Chat with a Provider: Postpartum Care with Stephanie Davis, PA-C
The fears that come with the unknowns of postpartum care are right up there with the fears of labor and delivery. In a culture of increased sharing and social media the access to information regarding the postpartum process is more prevalent. Even with this being the case, I know I personally was not prepared in the slightest, even after taking a childbirth class. When I look at the photo above I see myself, with a beautiful new baby girl, so deeply in love – but also deeply tired and overwhelmed with all the newness. Prenatal visits don’t often discuss postpartum care and it seems for most to be a learn on the fly situation. I have heard from almost everyone I know with a child that their postpartum staff was amazing; but it’s a lot of weight to put on that staff and the new mamas who are learning to care for a newborn as well. I spoke with Stephanie Davis, a physician assistant who has spent her career working in Women’s Health and currently works in postpartum care about many commonly asked questions that can help mamas through the immediate postpartum period.
Steph’s Bio:
Hello! I’m Steph. I have been a physician assistant in Women’s Health for the past 7 years. I have been working in inpatient Obstetrics (OB) for the past 3 years, with a lot of my time spent with postpartum mothers. I feel so lucky to be able to help these mamas in this immediate postpartum setting while they venture into motherhood, and I’m happy to share some of this with you all! All of my responses are my personal opinion and I hope everyone finds a health care provider they trust to dive deeper into any of these concerns or questions.
This information should not take the place of your healthcare provider’s recommendations. Please always contact your healthcare provider with any concerns, questions or need for further elaboration or clarification.
What should new mothers expect in the first few days post delivery in the hospital?
There will be lots of people checking on you and your baby to make sure you both are okay. It can seem like a bit much when you’re completely exhausted (especially when providers perform those darn “belly pushes” to assess your uterus and its size) but it’s all for the safety and health of mom and baby. You will likely be quite exhausted and trying to deal with sleep deprivation, so as obvious as this sounds (and hard as it may be), definitely sleep when the baby sleeps or don’t be afraid to ask for help from the nurses/nursery if you really just need a few hours to recharge. It’s okay to do what you need.
Hopefully all goes smoothly and as planned, but unfortunately sometimes there can be medical complications that need to managed such as high or low blood pressures or too much postpartum bleeding (aka postpartum hemorrhage). This sounds (and can be scary) but your medical team will know just how to handle this and be there for you through it. Sometimes, medical complications can extend a patient’s stay in the hospital to longer than they anticipated. Providers don’t like when this happens either but we need to ensure your health and safety before we can send you home.
Even if everything about your labor/delivery is perfectly normal, it’s still expected to have some discomfort and bleeding for a little while (up to a few weeks), but typically it does get a little better each day. You will also get tons of education and learn lots about your new baby, which is great but can also be overwhelming. Just take it day by day, feeding by feeding and diaper by diaper.
The first poop. An awful but necessary topic. Any tips??
Take the stool softeners and stay well hydrated!! It’s okay to bear down or “push” the poop out – We just don’t want you straining too hard of course so if its too uncomfortable, increase the stool softeners or talk with your medical team about other options to make having a bowel movement easier! Also, the first one is always a little scary, but it truly gets better each time! If you have a 3rd or 4th degree tear (god bless you), then discuss what bowel regimen your Obstetrician (OB) recommends to ensure easy, soft poops for a longer time period (approximately a month or so).
What are the best items to pack for postpartum care (for mom and/or baby)?
This one is tough as there are too many options out there!! This could also be a whole discussion in itself, which I’m sure my dear friend, Al, will talk about at some point. [[Oh she knows me well. See my thoughts about what to pack for the hospital here.]] In general, the hospital or birth center typically will provide the essentials for baby like diapers, wipes, baby blankets/swaddles, shirts, baby soap/comb/bath supplies for that first adorable bath. Hospitals that have a “baby friendly” designation typically do not provide pacifiers unless needed for a special circumstance or procedure like a circumcision. So if you want your baby to have a pacifier, best to bring your own. The hospital will also have plenty of formula and bottles if needed for your babe. The hospital should also have a breast pump and pump parts available to you. You can bring your own breast pump, but a lot of insurances won’t give you your own until after the baby has arrived (kind of silly, I know!), so be sure to check into this during your 3rd trimester to see how to get a pump through your insurance if you desire one. Truthfully, the hospital-grade pumps are amazing and can be helpful to get your milk supply moving if your needing or wanting to pump in the beginning of that journey.
For baby:
An outfit for baby to go home in is a must. Keep in mind you never really know how big your little one will be so a newborn size and 0-3 mo size might be a good idea. Of course, you can typically put your baby in cute outfits as soon as you want, but with all the newbie diaper changes and spit ups, they likely may only be in them for a short bit. A blanket for the ride home or your own swaddling blankets/sleep sacks if you prefer. – The car seat!! I suggest testing this out ahead of time. The hospital/birth center staff likely can’t help you figure out how to install it in your car for legal/liability reasons.
For moms:
Some women love to bring their own pads and those disposable underwear/depends undergarments. When I had my own baby, I personally felt fine with the hospital supplied pads and mesh undies [[I completely agree with Steph here!]]. And in the cases of postpartum hemorrhages, it is easier for us to measure how much bleeding the patient had when wearing our supplied pads. The hospital will also supply products for your “perineum care” (the area surrounding and including your vagina and rectum) like a peri-bottle, sitz baths, tucks pad, ice packs, heat packs, numbing spray, nipple ointment/Lanolin. Again, if you have anything specific you personally prefer, go ahead and throw it in the bag!
Comfy clothes!! If you plan to breast feed, its helpful to have something w/easy access to the boobs or a nursing tank/bra. Of course, you’re welcome to use the hospital gowns the whole time, but most patients enjoy putting on their own clothes (makes you feel better and feel a little more normal) But truly, don’t dress up for us, keep it comfortable!!
Basic toiletries for the bathroom like shampoo, soap, toothbrush/paste, hair brush
Slip on shoes! I definitely see people walk around in their bare feet too often. While we want you to feel comfortable in your room, remember it is a hospital where staff are walking in and out of your room and all over a hospital. Bring shoes.
Snacks!! Of course you can order your meals as a patient. The hospital typically allow patients to even order in food from outside places or their support person can bring them something from home. But, you never know what time of the day you’ll finally have that baby or if you need a late night snack after a feeding
Your own pillows or blanket can be nice if you like. Hospital pillows are never that great but will of course be available. A boppy or nursing pillow is lovely to have as well but we always have extra pillows available to help support during breastfeeding or whatever else you might need
Phone chargers, iPads if you want a Netflix fix and note pads for writing down questions/tracking feeding times and dirty diapers (it’s hard to remember it all with that sleep deprivation and early on the feeding schedule and wet diapers is important information). [[There are also apps for your phone to aid with recording some of these things if you prefer the digital route]].
What has changed since COVID-19? How can we best prepare to manage this new normal?
Less visitors is definitely one of the most noticeable things for patients. The hospital I work at currently allows 2 support persons but this is kind of an ever changing thing. Honestly, most patients and the staff have found this as a positive thing. I know, sounds harsh but listen – In the past, we allowed basically unlimited visitors which can make it very difficult for the new parents and new babes to rest, work on breastfeeding and heal. We, as staff, also find we are able to better care for our patients because we don’t have to break up the party every time we need to check on you or discuss your private health matters. It definitely takes a village to raise these little ones and help from friends and family can be so crucial for some, but there will be plenty of time and need for that once you are in the comfort of your home. That being said, I do think it is very hard when parents have other children that aren’t able to come visit yet. We try to encourage mamas to enjoy this special one-on-one time with the new baby, but I can definitely understand how it can be difficult to be away from your other babies as well. So if this could be you, maybe do a practice night away before the baby arrives for you and your other kiddos to prepare a bit for the hospital stay?
Of course, the staff and patients are still required to be wearing masks during the hospital stay to keep everyone (especially our vulnerable newborns) safe. If a mom is sick with COVID 19 at the time of delivery, this can change how things happen for many reasons, but the goal is still to keep mamas and babies together when safe and possible.
What medications and mama-care typically takes place immediately postpartum?
Medications: Immediately after delivery, it is recommended to get IV Pitocin. You may have already been getting Pitocin during your labor or induction if needed to help augment your labor. This is very important as this can help prevent postpartum hemorrhage (abnormal bleeding after delivery that can be life threatening). If you still have extra bleeding despite Pitocin, there are other medications or interventions your OB provider may give you to help stop bleeding. Depending on your personal preference, the baby may be immediately placed on you after a vaginal delivery as long as everything is safe and healthy. While we try to respect birth plans and preferences, you and your baby’s safety are always the OB team’s number one priority which can potentially interfere with premeditated ideas/plans. We try to encourage the “golden hour” when possible and safe for all patients. This is a special time to bond with baby (and the other parent or support person if they are present). I hope everyone gets to enjoy.
Your nurse will stop and remove your epidural (if you had one) when needed. After you’re able to feel your legs and move around on your own, your team will help you get to the bathroom when ready. If you had a c-section, you will still typically be able to see your baby right away and they will even bring baby right up by your face for a little snuggle as long as everything is going well and safe for mom and baby. Once the doctors are finished with your surgery and all is well, you’ll be moved to the recovery area with baby. Your OB and anesthesia team will closely monitor you to make sure you’re okay but they will do everything possible to allow you the bonding time with your baby, again as long as you both are stable and doing well. You will be transferred to your postpartum room or may stay in the same room depending on the facility you’re in. You may have pain or may not right away, but your team will have pain medications or other pain management options ready as needed.
Your nurses as well as other postpartum staff will push and massage your belly (this may seem mean and can be uncomfortable but it’s because we care, truly!). This helps ensure your uterus starts a process called involution which is when the uterus contracts and starts to go back to its pre-pregnancy state. This can hurt, we won’t lie. But it is necessary to ensure you do not ultimately have too much bleeding or a postpartum hemorrhage.
Any tips that you think all mamas would benefit from? Did your outlook change at all after having your own child?
I definitely think it’s helpful to think about what your preferences are regarding your delivery and care of your baby. It would be quite tough to have not thought about aspects of the delivery or post delivery, such as how you feel about an epidural (or other pain management options) or breastfeeding, until you’re in the heat of the moment. So, filling out a birth plan can definitely be helpful. However, I also think it’s helpful and necessary to be flexible with your birth plan and think of it more as suggestions and preferences. Your OB team should be willing to accommodate what you want (because we want our patients to be happy too and enjoy their experience after all!) but again, you and baby’s safety are non negotiable – And I believe most patients appreciate that. Similarly with breastfeeding, we love breastfeeding and we want all patients to succeed if that’s what they want. But truly, the only requirement that we have is that baby gets fed. And if formula is the best option for you and your baby, then that’s the best option. If it is breastfeeding, that is great too.
After having my son, hands down, I definitely have more sympathy for my patients! Haha! I joke that I work in one of the few professions where having a child actually helped my career: But it really did. I now understand and empathize the fear, the joy, the raw emotions and the uncertainty these new mamas are going through and I’m honored to be part of it all.
I cannot express how grateful I am to Steph for her time and information regarding this important time (not only for this blog post, but also for my personal experiences with my daughter as well).
What questions or comments do you have mamas? First time mama and wanting more information? Experienced mama and had a different experience? This community would love to hear from you!
Let’s talk soon,
Al