Your Postpartum Support Team

One of the most common questions we get here at ParentData is How should I prepare for having a new baby? People often focus on the stuff that they need (diapers, onesies), but far more important is the support structure you will have in place. Even when we recognize the need for support, it can be hard to know exactly what kind of support you need. That’s what today’s newsletter is for. We asked five amazing people who are experts in their fields to describe just what those fields are, and when you might call on them. Without further ado, let’s get to it. Perinatal psychiatrist: Dr. Pooja Lakshmin Dr. Pooja Lakshmin, MD, is a perinatal psychiatrist, the author of the new book Real Self-Care (Crystals, Cleanses, and Bubble Baths Not Included), and the founder and CEO of Gemma, a women’s mental health platform centering impact and equity. She also writes the Substack newsletter Therapy Takeaway. What does a perinatal psychiatrist do? Perinatal psychiatrists are medical doctors who specialize in taking care of women and birthing people during pregnancy and the postpartum period, which technically lasts for one year but also can extend longer depending on the feeding decisions that you make. We are the physicians who are most up to date on the latest research and best clinical practices for supporting women’s mental health not only in treating a perinatal mood or anxiety disorder but also best practices for the prevention of maternal mental health conditions when someone is high-risk. My clinical work is in helping patients make decisions about taking psychiatric medications, like antidepressants or mood stabilizers, during pregnancy and breastfeeding, titrating the doses of these meds, and assessing when someone is ready to come off them and how to do so without triggering a mental health decompensation. In addition to prescribing medication when needed, I provide talk therapy to my patients. Think of us as a first line of defense, a triage system, and your decision-making partner, all rolled into one. As I’ve written about in my own motherhood and mental health journey, taking steps to protect your mental health as a parent is not selfish; it’s paramount to the health of your family too. Who should consider going to one? People who may benefit include: Anyone with a history of a mental health condition at any time in your life — even if it was way back in college Anyone who has previously suffered from a PMAD (perinatal mood and anxiety disorder), had birth trauma or medical trauma, or previously taken antidepressants or anti-anxiety medication Anyone with a history of bipolar disorder or severe obsessive-compulsive disorder who is pregnant or considering pregnancy Lastly, please know that even if you are two or three (or 10!) years postpartum, you can still see a perinatal psychiatrist. I have never turned anyone away because they waited too long to get help. What does it cost? Like all areas of mental health, the ability to find and pay for a perinatal psychiatrist is impacted by your social determinants of health. There’s huge variability in the costs and access to this type of care. A silver lining of the pandemic is that many perinatal psychiatrists can see you virtually. A couple helpful tips if you are navigating this now, or to squirrel away for when you might in the future: Find out if your insurance company has out-of-network benefits. Even if your perinatal psychiatrist does not take insurance, they should be providing you with a “superbill” (basically a receipt). If your insurance has out-of-network benefits, you can submit the superbill and get some portion reimbursed after you have hit your deductible. I know this is more labor and very annoying, and I feel your pain — this is how I pay for my own psychiatrist, and this is how many of my patients afford me. See if your local medical school has a trainee clinic. For example, at George Washington University, where I am on the faculty, we have a low-fee clinic where patients can get five visits with a psychiatry resident trainee (supervised by someone like me) for a sliding-scale rate. Ask your OB to phone a friend: Postpartum Support International runs a free clinician helpline for health-care workers who have questions about medication safety and clinical decision-making. If your birth team isn’t sure about keeping you on your meds, ask them to submit a request here, and a perinatal psychiatrist will follow up with them for a free consultation. What resources might be helpful? In addition to my small private clinical practice, I founded Gemma, a platform for women’s mental health courses, community, and conversation. Gemma’s Pregnancy, Postpartum, and Mental Health virtual class starts on September 21, 2023, and is open for enrollment now. I’ve been teaching this class since 2020 — it’s one of my favorites. You come away with a solid understanding of what to keep an eye on for your mental health and a personal list of action items to reduce your risk. If you’re a reader or a book listener, my book Real Self-Care just came out in hardcover and audiobook. In it, I eschew consumer-oriented notions of wellness and instead show you how to make hard choices and prioritize what matters in life, while living in a society that oppresses anyone who is not a rich, white male. It’s written for all life stages, not just parenthood, but given my clinical work, it’s chock-full of stories from my practice. Of course I’m biased, but I think the book is a great starting point for going into tough or scary conversations with your partner, your family, or your health-care team! Lactation consultant: Jamie O’Day Jamie O’Day is a registered nurse, international board-certified lactation consultant, mom to three girls, and the co-founder of NAPS (Newborn and Parenting Support). NAPS supports families from pregnancy through early childhood with evidence-based care, support, and services through our team of registered nurses. Jamie knows first-hand as a parent and nurse that there is no one right way to parent, which is why she is most passionate about helping parents cut through all the noise and judgment and find the way that works best for them. What do lactation consultants do? At the most basic level, lactation consultants assess and troubleshoot feeding. They should also provide validation and reassurance that what you’re doing and feeling is normal (or not normal, but they can help!). They can also address simple or more complex issues like painful latch, cracked nipples, recurring mastitis, low or high supply, slow weight gain for the baby, and more. Beyond the basics, great lactation consultants can also assist with pumping, introducing bottle feeding, creating feeding plans for either term or prematurely born infants, and support your mental health. Another issue highly trained lactation consultants address is TOTs (tethered oral tissue, like a tongue or lip tie). At NAPS, we even go so far as offering a prenatal lactation visit to help establish a relationship ahead of delivery, orient parents to what to expect with breastfeeding, get them set up with choosing and being oriented to their pump, and answering any proactive concerns or questions. This way, we’ve already created a rapport to offer help with not just feeding challenges but also sleep, bottles, creating a plan to return to work and/or travel, mental health resources, and more. Do your research and find an amazing service that truly gives you what you need. While our philosophy at NAPS is to support parents in all of their feeding choices, we understand that this isn't the case for all lactation consultants. Short of completely revolutionizing the lactation industry (one day!), I would think about finding the right person to support your feeding choices in two buckets. The first is the bucket you can't control, i.e. the lactation consultant who comes into your room postpartum or is there on the day that you are in the NICU visiting your baby. If this person ever makes you feel bad or uncomfortable, or is pressuring you to do something you don't want to do, I would have a one-liner ready to go. Something like, "I am feeling really challenged by this interaction and would like to take a break." This gives you an out, to either revisit the conversation later or just not have to interact with that person again. In the scenario where you do have control over who you are seeing, like going to see or having a lactation consultant come to see you, you can likely get a sense of their values from their website. Do they state that they are here to support you regardless of your feeding choice — or can help with breastfeeding, pumping, bottle feeding, and combo feeding — or some combination of these words? If not, you can also just ask when you inquire about a visit. But no matter what, no one (consultant, OB, pediatrician, friend, family member, etc.) should ever make you feel bad or judged about how you feed your baby. Who should consider going to one? I recommend using a lactation consultant with 100% of clients (if this weren’t an answer for an economist, I would say 1,000,000%!). My goal for this country (and world) would be to include lactation consultations as a routine and normal part of the holistic care women receive after having a baby, not something you have to seek out or ask for on your own. Lactation consultants are not just for breastfeeding issues, and breastfeeding does not come easily to all (really, most). If you are a parent, or know someone who recently had a baby, you know that there are hundreds if not thousands of questions that arise when learning to care for and feed a newborn. Lactation consultants can answer so many of these questions with their vast experience and training. A good lactation consultant can also be a huge ally for parents throughout their entire feeding journey. This is why we train all of our lactation consultants in alleyship, so they too can provide non-judgmental, ongoing support regardless of how you choose to feed your baby. What does it cost? Like most things, it depends a lot on the consultant (years of experience and/or training) and where you live. Some consultants are free through your insurance and/or pediatrician’s office, while many others are private-pay, ranging anywhere from about $80 to $400 per visit. Most insurance companies do reimburse for all or part of a visit from a lactation consultant, meaning you would pay out of pocket for the expense and then submit paperwork to your insurance company for them to reimburse you for the cost. A lactation consultation may also be an approved expense if you have an HSA or FSA. The number-one tip I’d give when considering cost is to call your insurance and/or HSA or FSA provider before you deliver, so you have the time and energy to navigate your research and advocate for any choices you’d like to make in providers. What is your best postpartum advice? Let me focus on the things that we know positively impact outcomes for both parents and babies: proper prenatal education, peer support, sleep guidance, relationship support, and mental health services for individuals and couples. For prenatal classes, things to know are that most insurance companies also reimburse for all or a portion of prenatal classes. So when you call to ask about reimbursement for a lactation consultant, asking about prenatal classes is a great idea. It’s also great to find a class that expands their education beyond the basics and isn’t afraid to talk about parental mental health, ways to feed your baby outside of breastfeeding, how your relationship with your partner changes after the baby, etc. For peer support, you can look within your local community to see if there are any parental resources or groups available, or you can join a virtual group or community. Having the support of other parents who are in it with you is invaluable. For sleep support, coming up with a plan for sleep in those early months with your partner or other support network, and later having a plan for sleep as your baby gets older, can have profound impacts for your own physical and mental health and that of your partner and baby. Step one in understanding the impact of parenthood on your mental health as an individual and with your partner is understanding your risk factors. And then from there, understanding the warning signs and resources that are available to you, whether that is something as simple as a book like Fair Play or Cribsheet (this is not an ad!), or establishing a relationship with a therapist that can help you as an individual and/or as a couple. Knowing that all of these different facets of preparing for and transitioning into parenthood are ultimately what can positively impact parental and child health outcomes was the catalyst behind creating our annual Nurture by NAPS membership, so that all of these services could be available in one place and parents didn’t need to go looking in a dozen different places for classes, services, and support. Postpartum doula: Lindsey Bliss Lindsey Bliss is the co-founder of Carriage House Birth, a seasoned full-spectrum doula, a childbirth educator, and a mother of seven. Lindsey is considered to be a multiples expert after giving birth to two consecutive sets of twins. She is the author of The Doula’s Guide to Empowering Your Birth. She has been practicing since 2009 and has supported first-time parents, multiparas, single parents, LGBTQAI+ families, twin births, medicated and non-medicated vaginal births, cesarean births, and VBACs. What do postpartum doulas do? A postpartum doula provides focused support and full-spectrum care in the days (and nights) and months after your baby’s arrival, a period long overlooked when reinforcement is absolutely critical. They also provide evidence-based information on things such as infant feeding, emotional and physical recovery from birth, bonding with your baby, infant soothing, and newborn care. Families have an easier time with this transition if a good support team is in place. It takes a village. Who should consider having one? Because every family’s needs in the weeks after welcoming their new child are radically different, the first job of a postpartum doula is always identifying what those are. From that starting point, postpartum doulas assess and build out reasonable parenting goals for families; they offer guidance with baby feeding; they provide help with essentials like organizing, light cleaning, and cooking; and, perhaps most critically, they are present to emotionally support the new family. Overnight help and referrals (for lactation consultants or other specific needs) are an option too. Postpartum doulas’ services are applicable for both biological and adoptive families, and if you need care and support after a birth loss, miscarriage, or abortion. What does it cost? Postpartum doulas can range in price from $35 to $85 an hour, and rates are typically based on experience level and training. Rates are often higher-priced for supporting families of multiples. There are organizations that exist that provide postpartum services for low cost or free, so please inquire in the area that you live. What resources might be helpful? You can always reach out to us at Carriage House Birth for in-person and virtual postpartum doula support. Some other things I recommend for postpartum care include: Postpartum Support International The First Forty Days by Heng Ou, Amely Greeven, and Marisa Belger Stanley Quencher 40-oz. Tumbler Bodily care box Meal Train We launch Carriage House Birth postpartum doula training in September 2023. We believe that postpartum doulas are essential in supporting families in the often-forgotten fourth trimester. We also have a scholarship fund for postpartum doula training that prioritizes Black, Indigenous, Asian, and Latinx people, regardless of income; LGBTQIA2S+; and people who are experiencing financial hardship, in support of our larger goal to provide access for and train doulas who will raise the standard of care for the most vulnerable birthing bodies. Pelvic floor therapist: Dr. Sara Reardon Dr. Sara Reardon, PT, DPT, WCS, is a doctor of physical therapy and a board-certified pelvic floor physical therapist with over 17 years of experience helping women with pelvic floor issues. She is the founder and Chief Vagina Officer of The Vagina Whisperer, an online platform with pelvic floor and core exercise programs for pregnancy, postpartum, painful sex, and pelvic floor strengthening. Sara is passionate about normalizing the conversation around pelvic floor health and increasing awareness of pelvic floor physical therapy as a treatment option to prevent and overcome pelvic health issues. She lives in her hometown of New Orleans with her husband and two boys. What do pelvic floor PTs do? Pelvic health physical therapists specialize in treating your pelvic floor muscles, which play a role in bowel and bladder health, sexual health, reproductive health, pregnancy, postpartum, and menopause. During a pelvic PT session, the therapist inquires about your symptoms and performs a physical examination, which includes an internal exam of your pelvic floor muscles, through the vagina or anus. This exam assesses for pelvic floor weakness, tension, or pain and, along with your symptoms, determines if you would benefit from pelvic floor strengthening, relaxation, or coordination. Who should consider going to one? If you are experiencing any of the below symptoms, you should check in with a pelvic health PT: bladder issues, including urinary frequency, urgency, pain, or leakage bowel issues, including constipation, hemorrhoids, fissures, or incontinence pelvic pain, including painful intercourse, painful menstruation, or abdominal, vaginal, or tailbone pain pelvic floor heaviness or pelvic organ prolapse pregnancy-related pain or discomfort postpartum core and pelvic floor weakness or pain (recommend a six-week postpartum checkup) recovery from abdominal or pelvic surgery or cesarean section effects of aging, including urinary frequency, leakage, prolapse, or painful intercourse What does it cost? Cost depends on whether the therapist is in-network or out-of-network with your insurance provider. If they are in-network, it falls under your physical therapy benefits and is typically a set copay or percentage of the cost based on your insurance plan. If they are out-of-network, the price varies geographically but can typically range from $150 to $300 for an hour-long visit. What resources might be helpful? Check out the blog post What to Expect in a Pelvic Floor PT Session if you’re curious to learn more. To find a pelvic floor physical therapist in your area, check these PT locators: Pelvic Rehab and Academy of Pelvic Health. For pelvic floor workouts for pregnancy, postpartum, or painful sex, start your 7-day free trial of a V-Hive membership with online, on-demand workouts for your pelvic floor and core or get my free guide with 6 Exercises to Strengthen your Pelvic Floor and Core. What’s your best postpartum advice? First, take the stool softeners. After birth, constipation can oftentimes be more uncomfortable than birth itself. Take stool softeners from day one until your poops are pretty soft and regular, then slowly decrease usage. Second, check in with a pelvic floor physical therapist at six weeks postpartum. Often, after clearance from a medical provider, you return to sex, exercise, or work, and your pelvic floor and core have not been sufficiently evaluated or rehabilitated. A pelvic health PT should be the standard of care after the major physical transformations of pregnancy and birth and can significantly decrease pain, minimize urinary leakage, and increase pleasure with sex. Couples therapist: Dr. Ayanna Abrams Dr. Ayanna Abrams is a licensed clinical psychologist, the CEO and founder of Ascension Behavioral Health, and a co-founder of Not So Strong, an initiative to improve the mental health and relationship functioning of Black women. Her specialties include racism-based trauma, mood disorder treatment, burnout prevention, and helping people create and re-create healthy romantic, friendship, career, and familial relationships. She has extensive clinical and research experience working with Black people across the Diaspora and has been featured as a speaker or contributing writer in the New York Times, The Atlantic, Essence, Therapy for Black Girls, and Silence the Shame. What do couples therapists do? In short, couples therapists specialize in helping people in romantic partnerships increase relationship satisfaction through decreasing conflict, improving communication skills, helping them build insight into their needs and patterns, and creating more emotional connection through empathy, vulnerability, and emotional/physical closeness. We create a space for couples to practice new skills, learn a lot about themselves and each other, and make better-informed decisions about their future. Who should consider going to one? I would consider seeking couples therapy (and recommend seeking it) preventatively, as opposed to long after a problem or set of problems persists. Clinical and anecdotal data shows that couples often wait too long to seek care, which has more long-term negative effects on the relationship life span and each individual’s personal well-being. The main reasons to seek couples therapy include: to increase closeness and understanding, to improve communication patterns with regard to conflict resolution and problem-solving, or to practice vulnerability to understand each other at a deeper emotional level. Other reasons include stress and relationship management as it relates to career changes, relocations, adjustments to parenting (new or additional children), or differences in parenting styles/needs, concerns about children’s health or behavior, adjustments to major medical diagnoses/changes in health, in-law dynamics or caretaking responsibilities with older persons, financial distress, traumatic impact and how this shows up in relationships, sex/affection/arousal discrepancies, infidelity, abuse, addiction, and many other concerns, from mild to severe relationship impairment. So basically, seek couples therapy for anything, and we are here for you! What does it cost? The cost varies depending on a clinician’s training and licensure, where they are located, and if the presenting concern is considered a specialty or niche. A therapy session can range from maybe $50 with a licensed clinician in a rural area to $300 with a licensed clinician in a city like Atlanta or New York; it really depends on quite a few factors. Some insurance panels also assist in sharing the cost of care, so that really helps couples address that potential barrier. Some clinicians may have a reduced-fee option for couples, and some practices train emerging therapists who offer lower fees as they are building their expertise and are supervised by a licensed therapist. What’s your best postpartum advice? As a psychologist who specializes in seeing couples and in working with many families in the postpartum period and beyond, my advice is to talk to each other about things early and often. Do not try to tough these adjustments out alone; do not try to “protect” your partner by not expressing how hard this space is to be in, even if you love it. It’s hard not because you are deficient but because it is just hard, and you deserve to move through this with as much support as you need. Ask for help, clarity, listening, as much as you need to and whenever it will help, and be willing to seek assistance beyond your family and friends. Isolation and burnout in this stage has been staggeringly dangerous for families, with perinatal mood and anxiety disorders on a significant rise, and oftentimes the lack of support system is a key change factor in saving someone’s life, literally. What resources might be helpful? I usually recommend reading resources like Hold Me Tight by Sue Johnson, All About Love by bell hooks, I Want This to Work by Elizabeth Earnshaw, The Seven Principles for Making Marriage Work by John Gottman, Set Boundaries, Find Peace by Nedra Glover Tawwab, and Fair Play by Eve Rodsky. Seeking care with a therapist who has some experience with your specific concerns (you can ask directly about this) and who shares some aspects of your identities or your partners identities (i.e. race, religion, sexual orientation, ethnicity, etc.) is also helpful for many. Affirmation of your identities in therapy is crucial to increasing emotional safety, vulnerability, and change processes.

Your Postpartum Support Team

Five professionals you may need after birth

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