after birth care

PREPARING FOR BIRTH, BABY, AND BEYOND


PREGNANCY & PREPERATION 


Mrs. Nipple: So I met a friend on the internet :) That sounds as funny as I thought it would, but she's pretty awesome. Her name is Meg Hall and she has a great blog called, For The Long Hall. When I read her mom's post about preparing for birth & labor, I just knew it was too good not to share. Meg's mom has quite the track record. Family Nurse Practitioner, Certified Nurse Midwife, and most recently, a Doctor of Nursing Practice and Certified Nurse Educator. 


 

Meg Hall: Arguably the greatest benefit I've had at my disposal throughout my pregnancy is my mom! While she's a rockstar mama in general, she also happens to be an extremely talented women's health provider (and now professor). My mom has a passion for learning and caring for women and has worked for many years as a Family Nurse Practitioner, Certified Nurse Midwife, and most recently, a Doctor of Nursing Practice and Certified Nurse Educator. She's not only a super smart cookie, but also a very level-headed, non-judgmental and rational healthcare provider that immediately puts her patients at ease (you can ask my friends - who have been asking her 'embarrassing' questions my entire life ;)

Disclaimer: any and all advice below should not replace or override the recommendations of your healthcare provider. Please ask your doctor for recommendations specific to you or your pregnancy.

Brenda M Gilmore DNP, CNM, FNP, CNE (Meg's mom) will take over for the remainder of the blog post

Introduction

First, we’ll start with preparation for birth including the choice of the birth attendant and then we will talk about some common practices during labor and birth. We end with some thoughts about going home with the new baby. I am not including my resources for this post. However, I did consult the literature while writing this and I am including links with supportive information as I go along.

Preparing for Labor and Birth

Remember, women have been having babies for centuries. Our bodies are made for this amazing job. Have confidence that your body will know what to do when the time comes to give birth. We are extremely fortunate to have so many ways to support you in the birth process. Embrace this new journey you are about to take. Be thoughtful and informed about the birth process and the multitude of options you have in this country. Do some research and consider your expectations and beliefs surrounding labor and birth. This will facilitate your choice of a provider and your decisions regarding pregnancy, labor and birth. Be an active participant in your pregnancy and birth experience.

Choosing a Provider

When choosing a provider first you have to consider where you would like to have your baby. Are you planning a home birth? If so a licensed midwife may be the choice for you. Licensed midwives or direct-entry midwives who are non-nurses and they are trained to do home birth. Be aware that they are not available in all states. https://mana.org

If you are still looking for a more holistic midwifery approach but not necessarily a home birth then certified nurse midwives (CNMs) may be the answer. Certified nurse midwives are advanced practice nurses who can attend birth at home, in birth centers, or in the hospital setting. Overall, CNMs have a close relationship with the medical community for collaboration. They can also provide women’s health across the lifespan and not only during pregnancy. http://www.midwife.org

If you have medical conditions or other circumstances that may put you at higher risk then you may be more comfortable with a physician overseeing your care. Or some women just prefer care by a physician. There are many options for board certified OB/GYN physicians throughout the country. https://www.acog.org/Patients

Today, many OB/GYN practices have both physicians and CNMs who work together collaboratively so you can have the best of both worlds. Regardless of your choice you should verify your provider’s credentials and reputation.

Labor and Birth Expectations

What do you know about labor and birth? Have you done this before? Is this your first baby? Have you read up on the process? Have you taken any childbirth classes? Do you know what your options are regarding care? Who’s going to be with you? Have you discussed this with your provider? Have you thought about a birth plan? I know I’m asking more questions than providing answers but really knowing about the birth process and considering what you expect and want will lessen the fear of the unknown and help you prepare in a thoughtful way and reduce your anxiety while awaiting the birth of your baby.

Birth Plans

A birth plan is not a contract or a concrete expectation of what should happen during labor and birth. It is a thoughtful list of choices surrounding birth and labor that you would prefer. There should always be room for contingency plans in case emergencies arise and care for you and the has to be changed. By working through a birth plan it assist you in considering aspects of labor and birth that you may not have thought of before you became more educated and inform on this subject. The birth plan can also prompt conversation with your provider as specific questions arise. Here is a very comprehensive birth plan template.

https://www.cmqcc.org/resource/toolkit-appendix-e-preferences-labor-and-birth-plan-guide-decision-making-and-inform-my

Labor Support

Labor and Birth Coaches

So this is a big question for “the big day.” Who do you want to support you during labor?” Please notice did I did not say, “Who do you want in the room with you?” A birth is not a “show or circus” to watch. Labor and birth are hard work and you need people around you who can help you do that. Labor coaches should only include people you trust and don’t mind being naked or doing bodily functions in front of. That probably narrows the list down a little bit. Labor coaches should know your birth plan and/or expectations. They should be able to advocate for you and work with you through the process of labor and birth.

Doulas

There are also professional trained labor coaches available. For a fee, doulas provide individualized, continuous, and comprehensive support before, during and shortly after birth. I have worked with doulas throughout my career as a CNM and I have seen them make a huge difference for laboring women and their families. An effective doula is worth their weight in gold. If you are considering a doula make sure you meet with a few to insure they will meet your needs, include your other labor support in their approach, and be available when you need them. https://www.dona.org/what-is-a-doula/

Preparing for your hospital stay

A big step for preparing for birth is packing the hospital bag. My advice is to be thoughtful and brief. For an uncomplicated vaginal or c-section birth the hospital stay is usually only 2-3 days so leave the big suitcase at home.

Don’t:

  • Buy fancy PJs. You’re only going to get body fluids all over them. Use the provided hospital gowns and underwear for at least the first 24 hours after birth.
  • Bring a full complement of toiletries. Leave the majority of your morning preparations (make-up, curlers, etc) at home. You will be in the recovery phase for a few weeks so allow yourself some down time.
  • Bring your skinny jeans to wear home. You will not fit into them. Bring loose comfortable clothing. Your maternity clothing will still work well.
  • Bring a mini nursery for the baby. The hospital will supply basic supplies for the baby while in the hospital. Use those and leave yours at home. You really only need one weather appropriate outfit to bring the baby home in and one back-up outfit (for unplanned messes). Extra blankets, toys, little shoes, bows, etc. just get soiled or lost.

Do:

  • Bring your own basic toiletries including your toothbrush, travel size shampoo, soap, etc. Bring just enough to make you feel comfortable and normal.
  • Bring your own pillow(s). Hospitals NEVER have enough. Be sure to bring ones that you can part with if they are lost or soiled beyond salvation.
  • Make sure you have a safe and properly installed car seat for the baby. Hospital staff will not let the baby go home in anything else. Have a stocked diaper bag in the car for baby’s trip home

What every woman know should before labor/birth.

Labor and birth is EXTREMELY individual and unpredictable. My biggest pet peeve is every well-meaning friend and family member who must tell every newly pregnant woman their absolutely horrific birth story. DON’T LISTEN!!! This is your labor and birth and yours alone. Be informed and keep an open mind. Collect information and facts but don’t get caught up in others drama stories. Be flexible and know that labor may be tougher than you think so be ready to consider all of your options. Communicate, communicate, communicate with your provider and your labor support team.

Care and Coping during Labor

So now you are in labor. How long will this take? How much worse is it going to get? Unfortunately, there are really no answers to these questions. That’s what makes labor so intriguing. We know so much but labor really continues to mystify us. That’s why “going with the flow” is so important. Since I could write a book about coping with labor (and many have) I’m going to focus on the specific questions that were asked.

Eating in labor

Traditionally, in the hospital setting, woman have not been fed during labor. The biggest concern is complications of anesthesia administration (if needed) with a full stomach. However, there are randomized controlled trials that do not show any increase in adverse effects on maternal or neonatal outcomes with food consumption in labor. In my experience starving a patient does not facilitate labor and can make women pretty uncomfortable. Some birthing units will allow light meals during early labor and then limit intake as the labor progresses. Honestly, women in active labor are much less interested in food and if there are complications they are more apparent as labor progresses. The bottom line is that food intake during labor should be considered on a case by case basis and definitely not automatically ruled out.

Pain management

There is a multitude of pain management options available to cope with labor. Each setting or facility will have their own options for patients. The hospital setting will have the most options available. Intravenous pain medication and the epidural are the two most common options. There are pros and cons for both options. Informed decision-making is paramount in choosing what option is right for you.  I have provided a comparison table to summarize the information.

 

 

Breech Birth

After many decades of breech birth the evidence is pretty undeniable that overall neonatal outcomes are better with c-section delivery. Vaginal breech deliveries are still performed but there are very few providers adept at vaginal breech birth. If a woman has a primary (first delivery) c-section for breech position there are still many providers that would consider a vaginal birth after c-section (VBAC) in this circumstance.

https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Mode-of-Term-Singleton-Breech-Delivery

http://americanpregnancy.org/labor-and-birth/vbac/

After Birth

So now the baby’s out. What’s next? Believe it or not things that occur right after birth are EXTREMELY important.

Skin to Skin

I cannot say enough about skin to skin contact right after birth. There is so much new research that supports early skin to skin contact for mother and baby. The skin to skin not only facilitates closeness and bonding but it actually initiates the process of the breast milk composition to be tailored specifically to the baby’s immunologic needs. It’s called the “microbiome.” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4686345/

Really interesting stuff!

Delayed cord clamping

This when the umbilical cord is not cut or clamped for several minutes (or when pulsation stops) after birth. I have actually given a mother oxygen and watched a newborn pink up with the umbilical cord still attached directly after birth. In general, delayed cord clamping is recommended if feasible. http://americanpregnancy.org/labor-and-birth/delayed-cord-clamping-risks-benefits/

Breastfeeding

Initiation and maintenance of breastfeeding can be a challenge, especially in the first few weeks. Make sure you have the support you need during your hospital stay and beyond. Most facilities provide lactation services to their new mothers. Know what your options are in your community. https://www.babyfriendlyusa.org/about-us/10-steps-and-international-code

http://www.ilca.org/why-ibclc/falc

Breast pump recommendations

It’s funny that this is one of the questions. Meg and I just went through this process. I work in an academic setting and I am surrounded by maternal child experts. Two of which are experience lactation consultants. Four experienced nurses (including the 2 lactation consultants) recommended the Medela portable double pump for general use. However, they also recommended a hospital grade (you can rent them) double breast pump for the first month after birth to establish a solid milk supply. Please note that I have no relationship with any company that sells breast pumps. Medela is widely available and parts/supplies are easy to obtain. It is also recommended to maintain individual use (meaning only you use your pump) and follow the pump instructions to maintain sanitization and cleanliness of the pump and supplies.

(Meg note: I was deciding between the Medela vs. the Spectra S1. All of my mom's LC friends/academic colleagues recommended the Medela and all of the working moms I spoke to recommended the Spectra (mostly because it is apparently much more quiet, it is hospital grade (stronger), kept its suction longer and is a 'closed' vs. open system). I am still undecided but found this review to be very helpful!

If you cannot or decide not to breastfeed

Your breasts do not know you are not going to use them for feeding. The natural process of preparing to feed a newborn will still occur to some extent. To decrease discomfort related to milk production and engorgement avoid breast stimulation. Wear a snug fitting sports bra most of the time and use icepacks and take Tylenol/ Motrin for comfort measures. Do not express milk or pump as this will continue to stimulate milk production. Over time your breasts will get the message that their services will not be needed. It may a few days to a week to get them on board with your plan.

Going Home

Everyone feels overwhelmed when they go home with this tiny being they are now responsible for. You are new parents and it is normal to feel unprepared. Give it time for you and your baby to get to know each other. Again, know your resources and accept any help that’s available… on your terms.

Rest and Recovery

As a new mother your primary responsibilities should be to care for and get to know your baby and to recover from birth. The majority of other tasks like sibling care, house work, errands, and cooking should be delegated to others as much as possible for the first few weeks. This will sound cliché but SLEEP WHEN THE BABY SLEEPS if you can. It does help when you are up several times a night with feedings.

Visitors

Well-meaning friends and family may just pop over to “help you take care of the baby” or just stand around not quite knowing what to do. This is what I tell all mothers going home from the hospital. Schedule your visitors! Figure out when you and the baby are at your best and have visitors come at that time. AND if they want to know what to do to help tell them to bring food (especially if that is their expertise). This really helps minimize this job for you and your visitors truly feel like they are helping you. It’s a win-win!

In summary...

I believe I have incorporated all of your questions in this extensive blog post. I will be glad to do a follow up post to address any additional questions that this information may bring to light!

Brenda M Gilmore DNP, CNM, FNP, CNE