Dr. Tracey Agnese joins Dr. Fox to discuss the importance of planning to take care of a newborn as well as the mother’s needs through the fourth trimester, not just making a birth plan during pregnancy. She explains what considerations should go into a postpartum plan and what parents should expect for the first three or so months after their baby is born.
“The Postpartum Plan: Preparing to be a New Mom” – with Dr. Tracey Agnese
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Dr. Fox: Welcome to today’s episode of “Healthful Woman”, a podcast designed to explore topics in women’s health at all stages of life. I’m your host, Dr. Nathan Fox, an OBGYN in Maternal-Fetal Medicine specialist practicing in New York City. At “Healthful Woman” I speak with leaders in the field to help you learn more about women’s health, pregnancy, and wellness. Tracey, welcome back to the podcast. So nice to see you in person. So nice to have you. How have you been?
Dr. Agnese: Good, good. Thanks for having me. I’m so happy to be back. This was so fun last time.
Dr. Fox: Oh, it’s gonna be fun this time too. And we’re gonna be talking about your postpartum plan, but before then we were just chatting before, how’s the world of COVID treating you in your office with the youngsters, with the pediatric population?
Dr. Agnese: It’s a little bit crazy, you know, the kids, like we were just saying aren’t vaccinated, right? So there’s a lot of logistics around that right now and returning to school. And we’re seeing a lot of kids just getting normal, regular back to school, fall stuff, but that’s just not easy for any person or family or situation. So that’s just, it’s been quite busy.
Dr. Fox: Right. I imagine a year ago. So last fall and winter, you probably saw like no respiratory infections, no nothings, because no one’s seeing anybody and everyone’s wearing masks and it must been very odd.
Dr. Agnese: Yeah. It was. Yeah, it was very odd. And now things are just a bit delayed. Like the seasonalities of when we normally see RSV or hand, foot, mouth Coxsackie, you know, it’s all just, it’s not following the traditional trends. So it’s kind of just everything is possible.
Dr. Fox: Well, it’s the brave new world we are living in. You suggested to me that we do this podcast specifically about the topic of the postpartum plan. So tell our listeners, what are we talking about? Why did you suggest this? I think it’s a great idea, but I wanna give them an opportunity to hear your pitch.
Dr. Agnese: Yeah, sure. Absolutely. I think, you know, the more and more I learn, the more interesting that I find that people, you know, pregnant women, sometimes I find are focusing on maybe the, not the wrong things, but the things that in retrospect, they might have wished that they focused on other things, right? So I think a lot of pregnant women spend so much time on a birth plan. I listened to your podcast episode with Melka. I loved it. I thought it was really helpful, really insightful. And you know, I see a lot of them focus on this one day, you know, of the birth of the baby and they don’t really think about what’s gonna happen after, right? Like after they have the baby. They’re in the hospital with the baby and there’s doctors and nurses around there’s lactation consultants, there’s people bringing them food, you know, and then they leave the hospital.
And I remember actually with my first like looking over my shoulder, kind of thinking like, wait a minute, they’re just gonna, let me take her home alone. Like that’s it. I don’t need a checklist, a certification, nothing like I just get to go home? Right, so you go home and you’re alone with the baby and that’s what people don’t plan for. So I think it’s really important to just try and think about that and to plan, not just for that one day of the birth of your baby, but to try to plan for after. And I like to use the analogy that I heard a wonderful colleague say at one point that, you know, having a birth plan, but not a postpartum plan is kind of like, planning for your wedding day, but not planning for, or thinking about the marriage. That wedding date is one day, you know, and yes, we all want it to be a great day and go as planned, but really it’s about what happens afterwards. And so that’s what I wanna try to, you know, just let more people think about because you do have some more time on your hands, you know, before that baby, that extra person is there, that you have to take care of, that you can kind of reflect on things and put some stuff into effect.
Dr. Fox: So I think that’s excellent. And definitely, we spend a lot of time in pregnancy on our end talking about the birth. When is it coming? What’s gonna happen? What do I do? When do I do it? Where do I do it? And like you said, some people committed to writing, some people don’t, but there’s definitely a lot of discussion about that in this important event. And what kind of things do you think women should be planning for postpartum? Meaning what would you put in the postpartum plan?
Dr. Agnese: Sure. So first…
Dr. Fox: The PPP. The postpartum plan.
Dr. Agnese: The PPP. I love it. A different meaning. So first of all, I had no birth plan, no postpartum plan. So I don’t want everyone to go thinking that, you know, like, I didn’t have any of this, you know. I do think with the birth plan part of it, because I’m a physician that, you know, I was educated in the process. I had seen births, right, so not everybody comes to a birth with that. So I think that’s an important part of the birth plan, you know, but I didn’t have any sort of postpartum plan. So one of the things that I like to kind of mention, even just to start thinking about is to what’s in it is to just sit down and think about what you as a woman who’s about to have a baby, what do you normally do in your typical day, week, month?
You know, your just normal activities and, your responsibilities, the things you have to do. And, you know, write it all down. And that’s just really a good place to start and to kind of appreciate how much you do, whether that’s, you know, walking the dog and the, you know, the laundry and the dishes and, you know, all the routine things. Bills that need to be paid, stuff that all just like happens. And so start identifying, like, what are the things that you do. This way you could start thinking about a plan for going forward and to how you’re going to act on that.
Dr. Fox: And are you thinking of, in terms of the plan, are people mapping out the first couple of weeks? The first couple of months? First couple of years? Like what do you suggest people start thinking about and planning for?
Dr. Agnese: Yeah. I generally I’m thinking about the fourth trimester which is, you know, those first few months, like three months after having a baby. To answer your question, what’s part of the plan, right? The first part is just really acknowledging that you need as a new mom, like you matter, and you need to prioritize taking care of yourself in some way. And that’s one of the best ways could take care of your baby. So just, first of all, convincing yourself of that. And then from there, I do have some, you know, suggestions about setting some boundaries. And then the new mom taking care of her own physical health and then her mental health. That’s kind of how I think of it in like the broad thing. So, you know, when you look at other countries around the world, it’s very interesting that they have, a lot of them have a very defined name of the postpartum time, you know, for women and the defined time period.
Usually, it’s about 30 or 40 days. I think, you know, the most kind of well-known one is the Chinese confinement time where they have, you know, certain rules and regulations around what a new mom is or isn’t allowed to do as far as, you know, hot and cold foods into all sorts of different things. But when you look at all the different cultures, they really have a few things in common and that’s they just allow the new mom to rest and to recover. And they really acknowledge that. Yes, a new baby was born, but a new mom was also just born and this new mom, this new person needs to be taken care of as well. And I think that is priority number one, is acknowledging that. And you know, when you’re pregnant here in the U.S. everybody literally showers you with gifts, right? They give up their seat for you on the subway, they buy, you know, million onesies and baby blankets and everything like that. They’re giving you all this stuff. And then once you have the baby, the focus all goes, you know, towards the baby and people stop doing those things. They stop asking about the new mom. It’s just an interesting thing. And I think we can learn a lot from some other cultures as to really prioritizing caring for the mom in the beginning.
Dr. Fox: And do you think that in the U.S. it’s not happening because it’s just a cultural thing or because we have different priorities or like where did we go astray?
Dr. Agnese: It’s a good question. I mean, I think there’s a lot to go into it. I do think that it’s just kind of our, you know, mentality here to just… Asking for help is like kind of a weakness, I think in general. And, you know, people are take pride in doing, you know, all the things that they can do kind of, you know, on their own. I do think that there’s less just, you know, village family support, you know, logistically a lot of people that have a baby in the U.S. just don’t have family around, you know, whereas maybe in other parts of the world, they do. I think there’s a lot. Yeah, a lot that goes on to it. One thing I do think that the U.S. actually because I’ve interviewed a lot of different women and from different cultures around the world to kind of see what their traditions are. And, it’s super interesting. One of the things the U.S. does really, really well is involvement of the partner early on and really hands-on. And that’s something that’s come up a few times that a lot of, I think is a great thing to acknowledge.
Dr. Fox: I’m not worldly enough to know the answer to all these questions. And for me, it’s more of a curiosity, but I definitely would say that there’s this concept here of this, there’s a very strong value of independence. And maybe that’s born out of a good thing, sort of this idea, you know, this American dream, you know, if you work hard, you can do it. And it’s, you know, about the person and about the liberty. And it’s sort of the individual rather than let’s say, you know, the government to the society. And so there’s a very big positive to that, but maybe one of the downsides is you lose that sense of community potentially with that. So people, you know, for whatever reasons, for education, for their careers, for logistics, let’s say they move away from where they grew up. And so now you’re not supported by your family.
And frequently when people find their spouse, find their partner, they may be from different towns. And so now at best, you’re gonna be living near one of the two families. And yeah, I don’t know. I mean, I guess there’s obviously neighborhoods and communities where all the neighbors and friends do rally around people and there’s some where they don’t, but potentially that could be some of it like in our industrial dreams to get big. A lot of that involves moving away from where you started. It’s not that it’s a bad thing, but it’s something that needs to be taken into account. Like you said when you have a baby who do I know? Who’s gonna be around? Do I have family? Do I have close friends? And it’s not a weakness. People need others when you have a newborn. It’s not easy.
Dr. Agnese: People don’t maybe realize that much here in the U.S. because you know, we’re not seeing maybe babies, so many babies being born and raised, you know, kind of the same kind of thing as being away from your family and your, you know, big groups of people, right? So, you know, maybe the first time that were a lot of people who a lot of new parents, maybe the first time they’re even hold a new baby is when they have a baby. And so I think a lot of it is just kind of they just don’t know what their life is going to be like for those first few months, you know because they haven’t seen it even.
Dr. Fox: And I’m curious what your experience has been, first of all, it’s been intensified in the past couple of years because of this idea of everyone’s isolated from one another, due to concerns from COVID. But I think even before then there’s this idea that, “oh, I can get the answer online” or, “oh, I don’t see as many people because I’ve so many connections on Facebook and Instagram” or “I email people or WhatsApp with people” or “I’m in touch with them by phone, even though they’re out of town and it is a great way to connect”. But do you find that parents maybe on the front end don’t appreciate the importance of that actual like human to human contact in their early times as a parent?
Dr. Agnese: Totally. Yeah, I do. And I think that having so much information for most new parents is just too overwhelming. You know, so there’s a lot of just worry about you taking care of a new life is totally normal and having a newborn baby. And I think, you know, being able to then just quickly Google something or go onto some group with all these other new moms, you know, also in the same shoes as you kind of just fosters that and it feeds into that anxiety and, maybe makes you even more and more worried about the things versus, you know, being able to just go ask someone who’s, you know, had a few kids, they can calm you down a little bit more. And I think that they’re kind of almost going to the wrong people in a quest for all the knowledge and just then becoming a little more anxious.
Dr. Fox: I think it’s unusual that an online community is going to lower anxiety.
Dr. Agnese: Agree, totally 100%.
Dr. Fox: Because it’s always so, and they’re being like, oh, that’s not right. Everything blew up in my face. And they’re like, wait, why, what happened? And then it just, you obviously are gonna go down that rabbit hole. No one’s gonna go down the good rabbit hole.
Dr. Agnese: Totally. Because other people that you’re chatting with even at 2:00 AM when you’re worried, you know, are not gonna be in the frame of mind to calm you down. They’re worried too. They’re really worried too, yeah.
Dr. Fox: It is, you know, I sort of think of parenting similar to when I was, you know, starting as a new resident, there has to be this healthy balance between you wanna have some sort of, you know, confidence in yourself and your abilities as a person that, you know things, you have skills, you have talents, you’ve been trained, you’ve read things, you’ve seen things. So you need that confidence, but you also need to balance out with a healthy amount of terror that you’re gonna cause significant harm to somebody. And so when your doctor it’s always that balance like you know, if you’re pure terror, you can’t take care of anybody, but if you’re too confident, you’re gonna cause problems. And so you have to sort of balance those. And I find that parenting’s really the same way. If you’re completely terrified at all times, you can’t be an effective and loving parent, but if you have no terror, right, at all, then probably you’re gonna do some stupid things with your kids and hopefully get away with it, like most of us do when we do stupid things. And it’s really that balance of making sure you’re covering your bases, but you’re not just being too terrified at all times. Because it’s a tough balance, it really is.
Dr. Agnese: Totally. Yeah. And I do recommend as part of kind of, it’s a part of the postpartum plan, you know, identify two or three people who you trust and you’re gonna go to for advice, you know, for things about the baby and yourself, you know, not opening it up to everybody everywhere and listening to what everyone has to say, you know.
Dr. Fox: Right. Your pediatrician might be a good person.
Dr. Agnese: Absolutely. Your pediatrician, maybe your mom, maybe your best friend who has a few kids, you know what I mean? You know, but not go down the rabbit hole of everybody and everything, you know?
Dr. Fox: Yeah and it’s also interesting for those people, sometimes it’s good to identify one person who’s a little more anxious than you are. And another person is a little less anxious than you are. You can hear both sides of the story. You don’t just want to be surrounded by a bunch of yes people, you know, just say, “Oh yeah, yeah, yeah, what you’re doing, I agree.” You wanna sort of hear it and because you have to find your own path everyone parents differently. And there isn’t one right way obviously. And it’s also dependent on the kid, right? Every kid is different and every situation is different and every couple has different, you know, dynamics. And so it has to be individualized. But I think that your team should include people, I would say across the spectrum of this, you know, terror, non-terror.
Dr. Agnese: Yeah. And I like to think of it as a team kind of in all the different, almost like pillars of the postpartum plan. So you have the mom’s physical health. We could start with that. So for her, for the new mom and her physical health, right? So she should identify people who are gonna help with like nutrition, you know, chores around the house and also personal like care for after having a baby. So for the nutrition part of it, think about ways, you know, ways you’re going to feed yourself because that it actually takes up a lot of time of your day in order to, you know, grocery shop and prepare meals. So one of the tips I love to give pregnant women is, you know, if you do cook, you know, every family, every person’s different, right?
So find whatever works for you. But if you and your family, you know, cook, you can even just cook when you’re pregnant, like a little extra of a meal once or twice a week and put it in the freezer so that it’s like, ready to go. So you can just have that for a few months, you know, that’s another good.,. I’ve known people that have done that for baby showers instead of having, you know, a million onesies and blankets, they get a group of friends together and they all do this like food prep and then they put it in the freezer, and then they have meals for a few months. You know, another good idea for, you know, baby registry would be a meal train. You know, you can have people who don’t know what to do and wanna help. Especially in the times of COVID, maybe they’re far away, you know, you can put a meal train or you could put your favorite takeout, places or gift certificates to, you know, Seamless or GrubHub or whatever it is, you know, on there, you can get all of your like Instacart or FreshDirect or whatever you use.
You can get all your items in your cart, you know, just to make things easier for yourself for when you do have another human around. And think about things that, you know, you can eat to nourish yourself as a new mom, you know, quickly that are, and that are very nourishing, like, you know, smoothies that you could quickly make or nuts and, you know, have a lot of those snacks available, you know, do kind of all that stuff before. Get a lot of straws and paper plates, you know, maybe for a short time thinking about maybe not the total environment, but yourself is, it might be of a benefit because you don’t have a lot of, sometimes you literally don’t have an extra hand because you’re holding the baby. And you might need, you know, drinking water out of a straw. It’s so simple, but like doing less dishes, you know, all that kind of stuff that you can kind of think about and maybe plan for, will go a long way.
And people who have done that have really thanked me after that they had, you know, some food and some meals like already set up, you know. And then similarly with home chores, you know, is there anything you can outsource, hire out when you have some time on your hand now, are there trades, you can make this way, you can, you know, have, you know, all the dog walking, lawn care, cleaning laundry and stuff like that. You can have, you know, people set up, you know, when visitors come over, I love to recommend, have a checklist hanging on your fridge of stuff that like needs to be done. This way they can just start helping you and doing stuff, you know? And then for the new mom, her own like personal postpartum, you know, stuff, it’s like, make sure you have all the products there, right?
Like don’t wait to go buy the MiraLAX or the Colace, when you haven’t pooped for three or four days, you kind of like doing it a little bit before and getting it going before really will help you, you know. Do all the legwork to find any resources that you might need. So whether that’s gonna be a lactation consultant or a postpartum doula or baby nurses, which are very popular around here, or a pelvic floor physical therapist, you know, find out what does insurance cover? Who recommends what? You know, what are the resources? This way, you have all that. And if you need that person, you’re gonna feel it’ll be much nicer to quickly be able to just go and, make that call than to do all that research, which feels overwhelming.
Dr. Fox: So two things, first of all, for those of us who are trying to guess the over or under on how long it would take for Tracey to mention poop. The answer is 17 minutes and 10 seconds.
Dr. Agnese: Love it.
Dr. Fox: So if anyone had, if anyone bet 17, 10, or had the over on a 17-minute parlay, you’re gonna win. So 17, 10. The second thing is we’re gonna get canceled. I can’t believe you mentioned getting straws. That’s like a crime nowadays. And yeah, these poor postpartum women trying to drink outta those paper straws they are falling apart. It’s alright. So I will forgive you on the straw recommendation or…
Dr. Agnese: You can get a reusable straw, you know, get a water bottle that has a reusable straw and you throw it in the dishwasher.
Dr. Fox: Yeah, there we go. Yeah. For those listeners who were significantly offended by the straw line, you may fast forward that part and go to the reusable straw that Tracey mentioned which will be, of course, I was right after the poop mark. In all seriousness, what you’re mentioning is really helpful for moms to plan themselves, you know, all these things you’re talking about, you know, who’s gonna walk the dog? Where am I gonna eat? Get these things ready, get these chores up. I think it’s great. I think it’s also for those of us who are not new moms or not gonna be new moms, but who know new moms, instead of just saying, Hey, I wanna come over and see the baby, which is nice. It’s flattering that someone gives a crap to see your baby, right? It’s nice, but it’s not necessarily helpful.
Dr. Agnese: Totally. Absolutely.
Dr. Fox: To come see someone’s baby. But maybe say, let me come over and see your baby. And you know what, let me do a little laundry for you.
Dr. Agnese: Absolutely.
Dr. Fox: Something like that.
Dr. Agnese: Something like that, or what’s, I’m stopping and make it very easy for the new mom, you know.
Dr. Fox: I’m stopping at a supermarket. What do you need?
Dr. Agnese: I’m stopping at Target. What cheese do you like? What’s your favorite? What drinks are you out of? You know what I mean? And just make it really, really easy, you know, or a lot of times too showing up and I love to do this too. Like you show up and the new mom has all this equipment around. She doesn’t know how to use it. It’s like, what do you need to, you know, the baby stroller, the carrier, what do you need to use? Let’s find a quick YouTube video and, set it up for you.
Dr. Fox: Right. I know how to build that IKEA stuff.
Dr. Agnese: Exactly.
Dr. Fox: I’ll do that for you.
Dr. Agnese: Yeah, exactly.
Dr. Fox: And one of the things that I also learned, one of the great lessons I learned from my wife, other than, I don’t know how to dress myself. Is not just saying, what can I do for you? Or what do you need? Because most people are not gonna answer you. Some will, some will say, “Oh, I need this and this”, but it may not be something you’re able to do or you’re good at. Instead, something like that, like, “I’m baking cookies. I’m bringing you a batch.” Or, “I’m on my, yeah, I’m going to Target. I’m going to supermarket or I know you have a dog I’m gonna come over and walk your dog.” Whatever it might be that you think can be helpful, just offer that.
Dr. Agnese: Offer it. Absolutely.
Dr. Fox: And even if she says, no, don’t walk my dog. I got someone to walk my dog. Fine, but you offered. And a lot of people are like, oh my God, thank God. We didn’t have someone to walk the dog or whatever it might be. Offer something. It’s really if you plan on visiting the baby, which is nice again, it’s nice to combine that with an offer to do something. And people will really, really appreciate that.
Dr. Agnese: And if you are there, you know, holding the baby to just say to the new mom or new parent or new dad, or whoever’s there, you know, you’re holding the baby and say, “You know what, don’t worry about the baby right now. We’re doing great. Like, what do you need to do? Do you wanna go take a shower? Do you wanna go sleep?” You know, even if it’s 10, 15 minutes, you know, that can mean really the world of a difference in those postpartum days. And it can be just so, so helpful, you know.
Dr. Fox: Yeah or if someone does have, you know, a lot of time, it’s like newborns are pretty straightforward unless you have to feed them, right? I mean, you could say, when are you gonna feed the baby? Let me come over and watch or hold the baby while you take a nap, or while you, like you said, take a shower. I mean, these are things that, you know, moms need to do and want to do.
Dr. Agnese: Totally. And so postpartum, you know, the new mom’s postpartum mental health, I think is kind of another pillar of this, of a postpartum plan. And so thinking about, you know, your basic needs and, also like, I like to think of them as like, as bonus needs, right? Like what makes you feel like you, what do you need to do? You know, how many hours of sleep do you need to actually function? That’s gonna be different for everybody. You’re probably gonna get all of it in the first few months, but, you know, figure out like, what’s really important to you. Do you like to get outside every day? Do you not. Some people don’t mind, you know, some people it’s really important to. Are you an introvert or an extrovert, you know, which means kinda like, where do you derive your energy from?
Is that from talking to other people? Or is it from like staying home alone? You know what I mean? What makes you laugh? You know, who are those people of your friends who you’re gonna go to, you know, get a laugh or to make you smile, or maybe think about, you know, kind of identify all these people and things, and then also identify your primary support person, right? Whether that’s your partner or maybe it’s, you know, like a family member or something, and really, you know, have open communication before the baby arrives as to what your expectations are, you know, do you plan to split all the baby care stuff, 50/50 as far as like diapers and bottle washing and everything, or no, is it not 50/50? Because you know, when you have the baby there and, you know, the, you smell a poopy diaper and you’re, you know, you’re thinking, well, why isn’t my partner getting up to change that diaper?
You know, can’t he just go do it? But maybe he doesn’t realize that you want him to do that, or that you think he’s capable of doing that or whatever it is, you know? So just talk about all those things, talk about how you can connect, you know, with each other, if it is, you know, a relationship that you have to so that you don’t get to the point where you just don’t know. And, so it can be really helpful to talk about these things before.
Dr. Fox: And in terms of a plan, the reason some of this is also important for planning, not just to avoid, you know, strife, which can absolutely happen with a newborn. It can get ugly sometimes it’s a very stressful time, but also there’s practical decisions you may make based on those conversations. So for example, if you know, the two of you are having a discussion about, all right, what are we gonna do about night feeds? And the mom’s expectation is, well, I really need to sleep. Because if I don’t sleep, I’m a wreck. So I’m thinking we’ll switch off night feeds and I’ll pump and you know, you’ll bottle feed with breast milk or whatever it is. And I’ll do the other one using, you know, breastfeeding. And let’s say, he’s thinking I’m not taking my time off yet. I’m going to work in the morning. If I get up at 3:00, I’m gonna be a wreck the next day. That’s something you need to plan out. And so maybe you’ll decide, all right, maybe I won’t continue to work. Maybe I will take my time off on the front end rather than like, maybe you thought initially, you know, mom’s gonna take off 12 weeks, then dad’s gonna take off eight weeks. But you may see you know what? That’s not a good idea. Let’s take them off at the same time. Or maybe I will go to work, but we’ll get a nurse at night, and I’d rather spend the money in that. And there’s no right or wrong way to do this.
Dr. Agnese: Absolutely.
Dr. Fox: But you have to make these decisions in advance and planning it out is gonna help you. Same thing. Am I gonna nurse? Am I not gonna nurse? Some of it is obviously desire. Some of it is how well it happens for you and whether it’s something that’s, you know, pleasurable and bonding versus like miserable, and some of it is logistics. Sometimes you’re like, listen, it’s just me, right? I’m a single mom or there’s just no way my partner can get up at night. They’re just not capable of it, or they have to go to work in the morning. And if I get up every two or three hours to nurse, I’m gonna be a wreck. So I need some other plan and that’s reasonable. That’s totally fine. But if you don’t think about it in advance, it could really blow up and you don’t want it blowing up when you’re two days postpartum or you came home from a C-section and you’re in pain and you know, you’re miserable for whatever reason it might be. And it’s bad weather and you haven’t been outside in three days. That’s not have a good time to start sorting this out.
Dr. Agnese: Totally. And with any plan, they don’t go according to plan, right? And, but that’s okay. So when we say postpartum plan or birth plan, you know, we don’t mean that everything has to follow this trajectory. It’s just like having these conversations, thinking about things, putting as much support services in place, as you can beforehand, you know, to set yourself and your baby up for success so that you can actually enjoy some of this time taking care of your baby and each other versus, you know, being so surprised and maybe overwhelmed. Same thing too, with mental health. If you have a history of any sort of mental health issues, you know, I always like to recommend, you know, just reach out to that provider, that person just say, “I’m expecting a baby, you know, in case I need you. You still practicing? Where you at? If not, do you have a recommendation?” This way, all those things don’t seem so overwhelming when you need them because you’ve done the leg work already.
Dr. Fox: Yeah. I was totally gonna bring the exact same point that you know, everyone has to look at themselves and say, what am I at risk for? And so for some women, they know I have a history of OCD I have a history of anxiety. I have a history of depression, or I had a baby before and I had postpartum depression or whatever it might be. And again, just know it doesn’t mean it’s gonna get worse after you deliver, but it could. You’re at risk for it. And that’s something to be open about with whoever took care of you or takes care of you for mental health. And if you don’t have someone set up a relationship with your partner, let’s them know, listen, I have a history of anxiety and OCD. I’ve been pretty stable for the past year or two, but this may get worse after I deliver.
I need you to let me know if I seem worse and if I talk to you about it, like let’s be open about that. Obviously, it can happen to anybody with no history whatsoever. So that’s important, hard to plan for that necessarily. But certainly, if you’re high risk for that or whatever it might be, if you know that you have a very low pain tolerance and you know, I’m just gonna be in a lot more pain than others might be. Get pain medicine in advance. Think about what you’re doing. Do I have to walk up five flights of stairs? Maybe I should stay, you know, by my in-laws who have, you know, have a flat and I could stay there. All these things are good to prep in advance based on your own individual needs and people know themselves better than anyone else does.
Dr. Agnese: Totally. And you can have those conversations and say, you know, these are kind of my own warning signs of, you know, getting, you know, not in a good mental space, whether that be irritability or whether it be, you know, whatever it is. But like, you know, having those conversations can be super helpful. Similar with, boundaries too. I like to recommend having that conversation, at least even just with yourself, you know, as part of the plan is to identify, you know, what kind of boundaries you’re gonna set and when. That starts from even in the hospital, as far as, you know, having a baby, it’s a very vulnerable time. So, you know, who do you want there around in the hospital? The same thing for afterwards, you know, what sorts of people do you feel comfortable with? You know, and even if you plan, if you work outside the home or inside the home plan to go back to work at some point, you know, just a rough idea of when that’s gonna be. Are you gonna be fielding emails and phone calls before that or not, you know, setting up those sorts of boundaries, earlier can be really helpful. So that you and your partner and your family, and everybody can know what to expect.
Dr. Fox: Right. Are we making people wash hands? Are we not making people wash hands? Let’s decide.
Dr. Agnese: Are they gonna be, right? Vaccination status. Washing their hands when they come in, you know what happens? You know, I like to also recommend to, like, we have a plan because babies feed a lot in the beginning. They’re feeding every two to three hours. It takes a while, whether you’re bottle-feeding or breastfeeding, it’s a big ordeal. So who’s gonna, you know, be able to say to visitors, you know, “Now’s the time to feed, you know, we need some privacy or we need to take baby here.” You know, who’s so all those things are just.
Dr. Fox: Who’s the executioner? Who’s kicking everyone out?
Dr. Agnese: Who exactly, who’s kicking everyone out?
Dr. Fox: “Everybody out, we’re about to feed. Leave.” What else do you suggest women plan for their postpartum plan? The PPP.
Dr. Agnese: The PPP. I guess the other thing that comes up a lot is, there’s so much focus on the nursery, right? For after, having a baby and people love to make this beautiful, like Instagram-worthy nursery that they can, you know, take pretty pictures up.
Dr. Fox: That the babies are gonna puke all over.
Dr. Agnese: Baby might not even enter the nursery for like months. Because a lot of times the baby’s just gonna be, you know, in the room with the, mom or parents or whoever is feeding them and might not even be in the crib yet the nursery for a little while. So instead of having that, you have time for that. I think most people realize that by like second or third kid and they might not even put the crib together, you know, before the baby’s born and they know that that’s okay. But having a space for you, you know, as a new mom, who’s going to be feeding the baby, whether breast or bottle, you know, and having had recovering from a vaginal birth or a C-section and surgery or whatever it is, you know, tears, whatnot.
So have a comfortable place for you, you know, identify what that is. Get a chair that you’re comfortable in, a lighting source, you know, the middle of the night is dark, you know, so have light. So you’re not tripping over on your way to the bathroom or whatever. It seems really simple, but you know, having a space set up for you to do all those things can be really helpful, you know, a little, like, I think a popular thing right now is have a little cart of all your postpartum essentials there, you know, for nursing and, maybe a little, you know, a little thing for your own, like, your peri bottle and whatever, all the things are for you, but just really focusing on that in the physical space as well, can be really helpful.
Dr. Fox: That’s great. Well, that’s a smart idea. The babies do not really care.
Dr. Agnese: No.
Dr. Fox: Where they are.
Dr. Agnese: No, they just wanna be in your arms. That’s all they want. So while you’re holding that baby in your arms or trying to go to sleep or whatever, you know, you wanna be comfortable. And that’s important to think about.
Dr. Fox: We had our two-bedroom apartment in the city, and our third, when Neely [SP] was born, we were in one bedroom, the twins in the second bedroom. And we didn’t want Neely to like, you know, scream and wake everybody up. So she slept, we are such bad parents. She slept on the floor of the main room, like on a blanket. without going anywhere. She can’t walk, she can’t crawl. We don’t have any, you know, like, you know, mountain goats in our apartment. And that’s where she slept. She slept on the floor and perfectly fine, but everyone was happy with that.
Dr. Agnese: Yes.
Dr. Fox: And it worked out and…
Dr. Agnese: That’s the baby box. They have baby boxes that people get, you know, and like, that’s really, they don’t need much.
Dr. Fox: She turned out great. She was even on this podcast.
Dr. Agnese: Oh, was she? Oh, I have to listen. Oh, so fun.
Dr. Fox: Yeah. She’s a good one. It’s probably for that reason, but I like the idea of the physical space to think about that for the mom, not just for the baby.
Dr. Agnese: Yeah. And like, do plants make you happy? Put a plant where you’re gonna be spending a lot of time feeding the baby, you know, think about what makes you happy, you know, and, set it up so that you’re comfortable and happy.
Dr. Fox: Make sure the Wi-Fi works.
Dr. Agnese: You’re gonna spend a lot of time there. Make sure that you get a little internet. Wi-Fi extender. Do what you need to do so you can.
Dr. Fox: Do what you need to do.
Dr. Agnese: Yeah. You can watch Netflix or Hulu, you know, get all those accounts set up, ask your friends what their favorite funny shows are, have that all ready to go, you know? Okay. Not only is it okay to think about yourself as a new mom and to plan for it, you know, but it’s encouraged. And I think it takes some new moms way too long to figure that out. Because we do have this culture of like this sacrificial culture where we think that sacrificing ourselves is the ultimate, you know, act of love. But really it’s not. And I think that new mom space is kind of coming around to realizing that it’s not and it’s okay to be vulnerable and it’s okay… Not only okay to, you know, take care of yourself, but it actually is encouraged. And that’s how you could best take care of your family.
Dr. Fox: How much of this are you doing during the newborn visits? So you obviously see the babies and not always, but frequently. It’s the mom who’s coming in with the baby over the first month or six weeks. I mean, you’re gonna see him several times and clearly, you’re talking about how the baby’s doing and I know that you’re doing some screening for postpartum depression, but how much you get into the logistics and these types of things with the mom?
Dr. Agnese: It’s a hard question to answer, I guess I wish we had more time to go all this, you know, and I think that is another thing that in our system here in the U.S. it just makes it really hard for the new mom. You know, other countries, a lot of them have, you know, the practitioners teams of people going to the home of the new mom to check out the mom and the baby. I think that’s such a great model, you know, to have somebody go to the house and then to be able to see some of these things and say, you know, you should move this here and that there and make your life a million times easier. These are the things that when you go into someone’s home, you can really, you know, help them out. I go into as much as I can in those, you know, short times, a lot of times we’re just really focusing on feeding, you know, baby care, making sure the baby’s okay. And a lot of times, because they are, it takes a lot for a new mom to even come to the office. You know, a lot of times they’re just, they’re not so even focused on all these things and being able to ask those questions, but in their home being relaxed, I just feel like is such a great way to do it. I wish we did that more.
Dr. Fox: When we did our podcasts, on home birth. One of the things that came up is that the home birth midwives, many of them, I guess depends where you are, but many of them will come to the house one day after birth, two days after birth, five days after birth, a week after birth to do all the things that you get, the pediatrician’s office, you know, they’ll come and do the exams, do the weights, do the vaccines, whatever needs to be done for the babies and check on the mom. It’s the same person, which is really cool. And it’s a great idea. It’s I don’t know if we could pull it off in the U.S. quite yet. But people who are trained to do that, it’s really a great thing. First of all, for a mom not to have to go to the office is really wonderful.
And like you said, to have one person who’s caring for the mother-baby unit and not fracturing that into two different people. I do think it gives a much more holistic approach to the care of both the mother and the newborn, because, you know, if one’s not doing well, the other is not doing well in both directions. No mom is doing well if her baby is not well, right, zero. And people don’t realize this, but the baby’s not doing well. If the mother’s not doing well. Whoever the primary caregiver’s gonna be, doesn’t have to be the mother obviously. But that’s a really important point. And if it is fractured in a sense, which happens to try to be cognizant about it and to try to do as best as we can to remember those two are linked for quite some time.
Dr. Agnese: Yes. Totally. And I do think, I think that is a great opportunity for, you know, I don’t think physicians necessarily need to be the ones doing that. I think that some other models in other countries are just so great where they have, you know, midwives or other, you know, specifically trained people to go and provide this comprehensive care, you know? And I think when that happens, the numbers of, you know, maternal mortality are much better and the infant as well, just everyone, I think overall does better when they get that like care in their home, specialized to mom and baby. So I would love to see that.
Dr. Fox: I wanna follow with two final questions. The first is, do you suggest that people actually like physically write this down before the baby’s born? Like actually have a plan or a checklist or this, or just to sort of think about these things. What’s been your experience that would be the most helpful?
Dr. Agnese: I think whatever works for you. If you are a writer and you love to journal and you love lists and you wanna write it out, great go for it. I don’t think that’s necessary. I think even just thinking about these things is gonna make a world of difference to a new mom.
Dr. Fox: And the other thing I wanna ask you is, I know that you do a lot of education in other modalities than meeting with people one to one via, you know, online and YouTube. What are you doing in this space in order to educate women about this and how can they find you?
Dr. Agnese: Sure. Yeah. On all social media on @babydocmama, on Instagram and on YouTube, and on Facebook as well. And I have an online course for new moms called New Mom University. And I provide support, kind of like I just described in these pillars where I talk about the mom’s mental health, physical health, in that fourth trimester. But I also go into the baby’s mental health development, and physical health. And I try to, you know, week by week touch on all of those points because taking care of the baby, it’s not just about the baby, but it’s about the mom. So I like to bring those two together.
Dr. Fox: Do they find the New Mom University online, on YouTube? Is there a website? Is there a Instagram? Well, how do they find it for those of us who don’t understand all the hashtags? How can someone find you?
Dr. Agnese: Sure. You can just go to Traceymd.com, T-R-A-C-E-Y-M-D.com. All the links are there for New Mom University. And, you can click on to a waitlist to, and I’ll email you when it opens up for because it’s not open all the time, but it opens up every few months.
Dr. Fox: Amazing Tracey. Thank you so much for coming back.
Dr. Agnese: Thanks for having me. This was great.
Dr. Fox: Great to talk about this really important stuff. And, I just love what you’re doing and it’s always fun to talk to you. And I always really look forward to listening to what you and I are gonna sound like on 1.5 speed.
Dr. Agnese: Oh my gosh. It’s gonna be amazing. You know what? I actually tried to talk slower today, so I don’t know. We’ll see how that comes across, but I really made a conscious effort to try to do that today.
Dr. Fox: That’s awesome. No, it’s the joy and excitement. It’s great. It’s awesome. All right. Thank you so much.
Dr. Agnese: Thanks, bye.
Dr. Fox: Thank you for listening to the “Healthful Woman” Podcast. To learn more about our podcast, please visit our website at www.healthfulwoman.com. That’s healthfulwoman.com. If you have any questions about this podcast or any other topic you would like us to address, please feel free to email us at email@example.com. Have a great day.
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