Return to You: A Postpartum Plan for New Moms

Introduction

MOTHER/noun /moth·er/: a woman in relation to her child or children

When I gave birth to my first child, I was 30 years old. I was also a pediatrician, and I felt like I knew everything I needed to know going into my first delivery. Even now, I remember a nurse came and wheeled me and my now 19-year-old daughter to the front door of the hospital. It was time to go home already. At that moment, someone snapped a photo of me. In that photograph, I am sitting holding my newborn in the lobby, waiting for my husband to pull the car around. And I was crying. When people see that photograph, everyone always says, Oh my gosh, that picture is so special. While everyone sees the poignancy of that photo, I actually remember how terrified I was at that moment. I had just given birth to my beautiful daughter and now they were pushing me out of the hospital with a brand-new human being. Even though I had just completed 3 years of pediatric residency, I was scared and overwhelmed because I honestly felt so ill-prepared for this momentous occasion.

For me, this parenting book is not just a professional endeavor; it is a personal one. This is for the new mamas out there, who are either preparing for birth or who recently gave birth. What do you see when you go online to find a book on parenting and/or motherhood? Most books focus on the baby, addressing important topics such as development, nutrition, feeding, and sleeping. Although the focus on the infant is obviously important, very few books focus on the mother. In fact, I realized that these books, while focusing on infant care, often forgot a key piece of the puzzle: Mom.

Throughout my career as a pediatrician, I have always had a strong interest in maternal health. Although I didn’t completely understand the intricacies of what constituted maternal health during my education and training, throughout the years I have learned so much by caring for new mothers and babies. Every single day, I am reminded about the enduring bond between a mother and her baby.

When I began researching this book, my publishers and I were shocked that there was not one book, not one written about the postpartum period by a medical expert. There are books, articles, and websites out there, but figuring out what is opinion and what is fact can be challenging. And overwhelming. I am here to tell you, it’s not the quantity but the quality of what you read. I promise you that everything in this book is evidence based, medically sound, and exactly what I tell my moms in practice every day.

For me, everything as a new mother was a blur. I, like many mothers, was just trying to survive and get through the day. And while there are some wonderfully amazing moments, we also have to acknowledge the difficult times, when it takes every ounce of strength to care for your infant that day, that week. My postpartum visits with the obstetrician were fast and focused on my healing and how fast my body could return to functioning as a mother and wife. My child’s pediatric visits were, obviously, focused on the growth and development of the baby. I was never asked how I was feeling, how I was adjusting. No one was really focused on me, the mother. And in all fairness, during our medical training all those years ago, that is what we were taught. We focused on the immediate physical health of both mom and baby.

As a new mom, you have spent the past 9 months wondering about your baby. Who will your baby look like; will it be a boy or a girl? What color hair will the baby have, or will the baby have any at all? As a new mother, you can’t wait to cuddle with your newborn and to count all the fingers and toes. You want to kiss and smell the baby and wrap him or her up tightly. My guess is that with all those thoughts and images, you probably didn’t think too much about yourself, did you? Did you think about how tired you would be, or who you would ask for help in those early days if you needed it? As new moms, we begin to think of everything our child needs, while pushing our own needs aside.

In popular culture, movies, and social media, motherhood looks easy, often glorified, right? Mothers are often bombarded with advice and images on what a mother is supposed to look like and what she is supposed to be doing with her baby. Whether it is the onslaught of magazines in the grocery checkout line or the perfect images on social media, we see moms in their prepregnancy jeans, hair done, looking all put together while juggling a newborn. However, what we often don’t see are the images of new mothers as they struggle.

For me, this book is a way to help normalize this aspect of motherhood, where many mothers may feel lost or inadequate, as if they’re not good enough. Whether I was going from examining room to examining room visiting my patients and their new babies or speaking around the country, I saw and heard from mothers of all ages, races, religions, and backgrounds who were reaching out for help. These mothers shared their stories with me, of how they struggled, how they were embarrassed or afraid to ask for help. I am here to tell you that you are not alone.

WHAT IS THE FOURTH TRIMESTER? inline-image

TRIMESTER/noun /trīˈmestər/: a period of 3 months, especially as a division of the duration of pregnancy

A trimester is defined as a period of 3 months, which helps mark the various stages of pregnancy. Each stage is marked with its own set of milestones as mom and baby are continually monitored during the pregnancy. Many mothers-to-be read books about pregnancy that tell them various things about the growing baby based on the weeks of pregnancy. Various apps track pregnancy and capture special moments. As the mom and baby grow, customary celebrations mark different stages of the pregnancy. Whether it is a surprise baby shower, a gender reveal, a maternity photo shoot, or a baby-moon with your significant other (or even all of them!), pregnancy is generally an exciting time for mamas to be. As it should be!

However, once the baby is delivered, there are 2 of you. For the past 3 trimesters, a mother has become one with this baby, forming an intense physical and psychological connection. Thinking of 2 people but taking care of one body. Just because the baby is now outside the womb does not mean that mom and baby are no longer connected. In fact, in some ways you are now even more connected to your infant.

Why is the fourth trimester so important to me? Because as a mother and pediatrician, I am in the position to offer evidence-based information along with real-life advice. It doesn’t matter how many books you read or how many children you have or even if your career (like mine) revolves around babies, let me tell you this: There is no instruction manual for being a mom. Struggling with breastfeeding, feeling isolated and overwhelmed, having excessive guilt about returning to work; I had all of that.

I feel fortunate that my professional passion and my personal experiences allow me to help new moms and their families as they navigate the postpartum period. While having a baby is supposed to be the happiest time of your life, for some it isn’t. And for many, it is the most challenging.

My Mantra

I want all my mamas to know this: I want all my mamas to know this:

It is OK to ask for help.

It is OK not to do it all.

It is OK to want to take a break.

It is OK to talk to your doctor if you’re not feeling well.

Remember, once the baby is born, so is a new mother. We often forget to care for and nurture mama. We often forget to ask mom how she is doing. My mantra that I always tell mamas is this: Happy and healthy mama equals happy and healthy baby.

Whether you received this book from your best friend or from a family member, just know this: I wrote this book for you mama. A woman who is incredible, strong, and resilient, a woman who has not only carried but nurtured a human being. As you care for your baby, I want you to know that you too deserve to be taken care of and nurtured. Whether the issue is physical, emotional, personal, or professional, I will address each of these, and more, in the ensuing chapters. As you continue to care for your newborn, I hope you find that this book empowers you on your journey of motherhood. Thank you for trusting me on that journey.

CHAPTER 1

History of Postpartum Care

HISTORY/noun/ˈhist(ə)rē/: the study of past events

When I was a pediatric resident, I knew that I wanted to wait to have a family, even though I was married, because my grueling call schedule made it too difficult to manage a new baby while taking care of my professional responsibilities. During my month in the neonatal intensive care unit, I remember working with a younger resident, also married, who was from a European country. She told me, I’m not having a baby until I’m done with residency and I can move back home. I will have a lot more help and time off after delivering over there. Back then, even though I didn’t know the significance of what she told me, I still remember it clearly.

POSTPARTUM PERIOD inline-image

First of all, let’s define the postpartum period. While it means after childbirth, whether we discuss it within a medical context (your postpartum visit with the obstetrician) or a personal context (postpartum leave), many people, including me, define the immediate postpartum period as that 3-month period after the birth of your baby—in other words, your fourth trimester.

What did my colleague mean when she said that? After I had my baby, why was it that my relatives from India were shocked at what my postpartum period looked like?

Why do so many of my patients from other countries tell me it’s harder to have a baby in this country?

When thinking about this book, I felt it was important to talk about what postpartum looks like, not just in the United States, but also in different parts of the world. The United States spends more money per person on health care than other developed countries, but our health outcomes for mothers and babies rank much lower than those of other wealthy nations. Why is that? One major reason is that postpartum care in the United States is, frankly, disgraceful.

Birth may signal the end of a woman’s pregnancy, but it is only the beginning of so much more. The postpartum period is often not recognized as being vital to the health and well-being of both mom and baby.

When I spoke at a conference in the Philippines in 2019 about breastfeeding and postpartum depression, the audience, composed of physicians, nurses, and other health care providers who worked with mama-baby dyads, was shocked to hear that new mothers in the United States have their first obstetrician postpartum visit 6 weeks after delivery. Honestly, there was a collective gasp in that room of around 1,000 people.

On a professional level, I see a vast difference for my mothers who have had children in their native countries as well as in the United States. For instance, the level of support from family members and the community is different from the pressures placed on mothers in the United States. Every day I see mothers who, for financial and familial reasons, are going back to work or school within 6 weeks after delivery; I’ve actually seen mothers going back to work within 2 weeks. On a personal level, I witnessed the differences for my family and friends who had babies in India versus the United States and their expectations as to the amount of help they would receive on arriving home with their newborn. In many countries and societies around the world, it truly is a village that helps mom when she returns home with her newborn.

TRADITIONS IN OTHER COUNTRIES inline-image

What do other countries do to help their mothers during the fourth trimester?

One of the most common traditions in countries around the world is something called the 40-day lying in period. This has also been referred to as postpartum confinement. Before thinking this is crazy or not for you, let me explain how this helps moms and their babies during this particularly stressful time.

In India, the 40- to 60-day period, known as jaappa in Hindi, allows mom to stay home and rest while preventing her and the baby from being exposed to any type of infection. In Pakistan, this postpartum tradition is known as sawa mahina, meaning 5 weeks. The only thing for mom to do is rest and nourish (breastfeed) the baby. Mom is fed nourishing foods, cooked by family members, that are easily digestible and meant to keep her body warm. After having my second child, our nanny, who had emigrated from India many years earlier, was with me during those early weeks helping care for my oldest child (a toddler in diapers). She just could not understand why I was still doing things around the house; my husband was back to work within a week and we had no help from our families. Regardless of what she was doing to keep my toddler occupied, she tried to get me to eat well instead of snacking when I had time. I still remember the protein-rich dish she gave me made with herbs that not only nourished me but actually helped increase my breast milk. Ironically, as I learned later on while studying to become an IBCLC (International Board Certified Lactation Consultant) and starting my own breastfeeding medicine practice, I realized that the herb she used, methi—known in Western countries as fenugreek—is a common galactogogue that mothers can take to help increase breast milk production.

In China, the postpartum recovery period is sometimes referred to as sitting the month; during this time, new mothers are advised to stay inside to recover and focus on feeding their newborn. Aspects of Chinese medicine are included to nourish mom while increasing her breast milk supply. In some areas, visitors are not allowed for the first 12 days. Mothers are also discouraged from bathing, washing their hair, or having any contact with cold weather as this may increase their risk of catching a cold. In some, more modern areas, after mothers shower, they must dry off immediately and can use a hair dryer to help keep warm. Similar to other cultures, preparation of food in China is an important aspect of postpartum healing. Mothers are given easily digestible foods rich in protein that are prepared by female family members. These foods give mom energy while helping to shrink the uterus and facilitating physical healing.

In Korea, postpartum confinement is known as sanhujori, which can last from 1 week to 1 month. Mothers eat healthy food and perform easy exercises that help warm the body, which allows for physical recovery. While these services were previously provided by family members, they are now provided by various postpartum centers and workers who can come into the home. Services include anything from skin therapy and body massage to full-time help caring for the newborn. The goal is to help mom heal completely, both physically and mentally, not only to help her prepare for any future pregnancies, but also to prevent health conditions that can negatively affect her later in life, such as joint issues, incontinence, and depression. Clearly, the need is there, as more than 50% of mothers in Korea use these services.

Among many Latina mothers, la cuarentena helps them ease into the transition of motherhood. Cuarentena lasts about 40 days or 6 weeks (do you see the pattern?) during which she focuses on her physical healing and caring for and nourishing her newborn by breastfeeding. Members of the extended family take care of cooking, cleaning, and caring for any older children. Depending on the family, the type and consistency of foods are a central part of the mother’s postpartum healing