Plan Your Postpartum Period Before the Baby Arrives

By Ebony Marcelle, DNP, CNM, FACNM

Nobody thinks they need to think about the postpartum period while they are still pregnant. I get it. You are focused on the birth, the nursery, the name. But after 18 years as a midwife, I can tell you that the weeks after your baby arrives are when families need the most support, and when our health system has historically offered the least.

For a long time, the standard was a single appointment at six weeks. I remember patients telling me, “That’s it? I guess I don’t have any other reason to come back in here.” When I looked at maternal mortality, I saw that about half of it was happening in the postpartum period. We can do so much better, and you can start planning for it right now.

Why this is personal

I had my own baby after being a midwife for 13 years, a week before the COVID lockdown. All my fantasies about how joyful my postpartum period would be went out the window. It was isolated. Even doing a depression screening over telehealth felt wrong. I was angry.

One of my closest friends had a baby right after me, and we were mad together. So we wrote a grant to reimagine postpartum care, because it is so neglected. I had already been pushing for earlier postpartum care since around 2016. Living it myself made it impossible to look away.

Start the conversation while you are pregnant

I ask every pregnant person the same question: who is going to be there with you after you have the baby? Then I keep going.

• Does your partner get to take time off? Sometimes it is three days. Sometimes it is three months.
• Where is your family? Down the street or in another country? Would it help if they visited?
• What does asking for help look like for you? We pride ourselves on being independent. Right now, while you are pregnant, I need you to start practicing asking for help, because you are really going to need it.
• Put a postpartum doula on your registry. For some people, a postpartum doula is more helpful than a birth doula.
• Plan your leave realistically. I once told an office manager heading out on maternity leave that her plan could not include doing payroll. Too many people go back to work too early out of financial need, and it breaks my heart.
• Think about your other kids. A two-year-old or a seven-year-old is going through a big transition too.

Ask your care team for more than one visit

At Community of Hope, a federally qualified health center in DC, we designed our postpartum program with the community, based on what people asked us for. The first 12 weeks are home-based: a newborn visit and weight check, a two-week visit for mom, and a five-week visit at home. After that come peer-led support groups, classes, infant massage, and baby wearing, flowing right into our family providers for ongoing pediatric care. Many people don’t realize that midwives can do newborn care, too.

You may not find every piece of this everywhere, but knowing what is possible helps you ask. Questions worth bringing to your midwife or doctor:

• Can my postpartum visits be scheduled before I give birth?
• Is there an early visit, or a home visit, in the first weeks?
• Will someone check my blood pressure in the first few days after birth?
• Who do I call if something feels off?

You also deserve convenience. There is a stigma that poor people, especially poor Black families, do not deserve it. They do. They deserve nice things and care that is easy to use.

How friends and family can really help

Skip the “we’re coming to see the baby” visit. Create some rules for who comes over. Come drop off food, and you may not even see the baby. Take out the trash, wash the dishes, clean the bottles, bring diapers, or set up a meal train. You think you will be able to think clearly postpartum, but you won’t, and it is wonderful when a text arrives at 6:00 saying dinner is on the way.

Bring different kinds of food, including things that keep for later. Hold the baby so the new parent can take a shower. Take the older child to the park to run off some energy. And keep your visit short, so nobody is stressing about whether the house is clean or the bathroom has toilet paper.

Know when to call

Preeclampsia is sneaky and does not always read like the textbook, and it likes to show up in the first week. So I have simplified my advice: if you feel off, reach out.

If you feel off, if something doesn’t feel right, there is no harm in reaching out.

Pay attention to:

• Headache, blurred vision, or spots in front of your eyes
• Nausea or vomiting
• Pain in the right upper abdomen, or chest pain
• Bleeding that picks up. It can be a sign you are doing too much, especially after a quick, powerful labor where you feel great and move around a lot. Lie down, nurse, and call your provider if it does not ease up.
• Changes in your mood. Is your favorite movie on and you don’t even want to watch it? Are you sad, or not doing things you were doing in previous weeks? Anxiety is real, and so is OCD.

Headaches are easy to blame on lost sleep, but get them checked out. If you are in doubt, come in. Go to your provider or to where you gave birth, because urgent care centers and freestanding emergency rooms are often not used to caring for people who are immediately postpartum. I also wish everyone had a blood pressure cuff at home and that every insurance plan paid for it.

Give yourself permission

• You are not the only person who can change the diaper. Or feed the baby. That is a lot of weight, and it is not sustainable. When my husband puts Dru’s diaper on a little janky, I let him. She might leak, but she’s fine, and I get a break.
• Take the 3:00 a.m. shower. After the middle-of-the-night feed, the house is quiet and nobody needs anything from you. Take as long as you need. It is my pro tip for every new parent.
• Practice asking for help, over and over.

Resources I recommend

Pacify offers 24-hour lactation support, which is a lifesaver when something is going on at the 3:00 a.m. feed. For tapping into cultural practices for the postpartum period, I love Mama Shafia’s book, Mothering the Mother (by Shafia Monroe).

Hear the full conversation

There is so much more in my full conversation on Discover Midwives, including how I found midwifery and why continuity of care matters so much. Listen wherever you get your podcasts. To find a midwife in your community, visit midwife.org.

 

Ebony Marcelle, DNP, CNM, FACNM is Director of Midwifery at Community of Hope, where she leads Family Health and Birth Center services. A fellow of the American College of Nurse-Midwives and adjunct faculty at Georgetown University, she is a passionate advocate for midwifery as a pathway to reproductive justice. Her work centers on building culturally aware care models for under-resourced Black women and on shaping policy to close maternity care disparities, from congressional briefings to national and local leadership on the boards of the National Association for the Advancement of Black Birth, March for Moms, and the American Association of Birth Centers, and the District of Columbia’s inaugural Maternal Mortality Review Committee.