The days following the birth of your baby are like nothing else. If you are lucky enough to experience the safe delivery of a healthy baby, it may be the most joyful time of your life.
But it can also be confusing, stressful, and completely overwhelming. Your body is flooded with postpartum hormones and if you birth in a hospital, it may feel like there are a thousand people involved, all with more control over the situation than you. And nobody tells you the impact those people have on your life as a new mother. Breastfeeding, bonding and your mental health can all affected by your early experience with your newborn.
When I went in to hospital to give birth for the first time, I didn’t really think about anything beyond holding my daughter safe in my arms. My first midwife was amazing – similar age to me, highly competent and caring in a brisk, efficient sort of way. Before I attempted my first breastfeed, she warned me.
“Your nipples are basically going to break down. It will get better as they toughen up, but it’s going to be painful for a while.”
Then she sent my husband to the pharmacy to buy hydrogel pads, with instructions to put them straight in the fridge.
She’ll never know the impact her words had on our breastfeeding experience, thus the first 18 months of my daughter’s life. I had been anxious about it all along; I really wanted to breastfeed but I knew so many women who had struggled. With two sentences this midwife prepared me to persist, when everyone else said:
“If it hurts, you’re doing it wrong.”
Because it fucking hurt. For six long weeks. While I was in hospital, I would get someone to check at every feed that we were “doing it right;” and I must have had six different midwives over the course of my stay. Each one had their own approach and while they were mostly helpful, at times they straight-up contradicted each other. On about Day 3 (cue baby blues, sleep deprivation and the pain really kicking in), I started to get pissed off and called one of them out. A sweet older lady, she acknowledged my frustration and explained to me that this is often the nature of hospitals. You have many professionals working with the same patient, all with their own background, knowledge and experience. They are bound to have differing opinions on the best way to do things.
I should know this better than most people. I’ve spent years working in the public health system, examining and improving hospital processes. The reality of any hospital stay is that it’s a process, and the patient is the only person who sees it from start to finish. Doctors, nurses, clerks, physiotherapists; they come in, do their part, and move on to the next patient. They don’t all work from the same playbook, and they don’t all communicate well. They don’t always have the time or resources to do so. But communication issues are the root cause of 93% of all problems in healthcare. And life.*
(*I have no empirical evidence to support this but trust me, its true.)
A close friend of mine, Mae, also recently had a baby. She was determined to breastfeed, but her milk took longer than usual to come in. Her newborn daughter was unsettled and losing too much weight, so she started supplementing with formula. A midwife told her how much to give, based on the aim to transition to breastfeeding. But still her baby screamed. Then another midwife on a later shift said she was giving too much milk, and her baby was screaming in discomfort from an over-full tummy. On the next shift, yet another midwife took the baby away to give mum a break. When she came back, she told Mae she’d given her an extra 60mls of milk, which had settled her. The baby had been screaming because she was hungry.
Can you imagine? Sore, tired and flooded with hormones, the solitary aim of caring for your new tiny human – who just happens to be constantly screaming, crying out for something while three experts give conflicting advice on what that something is and how to manage it. It doesn’t get more stressful than that. And then the impact that stress could have on milk supply, and the baby’s mood… it becomes a vicious cycle.
Even though Mae was already an amazing mum to an older daughter, and actually a nurse herself, in this situation she was completely overwhelmed and found it very difficult speak up. Feeding wasn’t the only thing the midwives disagreed on – she was also told by one of them her baby was losing weight because she was too cold, then told off by another for overheating her (I mean, FFS). It wasn’t until she was finally able to say something that the midwives got together, did some research, and came to an agreement on how much to feed the baby.
Another (less extreme) example of my own was related to pain relief. As I recovered from my first C-section, I gratefully took whatever the nurses gave me. Sometimes they would ask me to rate my pain, and an extra tablet would appear in the little plastic cup. When the obstetrician came to visit on day 2 or 3, he looked concerned when I gave him a pain rating of 7 (out of 10). He asked me what I’d taken and I stared at him blankly. I didn’t know. Whatever the nurse had given me?
He checked my chart and admonished me.
“You shouldn’t be feeling so sore. I’ve prescribed you [whatever painkiller… probably oxy-something], why haven’t you taken it?”
Jeez, I dunno Doc? I didn’t know I was allowed? Believe me, if I’d known there were more drugs, I would have taken more drugs.
But I didn’t know, because I didn’t ask, and no one told me. The nurses didn’t feel the need because they do this every day. In my experience nurses have a more sparing approach to opioids than doctors – not a bad thing given the international opioid crisis, and the possible side effects e.g. they can make it hard for you both you and your baby to rouse yourselves for feeding.
But to heal, I needed to rest. And to rest, and focus on my new baby, I needed to be comfortable. So my doctor told me that if I was in pain I should ask for pain relief. This stayed with me when I went in to have my son, also by Caesarean section. I specifically asked what I had been prescribed and noted what I was given each time, asking for more if I needed it. (And not just for pain. I have this weird thing where some painkillers make me itchy. Like cant-sit-still, scratching-my-whole-body-red-raw itchy. I told whoever would listen, and the midwives were great at adjusting my medication as we went, trying alternatives and calling my doctor to prescribe an antihistamine.)
At my own request, I was discharged early to be home with my toddler. But that took a toll on my body and my discharge medication – I was running out of the good shit and having to ration. By the end of each day I was sore and grumpy, only able to relax when I allowed myself to take something for the pain (just before bed so I could get a good nights sleep – haha). Enter the wonderful Mae, who noticed I was struggling and suggested I ask for another script.
I truly hadn’t thought of it. Again I’d assumed the prescribed amount was correct, and if I needed more I must be weak or not following instructions to rest (likely, but toddlers). I was worried that people would think I was addicted to opioids if I asked for more. But Mae helped me to see I was over-thinking it and when I worked up the courage to call the clinic, the midwife I spoke to didn’t skip a beat. After congratulating me on the birth of my son and commenting on his size (“No wonder you need more drugs!” she joked) she organised for a script to be sent through to my local pharmacy. That simple phone call meant that for the next week or so I was comfortable and happy, and able to enjoy that precious time at home with my husband and children.
People definitely treated me differently the second time around. I didn’t get as much attention, but I felt like people took my questions more seriously and were less patronising in their responses. I’m not sure if it’s because I was more confident and assertive, or if they just thought I knew what I was doing because I had experience.
It was particularly noticeable with the whole breastfeeding thing. Although the first six weeks breastfeeding my daughter were rough, we managed to keep going until she was 18 months old. I had hoped that when her brother was born, feeding would be easy and pain free, but no such luck. Turns out six months is plenty of time to regain nipple sensitivity! And newborns are a whole different attachment ballgame to toddlers, especially when you have restricted movement i.e. you can’t feel the lower half of your body and it’s attached to various tubes and machines.
It took about a day for the grazes and cracking to start. Again, I got a midwife to check every feed. After hearing about my previous experience, “If it hurts, you’re doing it wrong” quickly became: “You probably just have very sensitive skin. They will toughen up with time.”
Mildly gratifying, but not overly helpful.
Then, I was assigned a male midwife. I won’t lie, it was a bit weird. Having a man remove my catheter and help me into the shower? Awkward. I wasn’t really even sure how to broach the topic of my traumatised nipples, but the feminist in me pushed through the weirdness and I started the conversation.
You know how we sometimes criticise men for always trying to solve our problems? Well, listening and empathy were not healing my nipples – I needed a problem solver, and that’s what he was. After I gave him the background, he didn’t bother examining me (relieving). He just suggested we get the physiotherapist to come and give me laser therapy.
Best. Suggestion. Ever.
Laser therapy basically fast-tracks the healing process so that the cracks don’t keep getting reopened every time you feed. It was what “fixed” my nipples the first time around – except not until my daughter was six weeks old, and I had to pack her up into the car and drive to the hospital for treatment several days in a row. This time, the physio came to me – I literally did not have to get out of bed. It fixed the problem again, this time by day 5 instead of day 42. And while she was there, I got her to check my abdominal separation and give me some exercises to start getting my strength back – all things that came much later last time, in a separate appointment that I had to leave the house for.
These are just a few examples of how small things hospital staff say or do have a huge impact on how our lives start with our new bub. I speak from my experience having two private, Caesarean births, but I can also give the perspective of someone who has worked in the public system. I’ve spent years working with patients, clinicians and administrators and there are universal things that we can all learn to improve our healthcare experience.
Most of life’s problems can be solved with better communication. This is especially true in complex processes where multiple people are involved, like a hospital birth. As a patient or health care consumer, you are at the centre of it all; but it’s easy to feel like you don’t have any control over what is happening to you. The advice below is what I would give to you or any of my friends giving birth in a hospital environment, in the hope that it might help you make the most of those early days with your newborn, and beyond.
1. Trust that everyone has your best interests at heart.
No one becomes a doctor or a nurse because they don’t care about people. They have studied and practiced their craft for years, and are generally doing the best they can with the time, resources and knowledge they have. But they are human, and there are ways you can help them, help you.
2. Ask all of the questions
Many people think that when you consult with a health professional, they’ll give you every piece of information you could possibly need. The truth is they’ll give you everything they think you need. A doctor won’t walk you through every available option, they will give you the one or two they think are best based on their knowledge and experience. He or she may not discuss the pros and cons in detail – they’ve weighed it up themselves, and they are experts in their field. But they aren’t experts on you. So you need to ask questions.
What are the side effects? What are my other options? What do you think about this alternative treatment option I have heard about? What can I do to prepare? Does our (breastfeeding) attachment look ok? Why won’t my baby stop screaming? Is it normal to be so fucking itchy all over my body?
Any questions you have, ask them. Don’t worry about sounding stupid, or needy. You and your baby are the reason anyone is in the room. As long as you are respectful, no reasonable person is going to mind.
3. Give everyone as much information as you can
Clinicians are always pressed for time and they will only ask you the questions they think are important (on the flip-side, they will ask you some things over and over). There isn’t always time to pass on details or read notes. There are strong communication processes in place around the life-of-death aspects of your care – allergies, what procedures you’ve had and your general state of health should not ever be forgotten or lost in translation. But for the finer details that have the potential to impact your experience, it is in your best interests to give as much information as possible to each person.
You don’t need to recite your life story to every person who walks into your hospital room, just use your discretion if you think someone might treat you differently if they knew more about you. It might be as simple as telling the physiotherapist you’ve had a previous back injury – they might spend some extra time with you to make sure you’re confident to move around in a way that will protect your back and your wounds while recovering.
4. Ask for what you need
You know yourself better than anyone else, and you’re not going to get into trouble for asking for what you need. In any case it will start a conversation, and if you’re not exactly sure what it is you need, refer to points 2 and 3 above.
This isn’t an exclusive list, but some things to think about:
a. Help with your baby
In both my hospital stays the midwives were very attentive, always making sure my babies were warm enough, feeding well, weeing, pooing. On the first night with my daughter we couldn’t settle her, so the midwife asked to take her so that we could get some sleep. She swaddled her (properly, not like we’d been doing) and our baby magically stopped crying – we all got a couple of hours of much needed sleep.
But many of my friends have not been so lucky, telling me they felt lost and left to fend for themselves. You shouldn’t have to feel like that. You are the reason everyone is there, so if you can, ask someone. Ask them to show you how to swaddle the baby, bathe them, change a nappy. Ask if they can take the baby for a couple of hours so you can have a break. The worst that can happen is you get is an eye-roll or told they are too busy and they’ll come back later.
b. Pain relief and other medications
As I mentioned above, sometimes drugs will be prescribed by the doctor but only given “as needed.” You may need to tell someone they are needed. Remember rest is important in recovery and it’s very hard to rest if you are in more pain than you need to be. But again, if you’re not sure, ask questions about the alternatives and side effects and weigh them up.
Access whatever you can while you’re still in hospital. It’s much easier to do it while you’re stuck in a room with not much else to do, and the sooner you can get things sorted the better. For me, it was seeing the physiotherapist and getting laser therapy, preventing weeks of pain and stress around breastfeeding. I still needed to see a lactation consultant but unfortunately I didn’t ask in time to see the hospital one. (PS If you have private health insurance and want to see a private lactation consultant, you need to do it within the first couple of weeks or it won’t be covered – another thing I missed!).
Other care providers to think about are the paediatrician (I asked mine to check my son for lip and tongue ties), mental health nurse (they can be valuable advocates especially if you have experienced trauma with this or previous births) and social worker.
5. Speak to as many people as you need to.
One of the best and worst things about hospital staffing is shift work. The hospital runs for 24 hours but only the patients are there for all of them (and in a maternity ward, probably awake for most). In that 24 hours, you will have three different midwives. It sucks having to “start again” each time, especially if you were getting along really well with someone. But the changeover is also an opportunity to a different perspective.
There is a plus side to having a thousand people involved in your care – there’s always someone else to talk to. If the advice you’ve been given is not enough, or not helping, or just not sitting right; if you don’t gel with the person who is caring for you. Ask someone else.
Listen to what everyone has to say, but take the information that serves you and leave behind the rest (within reason of course. Give your kid the fucking Vitamin K shot).
6. Try to accept that not everything is in your control… and repeat steps 1 to 5.
The last thing I want to do here is to make it seem like you can control everything that happens to you in hospital, or that it’s your fault if things don’t go to plan. Staff are human, humans make errors. Bodies can be unpredictable. Systems can break down. If the hospital is so busy that they can’t even move you out of the birthing suite onto the ward, if no one comes into your room for hours and when they do they are too run off their feet to do more than check your blood pressure, “speaking up” isn’t a magic solution. If you are feeling overwhelmed, exhausted, intimidated and out-of-control, you probably don’t even know what to ask let alone how to ask it. These are just plain shitty situations, and all you can do is lean hard on your partner or mum or whoever else is there to support you, have faith in yourself and your new family, and know that it will pass quickly.
The main point I wanted to make in this article is that no one in the hospital wants you to have a bad experience. Every single person in there exists to produce a healthy, happy mum and baby with the best possible chance of thriving. So you have every right to have a say in what happens to you, and you should speak up whenever you can, even if you’re not 100% sure what it is you’re trying to say. Better communication makes everyone’s job easier and you, as the person experiencing the process from start to finish, and also with the most to gain, are best placed to lead it.