How to have a nurtured postpartum during a pandemic.

There have been so many changes during the Covid-19 pandemic in the ways that babies are being born and families are being forced to adjust quickly. In many places homebirth has been restricted, and in other locations homebirth has been embraced anew. Hospitals have needed to alter their visitor's policies several times by changing who can be present for baby's birth, and sometimes hospitals have been shut down due to outbreaks of the virus and families have needed to scramble to find new birthing locations. Often, partners, doulas and other support people have been excluded with new hospital visitation restrictions in place. All of these changes have left many families concerned about how their baby will be born, where their baby will be born and who will be present for the birth of their baby. Furthermore, once baby has arrived, the support at home is often limited to the parents. Extended family members who would normally provide support are often unable to be present to support the growing family because of the pandemic. Common support limitations include large distances between families and the inability to travel due to regional restrictions; extended family members being immunocompromised and at a higher risk for contracting the disease; and concern for the baby's and birth giver's health. Often grandparents and families are left feeling alone and isolated when welcoming the new little person into their family. So what can be done to support the new family when social isolation is the new normal? Here is a short list of how you can prepare for the postpartum period during the pandemic.

1. Doulas If you are planning a hospital birth with a doula, have a back up plan for how the doula can be present during your birth and postpartum should healthcare policies limit the number of support people present for your birth. Many doulas are offering virtual support via FaceTime, Whatsapp or other platforms in addition to their text and phone support. Some doulas are also offering in home support while wearing appropriate personal protective equipment (PPE) such as masks, visors and gloves. If you are comfortable and will not have the support of family during the pandemic, I would strongly recommend hiring a postpartum doula. Many birth doulas have been offering more postpartum supports as an alternative when they unexpectedly have been unable to support clients due to healthcare policy changes.

2. Mental Health Perhaps your partner was not able to join you during your birthing time, or your mother or doula were not able to join you for the birth of your baby leaving you alone to cope with birth and the new birthing environment you find yourself in. Or perhaps things are different then you expected or didn't go as you anticipated in birth and you feel lost, confused and overwhelmed. Outside of pandemic times, postpartum mood disorders have become more common and causes include previous mental health concerns, birthing practices and the birthing person's wishes not being honoured, as well as high levels of stress. Needless to say, the pandemic has compounded these concerns. Since the pandemic began, several implications have increased the likelihood of a difficult birth, including the birthing person being unable to have the desired support team present for delivery; not knowing whether or not the family will be exposed to the virus by birthing in the hospital; changing healthcare policies eliminating the preferred location of birth; caesarean birth becoming standardized due to the unknown effects of vaginal birth when Covid-19 is present in the birth giver; and finally, removing the newborn infant from their families (sometimes for weeks at a time) in order to prevent the spread of Covid-19. All of these have dramatically increased the stress load for new parents. Unfortunately, many healthcare policies have been implemented without taking into account the fact that they can potentially cause more harm than benefit for the birthing person and infant. Furthermore, the postpartum period has become more isolated for families. As a result, there is an increased need for psychological supports in the postpartum period. Many psychologists and counsellors are offering support both in office with adequate social distancing or via teleconference or virtual conference call. Families can choose what works best for them. Always get the mental health help you need in the postpartum period- you can only take care of your baby if you yourself are well. An excellent book for working through difficult birth experiences is "Healing After Birth: Navigating Your Emotions After A Difficult Childbirth" by Jennifer Summerfeldt.

3. Lactation support If you are planning on breast or chestfeeding you will want to have a support system in place ahead of time. One option is to attend out-of-pocket paid for lactation courses offered by your local hospital or lactation consultant to educate yourself and prepare yourself for common nursing concerns. You can attend these before baby arrives or expect to pay a large sum out-of-pocket for services once baby arrives for a lactation consultant to come to your home and address your specific concerns. For a less expensive option, La Leche League International is offering free meetings to nursing parents throughout the pandemic online via Zoom, and it is relatively easy to find a local or international chapter at any time of the day offering meetings. Additionally, the most common breast or chestfeeding concerns can be searched for by topic on the La Leche League International website https://www.llli.org . Furthermore, La Leche League leaders also offer on call support and can work with your specific concern one-on-one should you need additional breast or chestfeeding supports. One benefit of the pandemic is that lactation supports are now accessible online throughout the world, you just need an internet connection.

4. Sleep. The most challenging part of having a baby is the lack of sleep you will get. Outside of pandemic times, most nursing parents lose approximately 700 hours of sleep in the first year of a baby's life- that's more than two months of lost sleep. Sleep deprivation is compounded by Covid 19 simply because your support system is no longer able to be with you as much as you need them in order to provide relief from the demands of newborn care. In the first months, you can help your body heal by getting as much sleep as you can. This may mean taking naps when baby sleeps and abandoning regular household chores. No one can come over during the pandemic anyways, so don't worry what the house looks like. It also might mean having meals delivered, or getting a housekeeping service. If you have older children to care for, sleep is very challenging. Perhaps older siblings have quiet activities that they can work on independently such as colouring or drawing while you and baby take a nap. Perhaps all of you can have a set nap time each day where you make up for some of your lost sleep. Maybe there is someone in your immediate cohort who can help you such as a partner, your doula, or a friend or family member. Truthfully, it will not be easy to get extra sleep, especially with older children around, but you will need and value any additional minutes you can manage to squeeze in. Sleep should be one of your biggest priorities apart from nourishment and healing. After baby has reached 4 months of age, you may wish to consult a Sleep Consultant. A helpful book about sleep is "Sweet Sleep" by Wiessinger, West, Smith and Pitman.

5. Pelvic floor physiotherapy is essential to the lifetime health of the birthgiver. Common postpartum health concerns that a pelvic floor physiotherapist can assist with include diastasis recti (a separation of the muscles in the abdominal wall), incontinence (usually due to birthing position, constipation, injury from birth interventions or hormones), prolapsed pelvic floor organs (rectal, bladder or uterine), painful intercourse, pelvic floor concerns and scar tissue healing from caesarean or perineal tearing. Ideally, every person who has given birth needs to see a pelvic floor physiotherapist and most services are covered by health insurance benefits. If you don't see a pelvic floor physiotherapist in the immediate postpartum you may be dealing with the same issues and concerns resulting from birth later on in life after menopause and of course with time these concerns are more challenging to heal.

6. Social interaction is important for parents to share and learn from others about caring for their children. Although it should be once the birthgiver and baby recover from birth (usually 2 weeks to 40 days), it is essential for new parents to have social interaction during the postpartum period. Only people who are coming over to help with newborn care, cleaning and food preparation should be present during the first few weeks after birth. Social interaction is essential for the mental health of the birthgiver as well as to discuss and receive support for the new challenges of parenting. If the weather permits and you feel safe to meet up, friends and family can meet at outdoor locations or with PPE indoors. Otherwise, communication apps such as WhatsApp, FB Messenger and FaceTime are great for one-on-one chats. Several new parent's groups have moved online holding their meetings on platforms such as Zoom, Google Meets, and GoTo Meetings. These social platforms are great for connecting with multiple people when you cannot be together socially.

7. Food Nurturing the new family with food is essential to the healing of the birthgiving person. Warming foods are most beneficial and include warm teas, spices, broths, soups and stews that are easy to digest. These can be prepared for the new family if they are willing to accept outside support or gift cards can be purchased with food delivery services and they can place their own order. Additionally, a grocery delivery service can also help to limit the new family's need to leave the home for purchases and save some extra time for those extra baby naps. Having a stocked freezer ahead of time will make meal preparation easier for the family of a newborn and can be prepared by the family themselves or extended friends and family members.

8. Housekeeping services can also be helpful if the family is willing to have help inside of the home. These can be offered by extended family members and friends or by house keeping companies. Asking for references from the company and contacting them will help ensure that the new family is fully aware of the quality of work and any concerns that previous customers have had. Even better than references is if friends or family can recommend a housekeeping company.

9. Exercise is often an overemphasized element of returning to health in the postpartum. Normally, weight loss and fitness can be returned to after 6 weeks postpartum with a vaginal birth. However, if you have had a caesarean, it is recommended to wait 12 weeks. The reason it is better to wait longer with a caesarean birth is because in addition to all of the regular postpartum healing that is necessary with vaginal birth, a caesarean birth has the added complication of having 7 layers of abdominal tissue cut through in order to get to baby. Muscles, skin, organs and tissue have been pushed aside and cut apart during caesarean birth, and in spite of the common belief that caesareans are an easy surgery to recover from, it is actually major abdominal surgery that can result in serious complications. For these reasons, beginning an exercise program prior to 6 weeks can create injury instead of promoting the necessary healing required after a ceasarean birth. Additionally, rest and clear liquids usually assist more than fitness in weight loss after birth. If you are still looking into fitness programs in the postpartum period, make sure you have been discharged from the care of your primary perinatal caregiver and any fitness program considered should be postnatal fitness. Attending a standard fitness class can actually set back the healing process. Postnatal fitness instructors shoud be very knowledgeable about the specific concerns during the postpartum period and provide exercise accomodations addressing diastasis recti, incontinence, perineal tearing, caesarean birth scarring and pelvic organ prolapse. Postnatal yoga is excellent for returning to fitness gently in a way that promotes healing. While the pandemic has resulted in many gyms and yoga studios closing or having limited space, it has also made online yoga accessible to many people. Here is a link to checkout my online yoga classes https://www.authenticheartlisteningdoula.com/yoga.

Clearly, the pandemic has made the postpartum period more challenging for parents. But with a little bit of planning, lots of flexibility, education and back up plans, circumstances can feel more manageable. Know that having a baby at any time is stressful and challenging, but with the right support for your family, you will all thrive. Enjoy your Baby Moon!