Why You Need a Postpartum Team: A new perspective on postpartum care and support
Mamas-to-be spend so much time preparing for birth and getting everything they need to welcome their new baby, they often forget all about themselves. A problem they will most likely continue to involuntarily perpetuate through the rest of their mamahood. Preparing for the postpartum period is just as important as everything else. In fact, if you believe the old adage saying “you can’t pour water from an empty cup,” then setting up a strong support system for postpartum may be even more important for new mamas than what came before.
Shifting the Postpartum Paradigm
So many books and movies focus a lot on women’s pregnancies and births, but they rarely depict what happens after baby arrives. When they do, most of the attention is focused on the baby rather than the mom. The same happens in most modern health care systems in real life. Mamas get monthly and later on weekly check ups during pregnancy, and baby receives several checkup with a pediatrician in the first year of life, but in the current continuum of care, new mamas only get a “6-week check up” from their care provider before being released back to their GP in the case of OB or midwife. Note that some midwifery practices offer more comprehensive follow-up care in the first six weeks, but will eventually still discharge their postpartum patients at six weeks.
After birth, the attention shifts to the care of the baby with close monitoring over the first few days, weeks and months. In the meantime, the care for the new mother unfortunately becomes almost inexistent. We don’t ask new mamas how they are managing this new transition physically, mentally, emotionally or environmentally. The burden to seek proper care and to raise any issues with care providers falls on them. The standard of care of postpartum women is incredibly deficient and until it is fixed, we have to find our own postpartum support teams.
The Fourth Trimester
Pregnancy is nine months, the birth is one day (or two in some cases), but postpartum can last much longer than this. No one really agrees on the actual length of the postpartum period. Some people believe it’s denotes the first six weeks, others the first three months (the fourth trimester), and some even believe it never ends. For our purpose today, we will assume that two main phases of postpartum exist: the fourth trimester, and the total duration of a woman’s breastfeeding journey, which is highly variable in length.
The Lost Village and Multidisciplinary Care
We often bring this concept forth when talking about birth; passed generations of women would’ve likely grown up in communities where they were exposed to birth experiences. They would’ve seen their mothers, aunts, sisters or neighbours birth a baby. In turn, they would’ve observed other women breastfeeding and caring for their babies. We know that to this day, in some parts of the world, this remains young girls experiences. Unfortunately, in western society, due to migration in large city centres and globalization among other factors, we have lost this community. Women have become so isolated from each other, a woman’s first experience with childbirth and postpartum is often her own. Mothers are no longer prepared for the journey they are about to face. Along with making efforts to rebuild the sense of community we have lost, we must face the fact that we will have to seek our support elsewhere in the meantime.
Ensuring adequate support begins in pregnancy. Knowing the main areas a woman is likely to require help in advance allows her to prepare for postpartum period by gathering resources and building relationships with providers she will work with postpartum. Doing this during pregnancy, when possible, ensures that she is not left stranded and scrambling to find help when a problem arises after baby has arrived.
On the paramedical side, a new mama’s postpartum team can include a Pelvic Health Physiotherapist, a Psychologist trained in maternal mental health, a Registered Dietitian, a Lactation Consultant, an acupuncturist, a chiropractor, an occupational therapist, a naturopath, massage therapist, and more. Non-medical support can also come in the form of friends and family, postpartum doulas, exercise specialists, and more. Finding the right people to support mamas during this transformative time is incredibly important.
I understand that not everyone has easy and affordable access to those services depending on their location and the quality of their insurance, among other factors. Some providers do offer sliding scales or pro-bono services for lower-income families. In any case, a list of free online resources to help you if you have difficulty finding or are unable to access individualized support in your area is provided below this article. I acknowledge that in our current continuum of care, access to the services mentioned in this article is a privilege, but the goal of this article is merely to encourage mothers to learn more about what kind of support is available to them and advocate for comprehensive care to become a right to all women. Until the care of mothers become a priority and quality and comprehensive care is available to all moms, this is the best we can do. Let’s acknowledge our needs and demand better from our elected officials. It’s also important to acknowledge that in the United States, women have difficulty obtaining decent maternal leave, so it is foolish to expect them to have a comprehensive mental and physical support system for new moms. But it is nonetheless, it is important to bring awareness to these issues.
Matrescence and Psychological Support
The profound psychological transformation a new mom undergoes is akin to that of a teenager entering puberty. You enter in one way and come out a whole new person. Like in adolescence, new mamas experience a significant change to their physical appearance along with important hormone fluctuations and a remarkable shift in identity. Every mama will experience this profound shift differently depending on how their birth unfolded, their own expectations for themselves during this period, and just as importantly the amount and quality of the support they receive.
Seeking professional support in that area can help avoid struggling to adjust to the new realities of motherhood which include, but are not limited to, a shift in identity and responsibilities, body image issues, changes in relationship dynamics, sleep deprivation, feeling overwhelmed, and the more serious mental issues related to the postpartum period — postpartum depression and anxiety. As many as one in five new moms may experience a perinatal mood and anxiety disorder (PMAD).
Other ways to get emotional support during this new phase of life could include joining a mom support group or making mom friends with babies of a similar age, practicing mindfulness through journaling and meditation, getting a friend or family member to talk to when needed, etc.
Physical Recovery and Support
Recovering from birth can be a long process. The body just birthed a baby, it needs time to heal. During a vaginal birth, a woman’s perineum is stretched to the max and tearing to various degrees can sometime occur. During a cesarean birth, a mama undergoes major abdominal surgery and multiple layers of tissues and muscles are cut through to make way for baby. After birth, many women experience discomfort such as pain, swelling, hemorrohoids, urinary and/or fecal incontinence, and pelvic organ prolapse. This can be the case even in a cesarean birth, especially if it was performed in emergency after hours of active labor. The seemingly arbitrary six-week clearance for resuming exercise and sex given to most postpartum mamas, doesn’t seem to take into account any residual healing that needs to be done physically or emotionally.
In addition to recovering from giving birth to a baby, moms have to remember that they are also recovering from nine months of pregnancy. Pregnancy changes a woman’s body. They spent nine months carrying an ever-increasing load (aka bundle of joy). The shape of a woman’s abdominals, pelvic floor and her posture are all changed during pregnancy and adjusting to no longer carrying this extra load overnight is easier said than done. Organs are shifting back to place, tissues are healing, the center of gravity is returning to its original place….
A key postpartum team member for all new mamas, in my opinion, is a pelvic health physiotherapist. They will be able to help with regular postpartum concerns like reactivating the pelvic floor and core, c-section scar release work, general physiotherapy, as well as more serious concern like painful sexual intercourse, leaking, or a sensation of heaviness in the vagina or rectum. Every woman should be assessed by a pelvic health physiotherapist in the first few months after giving birth. Many countries have begun to make this part of the postpartum standard of care including France, the UK, Norway and parts of Australia. Most physicians, in countries like the United Stares and Canada have not been trained to assess pelvic health or simply don’t have the time to discuss it in details, having appointments that often last less than 10 minutes. Women are often brushed off and told to do their “kegels” but one thing that is important to note is that a significant portion of women actually have hypertonic pelvic floor, meaning their pelvic floor is constantly contracted and holding tension. This means that rather than needing to strengthen their pelvic muscles, they must learn to relax them and let go. The help of someone specifically trained in pelvic health is therefore warranted. Along with supporting pelvic health, a trained pelvic health physiotherapist can also assist you in assessing and treating diastasis recti, the separation of the abdominal wall that often happens during pregnancy and postpartum, as well as other postural changes resulting from pregnancy.
New mamas should also consider seeking help in developing a rehabilitation program before resuming more intense physical activity. Another valuable team member could be a personal trainer or fitness professional specifically trained in working with postnatal women.
Sleepless nights provide little time for a new mama’s body to recover from the day to day activities. Breastfeeding can take a toll on the back and so does carrying baby around. Sore neck and back, tight hips aren’t uncommon in postpartum. Consider the benefits massage therapist or chiropractor has to offer to help keep moms ever changing bodies free of pain.
Adjusting to a New Normal
The division of labor may be in complete disarray following baby’s arrival. Depending on what kind of parental leave new parents and their partners can get, some support might be welcome. Mamas may be able to enlist the help of their families, friends and community to help with meals, sibling care, house work and errands. Alternatively, support may come in the form of a postpartum doula or a house cleaner, to name a few.
Postpartum doulas can be very versatile to help support mamas in whatever areas they need. Doulas can help with breastfeeding support, physical recovery, emotional support, processing the birth experience, light household tasks, preparing meals, postpartum education, supporting cultural practices, newborn care, and more.
Breastfeeding Support
Breastfeeding may be labeled as “natural,” but it often isn’t instinctive. A lot more often than we may realize, challenges arise. Common challenges include difficulty establishing a good latch, painful feeds, sore breasts, experiencing engorgement, clogged ducts or mastitis, issues with low milk supply or oversupply, slow weight gain in baby, return to work, etc. Lots of new mamas also experience self-doubt when it comes to breastfeeding, especially if they are experiencing any of these difficulties. Most breastfeeding challenges can be remedied by consulting a lactation consultant and getting more information surrounding the mechanics of breastfeeding. Most women do not breastfeed as long as they initially intended to due to the lack of support or due to their inability to manage a specific breastfeeding challenge.
The WHO (World Health Organization) and multiple other medical entities recommend babies be exclusively breastfed for the first six months of life and to continue breastfeeding along with serving complementary foods until age two or longer. Other organizations, like the American Academy of Pediatrics and the Canadian Paediatric Society, highly encourage breastfeeding for at least a year. The problem is that the current systems in place often don’t support breastfeeding mamas adequately, and therefore, this goal is often hard to meet.
Furthermore, the dietary needs of a breastfeeding mamas are a lot different than they ones of a non-lactating mama. Breastfeeding mamas are expected to require an additional 450 to 500 kilocalories daily to meet the demands put on their bodies. And although babies typically receive all the nutrients they require from their mamas’ milk, in order for mamas to stay healthy, they may benefit from the guidance of a registered dietitian specializing in supporting postpartum women. Let’s also all remember that breastfeeding does not inhibit ovulation and postpartum mamas’ cycles can reappear at any moment. With fluctuating hormones and irregular cycles, the support of a naturopath may also be useful to some. They can suggest alternatives birth control measures than the ones typically recommended by OBs and GPs.
We cannot expect that a single health care provider will be able to assist a new mom in the treatment of a multitude of postpartum concerns including mental health, physical recovery, breastfeeding challenges, dietary intake, fertility, and more. Women should therefore be encouraged to seek the help of the appropriate professionals for their issues. The value of a multidisciplinary approach to postpartum cannot be underestimated. The right support will ensure new moms can properly recover from pregnancy and birth.
Needing help does not make someone a bad mom. Many great moms suffer with perineal mood disorder, experience some type of pelvic floor dysfunction, or struggle with breastfeeding in one way or another. But in order for them to be the best mama they can be, we need to provide them with adequate support. Postpartum care should be prioritized just as highly as care for pregnant women and babies. What a team of support can bring to the care of a mother can make a world of difference in their postpartum experience.
List of free and affordable online resources for postpartum families:
For Psychological Support
https://www.jennifersummerfeldt.com/
https://www.villagetherapy.ca/
https://www.themotherhoodcenter.com/
https://www.mombraintherapist.com/
https://themompsychologist.com/
https://www.alexandrasacksmd.com/
For Physical Support
https://www.expectingandempowered.com/
https://www.thepelvicfloorplaybook.com/
https://www.instagram.com/Pelviccollectivept/
https://prenatalyogacenter.com/
https://www.thevagwhisperer.com/
For Breastfeeding Support
https://www.instagram.com/thelittlemilkbar_/
https://www.instagram.com/littlenursingco/
https://www.instagram.com/milkandlove_/
https://www.instagram.com/northern_lactation/
Books
- The Fourth Trimester: A Postpartum Guide to Healing Your Body, Balancing Your Emotions, and Restoring Your Vitality by Kimberley Ann Johnson
- The First Forty Days: The Essential Art of Nourishing the New Mother by Heng Ou
- Cherish the First Six Weeks: A Plan That Creates Calm, Confident Parents and a Happy, Secure Baby by Helen Moon
- The Postnatal Depletion Cure: A Complete Guide to Rebuilding Your Health and Reclaiming Your Energy for Mothers of Newborns, Toddlers, and Young Children by Oscar Serrallach
- Good Moms Have Scary Thoughts: A Healing Guide to the Secret Fears of New Mothers by Karen Kleiman
- Misconceptions: Truth, Lies, and the Unexpected on the Journey to Motherhood by Naomi Wolf
- Mama Rising: Discovering the New You Through Motherhood by Amy Taylor Kabbaz
- Ordinary Insanity: Fear and the Silent Crisis of Motherhood in America by Sarah Menkedick
- What No One Tells You: A Guide to Your Emotions from Pregnancy to Motherhood by Alexandra Sacks
