Sunday, July 17, 2016

My Best Pregnancy and Postpartum Advice

There isn't much I love more than giving unsolicited advice.

I've been meaning to write down some of the tidbits that helped me most during pregnancy and postpartum. This isn't particularly well thought out or organized, but it's Sunday afternoon and I want to go hang out with my super cute baby before the alarm rings to get up for work in the morning, so here you go! I will add extras as I think about them. As ever, please ask questions! I'm all about oversharing these days.

During Pregnancy

Hire a doula
I want to write a novel about how much I love our doula, Tiffany. My #1 piece of pregnancy advice is to hire a doula. Yep, it's extra money, and you'll already be shelling out quite a bit for medical bills, but pregnancy, labor and new motherhood are huge life-changing events and you deserve the support and care. I expected Tiffany's support to show up mostly during labor and birth, but honestly, although she was amazing and totally essential during those hours, the support she gave us then is only a small portion of the support she gave during and after my pregnancy. She has been with me every step of the way and was a critical piece to my pregnancy, labor, and adjustment to new motherhood. It is hard for me to not text her every day telling her how much I love and appreciate her! Hire the doula. Please hire the doula. Hire the doula. Seriously.

Consider midwife care
I switched from an OB to a midwife group at 32 weeks pregnant. I always planned to give birth in the hospital (no option is better than the other--you should give birth where you feel most safe and comfortable!) and just assumed that to do that, I needed an OB. Nope! Midwives look at pregnancy and labor as natural events and see women as totally capable of rocking both with minimal intervention, but are totally trained and capable of handling things when more medical care is necessary. I wasn't sure if I'd end up wanting an epidural or other interventions during labor, but I liked the idea that I would be in the driver's seat in requesting interventions rather than having them pushed on me. I had rotating appointments with each of the four midwives in the practice, so I knew I'd have a relationship with and trust whomever was at Bennett's birth. They spent lots of time with us (an hour at our first appointment, and 20-30 minutes at subsequent appointments) and I want to be best friends with all of them (seriously, there is some mourning that takes place when your pregnancy is over and you don't get to see your team anymore!). Midwife care is really lovely, empowering and supportive care, and I highly recommend going this route if you have the option.

My favorite sources for info
The Panic Free PregnancyExpecting BetterPregnant Chicken, our doula and our midwives were my pregnancy info go-tos. There is a lot of information out there, some of it good, some of it bad, some of it simply outdated. Whether you pick the same sources as me or not, try to pick a few and tune out the rest! It's easy to get overwhelmed. And whatever you do, if you have any complications or weird symptoms, do not google them. Ask your providers and let them tell you what you need to know. Being aware of all the worst case scenarios is not going to protect your baby or make it easier if any of those scenarios actually happen. Be informed but don't be overinformed.

I thankfully had very mild nausea throughout my pregnancy--enough to know things were cooking but not enough to knock me on my back--and I fell in love with the Unisom/B6 combo early. Unisom is an over the counter sleep aid and the primary ingredient combined with vitamin B6 made up one of the only drugs (or only? I dunno.) ever FDA approved for morning sickness. That drug is no longer available in the States, but you can DIY it by combining the two. Of course, talk to your provider before taking, but I found it to be a pretty magical cure for pregnancy related nausea and later, for pretty brutal pregnancy insomnia.

Natural Calm for insomnia
On the insomnia note, Natural Calm, a magnesium supplement, is amazing for supporting sleep. It also helps with leg cramps. I took it every night before bed during my third trimester and only had leg cramps after a few nights of not taking it towards the end. It also helped me fall asleep after all the middle of the night bathroom trips. I found it at Whole Foods but you can of course order online.

Pregnancy pillow
Buy one early and stick it in the closet. The first night you have trouble getting comfortable, you'll be glad to have it.

Nursing bras
Buy a couple of nursing bras before you give birth. You will want to have them ready to go when your baby arrives. I got a couple of soft, unstructured ones from Target, and also ordered a couple of nicer nursing/pumping bras. Save any packaging on structured bras, since your breasts will likely change size once your milk comes in and it's difficult to predict sizing ahead of time. My fancy ones came from The Dairy Fairy and I love them, in no small part because they are combo nursing/pumping and make hands free pumping easy. You want a hands free pumping option. Trust me.

Don't over accumulate for baby, but don't skimp either
I can't tell you how many times I heard "all you need is boobs and diapers" while I was pregnant. There is SO MUCH stuff available now for babies and it gets overwhelming (and expensive) fast. While I totally subscribe to baby shopping as a way to bond with your pregnancy and baby, you also don't want to end up with a ton of stuff you won't end up needing. Sign up for Amazon Prime so after baby arrives, you can quickly and easily order items as you find you need them. Remember that you won't need most things right away and you will still have the wherewithal to shop after you bring your baby home (says the woman who bought 6 packs of toilet paper in preparation for bringing a baby home).

That said, there are four things I'm REALLY glad we had before Bennett was born: velcro swaddles, gripe water, a swing and a soft baby carrier. These all helped (and still help) soothe Bennett and you want a small soothing arsenal the first time your baby starts crying and won't stop. Also, regarding clothes...babies grow insanely fast and mostly live in pajamas and onesies at the beginning (we are still in that phase almost 4 months in). Baby clothes are the cutest but you really don't need more than 7-10 onesies/pajamas for the first few months. Also, don't buy too many newborn clothes until your baby is born! 0-3 month sizes might work just fine, and you'll get more use out of them.

Oh, and burp cloths. Buy lots and lots of burp cloths. These have worked well for us.

Prenatal yoga
I started going to prenatal yoga around 20 weeks and I LOVED IT. It was a lot of hip circles and very gentle movement, and it felt great to slow down and connect with my body and baby once a week, but what I loved most about it was being in a room with a bunch of other pregnant ladies on the regular. If you're like me, you might feel self conscious talking over much about your pregnancy happenings with your non-pregnant acquaintances, and it was wonderful to have a place where I could share freely and pregnant. It also felt really good on my body, both when I was able to be more active and later on when I started slowing down. For those of you in Reno, I went to Mandy Colbert's class at Midtown Community Yoga.

Walking is absolutely the best pregnancy exercise, especially if you learn to walk from your glutes. It's an incredible way to get your pelvic floor healthy and strong in preparation for labor and recovery. If you are a runner, know you're doing your body a much nicer thing by walking rather than running while pregnant! It's not just a consolation prize for when running doesn't feel good anymore. Check out Katy Bowman's advice here and here for more on walking and squatting during pregnancy for a healthy pelvic floor. I loved listening to old episodes of the Pregtastic Podcast and current epidodes of The Longest Shortest Time while I walked.

Modern prenatal exercise specialists are starting to move away from the kegal and towards the squat as the best way to create a healthy pelvic floor before, during and after pregnancy. Trust me, you want a healthy pelvic floor! Check out the links to Katy Bowman's work above for more info.

Exercise smart
Prenatal exercise is not just regular exercise lite. Lots of other people have said it better than I can, but basically, it's smart to look at prenatal exercise as deliberate preparation for birth and postpartum recovery, not just trying to maintain your regular level of fitness in your usual activities. Check out Katy Bowman and Jessie Mundell for starters.

Write down your birth preferences
I know. Some of you might be totally on board with this, and some of you might be in the "the only thing I care about is a healthy baby" camp. Look, birth is a major life event. Even if you have a great relationship with your provider and are totally on the same page following the discussions you should have about birth stuff like medication preferences, episiotomy, how long they'll let you go past your due date before inducing, etc., your provider is not going to be there most of the time you are in labor and you'll want a quick way to communicate your overall appraoch to the nurses who will be caring for you. Also, if your practice is like most of the midwife/OB practices in this country, there is a good chance your primary OB/midwife will not even be the one at your birth, since practices tend to rotate who is on call. I know writing down birth preferences might sounds fussy, but it's your freaking birth! You are not asking for favors in stating your preferences. It is YOUR experience and you are paying someone A LOT of money to take care of that experience. Yes, everyone's goal is a healthy baby. Of course. But second to that, you really need to think about how you feel regarding some of the labor and delivery options and to make sure the people who will be there when you deliver your baby know what you're aiming for if and where your preferences are possible. You don't want to come out on the other side feeling like things have been done to you without your full understanding and consent, because you don't get a do over. Also, you don't really want to be making those decisions when you are in labor or pushing a baby out of your vagina/being wheeled into surgery.

Re: the "the only thing that matters is a healthy baby argument," I feel very strongly that this is not true. The MOST important thing is healthy baby, healthy mama. But that argument is like saying the only thing that matters at a wedding is that the couple gets married. If you uncle shows up drunk and picks a fight with the groom, then the cake falls in the swimming pool and the bride's tampon leaks all over the back of her dress and the wedding rings accidentally get flushed down the toilet while the father of the bride has a heart attack, everyone would support the couple in being a little disappointed in the experience, right? Good lord, the bride gets validated in being upset if her flowers are wilted. Why are the details of another major life experience--birth--not important? They are. Know they are. Be flexible with your expectations but also know it's important that you understand some of the possibilities and have a team that respects and supports  you. #rantover

As a note, include caesarian preferences. Hopefully you won't need them, but I was really glad we had a section on there addressing surgical birth preferences, like Bennett being brought skin to skin with me as soon as possible (or Harry doing skin to skin if I had been unable), and Harry staying with Bennett when he was taken to the nursery.

Finally, writing down birth preferences forced Harry and me to talk about them, which we might not have done otherwise. This meant we were on the same page and Harry was able to answer questions like, "do you want us to give him a bath?" and "are you circumcising?" while I was away in recovery.

All of my providers were totally nonplussed by our having a printed sheet of our preferences. Try to keep it to one sheet, ideally bullet pointed, so it's quick and easy to read through and reference. Do it respectfully but don't apologize for caring about your care.

After birth

Bring food to the hospital
A lot of births happen at night/in the wee hours when it's not super easy to get food. Also, the food at our hospital was pretty bad, so I had more than one meal of a protein Odwalla and some trail mix. Pack some easy, yummy nonperishables in your hospital bag.

Think about placenta encapsulation
The hormone thing is real. I have a history of depression directly related to hormone imbalance, and I swear taking placenta pills helped keep my baby blues from becoming full on postpartum depression. Even if it's placebo effect, it's really nice to feel like you can do something when you feel a little crazy postpartum. Even if you don't have a history of depression, it's a good idea to encapsulate, since once your placenta is gone, it's gone. Better to have those little pills just in case!

You might love being in the hospital. You might hate being in the hospital. Either way, take advantage of the lactation consultants.
Know this: the hospital can be super rough. We had a steady stream of providers in at all hours doing various tests on Bennett (we requested that all tests and procedures be done in room) and checking on me. What really sucks is that this happens not just during the day, but throughout the night. Both Harry and I were pretty stressed and exhausted by the time we got to go home. A couple of things to know: 1) there might be a sign on your door saying it's okay to come in or please come later (if there isn't one, make one!). Once we figured this out, we flipped it to "please come later" and experienced fewer unnecessary interruptions (like the gal who stopped in to try to sell us photos of Bennett, and people delivering trays of food I didn't want). This won't stop your nurses and doctors coming in, but might reduce some of the other interrputions. 2) You are the parent and you can refuse tests/procedures! Because Bennett was a big baby, he automatically got flagged for diabetes tests, even though my family just makes big babies and we have no history or indicators of diabetes. Some of these included fairly benign heel pricks to test his blood sugar, but some of them required squeezing vials of blood out of his heel one drop at a time to fill a vial, which resulted in 20+ minutes of breathless, horrible screaming. It took me until the third time of them coming in for a vial for me to figure out that I could refuse the test and stick with the heel pokes, and for those I requested that the nurse do the poke while I nursed Bennett, so he didn't even notice them. Yes, the nurse seemed a little miffed, but it's my baby, damnit, and not her call (I should note that I'm well educated in diabetes and felt comfortable with this decision because of that). It can be hard as a new parent to take ownership of the role and remember nobody can do anything to your baby that you don't approve, but it's your baby and you run the show. Trust your instinct.

All that said, even if you hate being in the hospital, the silver lining is the availability of the lactation consultants. At our hospital, a lactation consultant came in the first day to help me learn how to breastfeed and I called them to come in at least twice every day we were there just to make sure things looked right. If a lactation consultant doesn't automatically come in to see you, ask your nurse to send one in. It's an included service and enormously helpful, so take advantage.

Nap every day
I found the "sleep when the baby sleeps" advice hard to follow, since I wasn't always sleepy when Bennett was sleepy, or I had a hard time falling asleep because I'd get anxious that he would wake up right after I fell asleep. When we were in the hospital, one of our nurses wrote "nap every day" on our white board and it became my motto for the first couple of weeks. My mom came over to hold Bennett every day so I could lie down, but if you don't have that option, try to figure something else out. Hiring a neighbor kid to hold the baby, hiring a postpartum doula, taking friends up on their offer to help...make napping every day a priority.

Stay in bed for as long as it takes to get the amount of sleep you need
Tiffany gave us this advice and it is so obvious but I wouldn't have thought of it myself. This means if you go to sleep at 10 and your baby is awake for a total of 2 hours during the night and you need 8-9 hours of sleep, don't get out of bed until 8 or 9 the next morning. Hell, if you need to stay there till noon to get enough accumulated hours of sleep, do it. Rest is your priority for the first couple of weeks!

The first two weeks are for bonding, feeding and rest
Plan to rest for the first two weeks. This means lots of time in bed and on the couch. No errands, very minimal chores. Nurse your baby, eat, rest and sleep. Your body has a lot of healing to do and the physical and emotional demands of having a new baby are enormous, even if you feel great. Resting now means a faster recovery, so give yourself and your baby the time!

I went through a rotisserie chicken nearly every day for the first week after Bennett was born. Your body needs good nutrition and plenty of it while it's healing from birth and figuring out breastfeeding. My appetite wasn't great after birth so it was extra important to have a variety of easily accessible and high calorie food around to make it easy to get enough food in. My mom texted me every day before she came over to see what sounded good and would bring that (I know. She is an angel.). When people ask what they can bring you, tell them! They really want to help and bringing you food is a lovely way for them to do it.

As a note, this isn't the time to stock only super nutritious foods. Yes, nutrition is critical and you want to eat as many nutritious foods as you can, but calories are important too, both for healing and lactation. I ate lots of chicken and lettuce sandwiches, lots of salads, lots of berries, lots of oatmeal, but also lots of chips, ice cream and plenty of cake. It would have been hard for me to eat enough calories of only healthy food, and my body needed both the protein/vitamins/minerals AND the calories to support healing. Also, you just gave birth. If you need a better reason to eat cake, you need to reevaluate your celebration mentality.

Invest in straws
Every single time you sit down to nurse your baby, you are going to realize you are thirstier than you have ever been in your life. You know what's a pisser when you've finally got your baby latched on and nursing? Changing ANYTHING in your posture that might interrupt that latch, including tilting your head back to drink water. Straws are where it's at. I like these metal ones, but you do you.

Night sweats, omg
Um, I felt super prepared for the weeks of bleeding, but I was not in any way prepared for waking up every night totally soaked (like, even my shins) in cold sweat. My pillow got soaked, our sheets got soaked (on that note--my mom came over while we were in the hospital and put on fresh sheets, then changed them every few days during the first couple of weeks--HAVE SOMEONE DO THAT FOR YOU. IT IS HEAVEN.), my hair got soaked. I've got nothing as far as a solution, just giving a heads up, though I will say this: keep a towel by your bed (yep, you might be wet enough to need to towel off), keep the thermostat a little higher than usual so you don't get too cold from the persperation, and keep a spare pair of pajamas by the bed so you can change out of your wet ones when you wake up in the middle of the night to nurse. It will end eventually and then you will forget it ever happened. Yay for non existent new mom memory!

Set up the crib in your room
I spent an inordinate amount of time researching basinetts and hating the idea of spending money on something we'd only use for a few months before I realized we could just set up the crib in our room, then disassemble and reassemble in the baby's room when the time came. The bonus to this (famous last words) is Bennett will already be used to his crib when it comes time for him to sleep in a separate room (not that I'm going to be ready for that any time soon).

Breastfeeding might be easy for you
I feel like all I read during pregnancy about breastfeeding was either how much it sucked or how blissful it is. I'm somewhere in the middle. I haven't had pain with breastfeeding (at least not now while he's toothless!), but I also sometimes struggle emotionally with having to stop whatever I'm doing when he's hungry and being always on demand. I just want you to know not to worry about breastfeeding! It might be tough, but it also might not. Know your resources but don't worry too much until you know what you're dealing with.

Get a breastpump and start pumping early
Harry being able to feed Bennett sometimes or even me being able to give him a bottle when I'm feeling touched out is a godsend. Knowing Bennett had been taking a bottle at least once per day since his second week also helped ease the transition back to work, since I didn't worry about him taking a bottle while I was gone. I started pumping immediately after getting home from the hospital to help get my milk supply up and have continued to pump twice each day since (once after his morning feed, when my supply is highest, and once before bed). We also introduced a bottle super early (week two), which worked for us since Bennett is a little piggy but know some lactation consultants recommend waiting a little longer to avoid nipple confusion. I can't say this enough: being able to let someone else feed your baby is a huge relief sometimes, even if you like nursing!

My best pumping tip: you do not have to wash all the parts each time you pump. Throw the parts in a ziplock and toss it in the fridge between pumping sessions, then sanitize the parts at the end of the day.

Incidentally, we have been using these bottles with the #1 nipple (even now that age-wise, he could go up a nipple) and they have worked great. He's had no difficulty switching back and forth from me to bottle.

Learn to nurse lying down

You will figure it out
New parenthood is a huge learning curve, and it is super hard sometimes, but a lot of the time it feels totally normal and natural and lovely. Whatever you're dealing with, know that it WILL change. I read once to give everything three days, since things can change that fast with a new baby. Three days  of dealing with whatever is manageable. Have patience with yourself, your spouse and your baby. Before you know it, you will be packing away the newborn clothes and marvelling at how quickly your baby is growing and changing. As adults, I think we lose the frame of reference for how fast newborns turn into infants turn into toddlers and children and and and. I won't tell you to soak it all in, because sometimes you won't feel like soaking it all in and that's totally okay. But when you do feel like soaking it in, notice that urge and take some time to honor it. When you're just surviving, remember to reach out for support and to take the best care of yourself you can manage. The wonderful thing about new motherhood is some of the tougher parts blur away in the rearview mirror and the memories, even the tough ones, turn kind of sweet. You will be great.