What to Expect from your Hospital’s Birth and Postpartum Care

When I was 26 weeks pregnant, my husband and I moved from the Seattle area to Japan for the next three years for his work. We were going to be fine! We'd be looked after by the hospital on the US Navy base where he was working, and at every prenatal visit, my baby and I were declared super healthy and right on track. What did we have to worry about?

Ok, so this was our first baby, and we were seriously far from home, and we knew it was going to be hard, but come on… how hard could one baby be? Especially a healthy baby with two healthy, smart, caring parents. People have babies all the time and they figure it out. We were going to be fine!

So when we were planning to fly my mom to Japan to stay with us after the baby was born, we struggled to decide just how long she should stay. She was a first-time grandma, so, like, three or four weeks? Surely eight weeks would be a bit excessive…?

In the end, we settled on six weeks, scheduling her to fly out the week of my due date. In keeping with his character, the baby came a week early, and I arrived home from the hospital the same day that she arrived at our house from the airport.

The first week she was with us, we felt a little self-conscious. Our baby cried a lot, and we struggled to figure out what he needed. By the second week, though, we were really starting to depend on her a lot. By the third week, we were tempted to see if we could get her a long-term stay visa and move her into the guest bedroom.

Even though we had kind of scoffed at the idea of "needing" quite so much help to justify a 6-week visit, in the end, we were not ready for her to go home again so soon! In spite of all we had going for us, all the research I had done, all our efforts, we were not prepared for life with a newborn, even though we had what felt like plenty of help.

Our postpartum care was basically nonexistent.

But in fact, we had no dedicated postpartum help. There was no supportive postpartum care team to walk me through those early weeks with my baby. Post-childbirth, we were sent home from the hospital with a wave and a “good luck!” 

Yes, I could call my midwife and my baby’s pediatrician if something was medically wrong, and yes, we had the massive privilege of being able to fly my mom out to stay with us for six weeks. And yeah, the Internet is full of all kinds of new mom encouragement, tips, tricks, and baby advice, but that was not really what I needed.

What I really needed was a postpartum doula to check in with me, show me the way, ease my fears and worries, and cheer me on, but I didn’t even know there was such a thing as a postpartum doula, and I didn’t realize what other options I had.

And so, in this blog post, I want to give you a clear picture of what your first few weeks with your baby might look like, focusing especially on the kind of care you might be offered, and the kind of postpartum support folks you might want to seek out.

**Please note: there are several different ways to bring your baby earthside, and a few different places that birth might take place, but for simplicity, this blog will focus on what happens after a simple, uncomplicated hospital birth. Your mileage may vary.

Your postpartum hospital care during and after birth

Okay, so labor seems to be well and truly under way and it’s time to grab your bags and go meet your baby. Once you are admitted to the hospital to have your baby, you will meet with several labor and delivery nurses who will check on your contractions, monitor how your baby is tolerating them, and track your vitals as you work your way toward meeting your baby.

When you get close to the 2nd stage of labor, the pushing stage, the doctor in charge of your delivery will attend. This might be a midwife or your OB, and they will guide you through the pushing stage to the birth of your baby, and help you through stage 3, which is when you will deliver the placenta and get any immediate care you need. 

It's likely that your nurses will go through at least one shift change while you labor. For our team of nurses, this shift change happened at 7am and 7pm. So at some point, you will see new faces and realize someone new is checking your vitals and asking about your contractions. 

And if you’ve been having your prenatal checkups with a team of midwives or OBs, you might not know who will attend your delivery until the time comes, but ideally, someone familiar to you will help you bring your baby out into the world.

Okay, so far, your postpartum support team consists of labor and delivery nurses, and the doctor in charge of your delivery.

The rest of your hospital’s postpartum recovery team

Once you've met your baby, you’ll likely move from the labor or birthing room to the recovery suite (or whatever comfy or fancy name your facility uses). There, you'll get to rest and hang out with your baby for anywhere between 24-48 hours before heading home if everyone is healthy and recovering well. It might even be this short if you've had a c-section!

The labor and delivery nurses you sort of remember from the birthing room will come and check on you every few hours, monitor your postpartum bleeding, continue to track your vitals, and offer you painkillers on a firm schedule. You might have a chance for a shower and it will become important for the nurses to know that you've used the bathroom.

You'll also meet a pediatrician who will talk to you about how your baby's doing and will answer any questions you have about your newborn. They will also go over what kinds of health checks will need to be performed over the course of the next day or so. These include weight checks, blood draws, a hearing screening, and overall wellness checks. There will also be questions about whether your baby will receive a vitamin K injection, first rounds of any vaccines (currently, the American CDC recommends just a HepB vaccine at birth, followed by a booster and several other vaccines at 2 months), or possibly, a circumcision. Bring these topics up at your next prenatal visit if you have questions, hesitations, or concerns. These are not things you want to be thinking through for the first time after you've just given birth.

Hopefully, your hospital will also have a lactation specialist on staff who will visit within the first few hours of meeting your baby. This is super helpful if you’re pretty determined to breastfeed. They can watch you as you nurse your baby and offer support and guidance if you're struggling to figure out how to get your baby latched with just two hands when they are crying and you are half lying down. It can be tricky, and they are there to help! They can also offer you guidance around alternatives to breastfeeding, pumping, bottle feeding, and formula feeding.

Your postpartum recovery team at home

If your experience is anything like mine, you might feel a bit unsettled to be sent home with a baby, away from all the caregivers who've helped you through your first two days as a mom, so let me reassure you: It is totally normal to feel like you don't know what you're doing. Maybe you’ve never looked after any babies before, or never a baby this small, or maybe just not this baby!

And I agree that postpartum support is not exactly abundant or even accessible everywhere. Once you are home, there are precious few connection points to check in with your doctor or pediatrician unless there is a serious medical concern with your recovery or with your baby. There is a sense that you’ll figure things out on your own or you’ll call if there’s a “problem.”

But newborns are needy creatures, and childbirth is not something most of us simply bounce back from, so here are a few different kinds of support people you can call to help you with your baby and your recovery after birth. Some of those people might be affiliated with your hospital, but it’s more likely you’ll find these care providers out in your community.

First, if you're very determined to breastfeed, be sure to connect with a lactation specialist whom you like. The one you meet in the hospital might only be able to see new parents within the hospital context, or they might have available hours to support you at a separate lactation clinic. More commonly, lactation consultants or breastfeeding counselors offer home visits to help you figure out your baby's best latch, your most comfortable nursing position, and are available to answer all your questions about how to feed your baby with your body. Some lactation specialists now offer virtual visits, so it’s worth looking into if you’re struggling to find a way to get out of the house with your baby.

If your baby seems especially tense and fussy and your pediatrician doesn't have any clear guidance on this front, consider looking for a reputable newborn or infant massage therapist, chiropractor, or craniosacral therapist to help your baby adjust to life on the outside.

Likewise, your recovery and sense of wellness might benefit a great deal from a few visits with a body work specialist or even a pelvic floor physical therapist. It’s okay to take it easy and wait and see if things don’t get better on their own, but please know that lingering pelvic pain and ongoing struggles with incontinence or painful intercourse are treatable and well-worth a series of visits with a specialist.

And for ongoing support, education, and encouragement about your recovery, your newborn, feeding methods, soothing, baby sleep, and baby gear, look into hiring a postpartum doula. My support is 100% virtual through video chats and messaging, but you might prefer to find a local in-home doula who can look after the baby as well as you so that you can get a shower or a nap.

Speaking of which, what about getting a night nanny or overnight doula, or a house cleaner, starting a meal prep service, setting up a meal train, or trialing a laundry drop-off service? Even if you only use these services for a few weeks, it will free up quite a lot of space in your mind and time in your day when you need your attention and energy to focus on yourself and your baby.

Okay, so this is what is commonly available if you know what you want to help you through the immediate postpartum period. You just have to set it all up.

What does postpartum care look like in the rest of the world?

Here in the US, postpartum care feels pretty... inadequate. For most women, it consists of the immediate aftercare once the baby is born (stitches maybe, pain management probably, and the delivery of regular meals to your bedside for no more than 48 hours) and a visit with the doctor who delivered the baby six weeks after birth where birth control is offered, and a brief discussion about how you're coping is considered "medically adequate"

And that. is. it.

Elsewhere, new parents' experience is quite different. 

In Holland, where I'm from, new parents are assigned a postpartum nurse who visits your house every day for the first two weeks to spend a few hours with you. This is similar to the work of an in-home postpartum doula. The nurse checks on your physical recovery, the baby is given a general wellness check, you get support with feeding your baby, the nurse prepares a meal or two, does a bit of tidying up, and offers encouragement and support until the next visit.

In Japan, where I had my first baby, I was told that new moms are allowed to stay at the hospital for up to two weeks after they've had a baby. There, they receive nourishing postpartum meals, and have access to onsen (hot spring) services like rest, relaxation, massage, and other special self-care treatments.

And then there is the practice of 40 days of isolation which is part of the postpartum tradition in parts of Asia, Latin America, and elsewhere. A woman rests and recovers at home, focuses on getting to know her baby, and is surrounded by her female relatives - mother, sisters, aunts, grandmothers. She gets special postpartum food, she does not go outside, she does not cook or clean, and she participates in postpartum ceremonies for herself and her baby that mark the occasion of her steps into motherhood. 

Maybe 40 days of special treatment feels a bit over-the-top if this is not part of your tradition or expectations, but as a postpartum doula, I hear from women all the time who say they basically had to figure things out for themselves through the newborn stage with their babies and they would love to have had more support. But here in America, postpartum care is something you have to research, organize, and set up on your own.

How much postpartum help do you want?

And so as you prepare to meet your baby, it's important to consider how much care you want through your fourth trimester. For me, before my mom stayed with us for six weeks, I secretly kind of wanted to hang out in my postpartum bubble and enjoy the slow and dreamy days with my newborn on my own. But that was before I met my baby. When my mom was staying with us, three adults hardly seemed like enough people to look after him when he needed so much holding and bouncing and did so little sleeping.

But what about you? What is your vision for your fourth trimester? And who can you add to your postpartum team to bring that vision to life?

Start by taking a look at your local community. Who are the friends and family who live near you who you can call for help? Do you have at least one person who would drop everything and come on a moment's notice? What about someone who would be willing to stop by for two hours every day for a week? 

If it feels a bit excessive to plan for "so much help" right now, take a deep breath and remember that you can always laugh it off later and send them home early. But in my experience, new parents look forward to planned visits from the people they love with great anticipation, so set some of that support up in advance so they can keep their schedules clear for you.

Then do a bit of research and find out who in your area does in-home lactation visits? Who do other new moms love for postpartum massage or chiropractic treatment? What about for overnight care or mother's helper kinds of tasks?

And if you don't have attentive and supportive people you love and trust nearby, consider connecting with someone virtually. Knowing you have a virtual visit with a doula or therapist or some other support person coming up will be a huge relief when the days blur and everything feels like it's piling up. 

As a postpartum doula, I provide weekly virtual doula visits and anytime text support for new parents starting near the end of your third trimester all the way through the first eight weeks with your baby. And because I’m also a gentle baby sleep coach, we save two visits for the third or fourth month to focus just on what’s normal and what’s possible for your baby’s sleep.

Definitely check out the Fearless Fourth doula care page if you want more details.

Start preparing for your fourth trimester today!

If this blog post really got your postpartum planning wheels turning, you will love my Prepping for Parenthood course. It'll give you a bit of a crash course about what to expect from your recovery and your newborn baby in the first few weeks after birth, answer your questions about feeding, soothing, and baby sleep, and will help you figure out what is left to do so that you can feel really ready to finally meet your baby! Sign up for the Prepping for Parenthood course right here.

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