What do you think of when you think postpartum warrior?
For the third post in the State of Midwifery series, we’re diving into it.
After having my fourth baby this past November, I have spent hours thinking about how to support people better in their postpartum period – both as a mother, as a midwife and as a friend.
I think the healthcare system fails people tremendously in this area.
And, there isn’t going to be a change anytime soon unless the frontline changes their way of thinking.
I have three solutions to offer today that you can start this same week in your clinic, your postpartum rounds and your postpartum visits.
For pregnant and postpartum people, you can ask for these things starting the moment you read the post too.
It’s going to take everyone to make us all postpartum warriors.
In case you missed the last two posts on the state of midwifery, catch up below.
- 2023 State of Midwifery: The 10,000 Foot View of the Profession
- 2023 State of Midwifery: The Key to Making More Midwives
If you want to catch the 2020 and 2021 series, they’re available on the MAKE MORE MIDWIVES page.
Tip #1: In the clinic, start handing out postpartum plans and reviewing them just like birth plans.
I’ve started doing this in clinic with great success. Here’s what it look like…
At 32-34 weeks, I hand out a postpartum plan to the patient. I really like the one from Postpartum Support Virginia but there are a number out there to choose from.
I print out the packet at the clinic and staple a blank sheet of paper to the back as a place for additional notes, tips and resources they receive in the hospital.
I encourage the family to go home, complete the packet, and bring it back for review at the next visit.
The review part in the clinic might seem unnecessary but it can offer the family a lot of insight as to whether their plan is realistic or not.
Then I encourage the family to bring the plan to the hospital in their hospital bag.
If anyone has a had a baby in the hospital, the information you receive postpartum about resouces, education, tips, appointments, etc. is near constant and overwhelming.
But, if you already have a place to write that information down (your postpartum plan), it makes it much easier to digest the information within the plan you already made!
I think a postpartum plan might be more important than a birth plan but time will tell.
Tip #2: Implement double rounding as your standard in the hospital.
Most midwives are going to think I’m crazy for this, but I dare you to try it for a month and see if your discharges aren’t smoother, more educated and better prepared for the postpartum period.
Here’s how it looks for me.
I go through the patient census and review the charts for the mamas discharging the next day. I make notes about follow ups needed, medication questions, birth control counseling as needed.
Then I head over the postpartum unit and visit with each family one by one. I generally don’t write a note in the chart but only do discharge teaching, education as needed, address questions or concerns, and put in medications to their preferred pharmacy.
Because all of this is done around 9-11pm at night, there’s not a rush to the teaching or education. It’s very laid back and really prepares the family mentally to discharge home.
In honesty, I don’t always have time to get double rounds done. But when I do, it makes all the difference in the world to the family to see the provider for those extra minutes. It also allows for more eyes on the patient or the chart than you typically might do (i.e. following blood pressures closely; assisting with breastfeeding; catching symptomatic anemia earlier).
When I think about something that can change on the front lines to improve maternal mortality, this is one practice that I think makes a difference.
Tip #3: Offer a 3-6 month postpartum follow up and a well woman 1 year after birth at the postpartum visit.
Lastly, offer follow up at 3-6 months postpartum and a well woman visit at 1 year. Encourage the postpartum person to schedule these on check out. (This is a small step to a future goal: See the family every 3 months after birth in the first year.)
Not every postpartum person is going to want follow up or can afford the copay (it should be a 99213 visit). But a lot of people will.
Here’s the challenge: for some people, they aren’t going to want to pay a copay to see a provider that doesn’t know what to do with them.
My challenge to that challenge is this: providers need to step up their game and make the appointment something of value to the patient and the family.
It shouldn’t be a repeat postpartum visit.
What the heck do you offer people then at these visits? Well, here’s what I would ask.
Assessment of mental health
Offer a screening for depression and anxiety (and, if you don’t know how to assess and treat a positive screen, then learn how. So many providers won’t screen because they don’t know what to do with a positive screen.) Did we miss postpartum anxiety or depression? Is it there now? Or, are meds and counseling already in place and we’re checking to see if mood and coping are where they need to be. How is bonding with the baby? How is the family adjusting? Do they know about support groups within the community or online?
How is breastfeeding going? Is the baby eating foods yet? How has that transition been? How do you continue breastfeeding with the introduction of foods? Any issues with mastitis/review warning signs for lumps and mastitis.
Cardiac health assessment
Was there pre-eclampsia during the pregnancy, birth or postpartum period? How is the blood pressure now? What education can you complete to prepare the family for care in a future pregnancy (aspirin guidance and education…)?
Contraception and family planning
What was the contraception plan? Is the plan still the same? What does the family plan look like? Offer education about lactation amenorrhea method, natural family planning and risks to closely interspaced pregnancies.
Was there gestational diabetes? Was a postpartum glucose screening done to see if there is insulin resistance or diabetes outside of pregnancy? What diet and exercise modifications are recommended? Is an early glucose screen recommended in the next pregnancy>
How is the household doing with food, diapers, wipes and other child expenses? Any concerns about getting nutrition for the family? Do they qualify for resources within the state?
Infant and parent sleep
Assess for safe infant sleep, co-sleeping, questions about sleep training. But also, how is the postpartum person sleeping??
Exercise and strength training
How has the return to exercise gone? What are the currents goals for exercise/what free time does the client or family have to engage in exercise activities? Review the importance of strength training. Review expectations for weight loss after baby and how long it should take to lose baby weight. Review goal weight prior to next pregnancy.
Are they having any back pain that is still present from the pregnancy or postpartum period? What do they think is the cause (lack of exercise, lack of core strength, epidural placement)? This is a great time to plug the benefits of a physical therapy assessment and/or treatment.
Pelvic floor therapy
Pain with intercourse? Leaking urine with laughing, coughing or sneezing? Feeling a bulge in the vagina or some increased pressure throughout the day? Maybe pelvic floor therapy is indicated!
Return to work
Has the person returned to work? How is that transition going? When are they planning to go back to work if they haven’t yet? If breastfeeding, are they able to pump every few hours in a clean, private space?
Transition to motherhood
Do they have a support system of grandmothers or aunts nearby? Do they have some friends that have children? Are they involved in a local church or moms group? Have they gone out for errands and to the grocery store with success (I always find this is a good plug for baby wearing!)? Are they reading to their baby/children? Are they using a daycare, nanny or family for help? Or, do they not have any help? How is their partner transitioning into parenthood? If this isn’t the first baby, how are they transitioning to a bigger family? How arer the siblings doing?
Are any vaccines out of date? Are they a candidate for the HPV vaccine?
But Jamie, what if they can’t afford the visit?
I’ll offer this. In those cases, I would put a reminder in the charting system to call those mamas at 3 and 6 months and just ask how they are doing.
I can’t think of a better way to spend my lunch hour than to call a few postpartum mamas and just ask how they are doing.
Also, some people might think the pediatrician is supposed to cover some of this.
And some of those visits might.
My experience with 4 kids is that these visits are more about baby milestones and less about overall postpartum health and wellness.
There is a lot of room to improve postpartum care.
I hear about the need to improve care all the time and see new laws come into legislations about new postpartum coverage. And I constantly hear about the terrible maternal mortality the United States struggles with.
There’s a problem.
But I don’t see movement to implement change for the better on the frontlines.
Midwives can be those change makers.
If you need some inspiration for how to revamp your postpartum resources and counseling, visit the RESOURCES page and scroll down to “Postpartum.” I maintain an ongoing list of everything postpartum that I know about or recommend.
I hope these tips help you to become a postpartum warrior wherever you may be as a birth worker. Have a tip of your own? Email me at firstname.lastname@example.org or DM me on the insta.
Hugs until then,
1 year ago on the blog…What do you pack in your hospital bag for birth?
2 years ago on the blog…The State of Midwifery (Part 3): Advocate for Midwifery