This guest post was written by Austyn Smith.
Remember sex ed? All the funny phrases and shocking details that made you and all your 5th grade friends giggle nonstop at recess for the next month?! Good stuff. Important stuff. But I feel like women need ONE more sex ed class maybe around the end of high school or start of college. All about how a woman’s cycle REALLY works. What’s REALLY going on every month in terms of fertility.
When I had a hard time getting pregnant with my first baby, I came across a life-changing book, “Taking Charge of Your Fertility,” by Toni Weschelr. Having taken many science/anatomy/physiology classes in college I felt like I had a pretty good handle on how things worked, but after reading this book I realized how little we are really taught about the amazing work of art that is a woman’s body.
Weschler’s aim is to help women understand their fertility physiology for two purposes:
- To achieve pregnancy
- To practice natural birth control
Using the Fertility Awareness Method for pregnancy achievement.
Many women mistakenly believe they are infertile, when they’ve tried to conceive for 1 year without success. This can be exacerbated by irregular cycles, using the calendar to guestimate ovulation and periods, doctors prescribing clomid prematurely, doctors testing levels at the wrong time, etc. Many times infertility is not an issue, but more knowledge is needed both for patient and doctor.
Let’s start out by mapping out all the hormonal changes that happen during a normal menstrual cycle.
All of these different lines represent different hormones. I once showed this to my husband at a well-timed moment of emotion. It really helped me drive home my point that it’s just hard sometimes!
These powerful hormones are hard at work all doing different things during your cycle, preparing your body for peak fertility. The 3 fertility signs we’ll focus on here are:
- Waking Temperature
- Cervial Fluid
- Cervical Position
- Ovulation Test Strips (This one isn’t really part of the FAM but it’s a great way to back-up your results while you’re getting used to using FAM).
Tool #1—Waking Temperature
A normal pre-ovulatory temperature is 97.0-97.5 degrees. What’s cool is that after the egg has been released during ovulation, there is a big temperature surge, almost by 1 whole degree, (97.6-98.6 degrees) and it will remain high until the period comes…or pregnancy. One tricky thing about basal body temperature charts is that women can mistakenly wait until their temperature has spiked and then think, “Oh, perfect! I am about to ovulate. Time to have sex.” When in reality, the egg has already been released, and optimal conception time was a day or two earlier.
In terms of fertility tools, charting basal body temperature (BBT) can help a woman know IF she has ovulated, and WHEN she has ovulated. This can be a really helpful diagnostic tool if a woman is unsuccessful in getting pregnant. Ovulation can be delayed for many reasons—sickness, travel, stress, excessive exercise, diet changes. If you stop “trying” after the typical 14 day estimate (half of a 28 day cycle), you could miss ovulation entirely if that egg is not released for another 5 days. I once had a 54 day cycle when I was actively trying to get pregnant. Had I not been charting my temp I might have been frustrated at the slew of negative pregnancy tests, but I knew I hadn’t ovulated yet.
Another cool thing about knowing your temps is that after ovulation, the days until your period (the luteal phase) are ALWAYS the same. So once you chart a month or two and can tell your ovulation days, you know you’ll have your period in x number of days (usually 12-16). Helpful right?! This can also be a diagnostic tool, because if a luteal phase is less than 12 days after ovulation, pregnancy cannot occur. A doctor will know the exact treatment for this without you ever having to go through invasive tests.
Directions for taking waking temperature
- Take temperature first thing without even getting out of bed. Try not to move much, except to grab the thermometer.
- Take temperature orally
- Take at the same time every day, within one hour
- Make sure you’ve had three hours of consecutive sleep beforehand, or don’t count that day.
Here’s an example of a typical temperature chart.
Look at whole broad pattern, as temps will vary day to day. When there is a steady surge of temperatures .5 degrees higher than normal, you can know you’ve ovulated.
Tool #2—Cervical Fluid
The environment in a uterus is constantly changing throughout a month, while it is preparing for a potential pregnancy. Different hormone surges affect cervical mucus at various times during the cycle. A typical cycle usually follows this pattern: menstruation, nothing/dry, sticky, creamy, egg white, nothing/dry, menstruation. The most fertile type of mucus is egg white. The book has amazing pictures of different types of mucus to help familiarize yourself with all the types. If you are paying attention, you will start noticing wetness a few days before ovulation, usually on your underwear, and mucus will change. I feel naive to say that I had no idea this was normal! I thought something weird or gross was going on with me and that it didn’t happen to other women. Really it is just a signal to get moving with baby-making! This mucus is an ideal environment for sperm to thrive and move. And while we’re talking about it, most lubricant is toxic to sperm. Your best bet is to use your own fluid but if you need lubricant, use this one that is specifically meant for conception.
Directions for checking cervical mucus
- Start noticing mucus on the first day after menstruation ends. Focus on vaginal sensations throughout day.
- Check before you use bathroom (kegals before helps), about 3 times a day. Notice if it’s on your underwear throughout day. You can look on your toilet paper, on your underwear, or even check internally.
- Learn difference between semen and cervical mucus- what each type looks, feels, and stretches like. Eggwhite mucus is very stretchy, sometimes up to 8 or 9 inches!
- During the most fertile time, things should be wet often down there. Look in the toilet water during fertile time, especially after bowel movement. There will occasionally be some gooey globs of cervical mucus down in the bowl.
It might make you squeamish at first, but I have found this completely fascinating, and it has led to easier conception as a result!
Tool # 3—Cervical Position (optional)
Cervical position is also constantly changing during a menstrual cycle. At the beginning of a cycle, it starts out firm and low, then becomes closed and dry. During the fertile time, it is soft, high, open and wet. Then it returns to firm, low, closed and dry, and then finally, menstruation.
Directions for checking cervical position
Check once a day starting the day after menstruation. Wash hands with soap, and check at a consistent time every day. The most effective position for checking is squatting, but sitting on a toilet is also fine. Just be consistent.
A few other secondary fertile signs include: midcycle spotting, pain in ovaries, abdominal bloating, water retention, and breast tenderness.
Using the Fertility Awareness Method to track these 3 tools all together will give you a broad overall picture of where you stand as far as fertility is concerned. It will help you know when you are nearing your most fertile time (not always accurate by calendar!), and whether or not your body IS i fact getting fertile. You might find that your temp is changing, so you know for sure you are ovulating, but maybe you never have any egg white mucus. That can point you to the possibility that your uterine environment is hostile toward sperm. There are countless clues available from charting these variables every month. It can even help you know if you are achieving pregnancy regularly, but then miscarrying early. Knowledge is power, and the more info you can bring to your doctor the better.
FAM can be a very helpful tool in achieving pregnancy or diagnosing specifics with infertility. I’ve used it for many many years and have loved it. It’s brought me my babies, but equally important has helped me to better understand what’s happening with my body every month, physically and emotionally. And let’s just say- that’s a benefit for the entire family!
Whether you have a planned or unexpected cesarean section birth, the recovery can present challenges for any woman and being prepared for certain possibilities can help relieve you of added stress. After all, this is major abdominal surgery affecting nearly one-third of women in the United States and even higher numbers in some other countries; c-section prep and recovery are definitely worth thinking about and planning for, no matter what kind of birth you have in mind.
In Hospital Cesarean Recovery
If you know ahead of time that you will have a c-section, here are some things to bring and what to expect of your stay after delivery.
What to bring to the hospital
Aside from your normal hospital bag, these few extra items might be helpful.
- Nice shampoo and lotion. Your favorite shower items can be a nice way to treat yourself.
- Clothing. Definitely do not pack anything restrictive that could cut into your incision area. Maternity pants, sweats, and robes are all good options. These high-waisted panties have great reviews for c-section comfort and a bit of support.
- High fiber snacks. Many women report some degree of GI pain and discomfort following surgery, and constipation is not uncommon. Having some fibrous foods on hand to eat during your stay can aid in normalizing your bowels. Pack some easy snack items to munch on between meals. Apples, oranges, pears, berries, nuts, and dried fruit are all good options. Remember to drink as much water as you can!
- Slip-free shoes. Slippers with rubber soles or flip flops will be handy when you go for laps around the floor and to the bathroom. It may be difficult to regain your balance post-surgery because you use all those core muscles that are currently on the mend. So make sure your shoes have good grip.
- Fabric wrap for your waist. Purchasing a belly band or bringing some stretchy fabric to wrap snugly around your waist can really help with added support when you are moving around post-surgery. Even coughs and sneezes can be quite jarring to your incision area, so having that core stabilization is nice. It also helps to encourage your abs to come back together after separation during pregnancy (diastasis recti). Holding a pillow tight around your stomach when coughing or sneezing can also help ease the pain, but having a wrap or belly binder allows you to have support and free up your hands for holding your new baby.
What to expect post surgery
Hospital policies vary but a three or four day stay is most common. Recommendations for getting up and walking will vary based on the type of anesthesia you were given as well as how your body responded to it, but it’s not uncommon for the staff to have you up and walking around after approximately 12 hours. If 12 hours post-op falls in the middle of the night they will probably keep the catheter that was placed for surgery inserted and wait until the next morning. Some hospitals don’t suggest getting up to walk until 24 hours following surgery. This is something to discuss with your doctor to decide what is the best course of action for you personally.
Mobility After Cesarean Birth
The reasoning behind getting you up and moving as soon as is safe is to encourage good blood flow to your extremities and prevent clots. Walking will also help with digestion, but will likely wear you out, so don’t overdo it. Taking a lap around the floor every couple of hours is probably sufficient.
While you’re still in the bed you’ll likely wear cuffs around your lower legs that occasionally pump up with air and squeeze tight. These compressions lower the risk of blood clots when you are less mobile.
Some women may feel very gassy and bloated. This can make it uncomfortable to try to pass gas as well as cause discomfort to your incision area where the muscles used for bowel movements are still healing from surgery. Answering questions about whether you’ve passed gas or had a bowel movement yet can be embarrassing but the staff needs to know your GI tract is back up and working to ensure you don’t have any complications there.
Your first bowel movement can be a nerve wracking event. The act of pushing can be painful to your healing muscles so you’ll be given stool softeners beginning right after surgery to help minimize the amount of pushing required. Many women report the anticipation of pain during a bowel movement was much worse than the actual pain experienced while some women do experience severe discomfort.
Anesthesia, surgery, narcotic pain relievers, and decreased mobility can all contribute to constipation so it’s important to take the stool softeners regularly, drink plenty of water, eat wholesome fiber rich foods, and be as mobile as your energy and pain level permits to help alleviate possible GI issues.
Following all types of birth the uterus needs to contract in order to expel any remaining blood or tissue inside of it. Some women report no noticeable afterbirth pains (the uterine contractions that occur after baby is born), while others experience such strong ones that they equate them to labor pains.
Whether yours are mild or strong, they serve a purpose. It’s important for your uterus to begin the process of shrinking back down to its pre-pregnancy size. The nurses will need to assess the size and firmness of your uterus but palpating your abdomen. This is typically a fairly uncomfortable assessment whether you’ve had a cesarean or vaginal delivery. They have to press down hard to accurately assess the size of your uterus as well as how firm it is.
A shrinking, firm uterus is what they are looking for, whereas a ‘boggy’ uterus could indicate a problem requiring medication to help it contract more. The act of pressing down on it through your abdomen can help it along as well, and while they don’t usually have to press down very long it can be painful. The nurses will use this time to assess your level of bleeding as well. We recommend this afterbirth tincture.
Many women are surprised to learn that following a c-section you will still have very heavy vaginal bleeding, just like vaginal deliveries. This lasts for about 4-6 weeks and the protocol is the same—no tampons allowed, only big absorbent pads. Your caregiver will likely provide some large mesh disposable underwear to use after delivery. These are a great option for the first few days following birth as they typically don’t irritate your incision site or put any pressure on that area the way some underwear elastic can—basically they are glorious! Stocking up on these as well as large overnight pads (these are our favorites) is a good idea since you’ll be changing them frequently the first couple of weeks.
Passing some heavy clots is fairly normal. The rule of thumb is generally if you pass a clot smaller than your fist, it’s okay. Anything larger—call your doctor.
Cesarean Incision care
Following surgery, your incision will be covered with a bandage that usually isn’t removed until the next day. Your incision will either be closed with sutures (dissolvable or non-dissolvable), staples, steri strips, or surgical glue on your abdomen. Staples and some types of sutures will need to be removed by your doctor a few days after you’re discharged. Before being discharged you will be given incision care instructions specific to your type of closure.
Keep in mind that your incision will look very different immediately after surgery than it will eventually. Most incisions will shrink down considerably and flatten to a thin line. Itching and tenderness around your incision is normal but annoying, anything more severe than that would warrant a call to your doctor. Try this spray or salve for expedited healing and scar reducing.
Advocate for Yourself at the Hospital and Home
Recovering from surgery, adjusting to new motherhood, getting the hang of breastfeeding—the first few days after a cesarean can be stressful and overwhelming. It’s important to make your needs known to the staff. If they don’t know your wishes, they can’t follow them. It’s your job to advocate for yourself and your new baby. Be open and clear with the hospital staff and expect the same from them—you’ll both benefit from respectful and clear communication. Never be afraid to request a new nurse if you aren’t receiving the care you feel you need or even if your personalities are not meshing well.
You never get the first few days with your new baby back again and they’re too precious to have marred by having someone around who puts you on edge, this goes for visitors and family as well. While well meaning and excited for you, visitors and family often end up putting more strain on mom than support. If friends want to come see the new baby make them earn the visit! Have them hold the baby while you take a shower or nap. Fold a basket of laundry while you chat. Fix some lunch or start a freezer meal in the oven for you. Have older kids? Ask friends to take them to the park for a hour and let them peek at baby when the come to pick them up.
You might be surprised at how eager people are to help when given specific tasks! But if the thought of a house full of people fills you with dread then don’t put yourself through it. Ask your partner or a supportive family member or friend to spread the word that you aren’t ready for visitors yet but appreciate everyone’s well wishes and put a sign on the door with the same sentiments.
Breastfeeding after a Cesarean Section
The first few days, your breasts produce a nutrient-dense, antibody-rich yellow liquid called colostrum. Colostrum is nature’s first perfect food for baby and provides all the nutrition, immunity, and vitamins your baby needs. Colostrum usually transitions to mature breast milk within 2-6 days of delivery. It’s not unusual for milk production, or ‘coming in’, to be delayed following a cesarean due to the use of IV fluids and other medications such as Pitocin. Once this occurs your breasts will be much larger and you may experience some engorgement. The best remedy for the discomfort of engorgement is removal of milk from the breast by the baby. Your baby will signal the amount of milk she needs your breasts to make and your supply will normalize. There are wonderful breastfeeding resources to be found here.
Some women have no additional difficulties breastfeeding following a cesarean than after a vaginal delivery but some find positioning difficult while their incision area is still tender (we love this breastfeeding pillow for keeping off your incision). Utilize the lactation consultants at the hospital as much as you need them while there. It’s a great idea to have an outpatient lactation consultant’s contact info saved already prior to delivery in the event you need more assistance following discharge. Ask friends who have had fulfilling breastfeeding relationships with their children for references to check out before you’re home with a new baby, sleep deprived, and probably pretty emotional.
The International Cesarean Awareness Network has some great info available regarding breastfeeding after a cesarean that can be found here. Kellymom.com is a great breastfeeding resource website in general and wonderful article about breastfeeding after cesarean can be found here.
Recovery at home after Cesarean Birth
photo via @littlewhale3
Bringing a new baby home is an exciting time for everyone, but don’t forget to take care of yourself as well. Your baby needs a cared for mother as much as she needs to be cared for herself. Accept offers of help! People love to feel useful but may not know how best to help or are hesitant to step on toes. Give them direction and don’t be afraid to set boundaries when it comes to having people over. Physically, you’ll need to take it easy for a while. It’s often recommended that you not to lift anything heavier than the baby or drive for 2 weeks. After that, follow your body’s cues and rest as much as possible.
The best way to encourage a speedy recovery is to allow your body the time it needs to heal. Rushing the process can result in setbacks that will only prolong it. Once you feel up to it, which will vary for every woman, light exercises like walking can be beneficial.
Medication After C Section Birth
The types of medications prescribed for pain will vary from doctor to doctor and patient to patient. Ask someone (like your partner) to keep track of what time you take your medications as trying to remember on a sleep deprived brain is probably not the best plan. Many people recommend taking the meds on a strict schedule the first few days regardless of whether you’re in enough pain to feel you need it yet. This is suggested to prevent the pain getting ahead of you and then having to wait for the meds to kick in. Some people prefer to begin a slow weaning process off of the meds sooner if they don’t like the way they feel on them.
Pay attention to your reaction to the meds and to your pain level and make the best decision for your body. Don’t hesitate to call a nurse or doctor if you are concerned about any symptoms. There are many post-surgery symptoms that while totally benign, can alarm you if you haven’t experienced them before. Reach out for information when you need to.
Some women report referred pain in their shoulder during recovery. Not all women experience it, and it seems to be worse for patients who had general anesthesia vs. spinal anesthesia. The pain is due to irritation of the diaphragm, and trapped gas. Anti-gas medication and walking will help. The more regular you can get with your bowels, the sooner the pain will subside.
Bed comfort for Cesarean Mamas
Keep that wrap handy for when you get in and out of bed, to help with support. Wrapping before you get up and lay down provides stability and a little bit of comfort. Feel free to even keep it on for a while so you don’t have to constantly adjust it. Some women find it difficult to get up from a flat lying position in bed. Roll on your side first and push up with your hands to prevent straining your abdominal muscles. If this is still too uncomfortable try putting several pillows behind your back and rest or sleep in a reclined position. Your pelvis will be working to get back in its pre-pregnancy position and can ache after delivery. Try sleeping with a special pillow between your knees and ankles to help alleviate some pressure.
There are lots of hormonal changes that take place right after delivery, and your body is also getting rid of a lot of excess fluid it carried while pregnant as well as any intravenous fluids given before, during, and after surgery. All of these factors combined might have you waking up at night to find the bedding and your clothes completely soaked. For the first couple of weeks, some women sleep on an extra sheet folded in half, or a towel so they can remove it midway through the night to have clean linens beneath them. Others suggest having clean pajamas handy for a quick middle of the night change. Remember to keep drinking a lot of water. It sounds counter-intuitive to replace excess fluid you are losing through sweat, but remember how much water is going toward milk production, so it’s necessary to keep things functioning well, and restore balance.
Mobility After A Cesarean Birth
For some women, stairs prove to be tiring and awkward to navigate the first couple of weeks. If possible, you might consider setting things up at home so that all the supplies for baby and for yourself will be mostly on one floor. Then stay in that area most of the day minimizing the need to navigate the stairs repeatedly. For other women the lure of being in their own bed on the second floor is enough to make it worth it. Just don’t hesitate to ask for help going up and down, even just having someone walk along beside you can be reassuring.
Keep in mind that your center of gravity has drastically changed and your body is still adjusting to that as well as healing from surgery. It’s not uncommon to feel off balance and it’s better to have help nearby just in case. Consider having pillows handy on both floors should you need to squeeze one against your abdomen while coughing or sneezing. Plan to give yourself plenty of time to recover, should it happen sooner than you planned—it will be a pleasant surprise! Be gentle with yourself. All women are different. There is no ‘right’ amount of time for recovery. There are no hard and fast rules for a healing timeline. Listen to your body, introduce things slowly back into your routine, and ease into motherhood.
photo via @chan_askins
Emotional Recovery after Cesarean Birth
Take time to evaluate your feelings about your cesarean experience. Mothers with planned cesareans have the opportunity to consider this beforehand but may still find themselves overwhelmed with conflicting emotions after the fact. Mothers who had an unexpected cesarean may feel blindsided and it’s important to take stock of all of these emotions and know that they are all valid.
It’s ok to feel disappointed in the way your baby was born. If you had planned for or envisioned things going differently, it’s completely normal to be sad it didn’t work out that way. This does not take away from the love and joy you have for your child. You can be deliriously happy that they are here and still be upset about how they came. Birth trauma may sound like a dramatic way to describe it but it’s not uncommon for women to experience varying degrees of trauma after a cesarean birth whether it was planned or unexpected, or especially if it was an emergency situation.
Your Feelings Are Your Own
Birth is a highly emotional experience and any emotions you have towards your child’s birth are valid and you are not alone in feeling them. Perhaps your cesarean was calm, you felt respected, and things went smoothly—this is the hope for all women experiencing a cesarean. Many women feel at peace with their sections and might not understand why others are seemingly devastated by theirs. Other women are deeply saddened by having had a section and cannot fathom why someone would choose to have one unless necessary.
When speaking with other mothers or mothers-to-be, be respectful of others’ experiences and perceptions of their experiences. Just because you loved your c section doesn’t mean another woman is wrong for disliking hers. Just because you hated your experience doesn’t mean another woman is wrong for liking hers. Evaluate and process your own feelings towards your cesarean and reach out for help.
Find others who can be supportive of your journey of processing your cesarean. The International Cesarean Awareness Network provides support, education, and advocacy for women experiencing cesareans and interested in VBAC (vaginal birth after cesarean.) ICAN can be found online here as well as on Facebook and Instagram. They have local chapters across the world which can be located on their website. Many of their chapters have individual Facebook groups and hold in person meetings for support. Talking to other women who have experienced a cesarean is an invaluable resource for processing your experience as well as planning for a cesarean section or a VBAC.
Birth is hard. Birth is beautiful. Birth is transformative. Take the time to take care of yourself and be proud of what you’ve accomplished and experienced for your new baby.
This guest post was written by Austyn Smith and a very special thanks Laura Shawver and Elizabeth Quinn who provided lots of great information while writing this post.
- Hamilton BE, Martin JA, Osterman MJK, et al. Births: Final data for 2014. National vital statistics reports; vol 64 no 12. Hyattsville, MD: National Center for Health Statistics. 2015. https://www.cdc.gov/nchs/data/nvsr/nvsr64/nvsr64_12.pdf
- Althabe,Fernando; Belizán, José M.; Betrán, Ana P.; Gibbons, Luz; Lauer, Jeremy A.; Merialdi Mario. The Global Numbers and Costs of Additionally Needed and Unnecessary Caesarean Sections Performed per Year: Overuse as a Barrier to Universal Coverage. World Health Report. 2010; Background paper, 30. Health Systems Financing. World Health Organization. 2010. [January 22, 2017]. http://www.who.int/healthsystems/topics/financing/healthreport/30C-sectioncosts.pdf
- Basar, Birsen; Cift, Tayfur; Olmez, Fatma; Ustunyurt, Emin; Yilmaz, Canan. Shoulder Tip Pain After Cesarean Section. Journal of Clinical and Diagnostic Research. Ausust, 1, 2015 [January 22, 2017]. Bethesda MD: National Center for Biotechnology Information. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4576593/
Your Intuition, Your Gut, Mama Instincts — Whatever You Call It, Listen to It
Pregnancy, labor, and birth are monumental, life changing events. Doing research, educating yourself, being fully prepared, taking proper precautions, and trusting your OB and/or midwife are all important. However, keep in mind that women have been going through this since the beginning of time. Our bodies are engineered to create, sustain, and bring life into this world. Birth does not always go as planned, or as “textbook” as we’d like. There are times when preparation, education, and practitioner’s advice take a back seat and a powerful voice comes into play. Your intuition. A mother’s intuition is an important voice to pay attention to, and the more prepared and educated you are up front, the more you will be able to trust that your gut feelings are coming from a vital place, rather than from fear and panic. Below are some powerful accounts from women who paid attention to what their body was telling them, and the positive outcomes that followed.
Mamas Who Are Glad They Followed Their Intuition
“With my second baby’s birth, I had been 3 cm dilated for over two weeks and having contractions on and off, too. The night before my son was born (1.5 weeks after my due date and the day before my induction), I told my husband, that we needed to call my dad if I had three strong contractions and/or my water broke, because I just felt it would be a quick labor. At 2:30am I had those strong contractions, 3:00am my water broke and at 4:27am my baby was born! If I hadn’t had that feeling of things going quickly after a slow buildup, Sullivan may have been born in the car or even at home!” – Jesica Boro
“…My son was turned. I was feeling nauseous from not eating for so long. The midwife was trying to turn him and couldn’t so they wanted to get a doctor to help. I could feel it was coming time for me to have an emergency c-section. Before the doctor came into the room, I got on my hands and knees which [made me] throw up and that caused my son to turn so I delivered him naturally like I wanted. – @Celeste2401
“A week after i had my daughter in June, I was terribly ill. At a time when I was supposed to be mending and enjoying my new baby, I was so sick that all I could do was cry. My friends and family told me it was just after birth cramping and that I was still healing, but I finally decided to call in to the midwife and let her know what was going on. She advised me to go to the ER right away, and hours later I was having an emergency d&c for a retained placenta that was hemorrhaging. I am so glad I listened to my body. If I had waited any longer it could have been a much different outcome.” — Jamie Van Nuys
“I was laboring in the labor tub. I had only been in for 15 minutes and was just checked 30 minutes prior and only 5 cm. My intuition told me to get out and go lay in the bed (they don’t let you deliver in the tubs). I was standing up and felt the urge to push. Two pushes later and about two minutes later my son was born.” — Brittani Fink
“When I was in labor about a month ago, we were waiting for my mother-in-law to come watch our two older children. When she was about 40 minutes away, I got the feeling that we had to leave for the hospital NOW. My husband was a bit skeptical because I had only been in labor for about two hours. But, he went and woke up the neighbors in the middle of the night and we left. Our baby was born about one hour later. If we had waited, I would have had him in the car!” — Nicole Kavanaugh
“After three cesareans and no natural births I was told by my doctors that my body “wouldn’t know how to labor” so I decided to get a private midwife, not step foot in a hospital again for the rest of my pregnancy, and set my mind on a homebirth. Everyone gave me their unwanted opinions about it all and only my husband stood by me. After about 100 hours of labor, I gave birth at 42 weeks + 1 day to my biggest baby ever (all 9 lbs 10 oz. of him) in a pool in my living room! THE best feeling ever! I’m now 39 weeks with baby number 5, I have the same midwife as last time, and I cannot wait to give birth to this baby. I never believed for a second my body was broken, and I proved all the doctors and midwives at the hospital wrong. I did it.” — Rose McMurrie, Liverpool UK
“After the birth of my son last Thursday I was over the moon…but something kept telling me something was wrong and after the experience I went through I will never doubt my intuition! Three days after birth I knew something was wrong when I had been experiencing severe edema, painful headaches that wouldn’t go away, and sky high blood pressure. I decided to go to the emergency room and the doctors then told me I had developed postpartum preeclampsia. I was immediately admitted, I was at high risk for seizures, a stroke and even the possibility of going into a coma. After four very long, emotional, rough days I am finally responding to medication that is maintaining and stabilizing my blood pressure. I am back home with my baby and my fiance and most importantly I am alive and well…If I didn’t rush to the emergency room when I did, the signs I was showing could have been fatal for me. I appreciate my life so much more.” — @Ox.vs
“My first birth, I was in labor barely an hour when I told my husband to call the midwife. I had to push before she even got there. She didn’t even check me, but when I said I had to push she called the backup and got set up and my daughter was born 20 minutes later. So glad I didn’t fall into the thought that first births take a long time, or else I would have been birthing unassisted. Very glad to have planned a homebirth from the get go! Though my midwife training would have come in handy!” — Meganne Odile Coyle
“My baby’s bilirubin levels were high. Day three of life, the pediatrician made the assumption I wasn’t producing enough milk. “The baby will eat it if it’s there,” he said, and told us we needed to supplement with formula. I asked for a pump and made them weigh him before and after a feeding as well as pumped after. I was producing more than enough and wouldn’t you know it, his chart was being read wrong and he had been back to normal levels on day 2. Still breastfeeding like a champ nine months later.” — Marji Taylor
“At 38 weeks 5 days pregnant with my first son, I woke up in the middle of the night and found myself bleeding. I called my midwife who immediately recommended that I go into L&D and she would meet us there. Upon arrival at L&D the attending doctor recommended an induction and suspected that I was likely experiencing placenta abruption (i also had a low lying placenta). My partner and I decided to wait on the induction and the hospital admitted me for observation and told us to let them know when we were ready to be induced. But somehow, I felt that my son wasn’t ready to come. The bleeding eventually subsided, and after 17 hours of being observed, after one doctor after another came in telling us we needed to be induced, and braving through judgemental looks and fending off their repeated push to have an induction; against doctor’s orders, we decided to check ourselves out and go home. A day later, I went into active labor. After 9 hours, in the safety and comfort of our small apartment, with my partner and midwife by my side, my son was born at home. It was the home birth that we had wanted. I listened to my body and my son. My partner stood by my side and although it was very scary to leave the hospital, it was the best decision we made that day.” – @Bbmee
“The nurses wanted to check my dilation when I arrived at the hospital. I told them not to bother—I wasn’t fully dilated yet but was in transition and it would be soon. I told them my second stage is always under 5 minutes. They didn’t believe me. When I felt a shift I told the doctor I was ready to push and baby was coming. She checked and said, “No, you’re only at an 8.” She stood up and walked to the sink, and I called to my husband (who always catches our babies and who was ready), “She’s coming, catch her! “I heard his calm voice reply “I’m here, I’ve got her.” And she was born into her father’s hands at that moment, with no assistance from others. Which was exactly as I had wished.” — Elisabeth
“After 26 hours of non-medicated labor with a baby who had his head turned sideways and was in no hurry to come out, I decided to transfer from the birth center to the hospital to get an epidural. I knew that even if I did dilate all the way, I wouldn’t have enough energy to push my baby out on my own. After the epidural, I was able to get a few hours of sleep and when I woke up I was fully dilated and ready to push! I truly believe I was able to have a vaginal birth because of the sleep I got after the epidural! I am happy that I listened to my body and I have no regrets! My birth was hard, but that is what it was. My birth.” — Kristi Merideth
“I was on hour 6 or 7 of my twelve hour homebirth when I began to hyperventilate. I was in the birth tub facing away from everyone, so I don’t think they knew I was starting to lose it. I hadn’t dilated much at that point; how little, I don’t know. But I sensed the air of concern. I didn’t want to go to the hospital. That was my greatest fear. I began going down the “what if” spiral of doom and lost control of my breathing. Just then my intuition kicked in and told me to look up and open my eyes. A birth affirmation my friend made me came into view. It said: Think strong. Feel strong. Be strong. I began saying that over and over in my mind, pushing away the fear. My breath calmed, my outlook improved. I could do this. I would do this. At the next check, I was fully dilated!” — Katie Bunten
“When you reach the end of what you should know, you will be at the beginning of what you should sense.” ― Kahlil Gibran, Sand and Foam
I took a class in college called “Mind Body Health.” It was fascinating. It was all about the immense power of the mind and how it actually influences our physical chemical processes. Our attitude and thoughts can determine how disease prone we are, our life expectancy, our moods, our relationships, and even career success.
The Power of Meditation
The professor told a story of his friend who had a pretty aggressive cancer. The doctor wanted to do some drastic surgeries, but she was really against it. Her white blood cell count was really low, and she believed that she could increase her count by doing meditation. Her doctor gave her a few weeks and said if it wasn’t at a certain point, he would have no other choice but the surgery. She said she’d work on it. And then she really worked hard. She meditated for a few hours every day and envisioned in as much detail as possible white blood cells being produced and flowing through her body. She went back at the designated time, and her numbers had increased dramatically. It still wasn’t at a level the doctor was comfortable with, but he was pretty impressed at the progress. She asked for an extension, and he agreed. Again she worked really hard at meditating and producing more cells. Again, when she returned, her count had drastically improved. This happened one more time and she was able to avoid the surgery.
The mind truly is a powerful tool, and I believe an untapped resource to our emotional and physical well being. There’s been countless studies on the benefits of mindfulness meditation. It improves overall physical health, reduces stress, improves relationships, and on and on. Expecting mothers who meditate have less stress, less discomfort in pregnancy, and even shorter labors!
Mindfulness as Daily Self Care
As a mother, I have found mindfulness practices to be invaluable. I was first introduced to the power of meditation when I decided to study hypnobabies with my 3rd pregnancy. I practiced every day for about 45 minutes. Positive affirmations like “I am strong, and I listen to my powerful body” started to become the common thoughts floating around my head. I started to really believe that I could have the birth I was envisioning, even down to how far dilated I would be when I arrived at the hospital. When I delivered my baby almost exactly as I had pictured it all those weeks, I knew there was something to this meditation thing.
Meditation In Hard Times
I was re-introduced to meditation and mindfulness through therapy as I was experiencing some major hiccups in my family relationships. Again, this simple practice produced amazing results. I found myself more confident, filled with peace, filled with love and energy, even amidst emotional pain I was living with. My therapist told me that repetitive behaviors create routes in your brain and your brain will want to take the easiest route to get a signal where it needs to go. So if I normally cope with stress by Netflix and ice cream binging (anyone?!), then in the future when I feel stressed, I will have strong cravings to open that freezer. If we can replace a negative reaction (yelling at the kids) with a positive one (doing a meditation) that route will start to become easier for our brain and we will crave THOSE behaviors more. Interesting, right?
I have continued this practice and try to meditate several times a week. Just today after a rough morning with the kids (barking orders, drill-sergeant style, and constant threats until they were out the door—please tell me you have mornings like this!), I could feel the stress and tension inside my body. My heart was pounding, my shoulders were tight and high, my eyebrows were scowled, and my breathing was shallow. Instead of succumbing to this being a horrible day, I decided to do a quick stress reduction meditation. I got my preschooler set up with some toys and laid down with my phone and earbuds and did a 10 minute session. It completely worked. Deep breathing, focusing on the sensation of my breath, feeling every part of my body, being present in the moment, imagining all the negative energy flowing out of me…it all worked. The mood was just gone. I was able to get up and play with my daughter and start getting stuff done.
Mamas everywhere can greatly benefit from this powerful practice!
Here’s a few resources to help get you started:
- Expectful—An app for pregnant mamas, and non-pregnant mamas as a way to connect with yourself and your babies. Free trial available.
- Headspace—mindfulness that moves you through training stages. They also have categories for a variety of situations: pregnancy, stress, sleep, work, etc. As little as 10 minutes a day. Plus the leader has a lovely British accent so it’s fun to listen to.
- Hypnobabies—I highly recommend this if you’re thinking about a natural unmedicated birth. Many women have very positive empowering experiences birthing their babies. At the very least, it’s a wonderful meditative practice that completely soothes body and mind and connects you to baby.
There you have it. The answer to a more peaceful you! Can I still pound a pint of Ben & Jerry’s while I watch 4 hours of Gilmore Girls? YES! And sometimes I really enjoy it. But I’ve added in some other things too and the balance is coming! Hang in there mamas. Happy meditating!
This post is written by Austyn Smith.
Upon becoming a mother, I really worried about being a good one. I wanted to fill my child’s life with happiness and comfort, to teach him, feed him, love him, and float from one blissful moment to the next. I’d read a lot books, talked to friends, babysat, and I felt ready. I naively thought the best way to achieve these high expectations was to give everything I had to serving the baby. Isn’t this how “good” mothers do it? After months and months of striving for these unrealistic expectations, I hit rock bottom. One day I found myself in a blubbering mess while on the phone with my boss (poor guy). I couldn’t stop crying. I felt like my soul had been sucked out of me and a hollow robot shell was left going through the motions. Worst of all I was filled with resentment toward my baby and husband, like this was somehow their fault. I knew something was wrong but had no idea how to fix it. The only reasonable explanation I could come to is that I wasn’t cut out to be a mother, and I wish I’d known beforehand.
Valuing Self Care as a Mother
It took several more years of life experience to learn the invaluable lesson and secret to enjoying motherhood and life—The value of self care. In order for me to become the best version of myself I needed to invest time in, and practice loving myself.
I received quick validation as I first started trying this out. I had an obligation fall through one morning and found myself with 2 hours of unexpected free time. I initially started running through my to-do list in my mind and then remembered I was going to start trying more self-care. It was a beautiful sunny day (sometimes a rare occasion in Portland, OR) so I called my good friend to see if she wanted to join me in a walk. She did. We walked and talked and connected on so many levels. I came home completely energized, and felt so good that I wanted to do something for someone else. I thought of my friend *Jenni who just had major surgery and I decided to make her dinner. I surprised her later on and she was so grateful. I was full to the brim. I learned that self-care does not breed selfishness (as I had feared), but rather it breeds a greater capacity to love.
The airline safety advice to secure your own oxygen masks before helping children is a good analogy. If you you pass out while helping your child, due to lack of oxygen, you are no good to anyone. The same goes for motherhood and self-care. You can’t give from an empty bucket; and if you are trying to, what you are giving out is low quality and pretty useless. This is a great children’s book about filling your and other’s buckets.
I adopted this new affirmation from Melody Beattie. “I am a gift to myself and the universe. Nurturing self-care delivers that gift in its highest form.”
So, how can a mother invest in herself and still be a useful, productive woman, wife, and mother? I have a few suggestions.
Things to keep in mind when first starting out
Drop the guilt
Guilt serves one purpose, to alert us when we’ve done something wrong so that we can make restitution. That’s it. It is not helpful to let it creep in where it doesn’t belong and tell us lies about not being enough, or that we are selfish for leaving the children to do something for ourselves. Dismiss the guilt and stick to your guns. Write down some positive statements and read through them at the beginning of your time. Like these:
- When I take care of my needs first, I am a better mother.
- If I fill my bucket, I will be refreshed and ready to face my responsibilities with more energy and joy.
- I am teaching my children that my needs are important. When they are parents they will understand that investing in themselves is worthwhile.
Start with some ground rules
Boundaries are your friend. Set some for the children and for yourself. These are the rules I follow.
- No bothering mom allowed. If my kids disturb me during my “quiet time” they get to lay in their beds for the remainder of the time. More on how to occupy children during Mom’s Time later.
- Set daily and weekly appointments with myself and treat them as such. If I receive an invitation or am asked a favor that overlaps my scheduled time, the answer is usually no. I have an unbreakable appointment…with myself!
- No to-do lists allowed. No running errands. I am only allowed to do things that rejuvenate my soul. I keep a list of ideas handy (more on that later).
- No “vegging out” on social media. Not only is it a time trap, but comparison to social media “perfection” can be a quick recipe for depression. Right now, I need something to recharge me.
Learn to say no
We all love to be “team players,” help out friends, and volunteer ourselves. These are all good things, but they have to be done in balance. I think of the balance as a pendulum. On one side is service to others, and on the other side is selfishness. It can take a lot of practice to understand what it feels like for the pendulum to rest in the middle; a nice balance of meeting my needs and helping when it would fill my bucket to help. I remember the mantra “Just because I can, doesn’t mean that I have to.” I also like to Brene Brown’s philosophy to “choose discomfort over resentment.” It can be uncomfortable to say no to making 60 cupcakes for the PTA fundraiser that’s tomorrow, but if you will be aggressively whipping that batter with resentment, it’s better to decline.
Ask for help
This can be very hard for someone who is used to being a “people pleaser.” Guilt may creep in, but remember the purpose of guilt? To remind us when we’ve done something WRONG! Asking help of people is not wrong. In fact, accepting help provides an opportunity for others to show their love for you. Let one of your friends drive a carpool, or come and fold your laundry when you are sick. Let them love you and your children.
How to logistically make time for self care
Make a plan
Childcare: If you have young children at home, it can be tricky to get some time, but can also be the phase with the most urgent need for self care. You might need to get creative. Here’s some suggestions:
- Set up a babysitting co-op with some friends. Sit down together and assign a few days a month for each of you where you will watch everyone else’s children for a few hours at a time.
- See if your community or rec center offers babysitting. Some will give up to a few hours at a time for a small fee. Remember, no errand running allowed!
- Take advantage of gym time. Many gyms offer a few hours of childcare at a time while you exercise. Use the extra hour after you are done working out to sit in the hot tub or sauna, take a long leisurely bath, do a mediation, or even just sit in the lobby with a magazine or book.
- Swap with your partner. Choose one night a week that you have “off.” Hand off all responsibilities to your husband, while you go have some fun for a few hours. He gets another night for himself. This has worked great for my husband and me. I sometimes choose Saturday morning instead of an evening (because I’m usually exhausted by 4pm). That’s awesome too!
- For some daily peace, instigate quiet time. I have been doing this for years. Right after lunch, the kids know they go up to their rooms for an hour. I usually pull out some activities that are reserved only for quiet time, so it’s exciting for them (books, puzzles, building toys—things that occupy their minds), and they have to play quietly.
They know they have to stay inside their room and I come to get them when their time is up. I get an hour to myself to take a quick nap, read, meditate, connect spiritually, or work on a hobby or project. It’s the perfect break I need to recharge and then I’m ready to see my kiddos and tackle the afternoon. This can also be particularly helpful when you have a new baby. You can even do it a few times a day in smaller doses.
Give yourself an allowance
It makes quite a difference to have money set aside that is just for you. Add it into the budget. Buying something nice for yourself is an act of love, and it makes you feel really good. It is much easier to say “yes” to fun activities, lunch dates, or nights out with friends when you have some money set aside for that exact purpose.
Get to know yourself
- Make a list of things that bring you joy. If you are not used to having this time to yourself, you may find yourself wandering around wondering what in the world to do with your time. Take some time beforehand to write down a list of things and activities you love to do. You might have to think back to before motherhood!
- Think about your personality and your needs. Are you energized by being with people (extroverted) or does that drain you (introverted)? What phase of life are you in? What do you want and need the most right now? Some good girl talk? A massage? To sleep for 3 hours? A combination?
List of ideas for Self-Care
- Gather a support group of friends that can have “real talk,” and get together regularly. I credit this one thing for my emotional health the past several years, and those girls are my most prized gifts. Our get togethers are safe places where there is love and acceptance, healing and support.
- Keep it well rounded. Make a list of physical activities you enjoy, things that uplift you spiritually, and things that are healing emotionally.
- See a therapist regularly. Even if it’s once a quarter. My college psych 101 teacher stated, “Even the healthiest person will benefit from seeing a therapist.”
- Meditate. Listen to guided meditations, long or short. Light a candle. Do it while some tea is steeping. Indoors or outdoors. Meditation classes can also be fun. Keep a list of affirmations handy. Statements about you as a woman, a person, a mother.
- Yoga. It doesn’t have to be a physically challenging class (unless that’s what you want!) to be effective. Even some gentle yoga stretches or poses can rejuvenate your body and soul.
- Listen to an uplifting podcast, book on tape, or music.
- Take walks in different environments. Get to know your city. Find a peaceful garden, a country road, or a neighborhood with stunning houses.
- Schedule regular massages.
- Take a bubble bath. Add some bath salts or essential oils, light some candles, play some music, read a book. Really use your senses as you soak.
- Sleep. Make your nap really restful with cozy blankets, temperature, clothes, lighting, and quiet. You’ll awake completely refreshed.
- Create something. Draw, paint, sew, decorate, write. A friend once said she tries to do one thing everyday that cannot be undone (by the kids!). It makes her feel like she accomplished something.
- Discover a new hobby. Take a class, go to a craft store, take up a new sport, make some plans.
- Do things that enliven your senses. Light aromatic candles, use essential oils, discover new music/soothing sounds, gaze at beautiful or interesting art, snuggle with fluffy blankets or buy a new sweater. Taste new flavors at a restaurant, sample new drinks—seasonal flavors are fun.
- Write. Start a self care journal. Record your recent thoughts, dreams, and ideas. Include things you are grateful for.
- Ask yourself, “What do I need to do to take care of myself today, or for this moment?” Truly listen to yourself, and trust the answer that comes.
Learning to love and care for yourself leads to the best version of you. It’s a very worthy and worthwhile investment. Best of all, you’ll find an increased capacity and love for your family and others.
Questions for Interviewing a Midwife
A midwife you can trust and feel comfortable with is worth her weight in gold. Birthing a baby is an incredibly personal and intense experience in it’s own right. Having a professional there to assist you should only offer comfort and help. It’s vital that you find someone that you not only click with, but who you can trust wholeheartedly. Here’s a list of interview questions to start you on your journey to finding your midwife!
A good midwife will be able to speak frankly and to balance your needs/desires with the safety of you and your baby. The midwifery philosophy is generally hands off and more about trusting your body with guidance offered when desired by the mother and medical intervention implemented when required. At the same time they are extremely engaged with you throughout your care with appointments that usually last one hour and covering not only any physical concerns and questions, but also your emotional state as well. A good book to get you started if you’re new to the idea of hiring a midwife is Ina May’s Guide to Childbirth or watch The Business of Being Born.
Basics in Determining if a Midwife is Right for You
- How long have you been practicing? How many births have you attended? What are your credentials?
- Are you available via phone/text? Specific days/hours you aren’t available?
- What is your practice like—are you in practice solo or with other midwives? Are there additional staff like doulas?
- Is your practice involved in the natural birthing community at all? Are there resources for me to connect with other women?
- Do you work with specific OBs? Do you have a good rapport with OBs at the hospital? How does the hospital view you and your practice?
- How many planned births do you accept per month? If you are not available when I go into labor, who is your back-up?
- What is your overall philosophy on pregnancy, delivery, and birth?
- What do you feel your role is as a midwife?
- Where do you attend deliveries? Birth center? Home? Hospital?
- How do you feel about water births?
- Have you ever lost a baby or mother? What happened?
- What is your hospital transfer rate?
- What are your fees? Do you offer payment plans? Accept insurance?
Pregnancy Topics to Cover in Midwife Interviews
- What screenings and tests do you recommend? Which ones do you offer in house vs send me somewhere else to get?
- Have you ever worked with gestational diabetes? What is the process?
- What are your views on nutrition and exercise during pregnancy? Do you offer resources?
- Voice specific pregnancy concerns — does she offer good solutions and recommendations?
- Do you require a Group B Strep test? What if I test positive for Group B Strep?
- If I become “high risk” what is the process? When would I have to transfer to an OB?
- What “high risk” situations do you have experience with? Twins? Breech? Advanced maternal age? Pre-eclampsia?
Labor and Delivery Questions When Choosing a Midwife
- At what point in labor do you prefer to get involved? When would I call you?
- What is your view on VBACs? What is your success rate?
- Potential birth emergencies—what are they and how would you handle each one? Tell me some situations you have dealt with (Hemorrhaging, partial placenta delivery, shoulder dystocia, nuchal cord or limb).
- Are you equipped in neonatal resuscitation? How often do you refresh your training in this area? Tell me some experiences.
- What equipment do you bring with you to a delivery?
- If my baby is breech before delivery, what would you recommend we try? If it does not turn, would you still deliver? Have you had experience with this—both successful turning and breech delivery?
- In labor do you routinely perform vaginal checks?
- In what situation would an episiotomy be performed?
- If a labor stalls, what is the process?
- If my water breaks, is there a time limit to when I need to deliver by?
- In the event that I go past my due date, what is your philosophy and what would be the process?
- In the event I had to be transferred to a hospital, what would be the process? Who would drive me? Is there a specific hospital we’d go to? Would you come with me, or stay with me through delivery?
- Can you offer me some references from mothers who have had to transfer?
- How do you feel about delayed cord clamping?
- Can my husband catch the baby? Can I catch my own baby?
Postpartum Questions for your Midwife
- What postpartum care do you offer (herbal baths, sleep in the bed, meals served, massage)?
- What newborn care do you provide?
- Do you offer newborn testing? Do you require it?
- If I deliver at a birth center, how long would I stay there afterward?
- Do you make postpartum home visits? When?
- Will you offer breastfeeding support?
- Do you offer placenta encapsulation?
- When will I switch over to pediatrician care for my baby?
- Can I continue to see you for annual well-woman visits?
Question to Ask Yourself After the Visit
Overall, what general feeling do you have after talking with the midwife? How does your partner feel? A good sign would be connection, feelings of excitement, trust, and calm. Uneasiness, trepidation, or uncertainty are good clues that you should continue looking.
When you are thorough with research and questions, your gut feeling can really carry a lot of weight. Trust your judgement.
How to take care of yourself postpartum after a vaginal birth
I often hear women talk about how unprepared they were for their postpartum recovery period. I, myself was completely shocked that there even WAS a recovery the first time around. I thought you just pushed a baby out and then it was all over. I had never really heard anyone talk about it and I somehow hadn’t thought to read about it while I was pregnant. Recovering from birth is definitely something that needs more attention and emphasis as women prepare for labor and delivery. The better informed a mother is, the smoother recovery can go. Here’s some things to expect about the postpartum period, and how to aid your recovery from a vaginal birth.
Perineum care after vaginal birth
First things first—90% of women tear during a vaginal delivery. Ranked from level 1 through level 4, the degree of tearing is directly proportionate to the length of recovery time. This perineal trauma is a very common complaint after delivery, and can leave mamas feeling sore anywhere from a few days to several weeks (the average length of discomfort is one month). There are several things you can do postpartum to alleviate perineal pain.
Take a postpartum herb bath every day for a week
Postpartum herb baths can be taken immediately after birth (along with baby) and as much as you like after that. I liked taking one every day for a week. My husband would prepare the herbs in the morning so it would be a concentrated brew by the evening and I’d start my bath with the baby (they love it and it helps with umbilical cord healing!) and then my husband would take the baby after about 15 minutes so I could lay back and relax until the water went cold. I largely credit my perineum repair to these baths.
Purchase small herbal sitz baths
For a sitz bath, you’ll need a convenient toilet insert that allows you to soak your bottom in several inches of water without taking a full on bath. You essentially fill a gallon bag with warm water and connect it to the plastic insert that sits right in the toilet seat. It fills quickly and you can soak for up to 15 minutes. These are so helpful, because they keep things clean, and also alleviate swelling and irritation, especially if you have stitches or hemorrhoids. It’s recommended to use these every time you use the bathroom for the first few weeks to aid in recovery.
Many hospitals give these bottles out post-delivery. Prior to going to the bathroom, fill a peri bottle up with warm water. Spray it on your perineum as you are urinating to lessen the sting. Pat yourself dry rather than wiping (I used cloth diapers to pat with instead of toilet paper).
Squeeze your glute muscles when sitting and standing from the toilet. This will prevent your skin from pulling on the stitches.
Purchase a donut to sit on for a few days
These allow maximum comfort as you don’t have to put any pressure directly on your perineum. There will be lots of sitting and lounging the next few days, so this purchase is worth it, especially if you have several stitches.
Use an ice pack or cold compress
Do this a few times a day for the first 24 hours or so. This can help with inflammation. Make sure that you have a layer between the ice and skin so they do not come in direct contact. These cold pads are a great option as well.
Spray your perineum with bottom spray
This is a glorious cooling blend of herbs and witch hazel and it seems to work wonders. It helps with swelling, pain, and itchiness for both perineal pain and stitches as well as hemorrhoids. Plus it has an inverted spray mechanism meaning it sprays easily even when held upside down. Trust me when I say you will want a bottle for each bathroom in your house!
Night sweats after giving birth
There are lots of hormonal changes that take place right after delivery, and your body is also getting rid of a lot of excess fluid it carried while pregnant. These two things combined, might make you wake up at night to find the bedding and your clothes completely soaked. For the first couple of weeks, sleep on an extra sheet folded in half, a towel or a sheet protector. Keep clean undergarments and pajamas handy for a quick middle of the night change. Remember to keep drinking a lot of water. It sounds counter-intuitive to replace excess fluid you are losing through sweat, but remember how much water is going toward milk production, so it’s necessary to keep things functioning well, and restore balance.
After pains also know as afterbirth pains
Your uterus will contract for about a week, every time you nurse the baby, and these contractions (yes they feel like labor contractions!) tend to get more intense with each subsequent delivery. This is nature’s way of shrinking things back to size, and also encouraging the excretion of blood and tissue it no longer needs. Try to think of it as a good thing! I LOVED this tincture with herbs that ease these pains and would put a little under my tongue each time I felt the pains coming on! If the pain gets to be too intense, ask your care provider about taking some tylenol. After about a week or so, the after pains should subside.
You’ve enjoyed nine months of period-free bliss…now get ready for a massive comeback. Plan on bleeding for about a month to six weeks as your body gets rid of all the protective tissues you used to cushion and grow the baby. After about a week of heavy bleeding, you should start to taper off a bit in the amount you are excreting, each week losing less and less. Your caregiver might give you some large mesh disposable underwear to use after delivery. This is so convenient as you’ll be leaking all kinds of fluid for a while after delivery.
There are also very large overnight pads available that provide maximum coverage—I like these natural ones that don’t stick to you and keep you feeling dry. You’ll change these often and soak a few pads per day.
Passing some heavy clots is fairly normal (even the size of a golf ball or bigger in the first few days). The rule of thumb is generally if you pass a clot smaller than your fist, it’s okay. Anything larger—call your doctor.
Hemorrhoids after baby
A byproduct of pushing or acquired during pregnancy, hemorrhoids are inflamed veins in or around the anus that can become itchy, irritated, and swollen. Most hemorrhoids will go away on their own within a few weeks. In the meantime, try these tips.
Witch hazel tends to do wonders. Use TUCKS pads, which are medicated cooling pads with witch hazel. When you have a bowel movement, use a pad to wipe, and then throw it away or flush them. For added relief, you can put a few pads in your underwear and leave them for 15 minutes or so. Stay well stocked with a container in every bathroom and a pack in your purse.
Constipation after giving birth
Constipation can exacerbate the problem. It’s normal for things to get a little backed up for a while after delivery and that first BM can be downright scary. Being sedentary, stressed, and fatigued also worsens the situation. Ask your doctor what kind of stool softener works best (some hospitals send you home with some). Colace is often recommended and is safe to take while pregnant and nursing or take a milder step by drinking Smooth Move tea. Keep in mind the longer you put off having a bowel movement, the bigger the problem will be, so try to go often. Take your time, and relax. Use a hand with a warm cloth to put counter pressure on your perineum to ease the pain while pushing. Push gently. Don’t force it or strain.
Drink lots of water
With the hormonal changes going on, night sweats, and especially if you are nursing, dehydration is a threat. Drink way more water than you think you need. The large majority you are drinking will go to making milk, so keep large cups with straws filled all over the house—at your nursing station, by your bed, near the couch, in the kitchen. Drink, drink, drink.
Get your fiber
Eat high fiber foods like vegetables and fruits. Berries, nuts, salads loaded with crunchy vegetables, and whole grain foods all are high in fiber. Pour some flax seed (soaked in water) on your food or in a smoothie, and if you can stomach it, prune juice does wonders! Try to keep the sweets and packaged foods to a minimum. Stay clear of other constipating foods for a week or two while you normalize: cheese, bananas, chocolate, white flour, and fried foods all promote constipation. If needed take a fiber supplement.
Your pelvic floor has been thrashed. It will recover, but all your muscles have been stretched, pulled, and potentially torn. Pregnancy hormones have thinned things out, and it takes a while for elasticity to come back. While you wait, you may find you have a lot of incontinence when laughing, sneezing, coughing, or making sudden movements. Repeat to self: “This is normal, this is normal, this is normal.” Be patient with yourself. Wear panty liners, or better yet, purchase some of these disposable protective underwear to wear at the beginning or reusable ones that are a little cuter!
Kegels will be the very best thing you can do for your pelvic floor, and you can start these as early as the day you deliver. Slowly pull up your pelvic floor muscles as you “zip” up your lower abs. Progressively tighten the muscles and then slowly release. Do these periodically. Every time you nurse do a few reps (you’re not going anywhere anyway) and you’ll be sure to get in some good exercise time.
The first few days, your breasts produce a nutrient-dense, antibody-rich yellow liquid called colostrum. This is so so good for the baby. It provides protection, immunity, and vitamins. Your regular milk supply will come in within 2-5 days of delivery. At that time, your boobs will get HUGE which lasts for about 24-48 hours before the swelling goes down little by little. Naturally, that can be very uncomfortable. Use special warm compresses or a warm shower to aid with discomfort while being careful not to stimulate the nipples (especially in the shower) as that will just cause you to produce more milk.
There are so many potential breastfeeding challenges, it requires a post of it’s own, but I will mention three big ones here.
Thrush occurs when there is an excess of yeast production in mother or baby. If a woman had a yeast infection close to the time of delivery, thrush can be passed on to the baby during birth. Baby will have a white coating inside her mouth, and also a very red and irritated rash in her diaper area. Thrush can be tricky to treat as it is easily passed back and forth from baby to mother through breastfeeding. A woman can then get thrush on her nipples, which will be very red, and feel like they are on fire. Nursing will be extra painful, like knives are stabbing your areolas when the baby drinks but it is safe to continue nursing. You may want to try a nipple shield to help with discomfort.
It is treated by a prescription from your doctor or also by an over the counter medication called gentian violet (read up on it here). These ointments are rubbed on affected areas several times a day. Take great care in sanitizing everything that comes in contact with breastmilk, breasts, and baby’s mouth (toys, pacifiers, breastpumps, bras, shirts, etc). Avoid sugar and inflammatory foods while trying to treat thrush, as yeast thrives in sugary environments. Read more about thrush prevention, symptoms, and treatment here.
A blocked milk duct is easily identified when there is a hard and painful lump in a breast. This indicates a milk duct has become blocked and milk has backed up. This can lead to further problems, so try to deal with it at the first sign. Get in a hot shower and massage the area to loosen up the lump. Nurse frequently on the affected side, while rubbing the duct. The baby can help to excrete the blockage. Raw cabbage leaves also tend to draw the milk out and help with engorgement. Prevent blocked ducts by ensuring a proper latch, that the breast is drained completely after nursing, and that both breasts receive equal nursing time. Using a Milkies Milk Saver can help relieve pressure on the non-nursing side as well.
Lecithin is a supplement that’s often recommended to help unclog milked ducts. According to Kellymom, “the usual recommended dosage for recurrent plugged ducts is 3600-4800 mg lecithin per day, or 1 capsule (1200 milligram) 3-4 times per day. After a week or two with no blockage, mom can reduce the dosage by one capsule. If there is no blockage within another 2 weeks she can reduce it again by one. Mom may need to continue taking 1-2 capsules per day if stopping the lecithin leads to additional plugged ducts.”
Mastitis occurs when a blocked duct goes undetected or awry. An infection forms from the blocked duct and unused milk. A red spot or two will appear on the outside of the breast that is hot and tender to the touch and mother will start to get flu-like symptoms—fever, chills, muscle achiness. Call a doctor at the first sign of infection, as mastitis can progress very quickly. An antibiotic prescription will often be prescribed and clear things up fairly quickly, but make sure you are nursing frequently on the affected side or pumping frequently to alleviate the pain and clear out the old milk. Lecithin can also help with mastitis, see above.
You’ve just been through a fantastic physical feat. Your body is going to be sore in many places you didn’t realize you were even working. Holding the baby constantly, combined with nursing can also add to your muscle fatigue. Shoulder, neck, and back muscles are commonly tense, and arm and leg muscles might feel sore and tender. A postpartum massage or chiropractic adjustment can feel divine soon after delivery. Even if a partner offers a 15 minute massage here and there it can do wonders. We also love to use a tens machine for sore muscles.
Take it extremely easy physically for the next little while. Even if you start to feel energized or better physically, do not overdo it with housework or errand running. Force yourself to keep a low profile. If you do venture out, make short trips. If you decide to go for a walk, aim for refreshment rather than fitness, and keep the distance short. There is plenty of time for that in the future. Plenty!
When to call the doctor postpartum
Be on the lookout for any of these symptoms postpartum. They could indicate further problems. Call a doctor if you have:
- A fever of 100.4 degrees F (38 degrees c) or higher
- Soaked more than one sanitary pad an hour or passed a large clot (bigger than fist) or bleeding increases or turns bright red after having been brown for a few days
- New pain, swelling, or tenderness in arms and legs
- Vaginal discharge with a foul odor
- Painful urination, frequent urge to urinate, or are unable to urinate
- New or worsening belly pain
- Cough, chest pain, nausea or vomiting
- Headaches or vision changes
- Feelings of depression, have hallucinations, suicidal thoughts or thoughts of harming the baby.
- Sore breasts, accompanied by red spots/streaks, breasts that feel hot to the touch, cracked/bleeding nipples or areolas.
Simple ways to take care of yourself postpartum
- Take frequent naps, seriously.
- Nourish yourself for healing. This is an amazing book on food for the first forty days after giving birth.
- Take time each day to yourself to read, relax, listen to music, or do something you enjoy.
- Shower frequently and enjoy a postpartum herb bath nightly.
- Get fresh air.
- Schedule regular time with your partner to connect, even if only for 15 minutes.
- Limit visitors.
- Lower standards for house cleanliness and home cooked meals.
- Talk with other women who can relate to your situation.
- Ask for and accept help when you need it.
The way you care for yourself during this time will greatly influence your recovery speed. Besides, with a new little one, there will not be many opportunities for rest in the near future, so take advantage while the help is there and treat yourself to a good immediate recovery.
This post was co-written by Austyn Smith and Bryn Huntpalmer.
- Abraham, S., Child A., Ferry J., Vizzard J., Mira M. Jan. 1, 1990. Recovery after Childbirth: a preliminary prospective study. Medical Journal of Australia (152). [January 22, 2017]. http://www.ncbi.nlm.nih.gov/pubmed/2294386
- Royal College of Obstetricians and Gynaecologists. July 11, 2014. [January 22, 2017]. http://rcog.org/uk/en/blog/perenial-tearing-is-a-national-issue-we-must-address/
Having a baby, is an overwhelming experience. It is filled with the joy and wonder of a new miracle, yet also trepidation at the adjustment to this little person fitting into your life. No matter if you are having your first baby or your seventh, the postpartum period is exhausting and overwhelming. “Please let me know how I can help!” is a common offer from so many people, but figuring out how to get the help you need can be tricky, especially when you’re in survival mode. Here are some things you can do to help your friends and family provide the most valuable help to you.
Prepare Visitors Before Baby Comes
If your friends are offering a baby shower, that’s the perfect time to arrange a “help-list” for after the baby is born. I love seeing these at showers and it really allows people to help in the areas that fit them best and where it is the most convenient. Make a spreadsheet (or ask the host to) including sign ups for the following. Babylist also has this feature and you could set up a laptop or iPad for people to sign up:
- Meals. Mention disposable containers so no washing and returning dishes is involved.
- A big bag of healthy snacks for mama’s nursing station, a quick breakfast, or food to have on hand when making something seems overwhelming. Lactation cookies are perfect for the breastfeeding mom.
- Babysitting. This can include coming over to watch older children for a while, or taking them on a fun outing; or holding and caring for the baby while mom gets a shower or a nap, or both!
- House cleaning. Some people love to vacuum while others can make a kitchen shine in no time. Keep it generic here and have them sign up for specific dates. Every couple of days is best. It can be helpful to make a chore list and keep it on your fridge for when visitors come. They can choose from the list what they’d like to do, or look around and see what is most pressing at the time. Some ideas are: clean out the fridge, do/fold laundry, clean the kitchen, clean bathrooms, vacuum, and dust. You can also easily book a home service last minute through Amazon.
- Dog walking. The last thing a recovering mom wants to do it take the mutt for a walk. This simple gesture is so helpful and kind.
- Yard Work. The non-essentials usually take a back seat to pressing survival tasks, but it can be really nice to look out your window and see a freshly mowed lawn rather than weeds taking over your flower bed.
- Bring some necessity groceries. Ask a few close friends in advance to text you every time they run to Target or Costco to see if there is anything you want. It’s convenient for them since they are shopping already, and an urgent need can be filled when you suddenly run out of toilet paper, milk, eggs, bread, or coffee!
- Carpool arrangements for kids for a few weeks. No new mom wants to drive kids to school and activities, let alone buckle and unbuckle a screaming newborn a zillion times a day. Sharing the driving is a simple gesture, and so helpful to mama.
Register on babylist for help with service items and specific gifts. Include presents for mom too, like some cute new nursing tops or lounge wear for post baby. New pajamas or a robe can make you feel more comfortable in your postpartum body. Aside from “normal” baby gifts, include really helpful items like postpartum massage certificates, lactation cookies, and paper plates/products to get you through the first little while.
Prepare for the Unknowns
Keep a list on hand of close friends to call who would be willing to answer a 911 text. Postpartum hormones are no joke. Combine that with lack of sleep, a changing body, isolation, and recovery discomforts and any mom can feel pretty low. Ask your closest friends if they would be on standby for a “mayday” text. It’s hard to anticipate exact needs, but you may want someone to listen while you cry, to help you with breastfeeding challenges, or someone to just talk to you and tell you it’s all normal. Let them know ahead of time that they are on your list and put down about five names in case the first few people you contact are not available. Nothing can be more depressing than finally getting up the nerve to reach out only to be shot down.
Make a sign for your front door that says something like: “New baby. Please do not disturb.” Along that line, disconnect the doorbell. There’s nothing worse than finally settling the baby to sleep to be woken up by UPS five minutes later.
Write a note to your postpartum self about how this will not last forever and you will be back to your normal self soon. Assure yourself you will sleep again. Mention the good times ahead and suggest a list of small self care rituals you can do when you are feeling particularly low. Include affirmations. Be realistic but encouraging. This too shall pass.
Post Baby Helpers
Most people really want to help, but don’t know what they can do or are afraid of intruding. Help them by being honest and asking for what you need. When you get the “how are you holding up?” text be candid when you respond. Even if you feel pretty good at the moment, or can’t think of exactly what you need, ask if they can text you in the next few days to see how you are feeling then.
Suggestions you can give to friends when they ask how they can help
- Pick up some groceries or run some errands. Ask them to text you when they go to Target or Costco. Keep a list handy so when someone goes you know what you need.
- Suggest specific things you’d like done. Ask them if they feel up for some light housecleaning. Refer them to the list on the fridge.
- A good friend might be willing to crash on your couch and help with a night shift. I would personally love to do this for someone, especially when I am used to getting a good night’s sleep.
- If their schedule allows, the witching hour is a great time to show up (anytime after 4 pm). This is when energy is running low and patience waning thin, and there can be chaos in the house, especially if you still have to make dinner. A visit around this time can save the day.
- Need some social time? Plan a short walk together. Run an errand together—she can help with the baby while you try on a few new shirts or bras, or buy some new makeup or hair product to brighten your day. A quick girls outing might be just what the doctor ordered. Keep it short so you won’t get too tired or flustered or have a soaking letdown!
- If a friend wants to bring something, these small items can make a postpartum mom feel like it’s Christmas: fun magazines; items to pamper mom like lotions, candles, bath salts or nail polish; soft cozy things like socks, robes, shirts. Things that make you feel human and feminine go a long way.
Last but not least
Know the signs of postpartum depression, and keep a list of them handy. Review it every so often. Mention the list to your partner, so they can also be aware of your emotional, physical, and mental state. Sometimes it takes an outsider’s perspective to truly realize there is more going on beneath the surface. Remember there is no shame in seeking help. Be honest with your healthcare providers and yourself about what you are truly experiencing.
With thoughtful planning and a little foresight, you can make your postpartum experience a little more pleasant. Enlist the help and support of those who love you.
Packing a hospital bag is exciting, but can be a little overwhelming. Where to start? Think of it like packing for a weekend vacation, plus bringing along a few extra items. A large tote bag or small suitcase works fine. I like to use a carry-on suitcase with wheels, because it’s more convenient for my husband to help support me and easily wheel it behind him instead of having to also carry a heavy bag. Pack your bag about 3 weeks from your due date, and you’ll be ready when those first few contractions start.
If the hospital allows it, snacks are nice to keep on hand to munch on during labor, to keep your energy up while waiting for baby. Your partner might want some too. After delivery, food is essential. I am always starving after all that hard work and depending on the time of day, the cafeteria might be closed. Keep a few substantial protein-filled snacks on hand.
- Birth plan: Keep a few extra copies of your birth plan in your bag for nurses and doctors, especially in case of a shift change.
- Birth Affirmations: words, quotes or phrases you’ve written down to encourage and empower you throughout labor.
My first two deliveries were so unexpected we only had flip phone photos. So sad! Keep these electronics on hand and accessible, because anything can happen!
- Phones and chargers
- Ear phones if you plan on listening to a playlist or birth affirmations (wireless noise cancelling ones can be worth the investment)
- Portable speaker
- Laptop and charger
- Camera, extra memory card, and extra battery charger
Clothes to bring to hospital birth
- Robe: Hospital gowns are nice to wear the first day or so, as you are leaking and bleeding, and getting used to postpartum recovery. You don’t have to worry about getting your own nice clothes dirty. However, it’s nice to slip on a robe if you need to walk to the bathroom or around the halls, since they are not too modest in the back. This one is short and SO soft!
- Sleeping/nursing bra: Although your milk will most likely come in in about 3-4 days, your breasts can still feel tender and engorged, especially as you are nursing often. It sometimes feels nice to have some support rather than nothing at all. Make sure you bring something soft, breathable, and comfortable.
- Socks: Hospitals can be cold, and it’s also nice to have some cozy socks to help you feel more at home.
- Slippers: Merely a comfort item for walking around the room and for trips to the bathroom.
- PostPartum Band: I have heard people swear by these, as they help support your weakened core muscles after birth and help you get back to pre pregnancy size sooner. It also can help with diastasis recti (the separation of abdominal muscles during pregnancy) as it encourages the core muscles to come back together.
- Loungewear: Comfortable, loose pants are best. Maternity leggings are a great option too.
- Sweater: Hospitals can get cold and you generally don’t have control of the temperature. This one is SO comfy, nursing friendly and comes in tons of colors.
- Large, comfortable underwear you don’t mind getting bloody
- Your own hospital gown (optional): Advantages—you feel cute, you know it is clean and fresh. Disadvantages—you might get blood or bodily fluids on it. This is a great option!
- Coming home outfit for mama: choose something extremely comfortable. Stay away from tights or skinny jeans, especially since you’ll be wearing large pads and underwear. Stick to a simple nursing-friendly maxi dress or lounge pants.
Toiletries for Hospital Birth
- Hair supplies: It’s so nice to get that first shower after delivery. If you can, skip the hair washing and use some dry shampoo to save time.
- Hair tie or clips
- Lotion or moisturizer
- Makeup: You will be basking in the glow of meeting your baby and women look like goddesses after giving birth! If you feel comfortable with some makeup on, by all means pack your favorite items!
- Hand mirror: In case you want to have someone hold it so you can watch as your baby is being born!
- Make-up removing wipes: These are golden to keep on hand when you want a fresh face but are holding the baby, nursing, or just too dang tired to get up.
- Toothbrush and toothpaste
- Nipple cream: some hospitals provide this, but if you have a brand you prefer, or your own for home, bring some to apply. We love this nipple balm and this lanolin option.
- Cold gel packs: These can really help in those first few days when your nipples feel raw and sore as they are getting accustomed to breastfeeding. They also help with engorgement.
- iPad for watching Netflix if you end up waiting around a lot
- Nursing pillow: You may stack a few pillows on top of each other to assist in nursing, but if you’d rather bring a boppy or my breast friend, feel free.
- Wipes: many hospitals these days do not have wipes available, either because they irritate baby’s skin or because they are trying to cut costs. I’ve heard both reasons. Bring some unscented and sensitive skin brands just in case.
- Binky: hospitals tend to use soothies and if your baby doesn’t like them that could be frustrating. I like this one and this one for newborns far more than soothies.
- Coming home outfit: Bring two in case the baby has a blowout. Make sure they are comfy and soft and have the hand covers to keep him from scratching himself. I love these gowns. Include socks (or stay-on booties) and beanies to keep him nice and warm.
- Blankets: bring a swaddling blanket so you can practice swaddling with the nurses, and a medium weight blanket to spread on him in the car seat for the ride home.
This post was written by Austyn Smith.
You’ve decided to go with an OB/GYN. There are several advantages to using an OB for your care and delivery. Physicians tend to have experience with and knowledge about high-risk pregnancies and complications. If you know you are high risk due to advanced maternal age, diabetes, or any medical condition, you can have peace of mind knowing your OB is equipped to handle it and to manage medications if needed. If your intuition is telling you that you feel more comfortable knowing you have access to all the medical procedures and personnel a hospital offers, this is the route to go. OBs have access to advanced medical testing and screenings, and are connected in a network of specialists and colleagues. If you’re still considering a midwife, there are many midwives that work in collaboration with OBs so you don’t necessarily have the rule that out either. Talk to your care providers and come up with a plan catered to all of your needs.
Where to start in finding the OB that’s just right for you? You’ll definitely want someone you feel completely comfortable with, and that you trust to take care of you and your baby. This is your life (and emotional well-being) and your baby’s health in someone else’s hands, so it’s a big deal. Here’s some ideas to help you get started.
Where to look first
Ask around. Your best bet is going to be word-of-mouth. Talk to everyone you know and trust about their OB/GYNs. What things did they like/dislike about him? What was their prenatal care like? How was their delivery experience? Would they go back to this same person? The more details the better, just start asking. Of course it’s important to keep in mind that not everyone wants the same type of birth experience so the doctor that was a good fit for your sister may not be right for you.
Join Facebook groups in your area. There are many Evidenced Based Birth local groups that you can join where the admins and members are knowledgeable about the OBs in your area and which ones follow evidence based practices. What is Evidence Based Birth?
If you don’t know many recent moms personally, get in touch with your hospital’s Childbirth Educator. She or He should be familiar with doctors and nurses at the hospital, and know the ins and outs of the kind of care they give (and their bedside manners). She’d be able to give a few recommendations that you can then do more research about. Of course keep in mind that they work for the hospital so may not be able to be completely forthcoming.
Ask for statistics. Hospitals keeps track of things like induction rates, episiotomy rates and cesarean rates so asking for these facts will give you a good idea of hospital practices. Unfortunately, even if you love your OB sometimes the hospital policies limit their ability to provide the care that you may be imagining.
Do you currently have a gynecologist that you like? Do they practice obstetrics as well? Asking a few additional questions can help you get a feel for if it would be a good fit or not. If they don’t deliver babies, they could recommend some colleagues to you, that you could then check out. Keep in mind that prenatal and birth care is MUCH more involved than an annual exam so don’t just go with your current doctor because it’s convenient. You want to make sure it’s a good fit and that their maternity care is in line with what you want for your birth.
Once you have a few names of potential doctors, there’s a lot of things to mull over before the interview process. Here’s a few considerations:
Your health history
Do you have specific concerns about your pregnancy that not every doctor would have experience with? Plus-size pregnancy, previous recurrent miscarriages, diabetes, or trying for a VBAC (Read more in our post What you need to know about VBAC?) can be uncharted territory for some practitioners. Look at the websites and reviews of doctors to find out if they have specific experience in the areas you are concerned about.
What does the provider value? What is his/her overall outlook on pregnancy, birth, and labor? Are they super medicalized or do they lean toward the more natural route—and which do you prefer? What are his opinions on certain medical procedures like continuous electronic fetal monitoring, scheduling inductions, episiotomies, and epidurals? Do they tend to take control of how a labor is progressing, or allow the mother to take the lead? How pushy will they be?
Do you click? Do you feel comfortable? I had a friend who went in for a breast exam and the doctor chatted for a few minutes and then said, “Okay, flash me.” That exchange made her feel so uncomfortable she never went back. Bedside manner and professionalism matter! Do you trust their experience and judgement? Do they listen to your concerns and questions or just plow through the appointment as fast as possible? Are their credentials up to date? What does your gut say?
Are they supportive of you having a doula with you during labor/delivery? How comfortable are they with extra people in the room in general, and does your partner get a good vibe from them as well?
This is public information that you can request from your hospital. However, doctors don’t usually post their own personal stats. You can get an idea of how things go by calling the front office and asking some questions. Many offices don’t give out specific numbers, or may not even keep track, but you can get an idea by saying something like, “Out of the last 10 deliveries this provider performed, how many ended up being c-sections?” Or “Out of the last 10 attempted VBACs, how many were successful?” Get an idea of how willing they are to work with you. Keep in mind that specific hospital rates are higher than others for cesarean. Which brings us to our next item…
What are the c-section stats? You can search online to find this info. In general, what is the hospital like? Do they have natural birthing accommodations and tools if you’d like to go that route? Birthing tubs to labor in? Is the hospital friendly to natural delivery? Do they require IVs, continuous electronic fetal monitoring? Do they have VBAC policies? What are their standard procedures right after the baby is born? Do you get to have skin-to-skin bonding for a while? Does the baby get to stay in your room? Calling the Labor and Delivery floor is your best bet to getting answers to these questions. A nurse can help you out, or refer you to someone else who knows the specifics. Nurses generally want you to be informed about the hospital policies so that there aren’t any surprises when you come in.
Office Protocol—Questions to Consider
- What is the OB clinic experience like?
- How easy was it to get an appointment?
- How many doctors are in the practice?
- Are you a number who is shuttled through the routine, or are you treated like an individual?
- How long do you typically wait in the office?
- What are the after hour policies?
- Will your OB be the one to deliver you, or do they rotate who is on-call, and will that bother you?
- Is there an on-call nurse that is available to answer questions?
- What is the staff like?
Think about how you feel about all of these things.
Once you’ve thought about all of these issues, and researched a few doctors, narrow it down to a couple. You can either take the plunge and make your first appointment with the one you want, or you can be even more thorough and schedule a consultation, where you can bring your list of questions.
Above all else, keep in mind that you are not stuck once you make your choice. If at any time you start to feel uneasy about your care giver, or feel like you don’t align with his philosophies, shop around. It’s completely acceptable, and it happens all the time. If you feel uncomfortable firing your OB, simply call the front desk and ask them to transfer your files to your new doctor. You don’t even have to speak to the doctor you are leaving. This experience will be one of the most important of your life, and you deserve to feel as safe and as comfortable as possible. Follow your gut!
Interview Questions for Potential Obstetricians
- What is your general philosophy on pregnancy, labor, birth, and postpartum care?
- What is your role as physician? What is your role during labor and delivery?
- How long have you been practicing? How many births have you performed?
- How many births do you anticipate attending month? Is there a limit to the number of patients you take on?
- What is the chance of you delivering my baby? Who delivers when you are not available?
- What is your c-section rate?
- If there is a complication beyond your expertise, who would you refer me to?
- What is your after-hours policy? Are you reachable during an emergency?
- How often am I required to meet with other doctors?
- How much time do you spend with each patient during an appointment?
- Are you available in between visits if I have a question or concern?
- What is your view on nutrition and weight gain?
- What prenatal tests do you require and/or recommend?
- What childbirth education resources do you recommend?
- How do you feel about birth plans? Do you help with writing them?
- What experience do you have with high risk pregnancies?
- What would the procedure be if I become high risk?
Labor and Delivery
- When will you arrive on scene? Who will support me in the meantime? How often will you be with me during labor?
- If you have two simultaneous labors/deliveries, what do you do?
- How do you feel about a support team? A doula? Other friends and family?
- What if I approach my due date without going into labor? How long will you let me go past? What is your induction policy?
- Do you ever recommend induction for an estimated large baby?
- How long will I be able to labor after my water breaks if no signs of infection?
- What routine policies during labor do you recommend/require? What does the hospital require? (Continuous fetal monitoring, IVs, etc.)
- Am I allowed to move around during labor? Eat and drink?
- What are your views on pain management during birth, both medicated and unmedicated? Will you recommend different positions and coping techniques?
- What percentage of your patients deliver without an epidural? What resources are available to me, should I want to labor without drugs?
- What percentage of your patients get epidurals? What is your view on epidurals?
- How do you handle a “stalled labor”? What do you consider a stalled labor?
- What birthing positions do you allow for labor and delivery? What is most common for you?
- Do you perform episiotomies? How often? How often do you use forceps or vacuum extraction?
- Do you encourage and support VBACs? How many VBAC attempts have been successful? (60-80% is norm). What is the hospital policy for VBAC?
- At what point in labor do you recommend c-sections?
- Have you ever performed a vaginal breech birth? Twins?
- What procedures do you perform on the baby? What can wait?
- Is delayed cord clamping okay?
- What happens if there is postpartum hemorrhaging?
- Will I have uninterrupted skin-to-skin bonding time immediately following birth? For how long?
- Will the baby stay with me in my room?
- Do you assist in breastfeeding? Is there someone else available to help me?
- What if I hemorrhage?
- Can my partner stay in my room?
Questions to ask yourself after the appointment
- Do I feel comfortable with this person? Is he/she flexible?
- Do our philosophies line up? Or are they willing to work with me? (You want them to enthusiastically support your wishes not just be “willing to let you try that”)
- Do we have a mutual respect?
- Do I trust his expertise and judgement?
- Is the office staff friendly and helpful?
- What was the wait time? Did I feel rushed in and out?