During the pregnancy and after baby’s arrival, I remind my clients that I am not a pediatrician. The law does allow for midwives to care for babies for up to six weeks, but I encourage the parents to find a pediatrician and discuss how soon they should be seen. Most often, I am still the first one to see the baby by this 24-48 hour home visit window.
Lots of things happen during this visit for the baby. It is important to do a nursing check and help if there have been any difficulties with latch. If nursing is going well, then not as much time is needed there. We check baby’s vital signs including his/her heart rate, respirations, temperature, and review the chart that the parents have been using to track how baby has been doing in the time the midwife was gone. We review how many wet and dirty diapers that the baby has had, how much indirect sunlight the baby is getting (this helps to break down bilirubin levels and can help to prevent jaundice), and how baby is sleeping.
This is the ideal window to collect that first sample for the newborn screening and to perform the CCHD(Critical Congenital Heart Defect) screening. The baby is of course weighed, and we discuss how much weight loss is okay versus too much, as it is NORMAL for the baby to have dropped weight during this time. Because I do not have the equipment to perform the hearing screen, I remind the parents they will need to have this done either by their pediatrician or through another provider I refer.
Following baby’s checkup, he/she may be brought into the herbal bath with mom. If the baby will be in the bath, we delay applying the cord care powder to the umbilical cord until after the bath. I also use this time, if we didn’t already review it during the first herbal bath following the birth, to show the parents how easy bathing a newborn while in the tub with them can be. You’d be amazed at how overwhelming it can seem to bathe a new baby! I want everyone to feel comfortable and confident in this time! The baby is dried, diapered after applying olive oil to his/her bottom (GREAT tip for helping that tar-like meconium to slide right off!), the cord is examined and treated, and the baby is dressed and wrapped or ready for skin-to-skin with mom or dad.
You were able to deliver your baby at home, everything was normal and stable, and the midwife left you and baby snuggled up, resting in bed. I like to remind my clients to call me after their recovery sleep and after they’ve had some time to settle in a bit to let me know how nursing is going and to ask any questions that may have popped up in this time. Letting them call me helps to avoid me waking them with a phone call and instead allows the new parents time to adjust and do things on their schedule. If we didn’t set a time following the birth for the postpartum home visit, we typically schedule it at this time. The timing of the first home visit to check on mom and baby is anywhere from 24-48 hours following the time of birth. Of course, if there are any concerns, the midwife returns as appropriate.
While the particular timing is mostly due to the ideal time to collect a blood sample from the baby for the purpose of the first newborn screening (the test used to check for a myriad of metabolic disorders), it is also a great time to check in on mom to be sure she is remaining stable. Keep in mind that mom and dad (or perhaps another family member who was appointed for the task) have been keeping note of some vitals for the mom and baby in the time between immediate postpartum period and this first home visit. I work to make sure parents feel equipped for this and are not overwhelmed with this responsibility.
When I arrive, after washing my hands and greeting my clients and the new baby, I set out to boil another pot of herbs so that mom can take another herbal sitz bath. I didn’t used to do this routinely at this postpartum visit, yet I found all too often that when I asked if they had done any more herb baths since the birth, the answer was typically that they had not. My initial focus is on mom, addressing any questions or concerns she has.
I check her vital signs, feel her fundus (the top of her uterus), we discuss how her bleeding has been and any pain/discomfort she may be experiencing (from breasts/nipples to a sore bottom). We discuss her nutrition and her supplements since the birth. It is important to remember that a nursing mother needs more calories when breastfeeding than she did when she was pregnant! (A pregnant mom typically needs about 300 calories over what her normal was prior to pregnancy. A breastfeeding mom typically needs about 500 calories over her pre-pregnancy allowance.)
Many times it is through the discussion about supplements that a mom is reminded she should be continuing to take them. For many, it is an “out of sight, out of mind” issue. We have been encouraging moms to rest and take it easy, which typically means they are remaining in the nest of their room. This has pros and cons for sure! This protected isolation from the world can also deter some of the self-care they were so careful to instill during their pregnancy.
While discussing and addressing the various topics above, I am getting a sense of how rested mom is and a glimpse of her outlook and emotional state. I also ask directly how she is doing emotionally and whether or not she’s been able to fall asleep during her rest periods or if she’s just putting her feet up and taking it easy.
Following the mom’s assessment, we help her into her herbal sitz bath, bring her something to drink, and give her some time to herself while dad stays with the baby during his/her assessment. I have seen mothers light up with this opportunity to have some uninterrupted time in the herb bath. This is addressing her physically as well as emotionally. Sometimes, I have brought the baby to them at the conclusion of the baby’s exam and procedures, and sometimes they prefer that I don’t. The choice is yours. Those that choose to have the baby brought into the herb bath may choose to nurse the baby while in the tub, or simply hold the baby and help them to float, enjoying the warm bath.
Once mom and baby are ready to be helped out of the tub, the baby goes to dad and I help mom to the bed. During this time I demonstrate an abdominal massage and binding to help the mother feel supported and to encourage healing. The partner gets to see how they can be a part of this healing process and look forward to being in charge of providing the massage for the next couple of days.
To my former clients who are reading this and thinking things sound a bit different, you are right. Some of you are currently with me for another round and you WILL experience this. I am putting into practice new things as I grow and learn. I am blessed to have the opportunities to share this and find it providential that these changes occur and benefit the postpartum period. If you are “done done” having children, stay tuned…there is more.
The postpartum home visit is more than just a checkup. You are addressed physically as well as emotionally. I want to leave you feeling as though you matter, you are important, you are more than your birth, you are more than “just a mom”, you are (insert your name here)!
Similar to my departure following birth, I like to leave mom and baby resting comfortably together in bed, well attended and nourished.