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The 4th Trimester

A newly discovered fountain of resilience for the postpartum experiences our society doesn’t talk about. Well, at least, in 2020.

This is the third part of my series writing about a first time pregnancy of a working, mid-thirties New Yorker. First part: “Embracing change and a shift in mindset.”; Second part: “My birth story.

We felt well-prepared for my birth. Between education, classes and communication with the OBGYN team, I felt mentally ready and prepared to tackle all kinds of scenarios leading up to day-of. What I realized close to d-day is that we had no prep for what happens after that. I’m not referring to the “babies don’t come with a manual, figure it out” experience, I’m referring to how parents can be better informed on the most key things: nutrition and well being of baby and parents. Why isn’t this talked about outside of a plethora of blogs, forums, facebook groups and instagram accounts? Why isn’t this part of the healthcare system design?

Here are a couple of the puzzle pieces I’m trying to piece together. Perhaps you can help me out:

  • With only 1 postpartum OBGYN appointment post birth, and that being 6 whole dang weeks after the birth — there was no follow through with your medical relationship and support team for ALL that takes place to you, your baby and your home in 6 weeks.
  • With friends and family not wanting to overwhelm you, they would say things along the tune of “it will be tough at first, but it’s all well worth it” — there was no gravity in actually how hard things actually are. Why not talk about it more than that? We are (millennial generation) adults whom have voluntarily signed up for this adventure, give it to me like it is, please and thank you. I get that it’s all about your own self-discovery, but c’mon, we can be sharing more 🙂
  • You have to find your own pediatrician. No recommendations from my hospital care system nor OBGYN (this is such a missed opportunity for continued business in my opinion, but you know me, always blabbing about poor UX wherever I go). Being that our families don’t live in the States, there were no family referrals to lean on. Given that we are New Yorkers and most of our friends are single or not close to having babies yet, no referrals there either. Where do you even start with this in this case? Zocdoc? Haha. Thank goodness, my husband whom is a fan of OneMedical noticed they launched a pediatrician service a few months before our son arrived.
  • You have to find your own lactation consultant. No recommendations from my hospital care system nor OBGYN until after you have given birth. You are given an overwhelming amount of info day-of and don’t realize the first thing you need to do if find one asap. And one that takes insurance, is covered by your insurance bla bla bla.
  • With a pandemic on the sudden rise in NYC in early March, escalating real fast while in the hospital for just 2 days — there was a huge shift in our in-home support plans with a postpartum doula, night nurse and lactation consultant. We could not sign up for a “choose your own adventure” option anymore, we were moving real fast in the direction of just-do-it-and-figure-it-all-out-solo-with-virtual-support-and-in-isolation-to-boot.

Pandemic aside, this is still a valid topic to talk about. The 4th trimester is very real, raw and a rollercoaster. I had seen it referenced here and there thinking it was a marketing buzz word or instagram fad.

In short: You have spent 9–10 months shifting things in your body and life only to have a sudden crash/shift/change from that at rapid speed. Rapid, yo.

In long form: All the cute thoughts and images you have when decorating your nursery, setting up stations in your house etc., are well-cute in real life, but also very very very messy, raw and painful. Very real. I’m not complaining here, let’s be clear, I just feel that the pragmatic version of the experience isn’t what’s communicated in our society or talked about over beers with loved ones.

When this hit me hard, I realized, ok, it’s a wave of hardship and maybe folks shovel it under the rug because it’s traumatic, exhausting and you want to forget about it or you get past it, graduate from it all so to speak and there is no need to look back really. But wait everybody (yes, you experienced parents out there) — I would value so much from your stories, your cliff notes. Sure, it’s all about our own discoveries and journeys but let me pause and highlight that data is out there about how high postpartum depression (PPD) is for both sets of parents. PPD is not a fad, it’s as real as it gets. I myself wondered if the internet was being extra about it but when you find yourself in those moments where you are completely at a loss, sleep deprived, healing, learning, struggling, smiling, crying — depression can creep up on you if you don’t have a good support structure.

Breastfeeding deserves its own paragraph. Breastfeeding alone, has convinced me that there needs to be a better dot connection in the prep and execution experience between pre-birth and post-birth. I should not have to give birth and then be bombarded in 48hrs with nurses and a lactation consultant on 238 things I need to learn about my baby’s nutrition, weight gain, our new relationship to feeding and the intricate design and function between his mouth and my breasts. Just, wow. Folks only started speaking up about obstacles, only when I brought them up in conversation and realized more folks have had issues with breastfeeding than those whom have had none! I’m not saying my pre-birth, expensive, 3hr class on breastfeeding wasn’t worth it — it could be designed to be added into the planning experience, slightly differently — perhaps tied to my OBGYN, the new pediatrician and pairing with a lactation consultant, in advance of d-day.

More hand-holding, wisdom-whispering, tips-sharing is needed in those first 2 to 4 weeks. Perhaps previous generations survived just fine as is, and I tip my hat to them. From my experience, all pre-birth appointments involved a doctor and a medical support system, however post-birth it was all out the door. Ok, I won’t be that dramatic, I can message them in an app or request a telemedicine appointment but it’s not the same; it’s not a designed, well thought-through phase with a set of appointments set up, like it was pre-birth.

I understand that part of that gap I’m speaking of here, can be filled by a postpartum doula (mega respect for mine), but the trifecta with a lactation consultant and pediatrician is key. Maybe that’s just me. Maybe others like their set up being a la carte with these relationships being separate (and not connected) and then taking the advise offered by all of them and charging in your own direction with your best judgement. It took me reaching a point of desperation (See: engorgement and mastitis) to proactively connect all three; pediatrician, lactation consultant and my primary care all under the same group chat. I hadn’t felt such relief, support and re-assurance since the day I delivered my baby — 90 days ago. That’s 3 months. That’s just not ok.

If you know of services, programs or products achieving any of these dot-connections, I’d love to hear more you.

Thanks for reading.

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