipation immediately following delivery or “mommy thumb,” a tendonitis from picking up and handling a newborn; or more persistent complications such as back or pelvic pain, new moms should be equipped with the right knowledge to manage their options [5].

There is a strong possibility that your pelvic floor will come out of pregnancy and childbirth a little worse for the wear and, believe us, you will want to restore it to good health sooner rather than later.  From inhibiting exercise to causing pain with sex, pelvic floor dysfunction can really impact your quality of life. No one wants to show up to their favorite cardio class only to find out they can’t jump or cringe with discomfort every time your toddler wants “uppy”!  Pregnancy and childbirth can take a physical toll on our bodies, and many women are left with incontinence, cesarean incision pain, diastasis recti (a separation of the abdominal muscles) and perinatal musculoskeletal issues.  Hoping these issues will resolve with time is wishful thinking and delaying treatment could lead to prolonged recovery [6].

Rather than simply accepting this as your new norm we recommend early assessment by a physical therapist trained in women’s health and the pelvic floor.  To start, you should gain a basic understanding of your pelvic floor anatomy and how it works.  In doing so, you will be able to start engaging those muscles during pregnancy and in the early postpartum period, which will go a long way in jump starting recovery. A proactive plan would involve scheduling your first appointment either prenatally or three to four weeks postpartum and a follow up after your six week appointment.  For serious trauma or tearing, you may need a longer course of therapy.  This is such an important piece of the recovery process, one that has historically been overlooked in the United States but shown to have both short and long term benefits [7].  

Physical therapy Need to Know:

  • Pregnancy, childbirth and postpartum can lead to physical ailments, most commonly pelvic floor dysfunction, but also issues like back pain, and mommy thumb
  • Seeking PT in pregnancy or early postpartum can help you protect and rebuild your core and pelvic floor
  • Find a PT who specializes in women’s health and is trained in pelvic floor PT

Surely feeding will come naturally?

Many of us go into motherhood assuming breastfeeding comes naturally only to end up dismayed and feeling like a failure when hiccups occur. Whether you plan to breast-feed, or bottle feed or a combination of both,  it can be a challenge for new or even seasoned moms to get into a groove. It’s estimated that up to 60% of mothers that want to breastfeed stop earlier than expected due to outdated information and inadequate help [8]. Given the extensively studied and researched benefits of breastfeeding for both mother and baby this statistic is a shame.  

There are a host of reasons women may not reach their breastfeeding goals, including but not limited to, sore nipples, low milk supply, plugged ducts, infections and just plain old exhaustion. Not to mention the challenge of nursing and pumping once you return to work. When attempting to bottle feed you may encounter troubled behavior such as turning away from the bottle, feeding too quickly or too slowly, milk pouring out of mouth or refusal to close mouth around the nipple [9]. Enter the role of an IBCLC - or an International Board Certified Lactation Consultant - the gold standard in breastfeeding and lactation support. One of these experts can be your cheerleader, assist with common pitfalls and even help establish a pumping schedule if you plan to return to work [10]. There is no question that an IBCLC should be a key member of your team - consider an in-home session during the first week home and follow up as needed. Though finding in network providers can be tricky, most insurers will reimburse for this care as it is ACA mandated. Call your insurance to confirm.


Breastfeeding Need to Know:

  • Breastfeeding can be surprisingly challenging, especially at the start, so be prepared if it doesn’t just happen for you
  • Early support from lactation consultants can make all the difference, don’t wait to get help if you have questions, concerns or simply want to make feeding as smooth as possible

Doula care: What’s a doula, and isn’t in-home care for the elderly?

Before the development of obstetrics and hospital births in the last century, women exclusively gave birth at home with the aid of skilled midwives, relying on female family members for support and guidance throughout birth and beyond. The word “doula” was coined by the Greeks and means “woman who serves,” and serve they did, helping women during childbirth and recovery. Our modern culture simply does not lend itself to an abundance of female relatives living within close proximity and able to welcome a new baby into the fold; hence the rise of the professional doula to step in and get families off to a good start.


Doulas are certified professionals trained to guide and support families through pregnancy, birth and postpartum. Their training and experience spans perinatal mood disorders, infant feeding and newborn care. The hands-on support from a certified postpartum doula is versatile and exactly what new parents need. These people will be your guardian angel on the homefront helping with household chores, sibling care, newborn expertise and just another set of hands so you can rest and recover. They can also support overnight shifts, helping you get much-needed rest that will speed up your recovery. This extra support does typically require some investment but even a couple of shifts are worth it in getting you rested and back on your feet. Great doulas can book contracts well in advance, so this is something to start researching at the midpoint of your pregnancy.


Doula Need to know:

  • Extra hands-on help, whether from trusted friends and family, or a postpartum doula can make a huge positive impact in the early weeks of postpartum
  • Postpartum doulas are trained to support the family’s needs, whether helping with infant care, supporting parents in the recovery process, or keeping the household running
  • Doulas can also be hired for overnight shifts to minimize the health impact of sleep deprivation


What about parenting groups and communities?

When it comes to parenting “there is more that unites than divides us” and the ability to form connections with peers at similar stages of their parenting journey is priceless. Social support is so crucial in the first weeks home it is positively associated with improved infant care, maternal adaptation and breastfeeding, while a lack thereof is related to stress and postpartum depression [11]. If you don’t have a strong support network of family and friends nearby we suggest researching local moms groups that offer community meet-ups even if they are virtual in nature during our time of COVID. The contacts you make through these groups will really help tone down the isolation factor, allowing you to swap stories and build confidence and may very well turn into lifelong friendships.

OK, so how do I get started?

Now that you have an idea of what goes into a postpartum plan you can begin building your very own manual and adapt it to your family, birth plan and priorities. It is important to outline a well thought out plan that is flexible yet ready to execute as your due date approaches - we advise writing it down, sorting through your priorities and identifying who you want to call in for support. Ideally you can engage a specialist in each area - mental health, PT, doulas and infant feeding support BEFORE baby arrives. Incorporating the suggestions above will smooth your transition into parenthood allowing your baby and family to thrive.

About the Author: Melissa Kalil
Melissa is a single mom to three rambunctious girls. By day, she works to support mothers and families during the postpartum period. In her precious free time she enjoys writing about healing after divorce, rebuilding and being a great single mom. Melissa feels it is no coincidence that she only has daughters and feels passionate about supporting women during all phases of life.

This article was written in collaboration with Meloddi, an innovative startup supporting parents with high quality information and products for their little ones! Meloddi provides educational content based on research and reviewed by experts, so you don't have to differentiate fact from opinion. They help parents ‍select brands that align with their values - e.g. sustainable, minority-owned, small business, etc

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[1]https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2018/05/optimizing-postpartum-care

[2]https://www.health.harvard.edu/blog/the-fourth-trimester-what-you-should-know-2019071617314

[3]https://pubmed.ncbi.nlm.nih.gov/2206758/

[4]https://www.cdc.gov/reproductivehealth/vital-signs/identifying-maternal-depression/index.html

[5]https://www.healthline.com/health/parenting/mommy-thumb#home-remedies

[6]https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2018/05/optimizing-postpartum-care

[7]https://urology.stanford.edu/content/dam/sm/urology/JJimages/publications/Pelvic-floor-physical-therapy-in-the-treatment-of-pelvic-floor-dysfunction-in-women.pdf

[8]https://www.cdc.gov/breastfeeding/pdf/breastfeeding-cdcs-work-508.pdf

[9]https://www.healthychildren.org/English/ages-stages/baby/feeding-nutrition/Pages/Practical-Bottle-Feeding-Tips.aspx

[10]https://lactationnetwork.com/blog/what-is-an-ibclc/

[11]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6491158/

About the Author

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