One of the things we never seem to talk about is how very different the immediate postpartum period is at a homebirth versus at a hospital. I was recently a doula for a couple who planned a hospital birth. One of the parents turned to me at a postpartum visit and said, “You would not believe what postpartum was like in the hospital. Nurses coming in every 30 minutes, and if it’s not a nurse it’s someone coming in to empty the garbage or change the sharps container. Postpartum is REALLY why people have home births, I bet.”
I don’t know if I’ve ever had anyone choose to have a homebirth just for the postpartum period, but it’s absolutely true that there is a stark difference between the first few days and weeks after a homebirth and after a hospital birth.
Postpartum in the Hospital
In the hospital, after you birth your baby you stay in your birth room for 3-4 hours before you are transferred to the postpartum ward. You will birth your placenta and your midwife or doctor will suture your perineum if they need to. In most hospitals, you will get to hold your baby for the first “golden hour” before they take the baby away to the warmer. They do the newborn exam, weigh and measure the baby, do any procedures you want done, and give the baby a bath. After all of this, you’re moved to the postpartum ward. Once you get there, you have a whole new team of nurses and doctors. They know the details of your birth, but because they weren’t actually there, the care can feel impersonal and rote.
You might have to share a room with another family depending on the hospital. And folks come in to check on you. A lot. They check your bleeding. They check the baby. Someone comes in to ask you what you want to eat when meals are brought to you. Someone does a hearing screen on the baby. A nurse comes in to check on you and the baby again. Depending on your situation, someone might be in every 2 hours to do labs on the baby. Someone comes to ask about your carseat. And this continues day and night. It just seems to go on and on. When you most want to rest and bond with your new baby, it can feel pretty impossible.
After you go home, your pediatrician will want to see the baby pretty frequently. Nobody will check up on you, however, for a full 6 weeks no matter whether you had a vaginal birth or a cesarean/surgical birth. It’s an absolute failure of our divided medical system where pediatricians really don’t know anything about adults and OB/GYNs really don’t know anything about babies. And it’s one of the reasons we have such high maternal and infant mortality rates in this country, especially for folks of color (and especially for Black and Native folks) who are much more likely to have a c-section (which means a higher rate of complications postpartum) in an underfunded medical facility than their white counterparts.
Postpartum at Home
After a baby is born at home the baby goes right up onto the birthing parent’s chest. Even if we (my birth assistant and I) need to help the baby get started breathing, the baby usually stays right there. You’ll birth your placenta under your own power. We get you tucked into bed. And then that’s it for awhile.
We’ll come and make sure your bleeding is normal and that your baby is doing well, but our main goal (as long as everyone is otherwise healthy) is to keep you in bed with your baby in your arms undisturbed. When you and the baby are ready, we’ll help you get started with nursing. At some point (usually an hour or more after the baby is born), we’ll take a look at your perineum and suture if we need to (right there in the bed with your baby in your arms). Someone will make you a home cooked protein-rich meal.
We’ll help you to the bathroom when you’re ready. If you want to see your placenta, we’ll give you a tour. And two or so hours after the baby is born, we’ll do a full head to toe newborn exam, including weighing and measuring the baby. Of course we’ll do any newborn procedures you choose. This happens on the bed, right next to you, and we’ll talk you through every step. Oh, and we clean up your house so it doesn’t even look like a birth just happened there.
I usually stay 3-4 hours and then go home as long as everything is normal and stable. You have my personal cell phone number and are welcome to call or text 24 hours a day with concerns. No beeping machines, nobody bothering you. Just you and your family and your new baby tucked into bed to nurse and sleep and get to know each other.
I come back and see the parents and the baby quite a lot during the first six weeks. I see you at your home the day following the birth, 3 days and 7 days after the birth. You come see me at my office at 2-3 weeks postpartum and at 6 weeks postpartum. Mostly, we talk. We talk about what’s going on and what you need help with and what questions you have. I make sure that nursing is going well, and that you’re not at risk for postpartum depression or anxiety. If you need extra support, I’ll come see you more often. And of course, I’m just a text or a phone call away.
The difference between the postpartum period in the hospital vs. at home is night and day. I aim to wrap you up with support and shore up your confidence as new parents. It’s what every new parent deserves, regardless of where they birth their baby.