Postpartum Recovery Essentials: Round 2

I had my last appointment with the UVA midwives at 30 weeks and then I transitioned care to a certified nurse-midwife who does home birth. On my list of “things I’ll never do” is home birth. I’d like to write a post on how we made our choice to have a home birth at some point because when Nick and I started processing home birth together, I wanted to hear from as many Western medicine providers who chose home birth as I possibly could. For some reason, knowing people who work in hospitals and help birth babies in hospitals (particularly OBGYNS) and also choose home birth really resonated with me. A few driving factors in our decision to switch from hospital to home:

• the literature was conclusive & clear that for me, a second time mom with a low risk pregnancy who’s first birth was vaginal and uncomplicated, home birth was safe if not safer than the hospital (we also live less than a mile from UVA if we need the hospital which was a huge plus in our decision – living further could have swayed things)
• I had the complete and non-hesitant support of both the nurse midwife I work with and also the UVA midwives -that meant a lot to me that they were immediately on board and supportive when I asked them their thoughts
• Between COVID and having a toddler at home to consider childcare for with no family immediately around, I was really anxious about childcare for Cal and leaving him for a night or two – navigating the hospital and arranging logistics of overnight childcare didn’t leave ME feeling like the hospital was the safest place for me or where I would feel most at peace birthing

The farther I got along in this pregnancy, the more unsettling the hospital felt even though I loved the UVA midwives. As a first time mom with Cal, I 100000% felt safest & most at peace in the hospital with an OBGYN and had a really positive & empowering birth. I wouldn’t change a thing. I know that isn’t everyone’s story and I am really grateful for how his birth unfolded. I’ve also been reflecting a lot lately on his birth and my care this time around with everything currently going on in our world – it’s become clear to me that being white has, without a doubt, positively impacted my experience and health outcomes. I’ve been watching Giving Birth in America, a documentary put on by Every Mother Counts and CNN, and recommend it. I’m still sitting with, processing with others and praying about what actual action steps I can take to be a part of the solution to this massive gap between white and black maternal mortality. I feel like I’ve been learning for a while, but have been stagnant on the action front and I want to change that.

Given that we are planning for a home birth, if all goes as I hope, this baby will be born without drugs/medication through my vagina so that’s what I’m basing my postpartum recovery plan off of while also keeping in mind birth can go a zillion ways and having plan B (and C and D) in place if we need to transfer to the hospital and/or this baby needs to be born via Cesarean.

After recovering from a vaginal delivery once before where I ended up with a second degree tear, here is what I consider to be the essentials for the physical recovery and what I’m stocking up on in prep for baby 2 to arrive.

A REALLY GOOD PERI-BOTTLE

If you have your baby in the hospital, they will give you a peri-bottle that you can take home. I’m not sure about birth centers since I’ve never had a baby at a birth center. These peri-bottles do the job, but they aren’t great. If you can/want to, I highly recommend purchasing (or adding to your registry – no shame!) the Frida Mom peri bottle which has an angled spout and is 100000x more effective and easier to use. I didn’t want to wipe with toilet paper for a good couple of weeks so this was used A LOT.

PERINEAL BALM

A lot of women use perineal spray (which I’ll share next) but the Earth Mama perineal balm was my absolute favorite. It’s like a better smelling icy hot for your vagina and is postpartum healing magic! It might sound terrifying to apply a balm to your tender and healing perineum and you might be like, “where do I even put it?!” but trust me, it is so soothing for your tender lady parts. After about 5-7 days, I got the courage to stop using the spray and use the balm. Just apply a little to your finger and gently apply to your perineum – I didn’t use a mirror, but just kind of applied it all around down there. You could certainly get a mirror if you want! For an extra cooling effect, store it in the fridge. We lived in a tiny 700 sq foot apartment when Cal was born so our one bathroom was about 10 steps from our fridge. Our master bathroom and fridge are on different levels in our house in Charlottesville now, so I’m not sure I’ll be storing it in the fridge this time around….regardless, this balm is my must-have for postpartum healing and I send it to every new mom I know.

PERINEAL SPRAY

I used the Earth Mama perineal spray during the first several days home from the hospital when applying a balm felt way too scary with stitches and swelling down there. It’s nice to have, but not nearly as effective as the balm in my opinion. I bought a new bottle of spray this time around (when I bought it the price was $5.49 so I’m not sure why it’s jumped so much on Amazon since…) to have just in case since I’m not sure what the aftermath will be.

HERBAL SITZ BATH

When I was preparing for postpartum with Cal, the idea of making a bunch of padsicles was overwhelming to me. It was just one more thing to do and several different things to buy to do it. So what’s a padsicle? It’s basically a pad + ice pack all in one…here’s a good (and hilarious) post on how to make them if you’re interested. Instead I bought the 2 pack of this herbal sitz bath and would brew that (they are like giant tea bags) and after the liquid cooled, fill my peri bottle with it and use that instead of water. Then I’d put the leftover tea bags in the freezer and let them get almost frozen and shove those in my underwear with the lovely giant pads I wore in the beginning. I found that to be helpful if I was feeling extra sore. I only went through one box so I have the other box still left for this time around.

GIANT PADS

The hospital will give you these mega pads THE SIZE OF A 2×4 while you’re there along with the dreamy mesh panties (for real, those underwear are amazing) and those are great for the first 48 hours when your bleeding is bonkers. When I got home though, I didn’t need pads that were THAT BIG and so had stocked up on pads for home. I wanted a pad that would be the least irritating since I felt like the skin and area of my vagina and perineum that just pushed out a human would be very tender and delicate. So I indulged and bought some Rael pads off Amazon. I found them super breathable and gentle on my lady bits. I started off with the overnight pads and then as my lochia lessened, switched to the regular and then eventually to the panty liners. I bled for a good 6 weeks (maybe even 8?) so had to use the pads and panty liners for a while. I know some women who swear by adult diapers and skip the pads all together so do what feels best for you. This route worked great for me last time so I’m going with it again this time.

BLACK UNDERWEAR

Blood stains. Several pairs of basic black underwear are a must for me postpartum. I just bought these basic ones off Amazon that are inexpensive – it looks like they are out of stock now so I’ll find a similar kind for this time around since I still need to get some. With the pads, I didn’t really leak but just in case, the underwear are black anyways and not a huge investment so you can just pitch them afterward if you need.

MAGNESIUM TO POOP

I don’t find Colace effective so I decided with Cal and this time to continue taking the same magnesium postpartum I take pregnant for my restless legs to keep the bowels moving. That worked just fine and I pooped within the first 3-4 days after Cal’s birth. One trick that my doula shared with me to help you poop is to fold a small piece of toilet paper and place it on the palm of the hand you wipe with. When you think you have to poop, press the hand with the toilet paper gently against your perineum as if you’re taking some pressure off that area when you’re bearing down. That apparently relaxes all the muscles and tissues a bit more in that area and you don’t feel like you’re bearing down with so much pressure so you can relax and poop. It worked great for me, so hopefully that’s helpful for you too.

AFTEREASE FOR AFTERPAINS

Your uterus continues to contract down to its original size and expel blood clots for several days after birth. These typically occur when baby nurses because of the oxytocin release (the same hormone that caused your uterus to contract during labor) and they can be painful. I didn’t find afterpains that painful or frequent with Cal, but apparently they are worse with subsequent babies so I’m coming prepared this time. My midwife (and lots of other mamas) swear by the Afterease tincture. I have ibuprofen on hand too if I need (and will take it those first couple days for pain) but am hoping to mostly use the tincture after that since I don’t like to take ibuprofen if I can avoid it since it can be tough on your gut. I have no idea if there is research behind the Afterease so I’m not claiming it’s evidence based, but it seems to have very little if any harm and anecdotally seems promising.

A FEW OTHER THINGS FOR MY MENTAL HEALTH

I didn’t think much about my mental health postpartum with Cal, as a first time mom I was mainly focused on baby, logistics and physical healing. Thankfully, I had a really positive postpartum experience. But I’ve been thinking about my mental health A LOT more this go around since we are in the middle of a pandemic which means less socialization and less (if any) in person mom groups and meet ups. And I now have an 18 month old to simultaneously care for, so in a lot of ways postpartum this time around feels like uncharted territory.

Nick and I have had a lot of conversations around how he can support me best. I have contact info for a cleaning lady if we need it and will be utilizing Cal’s nanny who is also a postpartum doula if I need her – for childcare, housework, cooking etc, she does everything. Even with me furloughed for work the past few months, we’ve used her for occasional babysitting since I can’t take Cal to midwife appointments (thankfully she’s been so diligent with social distancing) and we love her. I really loved Cal’s birth and our first week post birth with just Nick, me and Cal so that’s what I’m planning for this go around – just our immediate family for that first week and then my mom will come for a while and then Nick’s parents. Thankfully, Virginia is about to enter into Phase 3 and so COVID isn’t making it impossible for our parents to come and that’s what I/we feel comfortable with. If our lives explode and we are drowning from day one, my mom can drive down from Indiana asap to be here and help us.

I’m planning on one mega Costco trip to stock us up on a lot of things so we aren’t running out to the store. I’ve also typed up Cal’s “routine” (more of a rhythm) so whoever is caring for him besides Nick has a rundown and I can initially be more hands off with him. It’s breaking my heart to know this likely will be a hard transition for him and I’ve thought so much about how I can be there for him emotionally and love him through this even when my physical capacity will be limited.

I have a weekly mom’s bible study I’m planning to continue when I feel ready (we’ve been meeting socially distanced outside and it’s been a great outlet for me) as a way to get out of the house 1x a week.

That’s my plan for postpartum round 2. I’m sure there will be adjustments, but it’s reassuring to know I’ve prepared the best I know how. I hope it’s helpful for you too!