Cesarean Birth Postpartum Recovery

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.

c section birth

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.

pospartum recovery cesarean

Gastrointestinal Issues

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.

Uterine Recovery

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.

Postpartum Bleeding

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.

preparing for cesarean

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.

what to pack for hospital

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

recovery postpartum cesarean

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.

advanced maternal age

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.

Night Sweats

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.

cesarean stitches

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.

Resources

  1. 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
  2. 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
  3. 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/

The Importance of Following Your Intuition in Pregnancy and Birth

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  

first latch

“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  

breastfeeding tips

“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

Pain Medication Options in the Hospital Setting

Pain Medication Options in the Hospital Setting From a Nurse’s Perspective

During labor, there are two options for pain medication in the hospital setting: IV medications and/or an epidural. Oral pain medications (pills) are usually only given in the postpartum period.

When you are admitted to a labor unit, your doctor or midwife initiates an Order Set. These are the same universal orders for each patient, with some choices that can be added on or removed. The option to have IV pain medication or an epidural if desired by patient is included in these orders. Your nurse, and occasionally your doctor, will work with you to discuss if and when these should be given.

IV Medication options during labor

First let’s talk about the IV medication options. There are two different IV medications that may be given for pain (please note medications may vary at different hospitals but these are pretty standard). One is called Stadol and one is called Fentanyl. They are small liquid doses that are administered through your IV site. There are usually half and full doses available, and you can usually repeat the dose again after a period of time. For example, Fentanyl may be ordered as 50mcg (micrograms) or 100mcg, every X hours, as needed for pain. And Stadol may be ordered as .5mg (milligrams) or 1mg, every X hours, as needed for pain. Both of them have a maximum amount that can be given. That means, if you’ve reached that amount, you can’t have anymore.

Benefits of IV medication

These IV pain meds can be helpful for taking the edge off. I tell patients they might knock the top off of the contraction mountain. The sensations are still there, but not as intense. Maybe mom will even get a short nap. She may be able to rest and regroup and get back in the game of coping with contractions. This is good for someone who is looking to avoid an epidural but is having a hard time. It’s nice to have something, and IV pain meds can be a useful tool in the “coping with labor” toolbox. The effect of these drugs in your system can last anywhere from 20 minutes to 60 minutes. On a side note, sometimes we see moms in triage having days of looooong early labor. We can give them these same IV pain meds, some IV hydration, some monitoring to watch baby during this, and usually they take a great nap. Often times they go home afterwards.  

Potential Side Effects of IV Medication administered during labor

IV medications go into your bloodstream. Therefore they cause systemic effects, like mental changes. They’re narcotic drugs. They may make you feel loopy and out of it. You may not have a lot of experience feeling loopy and out of it or tipsy (especially since you’ve been pregnant for 10 months!). You may not like the way this makes you feel at all. The good news to that is that these are short acting drugs, so the effects (both good and bad) will be over quickly.

Will Baby Feel the Effects?

Since the drugs are in your IV and bloodstream, that means they are also in baby’s bloodstream. You will have to be continuously monitored with the belts around your abdomen during the time these drugs are in effect – the monitors are listening to and graphing baby’s heart rate as well as your contraction pattern. They sedate you, but they also sedate baby. Baby’s heart rate pattern will appear similar to what it looks like when they are sleeping. We would not be able to administer these drugs to you if baby had recently shown us any reason to be concerned about their wellbeing. Baby’s usually metabolize these drugs faster than you, and we see baby’s sedation wear off relatively quickly on the monitor.

How Long Can You Wait to Get IV Meds?

We also would not want to give you these drugs if delivery was imminent (meaning 8cm or more dilated for a first time mom, or a second + time mom who is dilating quickly). We would not want baby to be born with these drugs still active in their system, since they may make their responses to extrauterine life not as vigorous. We want a baby alert and crying (hello apgar scores!), not sedated. To be clear, these two IV narcotic pain medications and their doses are chosen for their use in pregnant women because they are safe to cross placenta to baby’s bloodstream. That’s why they aren’t very awesome and magical and pain relieving for you (those would be IV pain med drugs such as Dilaudid or Morphine), because that has to be balanced with safety for baby as well.

Alternatives to IV meds

Of course, all non pharmacological pain relief options are alternatives to IV pain meds. Additionally, if you don’t like the idea of your baby being exposed to short acting narcotic pain meds in utero, an epidural is a great option (more on that next!).

Reality & My Opinion as an L&D Nurse

I usually see IV pain meds administered as sort of a prelude to an eventual epidural. I usually don’t see IV pain meds alone. If you’re looking for that sort of relief/release, you will usually eventually have an epidural. Patients ask for some IV pain meds after either exhausting all of the non pharmacological coping strategies the doula or I have suggested (shower, walking, swaying, hip squeezes, distraction, birth balls, calm voices, encouragement…), or as a means of prolonging the time until they get an epidural (“I want to be 6cm before I get an epidural”). Probably an equal amount of times people are happy with the effects and take a spacy nap, vs feeling like ‘yuck, I hate feeling this out of it.’ And, for what it’s worth, I prefer to use Fentanyl for my patients because there seems to be less of the yuck.  mama papa laboring

Epidural Relief during Labor

On to our next pharmacological method of pain relief: the epidural. Epidural is not the name of the drug; rather it is the name of a space in your spinal column. That’s where the small flexible tube that will administer medications is placed. Think of it like your IV: we use a needle to get a small flexible plastic tube into a place, and then we remove the needle and tape the small tube in place. Medication drips continuously into this space and numbs the pain sensations of the nerves below it. The drug cocktail that makes up an epidural is a mix of Fentanyl and Bupivacaine.

When a patient says “I want an epidural now,” it takes about 45 minutes from that statement until you start to feel relief. Let’s suppose you already have an IV. I start giving you a whole bag (one liter) of IV fluid really fast. I let the anesthesiologist know that you want an epidural. Where I work, there is always an anesthesiologist or a nurse anesthetist in the building. I get all the materials anesthesia needs to perform the procedure at your bedside. I help you cope with the contractions that keep coming, because usually these last ones feel really intense. Mentally you have decided on the epidural, so you are ready for these contractions to be over. They may not actually be stronger, but they feel stronger because your coping has lagged.

Procedure for administering an epidural

When anesthesia arrives at the bedside, we sit you up on the side of the bed with your legs dangling. We sit your support person down on a stool right in front of you to help squeeze your hands and talk to you and distract you and just generally be up close in awe of how tough you are. We discuss what’s going to happen. It’s all about positioning, so we coach you into the right position. Think of the cat pose in yoga, or pushing your lower back out in slouchy posture. Maybe a pillow helps you round over your belly, chin to chest, shoulders relaxed. Anesthesia cleans your back, places a sterile drape over your back, touches your bony spine to determine the spot they are going to place the epidural. They numb your skin with lidocaine – which burns! That’s usually the worst part. But everything burning and tingling is getting numb. After that you just feel touch.

Positioning for Getting an Epidural

We help you get in the ideal position with rounded back. Having a rounded back makes the spaces between the bones of your spine bigger. They use a needle (that large, long needle everyone talks about, but your eyes will never see it) between two of your lower vertebrae almost like a dart. Then they thread a long, soft, flexible skinny straw into the space, and pull the needle away. It takes just moments. The needle does not stay in your back. We test and make sure the tube is in the right place by giving a tiny bit of medication first. We would know instantly if it was in a wrong place such as a blood vessel. Your heart would race, you would have a metallic taste in your mouth and a ringing in your ears if this happened. I’ve seen it happen twice. The amount of the drug is so small those side effects are over almost immediately, and anesthesia fixes the placement of the catheter.

Do Epidural Meds go to Baby?

It’s important for us to determine that the tubing is in the right place because we only want the epidural to  be in the epidural space of your spinal column. That’s where the medication stays. The medication does not go in your blood stream, and does not go to your baby. I’m anticipating some comments here about studies and evidence to the contrary, but the point I’m making is that compared to IV pain meds, epidurals do not “drug” your baby at all. Your baby does not know you have an epidural, and your uterus doesn’t know you have an epidural.

Dosage of Epidurals

Then we tape the tube to your back really well and connect it to the pump that gives you medication constantly. Epidurals don’t run out—we continue the medication until it’s no longer needed. You are usually quite comfortable initially because you get a loading dose, and then afterwards you have a remote button that you can press and give yourself a little more. I tell my patients if they are ever making the wincing ouch face again, it’s time to press the button. The button is totally optional.

We lay you down flat to let the medicine settle evenly across your whole pelvis. The contractions fade away like a sunset, rather than a light switch. The first couple feel shorter (even though they’re not) and then eventually you don’t realize that you’re talking to me through a contraction without noticing. We monitor your blood pressure closely. We place a catheter in your bladder to drain urine since you can’t walk to the bathroom anymore. This does not usually hurt.

Moving Around After an Epidural?

Once you have an epidural you can no longer bear weight on your legs, and it’s not safe to stand up. I don’t know what people are talking about when they request “walking epidurals.” You are bed bound. You’re not totally numb in a panicky “I can’t feel my legs” way. You are able to help us change your position every hour or so from side to side. You don’t generally lay on your back for the same reasons we tell you not to do that when pregnant – bad for blood flow to uterus. I like to keep a peanut ball or a folded pillow in between your knees to keep your hips open. It’s important to remind your care team to do that if it’s not being done. Epidurals take away pain, not pressure, so you may still have awareness of your belly getting hard with contractions, and ideally you still feel vaginal and rectal pressure with contractions when it’s time to push. If you’re getting close to the time to push and you are really really numb, I’ll suggest not pressing the button for awhile.  epidural birth

Benefits of an epidural

You’re able to sleep. Many of the epidurals I am apart of are for therapeutic rest, and not for an inability to tolerate painful contractions. You’ve been awake for days or even just all night (especially with the long early labors that are notorious in so many first time moms), and the epidural is a valuable tool to allow rest, relaxation and regrouping for pushing and early parenting.

Maybe mentally you’re in your own way. Fear, anxiety, and interpreting pain as suffering send your body “fight or flight” messages. Adrenaline overpowers oxytocin, and can stall labor. You need to feel safe as an animal to give birth. Your body needs to relax in order to release, surrender, and dilate. Sometimes the relaxation of an epidural is exactly what that body needs to dilate.

You remain numb throughout the rest of dilating to 10cm and throughout the one, two or three hours it may take to push baby out (if you’re a first time mom) or the maybe 20 minutes of pushing if you’re a repeat mom. We turn off the epidural pump after the placenta is delivered and any possible repair to your perineum (aka stitches)  is completed. We take the tube itself out an hour or so later when we get you up to try walking to the bathroom. You might complain about the tape coming off your back and won’t notice the sensation of me pulling out the tiny tube.

Potential Side Effects of an Epidural

We need to monitor baby and contractions continuously, so you’ve got those belts on from now on. We also need to monitor your vitals pretty regularly (aka the annoying blood pressure cuff stays on, sorry). The most common side effect of an epidural is a blood pressure problem. It can drop low. We try to prevent this by giving you all that IV fluid first. If it drops it can make you feel sweaty, nauseous, light headed, and gross. That’s what low pressure feels like. But baby doesn’t like it because they’re used to the glub-glub-glub of your blood pressure chugging along nicely. If we see this we will intervene quickly to raise your blood pressure back up and correct baby’s response to it.

Let’s talk about the Cascade of Interventions. Yes, if your contractions space out from every 2-3 minutes to every 5-7 minutes, and your cervix pauses in its dilation progress, your doctor will recommend augmenting with some pitocin. That means giving you an IV version of the drug pitocin, which is modeled after your own hormone oxytocin, which causes uterine contractions. We would also suggest this to you if these same conditions were present in labor without an epidural, by the way. Yes, if you get an epidural in early labor, you will have an epidural for a long time (first time moms take about 1 hour to dilate 1cm…and we’re going to 10cm = 10 hours at least, usually 16-24 hours), and interventions will likely be offered to you.

when to call the doctor

Reality & My Opinion as an L&D Nurse

We don’t have “rules” about getting epidurals only after 4cm and only before 8cm, but ask your nurse or doula to help you cope with contractions until you’re in active labor. And once you have an epidural make sure you are turning from side to side every 1-2 hours, and keeping knees and hips open with peanut balls or pillows. If you have an epidural you will not be able to take advantage of gravity efficient birthing positions such as squatting, so it may take you some time to learn how to push, and you may push for one, two or three hours. My advice: use the mirror!

The same rules apply to interventions whether you have an epidural or not: always be an empowered and informed healthcare consumer. If an intervention is offered and discussed it is totally ok to ask:

  • What are the benefits?
  • What are the risks?
  • What are the alternatives?
  • What if we wait an hour?
  • What if we do nothing?

Other side effects to note in an effort at full disclosure: maybe it takes several tries to get it in the right spot, maybe it works better on one side of the body than the other, maybe there is a hot spot on your belly where you still feel discomfort, maybe you weren’t as numb as you wanted to be, maybe you’re too numb when it’s time to start pushing. Your nurse and anesthesia provider will work to troubleshoot these problems. Before they start placing an epidural you will need to sign a consent form whereupon are all other possible known risk factors and serious side effects of having an epidural. The only serious side effect I’ve seen in my career is when there is an error in placement and a couple days later (usually when you are still hospitalized on the postpartum unit), you end up suffering from a terrible postural headache. That means you are fine when laying down, but feel awful when sitting up. It has to do with the levels of fluid in your spinal column and gravity. It is treatable.

Reality & My Opinion as an L&D Nurse

I feel like patients with epidurals are divided between women who know they want an epidural eventually and it’s just a matter of when (my job is to help steer them towards being in active labor first); women who maybe want an epidural but are afraid and anxious about getting one (my job is education and emotional support); and women who are getting epidurals for therapeutic rest after fighting long hard battles with natural labor (my job is emotional support).

The ebb and flow of popularity for different trends in obstetrics is interesting over time. We are currently in a natural parenting surge, which is great. I sat down to write this article after breastfeeding my 3.5 year old. I get it. I just want people to remember that access to an epidural was once a women’s rights cause, and women marched in the streets demanding access to them. I completely reject the guilt, shame, and “mommy wars” hostilities that women place on each other for their childbirth and parenting choices, especially the choice to have an epidural or not. You do you! I did not have an epidural with either of my deliveries, but oh I was talking about it. I had put in some good hard time (naked, moaning, out of body experience), and if my midwife would have said “You’re 5cm” I would have said “Epidural.” Done. But it just so happened that she said “You’re 8cm” (and with second baby, “You’re 10cm”). The thought of being close to the end was reward enough to keep going, and soon after those babies were here. I may be biased, but I think most pregnant L&D nurses and obstetricians (at least all the ones I know) operate on a pretty similar and effective “Birth Plan” for their own deliveries: use whatever you need if you need it. No shame, no guilt!

This guest post was written by Maureen Hodges, BSN, RNC-OB, LCCE. Maureen has over ten years of Women & Children’s nursing experience. For the past seven years she has been a Labor & Delivery nurse at a very busy hospital in the Austin area. She teaches private, hospital, and online childbirth classes. She has two children, aged 1 and 3, and a husband who knows all her L&D pep talks verbatim from listening to her answer every pregnant woman’s questions at dinner parties, on airplanes, and on the phone in the middle of the night. She has attended the deliveries of everyone in her book club. She could not pick any of their vaginas out in a line up. You can find her on instagram at @empoweredbirthatx or on facebook at Empowered Birth Austin.

How to Be A More Mindful Mama

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?

sleep when baby sleeps

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:

  1. Expectful—An app for pregnant mamas, and non-pregnant mamas as a way to connect with yourself and your babies. Free trial available.
  2. 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.
  3. 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.

10 Things Labor & Delivery Nurses Want You to Know

 

  • We want to see your poop.
  • You’re getting an IV.
  • Take a class or a tour.
  • Your first labor & delivery is the longest.
  • Get a doula.
  • Let go of control.
  • It’s only one day.
  • Are you with the right doctor?
  • Say something.
  • How to thank us.

We want to see your poop.

Let’s get this one out of the way first because it’s my favorite. Everyone who comes into L&D to have a baby is worried about “pooping on the table.” They think that they are going to try and push a baby out, and the baby will stay inside their body, and instead a huge poop will come out and it will be mortifying. Wrong!

When you are completely dilated (10cm) the only thing holding your baby in is your pubic bone. Pushing is the act of bearing down to rock baby under your pubic bone and stretch/make space for your baby in your vagina. When you are doing a great job of pushing, if (big IF!) there happens to be stool (medical term for poop) in your rectum (medical term for butt) at that time (and maybe there isn’t because diarrhea sometimes happens in earlier labor), a little smear of poop might come out with pushing.

Nurses think this is a great sign that you are pushing effectively! We like to see this! We are usually quite good at keeping this discrete. I keep a “poop drape” towel tucked under your bottom and folded up to hide your bum. We change these towels often, and chances are you will have no idea if there was a little bit of poop or not. Ditto for any support people in the room at the time.

You’re getting an IV.

Please don’t write a birth plan that says “No IV unless medically necessary.” You’re all getting IV’s. Think of an IV like buckling your seatbelt when you get in a car. It’s for safety. It’s for just in case. There are people who say “telling moms they need IVs in case of emergency is hospital fear language and negative because it implies there may be emergencies.”

There are people who say “can’t you just start an IV if there’s an emergency?” These people have obviously never started an IV and have never been in a true medical emergency. It’s not always easy or quick to start IVs, so we like to place them soon after arrival to the hospital. An IV is a tiny plastic straw inside a blood vessel. The needle we use to get that straw under your skin doesn’t stay in! Lots of people fear IVs because they mistakenly believe a needle is going to stay inside them. Wrong, it comes right out immediately!

hospital birth IV

The straw (catheter) is connected to a small access port. We can connect that access port to a longer strand of tubing and use it to infuse fluids or medications. If the straw and port are not connected to the tubing, it’s called a “saline lock” or a “hep lock.” But the IV part remains the same. Please don’t write a birth plan that says you want a “saline lock instead of an IV.” That doesn’t make any sense. If you don’t need to be connected to fluid or medications, we will disconnect the long tubing so you will have more freedom of movement.

If you don’t think you need extra fluids and you aren’t requiring medication at the time, it’s always ok to ask for your IV to be saline locked. Requiring patients to have IV’s isn’t a thing that’s going to change anytime soon in the hospital setting. If this is really a big deal for you, look into giving birth at a birthing center or at home.

Take a class or a tour.

If you took a childbirth preparation class, you would have already heard that pooping pep talk, and heard that you’re getting and IV, and had the chance to ask a birth professional anything you wanted! Classes are amazing for lessening anxiety and fears, building confidence, empowering you to make informed decisions about your health care, even teaching you the anatomy basics. I started teaching classes because I couldn’t believe how many times I would be holding a woman’s dilating cervix in my fingers talking to her, and she had no idea what that was or its very important role in labor. Get informed!

At the very least, take the tour of the hospital’s birthing facilities. It’s packed with information, tips, and you get to ask the nurse leading the tour any and all questions about policy or procedure.

Your first delivery is the longest.

Your first labor and delivery usually takes the longest time of any pregnancy you will have. Be patient. Be more patient than you ever thought possible. It can take days or weeks for your cervix to soften, efface and start to dilate. Then it takes awhile to dilate to 4cm (awhile = hours or days). Then it takes about a centimeter an hour to go from 4cm to 10cm. And then it takes anywhere from 20 minutes to one, two, or three hours to push your baby out.

While we’re on the topic of things you should know: know that your doctor won’t come push with you until the very end, like the last several pushes. You could push with your nurse for two hours, and the doctor two pushes. Might as well tell you all of it: it might not even be your doctor. It might be one of your doctor’s partners.

The active labor portion of this whole experience (where contractions are strong and require all your coping attention) can start at any time of the day or night, so maybe you end up being awake for a long time. Even if you are planning on having an epidural, you must come prepared to cope with strong contractions. We will help you cope of course, but it’s naive to think it’s possible to feel nothing.

Many of the epidurals I help administer to patients are for exhaustion, not inability to handle pain. We call it “therapeutic rest” and is very common for first time moms.

Coincidentally, the time when most women think they want to try and have a baby without an epidural is the first time they are pregnant. It’s like if someone tried running for the first time and found out the course was a marathon. Some people might reasonably decide, well running isn’t for me. I sure would. The problem with this is that the second meeting of the running club is just a 3 mile loop around your neighborhood. Your second, third etc labors are much faster! Like, hours and hours faster! Once strong labor contractions start your cervix can dilate to 10cm very fast.

We joke that we don’t trust those moms for a minute. They could “go complete” (-ly dilated) at anytime and push that baby out in minutes. My point is, don’t beat yourself up if you thought about not getting an epidural with your first delivery and you ended up having one. Maybe try it with your next delivery, or…

Get a doula!

If you are a first time mom and your goal is to deliver epidural free in a hospital setting, think about getting a doula. When you are in the hospital, a doula and I aim to do basically the same thing for you, with one catch. The doula only has to do it for you. Sad but true, I may have another patient I am taking care of at the same time as you in the early part of your labors. Additionally, your doula usually starts caring for you at home in early labor. This can keep you home for a longer amount of time than if you were laboring alone.

Constant, reassuring, expert bedside support is crucial for managing natural labor. Doulas can be expensive. If you can’t afford one, make sure that when you first arrive as a patient in Labor & Delivery, you ask to speak to the charge nurse and request a nurse who loves working with natural labor patients (we all are capable of doing this, some just have a special passion for it). 

Let go of control.

There is a huge spectrum of normal in Labor & Delivery, and you can’t plan it all out in advance. You just can’t. Trust your support team and your providers to give you good advice and expertise, ask the right questions, and pay attention to your intuition. Breathe. Think of this as your initiation into parenthood. Anyone who’s been around kids knows “control” is not a word used to describe the experience of raising young children. More like: “SURRENDER”, “LET GO”, “WHAT WILL BE WILL BE”, “BE OPEN TO THE EXPERIENCE”, “RIDE THE WAVE.” Coincidentally those are great birth mantras. Another one of my favorites: “Let go or be dragged.” Breathe. It will be ok.

This is only one day.

Ok, maybe it’s two or three or four days, but your time being in labor and delivering a baby is relatively short. It can be an empowering, life changing, positive experience, but it is still only several days. Parents spend so much time preparing for (and worrying about) this portion of the experience (where you will have a constant bedside presence of a supportive L&D nurse or doula), and neglect preparing for the postpartum period (where you will be sleep deprived at home with another sleep deprived person as your companion and a confusing tiny new member of the family who you love in a terrifying way).

Labor is one experience. After your baby is born, breastfeeding is an experience that is going to happen every three hours for almost the next three months or longer. Breastfeeding is natural, but it doesn’t come naturally. Babies and moms have to learn those behaviors. Take a breastfeeding class; identify three friends who have breastfed successfully that you can text with questions; and get the name of a good lactation consultant in town. Most breastfeeding issues come up after you’ve been discharged from the hospital. Not breastfeeding? No judgment here, fed is best.

Make a postpartum care plan (great book). Put just as much effort into that care plan as your list of birth preferences. Identify a new moms group you can go to, an online community, or a postpartum doula service to come love on you at your house if needed. Make a plan for postpartum mom not being the person solely responsible for dealing with household chores, cleaning, cooking, laundry, etc. Make a plan to have friends drop off dinner. Key words: drop off. You’re not hosting people to dinner every night. Drop off food and leave, thanks. People who understand this are the best kind of people to include in your postpartum plans.

Be kind to yourself. Let your house be a mess. Just a total mess. The default position is on the couch with a baby skin to skin, feeding when needed, next episode on Netflix starting in 12 seconds. Be kind to your postpartum body. Don’t say mean things to it or think mean things about it. It’s beautiful. You’re beautiful. You just did a beautiful thing.

Postpartum depression is real. Postpartum anxiety is real. Weepy is normal. Feeling hormonal and overwhelmed is normal. It’s ok to feel like you should be so happy but you’re just not. If this lasts longer than three weeks or you have thoughts about harming yourself or baby call your doctor or midwife immediately and get an appointment to see them in person. If you feel traumatized by your birth experience, talk to someone. Partners and friends can help, but don’t be shy to talk with your providers. And ideally, if you were delivered by a different provider in that practice, make your follow up postpartum appointment with them. Maybe they can help you work through and process some decisions and emotions from that day. You’re not alone. Seek out postpartum mental health support group or alliances in your town.

when to call the doctor

Some of you are with the wrong doctor.

We scratch our heads over this one all the time. Let’s say Doctor A and her partners are the group at our hospital who have the highest volume of pain med free deliveries (what a lot of people call “natural” childbirth), and the lowest rates of interventions (inductions, C-sections etc). Doctor Z and her partners have the highest rate of epidural deliveries and highest rates of interventions, with all the other practices that deliver with us having A-Z variations in between.

It is always perplexing to us nurses when patients with goals and philosophies similar to Doctor A group (and usually quite adamant about their desires) show up but are patients of Doctor Z group. You’d be better matched with another doctor, but our hands are tied. When we are meeting you, you are already in labor or showing up for an induction. We can’t, and we shouldn’t, tell you then to switch doctors. We can only attempt to navigate you through the maze of possible interventions. This is a finely honed art of professional relationships between the doctor and the nurse.

Our job is to advocate for you and your preferences. Your job is to do your homework. Don’t just choose a doctor because they are popular or your friends go to them or they are already your doctor who’s been prescribing your birth control pills and doing Pap smears for a couple years. Spend some time thinking about your birth philosophies and preferences, ask friends about their births and their providers, and know that it’s ok to interview OB’s before choosing a practice.

choosing an ob

You’re the consumer. Say something!

If you have a bad experience in a hospital setting, say something. Not to your friends, not to the internet, say something to the hospital administrators themselves. All hospitals call you in the postpartum period for a follow up survey. This is your chance to tell us the things we got right, and what areas we need to improve. Be specific. If you didn’t get this call, or you didn’t realize you could speak so openly during that call, call the hospital back. Ask to speak to the unit manager or director. These days, patient voice and satisfaction is everything in health care. Almost to a frustrating degree, hospitals will listen to what patients say more than what the nurses say. Upset about some of practices you encountered in L&D that you don’t feel are evidence based medicine? Let them know.  

Here are some possible suggestions, wink wink: strict restrictions on eating and drinking in labor, nurse to patient ratios in labor, baby remaining skin to skin with you in the first hour of life, enough staff for breastfeeding support.

How to thank us…

We love to eat still-hot Tiff’s Treats cookie delivery and a baker’s dozen Einstein bagels and cream cheese, but we can live off a genuine thank you note for weeks. I still have every one I’ve ever received, and they are among my prized possessions. Oh, but if you’re going for food we also like breakfast tacos, pizza, coffee…

This guest post was written by Maureen Hodges BSN, RNC-OB, LCCE. Maureen has over ten years of Women & Children’s nursing experience. For the past seven years she has been a Labor & Delivery nurse at a very busy hospital in the Austin area. She teaches private, hospital, and online childbirth classes. She has two children, aged 1 and 3, and a husband who knows all her L&D pep talks verbatim from listening to her answer every pregnant woman’s questions at dinner parties, on airplanes, and on the phone in the middle of the night. She has attended the deliveries of everyone in her book club. She could not pick any of their vaginas out in a line up. You can find her online at @empoweredbirthatx or Empowered Birth Austin on Facebook.

Breastfeeding Tips & Setting Up a Nursing Station

Breastfeeding Tips, Setting up a Breastfeeding Station and How to Get Support

We hear that “breast is best” all the time—the news, the hospital, our doctors, our friends, and even that random lady in the organic foods aisle at the grocery store. Even our social media feeds are peppered with research articles telling us why breast is the right choice. That’s all well and good, of course we all want what’s best for our babies!  But it’s one thing to know what is best and another thing to know how to actually accomplish it. As a lactation consultant, I’m called to give specific advice for breastfeeding issues but I also get asked all the time what my top breastfeeding tips are—so here they are!

Top Breastfeeding Tips from a Lactation Consultant problems with breastfeeding

Take a breastfeeding class while you’re pregnant!

Prenatal education is a top indicator of breastfeeding success after baby arrives! When you know what to expect and what’s normal, you can prepare! If you don’t know what latching is or looks like or how often baby should breastfeed per day, it’s hard to succeed.

Have support.  

Women find support from all different sources—some women find the best support is their husband. He may never have breastfed before, but he can certainly help you and cheer you on no matter what! Other women find their friends or mothers who have breastfed to be their top supports. Either way, research shows that women who have support have more success in breastfeeding.

After baby arrives, make plans to make no plans!  

Skin-to-skin time is so important with a newborn. In the first couple of days after birth, keep your naked-in-a-diaper baby on your chest as much as you can! This can be easy in the hospital since it’s pretty private, other than the nurses who want to look under your gown all the time, anyway. Once you get home, you may have to make more of an effort to rest and keep baby close. Make sure your partner knows ahead of time it will be his job to take over the cleaning, cooking, and bringing home the bacon (literally and figuratively!) for a few weeks after baby arrives. I love this shirt for convenient skin to skin time—or this one that comes in plus sizes too!

breastfeeding skin to skin

Feed baby very frequently.  

I tell moms all the time during personalized consults that you can’t feed baby too much, only too little!  Follow baby’s lead: during those first few days after birth before your milk volume increases, baby’s tiny tummy will need to be filled often. If baby’s awake, turning his head, or fussy: put him to breast!  

Get help if you need it!  

Breastfeeding may be the best and seem like it should be “natural,” but that doesn’t mean it always comes naturally.  If you’re in pain, baby’s not feeding well, or something seems off—get help right away. There’s no shame at all asking an IBCLC for some personalized help.  In fact, research shows that IBCLCs increase the rates of women who start breastfeeding as well as the rate of women who breastfeed exclusively. If those are your goals and you don’t feel confident in your ability to meet them, call an IBCLC!

Setting Up a Breastfeeding Station

breastfeeding lifestyle photos

Now that we’ve gone over some great tips for meeting your breastfeeding goals, let’s talk practicality. Just like “breast is best” is only helpful when we know how to actually breastfeed, those breastfeeding tips are only helpful when we can actually fit breastfeeding into our lives! One of the best ways to accomplish this is to set up a breastfeeding station in your home.

If you anticipate that you’ll breastfeed your baby in many different rooms depending on the time of day, then create your station to be a basket that’s easily transportable. If you know you’ll always be sitting down in the nursery to feed your baby, then it can be a shelf or drawer near your chair. What should you fill this station with? Anything and everything that you think you might even need! This can vary some from mom to mom (are you a reader who will need your Kindle nearby, or do you prefer to binge watch a show on your tablet?).

Lots of Water 

Get a water bottle you can operate one-handed while you’re nursing, I recommend one with a straw because you will drink more. Some moms get very thirsty as soon as baby latches on. A straw type can be great so you don’t have to lean your head back and get off balance, disrupting that perfect latch. I always kept two water bottles or cups at my nursing station at all times because I would inevitably drain all of one and then baby falls asleep on you and you feel trapped and oh so thirsty!

Healthy Energy Snacks

Did you know breastfeeding moms burn an average of 500 extra calories per day? You’ll need to make that up somewhere, so portable snacks like granola bars (these are great if you are trying to limit sugar intake—turkey flavor is my fave!), a piece of fruit, or a simple sandwich can be great to keep close by in case baby is on a marathon nursing session.

Netflix and Chill

Whether it’s a book, your phone, the remote, a tablet, or a sleep mask to catch some zzz’s while baby nurses, you’ll want something. Babies eat very often, so you’ll be spending a lot of time feeding!

Nipple care supplies

If your latch is good, you shouldn’t have much more than transient soreness for the first week or two.  If your latch is painful, talk to an IBCLC and have some of these supplies on hand.  A good nipple cream can be very soothing.  Some moms love lanolin and some love simple coconut or olive oils from the kitchen.  If there are open wounds, something like All Purpose Nipple Ointment (a prescription) or Medihoney can help prevent infection and heal your nipples. A Milk Saver is great to catch extra milk on the other side when your milk lets down and breast pads are great to protect sore nipples.  

Baby care supplies

Babies often will poop during or after a feeding—it can’t come out if it didn’t go in, after all!  So have a diaper and wipes nearby.  In the same vein, veteran moms know that an extra outfit can be needed in this situation, too!  Also make sure you have burp cloths (I’m a a big fan of a stack of plain prefolds as they are super absorbent, cheap and have a million uses!). Burping can be messy and just in case some of that milk makes another appearance, you’ll be reaching for them. Baby nail clippers (obsessed with these!) can be a good idea, in case baby falls asleep or is just finally still enough for this surgery-like activity.

When You Need Breastfeeding Support

breastfeeding tips

We’ve gone over top tips to be successful with breastfeeding, in addition to practical ways to implement those tips, but what if you do everything you can and things don’t seem to be going well?  Ask for help!  The tip to have a support system wasn’t just lip service—it’s really important!  If things are hard now that you’ve been thrust into the trenches with a brand new, needy baby, some simple love, help, and attention from your partner, mom, or friend can be just what you need.  

If breastfeeding itself is the issue, ask an IBCLC for some help!  

Nipple pain isn’t normal outside of some soreness in the first few days.  If you’re in pain or baby isn’t gaining well, breastfeeding support by a professional can be the ticket to breastfeeding success. Lactation Link offers in-person consults in Utah and e-consults for anywhere else, or you can find an IBCLC in your area through ILCA.

If motherhood seems lonely, know that you’re not alone.

Even though you’re constantly around this new little person, it can feel very isolating.  Finding a local group like La Leche League can be the answer to getting out of the house and making some mom friends.

Breastfeeding is Possible!

Breastfeeding can seem overwhelming, but you don’t need to go into motherhood unprepared! A little education, support, and preparation can go a long way in helping you achieve your goals.  Next time you see “breast is best” online or in the news, now you can add “breastfeeding is possible” to it!

This guest post was written by Kristin Gourley, IBCLC. Kristin is a mother of 5 and one of the 3 International Board Certified Lactation Consultants with Lactation Link, a private practice offering breastfeeding support through breastfeeding video classes, blog, and online support forum. She also offers in-home (or hospital) lactation support services as well online lactation support services before and after baby is born. Lactation Link’s goal is to empower women through education to reach their goals, whatever they may be.