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MegBoz 08-18-2010 03:49 PM

I’m not sure what my new HB MW does (I’m only 10 W now), but my DS was born with CNMs in a hospital. I had to stay 48 hours (well, baby did), then I went back for a PP checkup at about 6 weeks. That was it.

I read on another HB MW site yesterday that PP visits are like 1 and 4 days PP, 1 week, 4 week and 6 weeks (or something like that.) That struck me as really excessive. She said it was to check on BFing & PPD. But, again, that still struck me as excessive to be routine for every single mama (especially those who have BTDT with BFing, as I have BFing through challenges.)


babyjelly 08-18-2010 04:11 PM

I'm not sure on frequency, but my MW gives six months of PP care rather than six weeks. that seems more reasonable to me in terms of catching PPD (I always have later onset.).
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MsBlack 08-18-2010 06:56 PM

I offer 1day, 3-4day (approx.), 2wk, 6wk, also on call all that time. With a 1st time mom, will talk (phone) every day 1st wk, if only a quick check-in; with all moms, usually talk once, between 3dy and 2wk vis.

Some moms do not want all of it, which is fine--but really they are the exception. Most enjoy these visits, whether or not they really 'need' anything. Especially with the 2wk and 6wk visits--we chat, weigh the baby, talk about the birth or the reaction of sibs to new baby, BF, anything at all. Sometimes these visits are pretty short, mostly just a weigh-in. Sometimes they do end up longer, if there are any issues that need sorting. It's a time for a new mom to get some time for herself--someone paying attention to her in almost any way she might enjoy that.

No one is required to take it all, but I do urge fams to accept at least 1dy and 3dy visit (only a rare few even question it) so I can see if baby is transitioning well enough--many of my clients do not plan dr visits until/unless baby gets sick, or vax time arrives @2mos or beyond, so I'm a sort of 'first-responder' in a way.

I believe this plan is why I only rarely see ppd...not only because I'm 'on the lookout' for it--but because as we go along, I can see stressors arising, and help families to find solutions before they get far. So it's not so much any major 'professional intervention' as hearing how all is going, knowing if mom is able to take it easy-enough (for her) following birth for a quick recovery, making suggestions if needed....lots of little things. Some families do need more by way of this sort of observation and support--some don't--by and large my moms/fams like to show off the baby, talk about family stuff, etc...just fun!

Altair 08-18-2010 07:01 PM

My HB midwife does a few days after, 1 week, and 6 weeks. I ended up with a c-section transfer and she still did all these visits and even told the OB I didn't need to come in for my staples to be removed she'd be happy to do it on my couch. Same place she inserted by IUD at 6 weeks. Love that woman!

cocoanib 08-18-2010 07:32 PM

My MW visits were later that day, day 4, sometime in the next week and then a couple more after that. Ending with the last one at 6 weeks.
I really appreciated and enjoyed that times she came and spent with me after the baby.

alegna 08-18-2010 08:01 PM

My mw does (and seems standard here) 24 hours after, 1 week, 6 weeks.


CoopersMommy0308 08-18-2010 09:26 PM

I just asked my MW at our home visit and she says she does day 1, day 3, one week, 2 week and 6 week. More if you're having difficulties and need extra support.

nova22 08-18-2010 10:03 PM

Originally Posted by alegna View Post
My mw does (and seems standard here) 24 hours after, 1 week, 6 weeks.


jennica 08-18-2010 10:10 PM

24 hours, 3 days, 1 week (all at my home), then 2 weeks, 4 weeks and 6 weeks at their home where we did prenatals. I like all the visits, even though I really don't "need" them. It's fun to see how much baby is gaining, and to have someone making sure we're all okay. I think there is also a natural attachment created that I appreciate being weaned away from gently, rather than abruptly.

cileag 08-18-2010 11:23 PM

Truth be told, the postpartum support was a major reason I chose home birth the first time around---those first 6 weeks can be so draining and I was worried how things would go. My midwives came to me at 24 hours, 3 days, 1 week and I went to them at 2 weeks and 6 weeks. I agree with MsBlack above--I really didn't need them at all---my daughter latched like a dream and I had wonderful support from family, but I loved the visits. It was great to process the birth with them---great to celebrate how things went (I think it would have been good to commiserate if things didn't equally well).

I also agree with Jennica that you spend so much time with them during the pregnancy that it would seem unnecessarily harsh to suddenly stop seeing them---but then again I'm a big birth chatter so my prenatals sometimes went extra long.

BlackSheepPDX 08-19-2010 01:59 AM

My midwives also do a 1, 3, and 7 day home visit, with 2 week and 6 week office appointments. I appreciate them monitoring baby's growth, and keeping an eye on me. With my first I had a 3rd degree tear, so having someone looking out for me was pretty important.

MsBlack 08-19-2010 07:54 AM

Keeping an eye on perineal tears is another good reason for pp visits. Even minor tears, which most often heal fast and well, can 'backslide' for various reasons--being able to hear mom's reports on healing, and getting another look if all does not sound great, can help get healing back on track.

billikengirl 08-19-2010 09:17 AM

It seems like my midwife came to me a lot, every day for the first two or three days, then 2 weeks, then I went to her at 6 weeks. And we were on the phone often, too.

luckiest 08-19-2010 05:45 PM

I know that I'll get 6 PP visits, but I'm not sure how they're spaced out. I also managed to find a pedi who does the first visit in-home! I say "managed to find," but he's the guy my midwives send all their clients to because he's the only one who's outwardly HB friendly.

donutmolly 08-19-2010 06:03 PM

My mw does a visit between 24-48 hours, 1 week, 2 week, 4 week phone call/office visit, 6-8 week office visit. She will do extra visits as necessary too. I don't take my babies to the dr. until 4 mo because she does the infant checks, which makes fewer appts to deal with, a big plus imo.

If you aren't interested in visits from your mw so often, you could probably just request to skip it -- or find out what she wants to check on each visit: baby weight, signs of jaundice, mama's healing/bleeding, etc... seems like there's always a lot to check at the pp visits.

nikirj 08-19-2010 11:05 PM

Some MWs are counting on being baby's practitioner during the first few weeks, too, and so when they do your checkups they are looking at the both of you. This is different from most hospital based practices where they assume that you'll be getting baby weighed/checked up at the peds at a week.

MidwifeErika 08-20-2010 03:47 PM

I do visits at 1 day, 3-5 days, 7-10 days all in the woman's home and then offer 2 wk, 4 wk, and 6wk visits in my office. It may sound excessive when looking at it, but there is usually so much going on in that immediate postpartum time that I have found many women really enjoy the extra care during this time. I do more visits if needed as well for things like breastfeeding issues and such.

I am not just on the lookout for PPD, but I am also making sure that the mother's needs are being met so this time can be enjoyable and not stressful or lonely. I want to be sure her pp support is working out the way she planned, that I can give her referrals to anything she needs, that she feels like we are all around her to help her through this transition into mothering this next child. I want to know that if she bled a bit too much or had a tear, that she is healing well from these things and not just waiting for 6 weeks to tell me that she has been miserable. Or if things are going great, sometimes it is just nice to have someone celebrate that with you. I think it also reminds women that they JUST had a baby and shouldn't be pushing themselves too hard.

If a mother doesn't want all of those visits, that is just fine and totally up to her. It is just a suggested schedule of visits that I offer. In my apprenticeship we had many grand multips who simply didn't want that many visits. They wanted the first one for the newborn screen and then would often just say that they would call us when they were pregnant again. I would never force visits on someone who doesn't want them, but they are pretty nice for those who do.

MegBoz 08-20-2010 04:40 PM

Ya know, after I posted this & read replies, I realized that my initial reaction to this as negative was because I was so disappointed in the poor PP support I got from my hospital-CNMs. It was really dreadful.

Originally Posted by MidwifeErika View Post
Or if things are going great, sometimes it is just nice to have someone celebrate that with you.
So of the 3 CNMs, one was known for poor bedside manner. She was on-call the day after DS was born & came to talk to me about PP care. She said there were 3 things to discuss:
1. Bleeding
2. Birth control
3. PPD

We discussed #2 & I felt like a 14 year old! I felt she was being condescending & irritating. Um, yeah, I know if I don't want to conceive another child ASAP & I have sex with my husband, I need to take some action to prevent conception. & yes, I know this whole unprotected-sex-can-lead-to-conception concept still applies after giving birth!

& #3 was an uncomfortable discussion. I had such an awesome birth experience - I was OVER THE MOON! haha! Literally, I couldn't stop thinking about it, I couldn't stop talking about it.

I remember literally struggling to suppress my grin as she discussed PPD in this serious tone of voice. (Because I know PPD IS a serious issue & a real concern.) Again, intellectually I realized PPD is a serious thing, but I felt so overjoyed then, I wasn't worried about it at the time.

She did not share in any of my joy.

A simple, "Congrats! You seem overjoyed. That's fantastic! I'm sure you'll love motherhood! But let's talk about PPD too just in case so you know what to look out for & just in case, you can make sure to get help if you do happen to need it in the future."

No, it wasn't like that at all. It was like, "Meg, get your head out of the clouds, suppress your joy & let's get serious here!"

I couldn't wait for her to get out of my room so I could return to my blissed-out state. Literally, her presence felt like a big rain cloud on my sunny family picnic.

& that is all to say nothing of the AWFUL LCs & her COMPLETELY SAYING NOTHING to me about perineal healing. I had a 1st degree tear, but the other CNM had said it was such a minor tear, she wasn't even going to suture it, but she did since it kept bleeding. So I was thinking it was "no big deal" & nothing to be concerned about. I didn't even know I was supposed to use a peri-bottle after urinating. Ugh!

Of course, now I'm seeing a HB MW & obviously I expect a lot better care! So I need to let the past go & move forward. However, all prenatals are at her home office so I wouldn't assume she'd do as many as 6 PP apts in my home. There is no way I'm driving up there at 2, and 4, and 6 weeks PP. It's 50 min each way for me. That's too much.

MsBlack 08-20-2010 05:21 PM

No wonder you were questioning pp care! You poor thing...and all that from the dour one, on day ONE?

I have a series of questions that usually get asked, just to be sure nothing is getting past me that is 'abnormal' that mom may think is 'normal' and just has to put up with...and I am watching mom's/families signs--tones of voice and choices of words, general affect and how the family seems to be doing. But I don't generally mention ppd at all, until/unless I see possible signs arising. I should say, I am more likely to mention it before birth, when we are discussing pp recovery, having help with chores and other kids, bf support. It's my experience that a well-supported pp recovery/babymoon is the best prevention of ppd for most women...and I'm a big believer in wellness focus, and thus prevention of problems.

And I don't mention birth control until the 6wk, unless it looks to me like mom is feeling very frisky before that , or she asks. Again, prior to birth it's most likely that we have discussed bf suppression of fertility and how reliable it is not. Even at 6wks pp, I don't deliver a standard speech, but ask women if they need info on bc. Yeah, they are grown women; I am happy to discuss bc options if they want to, but don't assume they know nothing (including the basic facts of conception!) and don't make them listen to a spiel if they prefer not to.

Quaniliaz 08-20-2010 05:27 PM

In my experience (and area) postpartum visits are done in the mama/baby's home. (6 wk visit might be at midwife's office). Usually felt like a nice visit, to me...with someone who didn't expect anything from me (not even to hold the baby - just checking in to see how I was doing.) And all of my midwives have been very joyful and celebratory at the postpartum visits.

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