By Jasmine Maes, LM, CPM
The first days and weeks after a baby is born are full of emotion, new experience and adjustment to life with baby. There are often tears of joy and frustration, limited sleep and new physical sensations. Caring for baby, healing after birth, and the arrival of breast milk all bring a sense of fullness to days and nights. New parents are often recovering from labor and missed sleep.
Following a hospital birth, a woman may stay for 1-3 days as a patient at the hospital. During these days, her vital signs, healing and functions are monitored by the staff. Her baby also is a patient, and a nurse comes in frequently to check vital signs, feeding, weight loss/gain, and jaundice. On the second day most families are discharged home with strict instructions to follow-up with their family doctor or pediatrician within a day or so for weight and jaundice checks for baby. A woman’s milk has not arrived yet, and her nipples may be sore from the adjustment to feeding baby, not to mention tenderness from any healing stitches. Her sleep has been interrupted by regular visits from staff and family, and there is little to no space made in the hospital for families to snuggle together. Even more stressful for many families, little accommodation is made for older siblings to be in the hospital with their families.
It is often routine for babies to be taken to the nursery for weight checks, tests, and hearing screening. Even seemingly harmless procedures like bathing a newborn in the hospital can do more harm than good, as amniotic fluid and vernix are shown to be protective against bacteria, as well as to play a key role in newborn feeding, imprinting, and bonding (No smelly synthetic Baby Magic shampoo for my new baby, please!). There are often rules about baby’s safety and co-sleeping, which can limit skin-to-skin time and breastfeeding. After discharge from the hospital, parents are instructed to return to their pediatrician’s office every few days for weight checks until milk has arrived, baby has regained its birth weight and breastfeeding is more established. No care is regularly scheduled for new moms following hospital discharge until 6 weeks following the birth! No evaluation of healing, minimal breastfeeding support, no postpartum depression screening, or the chance to discuss, process, and ask questions about labor or her baby’s birth. A woman who gives birth by cesarean may have a two-week post-op appointment with a doctor to check her incision, but otherwise it’s the long six weeks till she is seen again by her doctor or nurse-midwife.
In contrast, following a birth center or home birth, the focus is on uninterrupted bonding and skin-to-skin connection with baby. Assessments of mama’s and baby’s well-being are done unobtrusively with baby at the breast or in a parent’s arms. Separation is neither encouraged nor necessary to provide thorough care for a newborn baby. Midwives recognize that the safest and healthiest place for a baby is with it’s mama. Even the routine and thorough newborn exam following birth is offered in the bed with parents and no procedure is ever performed without clear permission and consent. After a nap, a good hot meal, and some care and teaching by our midwives, families get to go home to the inviting comfort of their own beds around 4-6 hours following birth or in the morning if the birth occurs overnight. Or even easier yet, following a home birth, the midwives tuck a family into their own bed and plan to return for follow-up care the next day. Here is where the truly deluxe treatment begins.
Whether birth happens at Thrive or at home, a midwife visits the family at home within 24 hours of birth, on day 3-5, and again on day 7-10. These visits last about 90 minutes, with time for care of both mom and baby. Vital signs are checked, baby is weighed and evaluated for jaundice, with appropriate referral for any abnormal findings. In-depth discussion of breastfeeding and any emotional or physical challenges are reviewed. Newborn Genetic and Metabolic screening, which is offered to all families in California, can be performed at the 3-5 day home visit, with parents’ permission. Additionally, families are invited to return to Thrive at 3 and 6 weeks post birth for continuing postpartum care visits for mom and babe, including family planning counseling and well-woman screening. Additional postpartum visits are available in the event that there is a concern or challenge.
As licensed primary caregivers for low-risk mamas and newborns in the first 6 weeks after birth, midwives are trained and equipped to give comprehensive and safe care during this especially sweet and sensitive time. The midwife returns at these regular intervals so that parents can spend these precious and vulnerable first days in the privacy and comfort of home. No unnecessary exposures or long waits in germy waiting rooms, no delayed feedings, no climbing in and out of the car for sore mamas, or wrestling engorged breasts into uncomfortable nursing bras. Just rest, recuperation and togetherness. Another benefit is that older siblings can be a part of postpartum care to help ease adjustment to the new baby’s arrival.
Help with breastfeeding challenges and support for mamas with emotional adjustment stand out as two of the most valuable pieces of this ongoing care. Plenty of new mamas are unsure their baby is getting enough milk, feel overwhelmed learning to help their baby latch, have challenges with producing enough milk, or receive mixed messages or inaccurate information about breastfeeding. The US has a relatively low breastfeeding success rate, with 72% of women breastfeeding at birth, but only 49% still breastfeeding at 6 months, and a dismal 27% still breastfeeding at 12 months, despite the World health organization recommendation of breastfeeding through 2 years of age, or as long as mutually desired by mother and child. Multiple studies show that prolonged breastfeeding gives children the absolute healthiest start to life by reducing incidence of obesity, diabetes, autoimmune disease, food and environmental allergies throughout the lifespan. What most women need for success is more support and information. Women cared for by midwives regularly have breastfeeding success rates that surpass these national averages.
When choosing where to give birth, doesn’t it make sense to consider what care will look like after baby arrives? It makes sense to have care that takes into consideration the needs of the entire family, and to have frequent, professional, and personalized care in those crucial first days and weeks of your baby’s life.