Your BIRTH Partners

Postpartum Care Failings & Foundations #031

March 29, 2021 Season 3 Episode 3
Your BIRTH Partners
Postpartum Care Failings & Foundations #031
Show Notes Transcript

Ray Rachlin of Refuge Midwifery joined Pansay of Sacred Butterfly Births & Maggie to lay out some of the ways we are failing to provide adequate care to postpartum families.

The postpartum time frame spans anywhere from 6 weeks, to the full year after birth depending on what dictionary you check, and for those who've lived it, the "postpartum period" may never truly close. Despite this, many people feel inadequately supported through this transition from pregnant to parent. We see this in how postpartum is treated through the medical lens following a hospital birth, we see it in the way attention focuses so squarely on the new baby that the person who *just* gave birth is left in the dust, we see it in how so many of us have been conditioned to treat ourselves after birth as we "snap back."

Join Ray, Pansay, & Maggie this week as we explore:

~how to prepare clients for the realities of postpartum during pregnancy

~navigating the shift between pregnant & parent to rediscover one's self

~home-based & community-based models of postpartum support

~the missing links in creating comprehensive postpartum care for physical, mental, emotional, & spiritual health

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Maggie, RNC-OB  0:06  
Welcome to Your BIRTH Partners, where our mission is to cultivate inclusive collaborative birth gear communities rooted in autonomy, respect and equity. I'm your host, Maggie Runyon, labor and birth nurse, educator and advocate. And I invite you to join us in conversation, as we step out of our silos, break down barriers and hierarchies, and step into the future of better birth care. 

Here at your birth partners, we love to talk about all things pregnancy, birth and postpartum. And certainly a lot of the topics that we cover, tend to fall more into that immediately surrounding the birth period, and really preparing for that piece of it. And one of the things that we wanted to cover is postpartum. And there is way, way more to postpartum care, then we're going to touch on in this one podcast episode, of course. But we wanted to start laying the groundwork for someone conversations we look forward to having in the future. So we want to take this time to highlight some of the major flaws in the system, some of the ways that we have ignored the reality of postpartum and the challenges that are inherent in that period. And we also want to talk about some of the ways that we think that can change and some of those are big system changes that need support, so that we can change legislation that impacts insurance reimbursement and time off from work, so that people can have access to the services they need, and the time to actually take advantage of them. And some of them are things that we can do as birth workers, ways that we can support our clients to make sure that they reap the full benefits of the postpartum period and aren't rushed through it. And some of them are things that we can do as loved ones, friends, and for those of us who go and give birth ourselves, ways that we can be more cognizant of the two worlds that we occupy during that immediate postpartum period as we transition from being pregnant to being a parent. And ways that we can show ourselves grace and understanding and love. So I am so excited to share this conversation with you.  On to the show!

We are going to dive into all things postpartum care, and I'm really excited to have Ray Rachlin and Pansay Tayo with us today to talk about that. So if you'll just want to quickly remind our listeners about who you are and what you're up to, and then we'll get going.

Pansay, Doula  2:41  
I am Pansay Tayo, I'm a doula located in Baltimore, Maryland. I do now own and run a sacred space with the community The Sacred Pause Red Room, a space to come and just be to escape from the world and just connect, I do hold childbirth ed classes here, my prenatal visits with much clients, sacred ritual and ceremony to tend to the spiritual body, as well as the emotional and physical body, I am a placenta encapsulator and yes, Sacred Butterfly Births.

Maggie, RNC-OB  3:19  
Yes, doing all the things there.

Ray, CPM  3:21  
Ray Rachlin, my pronouns are shey & they, I'm a certified professional midwife and licensed midwife based in Philadelphia. My practice is Refuge Midwifery, and I do kind of home birth in the greater Philly area & South Jersey as well as home IUI, Fertility Care and like education around LGBTQ birth. 

Maggie, RNC-OB  3:39  
Ok, so yeah, so we want to talk about postpartum care this week, and acknowledging some of the things that we can do better some of the benefits of postpartum care that are typically kind of missed in the way we have set up postpartum care from a kind of health care legislation, insurance reimbursement setup, and where are we finding kind of those gaps in in coverage, and really what people need during this really pivotal transition period in our life, and kind of dive into some of the ways that that we can do postpartum care better, and how we can kind of change the ways that we're connecting with folks. So, you know, just kind of setting the stage a little bit for where we're at. Now, what do you typically do when during the postpartum period, when you're kind of talking to clients and maybe start first by talking about how do we prep them for the postpartum period?

Pansay, Doula  4:29  
Well, my preparation first of all, I think that preparation is vital, vital for the health of mom, baby. One of the main things I focus on is helping clients to change their perspective, and their knowledge of what postpartum care is. Most of us are alike with, you know, remembering what we seen when we were you know, younger or what what the doctors are telling us, you know, what postpartum should look like, or the medical, you know, community. So, really just enlightening them and educating them on how important postpartum is, it should fulfill one the future house, you know, a lot of times just thinking about right now, but what about 10 to 20? You know, years, you know, from now what about when you if you would like to have more children, but the importance of, of rest and bonding, for, you know, mom and baby, when you look at other cultures, you know, it seems that you know, we are, we are the culture that does not honor the postpartum time period, you know, it's almost a, you know, rush, rush, get back to it, you know, type of feel. So helping them to, you know, see and connect with the sacredness of postpartum and how important rest, and the proper nutrition is how important it is to prepare the village, the family to, you know, do be very active and helping and assisting a mom and not just, you know, kind of sitting in her face, you know, just wanting to hold the baby, we're looking at that timeframe, that six weeks is not enough time to get one detailed, as far as the types of foods that mom should be eating those foods, you know, helps to bring in, you know, her milk helps you know, her body to restore and heal her organs, you know, to heal her muscles to to regain, you know, pre pre pregnancy state, or to help with postpartum blues and postpartum depression. So, and the other component of that, but I think we forget is that, you know, these are new positions for both of them for the mother and the father. And as much as we try to teach and educate of what to expect, it still hits very hard the moment that baby comes out, and I almost see it on every client's face like the next day like, "Oh, what is this?" You know, so make ensuring that proper preparations are made for when that hits, okay, do we have a meal train? You know, going? Do I have a postpartum doula? Or do we have you know, family members kind of, you know, what will be staggering, you know, and with meals cleaning, helping mom bathe, and also, again, detail the specific foods that she needs for healing and milk production and to, you know, regain all the vitamins and minerals and things that she has lost.

Ray, CPM  7:36  
So on the home birth midwife, friend, I think, first, I want to say that the reason I can do a lot more postpartum care then kind of in the mainstream medical system is because homebirth is really poorly covered by insurance. And so we just have a flat fee that includes postpartum care, regardless of how much insurance reimburses or doesn't. And also, that also allows us to have a lot longer prenatal and postpartum checkups. So I typically I like to start talking about postpartum planning with folks somewhere between 30 to 32 weeks that can talk about, like, you know, how do you want to feed the baby? Have you gotten a breast pump? Like, I have a like handout on like, what's normal in the first week? Like, what can you expect? If you're healing from a C section or from a vaginal birth? What can you expect that your chest is going to do? encourage people to do like, kind of like, making kind of a postpartum planning sheet or, you know, around, like, who is going to help feed them? Like what are the things that they're going to, like bring in their community for with support, which has definitely been a lot harder with COVID. And then who were their resources, like, if you or your partner like is having a crisis moment, like, you know, who are the friends that you're going to call or like, maybe the support groups that you're going to reach out to, or the therapists are going to check in just kind of like having a your a postpartum care plan for your family together, including, like, you know, when whenever things like hitting the fan, like, who were pre going to, and, you know, I think I homebirth those tend to do a lot of like self education. But I think still there's a lot of ways that our culture, which is like just so cruel to postpartum people, really doesn't set people off well understand like the amount of rest and the amount of food that we need and like I think there's this like desire to like, you know, participate in the world or like you know, just there's like the tension with like having like your own life and on social media with like, what the body does too can really lead to a heart experience for some but regardless of like, where and how the birth goes, you know. I always like you know, as a midwife I'm like can you do one week in the bed, one week on the bed, one week near the bed? And if you can't do that, can you do five days you know in, on, around, and if you can't do that, three days like and if you like wind up having to go to the hospital for job this like can you like restart that when you get home? Like I think there's lots of ways to create this like postpartum cocoon and I will do, pre-COVID I would do four home visits in the first two weeks, and then a six week visit in the office.  With COVID, I've been doing like three home visits in the first two weeks and then like a telehealth in the week next time. So usually if I want to catch people around 24 hours when they're like what's happening with my body, it also in addition to like doing kind of like, this is what's happening, what your healing is going to need in the next few like days to also like, do the like midwifery thing. So it's like doing the newborn metabolic screening, but congenital heart defects screening at that time. And then I like to come around three days, because typically, milk comes in around a three or four. And it is super, super intense, emotionally, physically, it's also the time that the babies can have their lowest weight and that we're assessing for jaundice. So you know, like, both like making sure we're kind of helping babies, they clinically healthy and while at that time, as well as just like having a supportive, you know, midwife come to your house and be like, "yeah, this is really hard. This is super temporary, like, this is how we're going to get you through it with your body.  This is like, you know, these things are normal," like this is, you know, just kind of like having some guidance to get through that. And then like, you know, at a week, I used to come to people's houses and typically doing that on zoom right now. Virtual check in and then coming back at like two weeks round. Okay, like, is this baby back to birth? Wait, do we need to like help, you know, just really trying to help catch nursing issues before they become problems. And like, if we can't fit up with a breastfeeding issue, develop students triage it early I have, I work with people who really typically want to rester chest feed. And so catching an issue before it becomes like a weight issue with a pediatrician can be a really, really big deal. Because then we can like support the milk supply or someone you know, and like, while we're like working out a latch issue. And then, you know, around four weeks, I often talk about, like, are you Yeah, like, are you ready to like, want more do you want to start doing breathing exercises to teach your abs to turn on again. Two weeks, I'm like, maybe if you want to go for a walk, go for a walk, if you want to give it two more weeks, give it two more weeks. But just like talking about slowly increasing levels of activity, not going more than like 40 50%. And then like giving it four to five days and letting your pelvic floor be the guide. And then somewhere between four and six weeks, I asked about if they're interested in returning to intimacy and if they're not, and what's normal, and how to like both gauge with within themselves, and also how to kind of care for their body when they're ready. And kind of also doing like, mental health screening at all those appointments to just yeah, again, like catch things before they cause problems. If you can catch a mood disorder in the first week or two, you can help people pull out much faster than if it's been going on for a few months.

Maggie, RNC-OB  12:36  
You both just touched on so many really important pieces of it. And I think one the timing that you just talked about. Ray, I think is really crucial. Because I think that's, you know, when during pregnancy, you know, typically people have somewhere in between, you know, 10 to 15, more, you know, kind of appointments and chances to check in with their provider, and then following the hospital birth, you have like one, maybe two before you're kind of just released back out into the wild. And, you know, we see that that it's not enough. It's not enough to spend, you know, a couple of days kind of like full on recuperating. And then Okay, yeah, maybe we check in in two weeks, if you had a cesarean birth, and then you know, everyone else we're checking in around six weeks, you know, again, to kind of get your like, bill of health to be back, you know, off to the races, and that's like really inadequate, and that for those people who are waiting six weeks in between birth, and then like an official followup with their provider, like you said, You're not getting a chance to pick up on feeding issues before it's become a really big deal. You're not getting a chance to understand how mental health is going. And so many people push themselves way too hard during that initial postpartum period. And, you know, Pansay touched on this as well in terms of just like how, what our expectations are society for this time. And absolutely like, the US is the "go, go, go" culture is such a part of how we typically relate and I think parts of living through this pandemic has probably helped that piece of it a little bit because there is less to do and less to go out. And there's there aren't activities to participate in, in the same way outside in the world. So I have heard from a lot of people who have given birth during this time, that this kind of forced pause has actually led them to take a little bit more care of their physical body because they haven't felt this same urgency to like get back out there and start you know, moving around and meeting up with people over the place. And then at the same time, there's been that flip side of it, where the mental health is always something to be conscious of and you know, aware of, and then having a baby during a pandemic where you don't have that same access necessarily to all of your support services where it's so much harder to get in touch with people, where the limits of a telehealth or a virtual visit, versus being in person with people to discuss issues like all of that piece of it has been amplified so much more. And we know that we're seeing higher rates of postpartum anxiety and postpartum depression. I think that that tension there between how do we as we go forward, as we come out of the pandemic, how do we really allow ourselves still that time to, to rest and to be and accept that we don't have to, you know, the snapback culture in terms of our body, you know, that we're not just trying to immediately get right back to where we were pre pregnancy. And I think for so many pregnant folks, you're, of course, so excited to have the baby and meet them and kind of move on to that piece. And then you are also really clinging to who we were before the baby, and that there are parts of it that postpartum then you're trying to just get back to that piece. And so for many of us, that means like, sure, you could go out meet up with a friend, and, you know, get a cup of tea, or you could go, you know, for a hike, because that's how you really connect with nature. Like there's all these things that we do pre birth that help us to center into who we are and how we relate to the world. If you can talk about how do you coach clients through that piece of it through that transition, and kind of weigh the benefits of actually being able to slow down during postpartum with that desire to be your full self out in the world as a parent?

Pansay, Doula  16:24  
As the doula again, showing them the flip side of what's being taught and ask them, definitely the benefits of, you know, taking that time and not trying to get back to the person you were because the reality is, you are a different woman on the other side, once baby's born, so enlightening them about the transition that is actually taking place, the physical transition, the emotional transition, and a spiritual transition that is taking place in pregnancy, and postpartum you know, the importance of that, that 40 day window, and getting to know the person that you have become, and are becoming, because you are a new woman, each and every Earth. It seems that, you know, once once you bring this type of information to clients, it's, for some of them, it's like mind blowing, like nobody ever, you know, told me anything about a 40 day, you know, spiritual window. And, you know, during during that 40 day time, you know, they say that, that is when you know, women are closest to the grave. Because childbirth is a lot of work, it's a lot of work, it's hard on the body. And I'll hold being as open, you know, we just brought forth entire you know, spirit or you know, human So, you know, helping them to realize how to nurture and nourish that shift in your life in your being in the physical body. And also showing them the tools Okay, how do we go about doing this ceremonial baths, you know, honoring the sacred period, energetic or, you know, body work sealing ceremonies, healing teas, it's, it's usually welcomed very much, you know, once you know, I have these conversations with clients, so much so that, you know, some clients I see maybe every seven days, or, you know, seven day, the seventh day, the 14th, day 21, and moving on up to the 40 day for the entire sealing ceremony, which encompasses very reflective day for them to be able to, you know, look at the entire transition that's taken place, and also celebrate themselves celebrate the, you know, beautiful work that they have done, and honor stillness, and not try to, you know, race back to the way that things are being you know, taught to us, my biggest hope with all of this is that we bring on an amazing shift and how we do postpartum you know, without children so once we make that change within ourselves, we know that our you know, our daughters are watching, you know, sometimes the babies are a part of our, you know, ceremony, the ceremony and spiritual baths. So, you know, this will bring change, you know, going forward with generations.

Ray, CPM  19:20  
I feel like this question really, maybe resonate with the idea like that birth and death are very much the same, like in terms of how you got to go to this otherworldly place where time goes away. And I think the processes really mimic each other and I think there is a loss with birth, you know, there is a loss of the person that you were beforehand and it might be welcomed and desired and it also might be really traumatic to have this like fully adult human that was lived in the world for 20, 30, 40 years and that to go away overnight and to you know, for day and night to go away all these things but I think kind of like kind of setting up that that like As a part of the experience, and that's okay, reminding people that there's going to be a point where they like, get to, like feel like them full selves again, and they won't feel like this really vulnerable open place, but it's not right then. And how, you know, like, how are they going to like kind of care for themselves in a time that like, they're just very vulnerable and like, need no rest, and like nourishment and support. And that looks like really different for different people. I think our culture really does a disservice in this idea that like, yeah, like, you got a healthy baby, that's all that matters, and all this stuff, and that it's like, the best thing in the world because it's like, not like, it's like, yes, like, babies are awesome. And also, they can Yeah, really complicate your life. And I think holding more than nuance or holding the more than mixed feelings and making space for that instead of it having to be something which is shut down, like, create space for like things to move in that time.

Maggie, RNC-OB  20:53  
That hold it being able to hold both of those things and being able to love your baby being so excited that you are now a parent and enjoying and relishing in parts of that whilst also dealing with like the really challenging parts of physically, your health, mentally adjusting to reality, you know, the relationship that you have with your partner with other children with everyone else in you know, in your world also shifts, you know, during that, and I do think that is really, it's really hard. And I personally like that it is hard to take all of those pieces of how your life has changed in in wanted and unwanted ways, you know, and know how to how to move forward in a way that feels really like authentic and genuine and honors the feelings you're having, whilst also still trying to get to, to that place where you feel steady, where you feel like, "Okay, this is okay, we can do this, we're moving forward." And I think so much of us, I know there's been more attention lately about, you know, kind of the harms of like toxic positivity. And you know, we don't always want to just brush everything over or gloss it over and just kind of power through that has been present so often in the postpartum period. And like you said, it's there's also that piece of how how we all support postpartum people, you know, people tend to ask so much about the baby, people want to come over and hold the baby and talk about that. And the person who just gave birth is like, "I'm still here," you know, like, and they're just we don't, we don't spend enough attention on that piece of it. And I think that certainly plays in into the mental health complications that that come up there. What do you find is helpful, really, as you're processing with clients, that identity shift, and kind of what are the some of the things that we all can do as birth workers in various, you know, clinical and non clinical roles to really support that mental health piece of it as we're, as we're talking to people kind of beyond the like, oh, here's your, here's your postpartum mental health checklist, where are you at with these things here, some sort of rubric to fill out, we get a score, and we say you're good or not.

Pansay, Doula  22:59  
I feel that providing providing the space for birthing people to, to open up, you know, I see where some women where they want to, you know, I'm okay, I'm going to be the strong one, I'm okay, I'm going to press through this, but inside it hurting. Inside, you don't want to voice that you didn't like how your birth went? Or you're not connecting with your baby, you know, or, you know, I'm really sad, because, you know, baby isn't latching, you know, my body is supposed to just be able to do this naturally, you know, all those things? are we providing safe space? That's important, safe space, where we are comfortable, saying, "I don't feel so good about this right now." I know that focus on, you know, natural birth, you know, or how fast the baby became, you know, all those things that we're trying to hold up to these measures, you know, being the strongest one, I did it, you know, I did it this way, you know, I bounced back so quickly. So what support, people are around saying, you know, sometimes sometimes we have problems connecting without baby, you know, there are challenges that can come with breastfeeding, and that's okay. It's all right. Letting them know that it's okay. And that is it's normal. It's a part of the norm. Yes. And helping them to feel comfortable enough to voice those things. And those are the type of conversations that I had from the beginning. Because you know, everyone they are highlighting, you know, baby, baby, baby, and it's, you know, everything just butterflies and roses. Right? But who was talking about the challenges, and I see that when clients are aware of what those challenges can be and know that, that it is a norm, then it kind of helps their shoulders to relax. They Okay, I'm a part of the normal. Yes. And once you know and feel okay, with reaching out and voicing that I need help. This is what I need. 

Ray, CPM  25:18  
Yeah, I think so much of it is about not rushing, you know, like, if you just go through an Edinburg scale? And there's not that kind of like, "how's it going? Are you sleeping? How's your butt?" like slower time for open ended questions were like, the stuff can come out. You know, I think there's a lot of shame around, like some of the things that you just said up like, you know, like, I'm not connecting to my baby, like our culture is like, "Oh, you do it. And it's instant. And it's perfect." And it's like, it's not like that for a lot of people. But just having more like space emotionally and physically and time to like, ask open ended questions and then hear the answer and like, reflect back help people, like find the resources they need, whether it's in themselves or in their community, or like with, you know, professional support, changes things, you know, just like having to, like sit with people, like really can change things and ashamed or ignoring or minimizing is kind of the opposite of what we need.

Maggie, RNC-OB  26:17  
Yeah, absolutely. That is, like, it's so hard to come by that support, and the way that we have set up our healthcare resources right now for a lot of people and you know, and that's, that's really disappointing, and it leaves a lot of, it leaves a lot of people out, a lot of people slip through these cracks, then when they don't have access to someone who is willing to take time, and ask those questions, and, and really, you know, be there for them and, and realize it, like so many of these issues are not going to be magically wrapped up in six weeks or in, you know, the 60 days that you know, is covered by Medicaid right now in our country for you know, pregnant people like there has been a big push there, you know, to, to change that legislation around Medicaid to increase access to the people have, they have more time to connect with people, they have more time to resolve issues that come up, and people are not just thrown to the streets uninsured, they don't know who to turn to they don't have the funds to access resources that they need. I feel like from a larger birth community, we need to be putting more of efforts to think of those system changes we can make as well so that everyone has access to someone who was able to like sit and have those questions with them and that it's going, you know, we need more people to we need more postpartum doulas, we need more mental health therapists who are really focused on the mental health issues that come up, you know, during all of this, and who are you know, because it's not, I think it's not fair for anyone right now that like we expect people, you know, typically, you know, they have good rest of the hospital. Hopefully, they have a supportive partner or, you know, other family members, friends who were able to help wrap them in some support, at least during that, you know, initial period. But then for so many of them, like because of family leave policies, like their partner is probably going back to work after a couple days, maybe a week or two, if they're, if they're really kind of lucky in the system, a lot of us live so much farther away from our families than we did in the past. You know, people don't necessarily have someone right there. And then I feel like add on to that by just taking away then like the access people do have to services to their healthcare provider, by kind of, they barely have a chance to reach out to them. And I know when I do, like discharge teaching for people who are leaving the hospital after having their baby, people are so hesitant about the idea of ever calling the pediatrician or ever calling their ob or midwife again, if there's an issue, like we're talking through, "hey, this could come up, this would be normal, this be something you'd want to call for." And they're like, oh, like, they don't want to bother anyone they don't want to impose on, you know, on someone else. And it's not how it should be like, we want people to feel comfortable reaching out to us, we want people to know that like that is, that's our job, we want to support you on this. And then we need to have better social nets in place and structural nets in place to really catch people. So then like your ob, of course, doesn't know everything about postpartum care or your midwife or anything else. But these people, they can refer to these ways we can be more collaborative about it. So that if what you really need is postpartum doula, we really need to see a therapist or you really need some help with childcare so that you can focus on yourself a little bit like we need to have better ways of working through that piece. So it's not like we're just doing such a disservice to people during postpartum.

Pansay, Doula  29:50  
This this particular topic has frustrated me and has brought me a lot of sadness over the years to the point Well, I'm really, I'm doing something about it. So I've just, you know, in addition to my postpartum visit that my clients get, you know, and it's usually three to four hours of, you know, yes, we want to talk through the, the birth story, but I always, you know, want to be of service. So, you know, sometimes I'm washing clothes, cleaning the house, whatever that a need, then, you know, you still find, like you said, partners on the work, you know, nobody's around. So I've built in four to six additional hours of postpartum, I'll be using my mentees, paying them, but it's built into every contract. Now. So it just saddens me that, you know, once I'm done with my visit, it's a week later, you know, I get these calls, and nobody's around, you know, they're sad and nervous, you know, that the baby, maybe hasn't had a bowel movement, it's all these things for new mom or new parent, or the fact that, you know, she wants something to eat and can't get down the steps. And it's like, Okay, this, this just can't be. And again, as much as you talk to, you know, maybe the mother in laws or, you know, the family and stress, the importance. Some, a lot of times we run into this, you know, so you know, that the more and more I can add more hours, you know, to my clients to be able to give to them, I will. But it's it's sad, a change has to come.

Maggie, RNC-OB  31:22  
There is obviously there has to be a shift in the way that we're the way they're doing it. And like you said, the way that we're supporting each other, you know, that you're pulling in additional doulas who are looking to provide more postpartum care like that there are there are more ways to bond that within, like the birth community to provide better support. And obviously, I'm, I'm all about that's like, the whole cornerstone of what we're doing here is trying to talk about ways that we can always bring more people like into the circle, be connected, be on the same page about what we're, you know, looking to do, but I feel like there is such an opportunity, you know, like, we know that somewhere around like a third of the, you know, perinatal mortality, like the deaths that happen, happened in the postpartum period. And like, we are missing an opportunity to, to be there for people. We are missing it; these are preventable deaths, because we're not there, because we don't have access to services, because people aren't reaching out because there isn't enough, and so we do....

Pansay, Doula  32:24  
Yes.

Ray, CPM  32:27  
Maggie, yeah, you're talking about like, lack of system integration, you know?  I think, I feel like all these things that are kind of piecemeal, it sometimes just felt like putting a bandaid on like a giant gaping wound, you know, and years ago, I had a client from Germany, who told me that, like in Germany, the government pays for you to have a midwife stop by your house every single day for 30 days. And, like, I think I do something like 60 times more postpartum care than most people get in, like a typical hospital based care setting just was like, hours wise. And I just like, couldn't conceive of like, what I would do every single day for 30 days, but it's just like, yeah, more support and like, more consistent support needs to be like, in your home, you know?

Pansay, Doula  33:12  
Yes.

Ray, CPM  33:13  
It was, like, you know, there was this move for us by ACOG to like, move the postpartum appointment to three weeks postpartum. But like, that's still people having to leave the house. You know, there's just, yeah, I mean, like, the integration has to be like, home based care.

Pansay, Doula  33:28  
Yes.

Ray, CPM  33:29  
For where they're at. And like, you know, I do think telehealth offers some options for that. But it's not everything, you know, you can like, you can only do so much lactation support, you know, on telehealth.

Maggie, RNC-OB  33:41  
Absolutely, at the hospital, where I work at now, they within the last, pre pandemic, but I think it was the beginning of 2020, or the end of 2019, they took away our visiting nurses, so we used to have this visiting nurse so that at least postpartum people could, you know, it was part of their discharge planning that they would get to have somebody would come by the house, you know, two ish days after they left, have a chance to like check in see how things are going if baby needed extra tests, or, you know, if there was, you know, more support needed, that there would at least be someone there, come to their house, put eyes on them and maybe see what's going on. We lost the funding for it. And that was purported to be because that there was an interest in it, that they didn't have enough parents who wanted that. Which we were surprised to hear. Because in our experience there a lot of, sure not every family wanted it, but but a lot of parents were looking for that we're looking for someone to just be there and yeah, and check in. And so I think that is something that has happened like across I think that's just a slice of what you know what I've seen, I think that's something that's happened across where we take we've instead actually, like taken away these programs and whether that's under because of a misconception or lack of comfort that like parents have with what that visit would look like or is this invasive. You know, are people there to check up on something versus there to really support? What is you know what's going on? But absolutely, I think it would be phenomenal to see integrated within the community care, like, these are the people who, you know, you've seen them in, maybe you see them in your prenatal visits, and you know, okay, this is whoever they're going to come and they're going to be part of, and your friends know, they've had that person also come to support them. So they, you know, you kind of prep for it, like that idea of just having recreating some of that network of support, to really be like, these are familiar faces, you're looking forward to them coming, you understand that support, and it's built into it. And it doesn't feel like it's a like, it doesn't feel like it's necessarily just like this, check the block like medical checkup piece of it that plenty of us don't want that. I don't know. I feel like there is, there is something to that. And I absolutely, I mean, countries around the world, again, as we're always talking about here they are, they are doing such a better job with perinatal well being than we are here, despite us spending the most money on it, you know?  I know, I think like, it's Finland, I think they are the ones that sent up like that box, it's got everything from like the little bassinet for the baby sleeping and like a million other things ready to get out, you know, there's family leave policies around the world that you know, provide, like a whole year or two of leave off of work so that one or both parents are able to support baby's first year in this transitional period, like there are just so many other ways that we could be providing

Pansay, Doula  36:31  
Right.

Maggie, RNC-OB  36:33  
...encompassing support, so that people aren't left in, you know, in the dark. And so for everyone listening, like if that's something that's important to you, please look into these policies, like see what you know, what's happening on a political legislative level to increase that support and to make it so that we actually change some of the a lot of it always comes down to money, unfortunately, but that we're changing those systems that we're increasing funding, so that we can have better care all around. And we'll link to some of that stuff in the show notes of some people who are really like working towards that and how you can kind of partner in that piece as well. But, you know, as we're kind of closing this out, like, is there anything else?  Pansay, did you want to share any more about kind of the sealing ceremonies and how you kind of helped to kind of close out that period or anything else you want to share?

Pansay, Doula  37:18  
Yes, it's, it's been an amazing journey, educating you know, the community and women, you know, on the importance of celebrating and honoring pregnancy and postpartum. And these traditions and ceremonies, you know, to do that, the sealing ceremony is a beautiful, reflective, you know, time for mom to focus on transition from pregnancy, you know, to birth, and truly just have a day of celebrating herself and also, you know, women nurturing and nourishing her, you know, with with amazing food where was being held, it's decorated so beautifully with, you know, delicious aromas, bodywork and ceremonial baths, you know, for special things, teas, massage, but she's able to really just sit and think about this transition that's taken place. And again, it's safe, sacred space for her to be able to voice the likes, the dislikes, What was this? What is this experience been for you? You know, how do you feel husband and partner is feeling about it? You know, all, you know, ways that she may need help, she feels like that feels like she needs help moving forward. So just just time when no rush is put, you know, put on her we do call in the village I have other sisters that, you know, they come and they take care of the baby so that we can, you know, take care of our mom, someone that's in a kitchen, you know, cooking. Yes, it's a beautiful time. And I love how it's it's picking up more and more people are you know, calling and reaching, you know, reaching out, but the education is being put out there that, yes, pregnancy is an amazing thing and we love the babies, but on the birthing person deserves to be nurtured and nourished to we can't just leave them, you know, on the side and it's bigger than the physical, what's happening with their heart, what's happening with their mind, you know, what time what what type of trauma and fears you know, out there and to to address that, to love on them and address that. You know, doing that we're helping so many things we're, you know, we're helping the next pregnancies to be better we helping the body to be, you know, more healthy and capable, we're helping the relationship. We're helping the generations of children to come because they'll pass these traditions and education, you know, down to them. So yes, yes, yes. I'm thankful and grateful for the opportunity to be able to serve in this capacity.

Ray, CPM  39:47  
I think the one other thing I want to add is that all like perinatal health care providers need to learn how to do appropriate pelvic floor and diastasis recti assessment at six weeks postpartum. 

Maggie, RNC-OB  39:57  
Ooh, yes. 

Ray, CPM  39:57  
One of the biggest problems We have in our society is that we treat peeing yourself when you sneeze as normal for people who've had babies, and it's not, it's a sign of dysfunction and for healing, the poor healing is caused by or in part by our cultural, insane expectations on postpartum people. So, having hands on training to learn how to assess for prolapses, for muscle tightness, as well as muscle laxity, and diastasis, recti. And either like, there's definitely a range over the years of like how much you can like, help people in office and give them just like programs to do on their own to heal that and others who like I automatically send a PT. And that's a little bit of like, an experience thing of like, how many you feel. But if you're not checking, if you don't know or not checking for prolapses, and informing people and helping them create plans, you're setting them up for like a lifetime of like pelvic floor issues that like if you heal in the first year, you're going to have a lot better results than if, you know, your uterus falls out of 10 years, 10 years after you gave birth.

Maggie, RNC-OB  41:01  
Yes, we'll be diving into pelvic floor PT in a later episode of this season. Because I think it is something that like it's so important, and we are treated as like an extra or a bonus or like saying that, like, you're not going to refer someone to help PT unless it's so serious, instead of realizing that like all of us need functional. Yes. That's that's the standard, we all should be meeting. And so pulling in the kind of expert advice and treatment that is needed to help people do that. Like that's not something you don't need to like, hold that out, like, keep giving those referrals out, like, let people know, talk about it at your appointments. And so thank you so much for bringing that up. Right? Because I do think that's so that is so important. And we have totally internalized that idea. Like you talked to plenty of folks in their, you know, 30s 40s 50s, who like, Well, of course, I pee when I run or laugh or sneeze or jump up and down or dance and you're like, No, that is not something you have to live with just because you had a baby. Absolutely. I love that call for everyone to be more informed about that, and educate yourself so that you can make sure the folks in your care also being healthy. 

Well, thank you both so much for having this conversation and digging into all this today. 

Pansay, Doula  42:21  
Yes, thank you for having me. 

Ray, CPM  42:24  
Thanks for having me.

Maggie, RNC-OB  42:25  
We hope you've loved listening to this and you've gotten some good information that you can think of as you approach next birth you're involved in. And we'd love to hear from you too. As we you know, said this is certainly not an exhaustive list of postpartum practices that you found helpful. So we'd love for you to join the conversation and share with us what works for you and how you are creating better postpartum experiences. We'd love to learn and grow alongside with you. So please follow us at Your BIRTH Partners across social media. And in particular, we'd love to invite you to join us in our Facebook group, Your BIRTH Partners community. And that's where we really have a chance to talk a little bit more about the topics on each week's podcast and work through some of the hiccups that come when we go to take these conversations out into the real world with us. And we'll also highlight in our show notes, some of the people and practices that you might want to share with your clients and loved ones, some book recommendations, some courses you can take, and some other great resources. Thanks for being here with us as we work together to create more inclusive, collaborative and equitable care for all.  Till next time!