Mamas on Bedrest: Mama’s “Dream Team”

January 12th, 2012

As the debate over who is the better provide of peripartum care wages on, I often wonder, has anyone ever stopped to consider what mamas want? What are mamas’ ideas of the “perfect birth scenario?” What would constitute a birth “Dream Team?” I have often contemplated what would have been my dream scenario (not that anyone ever asked me!!)? If I had to do it all over again and could have things organized around what would have served and soothed me, this would have been my “Dream Team”.

AntePartum Doula.  For both of my pregnancies, especially my first, I would have loved to have had someone come to my home, perhaps once or twice a week and check on me. One of the main reasons that I was so reluctant to go on bed rest and pushed back against it was because during my first pregnancy, I was completely on my own (my husband travels for work) and for my second, I was on my own with a 3 year old. How nice it would have been to have folks stopping by, helping out around the house and making sure that I had any and all supplies that I needed. Had I been on full bed rest, helping me to be comfortable, helping me to exercise my muscles and providing massage would have also been greatly appreciated.

Birth Doula. I sort of had this my second go round (We flew in my sister and she was a HUGE source of support and relief!!), but the first time, things went south very quickly and both my husband and I could have used some support in the delivery OR. While I was bleeding profusely (don’t know if they classified it as hemorrhaged, but it wasn’t pretty) immediately post partum, to have had someone that I knew and trusted to help me calm down (they had whisked my daughter away and I was a raving maniac!!), someone who could have told me what was going on, someone to convey that I was in great pain and got me the relief that I needed immediately and not 6 hours later would have been great. I think that incessant emesis and screaming should  have been a clue, but it didn’t get me any relief, so I am thinking verbal requests might have worked better.

Midwife AND Obstetrician. I think that both should be present! In the case of my daughter, things went south pretty quickly, so the obstetrician would have definitely been in command. But for my second birth, I think it would have been nice to have a trial of labor with a midwife, with an OB standing (very close) by. I had a scheduled c-section at 39 weeks, my cervix was totally closed and I had no hint of labor. While my son was and is totally fine, I think he and I both were strong enough to have “gone the distance” for a VBAC. But I guess hindsight is 20/20. I wonder if I had had a skilled midwife present could I have at least tried labor? Hmmm.

Lactation Consultant. The hospital in which I delivered my daughter (my first delivery) did well with this one and I really liked this lady! The neonatologist was all gunho on giving my daughter formula because she was unable to latch initially and she could not breathe and suck (her O2 saturation would drop into the mid to low 80’s). I refused. I wanted her to have breastmilk, but mine wasn’t in yet. The neonatologist was insisting on formula so that they could measue exactly how much my baby was getting. A very wonderful Lactation consultant arrived and asked, “Why hasn’t this mama been given a breast pump and offered donor breastmilk?” Everyone in the NICU kind of looked at her like, “Curses, foiled again!” but by the end of the day, I had a breast pump and was pumping out small amounts of colostrum and my daughter had a bottle of donor breast milk which was all we needed until my milk came in. This lovely woman also showed me the best ways to help my daughter to latch on so that she didn’t desaturate as much (just into the low 90’s) and her monitors didn’t all sceech and holler when I held her.

Social Support/Discharge Planning. Now I know that some of you reading this will say, “But most hospitals have social workers.” This is true. But neither time I delivered in either hospital (my children were born in two different hospitals) did a social worker come in and see if there was any support that I needed at home, did I have any questions or if I had any concerns. No one gave me any instructions on wound care  for my c-section incisions and no one gave me, “If this happens, come back immediately” instructions or anything on the signs and symptoms of post partum depression. Interestingly, a social worker did come into my room when I had my son to offer me Medicare and WIC (foodstamps) papers. (Obviously she hadn’t read my chart and seen that I had private insurance or a well employed husband, but had merely seen “my face” and had made some pretty biases-okay, racist- assumptions. But I’ll leave that discussion for another post!)

Post Partum (Home Doula). I really needed this, especially after my second delivery! While my sister attended my birth, she had to leave the very next day. (I wasn’t even out of the hospital!) I was in the hospital most of the week following my c-section. When I went home, my parents were there, but they had already been there a week and only stayed two more. So at 3 weeks post partum, still sore and achey, I got up, got my 2 little ones ready and drove my parents to the airport. (Husband had already set off on another business trip!) I have to admit, my response timing was off and I really couldn’t adequately feel my feet to drive but I did it. And at 3 weeks post partum, I was on my own with 2 little people. At that time, I didn’t know about doulas and no one suggested one to me. A few friends stopped by, but for the most part, I was on my own. A doula would have been a Godsend! Post partum follow up is the norm in many countries. I truly believe that it needs to be standard of care in the United States!

So this would have been my dream team. This is actually the reality in many countries. Women in many countries receive this type of perinatal care as routine, and it’s  covered by (often universal) insurance. Sadly, this level of care isn’t available to everyone in the US, only via private pay, so often women who need it most are least able to afford the assistance. Thankfully many doulas are able to fulfill the intrapartum, post partum and lactation duties, so you really get 3 rolled up into one. But we have a long way to go!

Few practices utilize both Obstetricians and midwives in the US. To me, this is where we really fall short of providing optimum care. The saying, “It takes a village to raise a child” is approriate because while takes a village to raise the child, it really takes a TEAM to bring the child into the world. It is high time that we all realize that no one provider-Obstetrician or Midwife-is better than the other. They have different skill sets, different strengths and mamas need both available to her as she brings her child (ren) into this world. It is high time that this bickering back and forth STOP and we get about the business of caring for the needs-medical, social and otherwise- of mamas and their babies.

Mamas, what is your ideal “Dream Team”? Do you have it? How can we help you get it? Share your comments below and be sure to subscribe to our RSS feed at the top right corner of this webpage.

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