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Coronavirus has changed birth + postpartum forever

It shouldn't take a global pandemic to change the way our country supports women, but since it did, let's hope these changes stick.

business of birth and postpartum care

As the coronavirus transforms the world as we know it, in recent weeks expectant and new moms have been particularly affected—and left in the lurch. Some have seen prenatal appointments rescheduled, others are afraid to go.

Mothers in New York were, for a time, forced to birth alone. New moms find themselves without the postpartum support they planned for and expected and postpartum group gatherings have been canceled or moved online.

Coronavirus has lifted some telehealth restrictions

Yet as our efforts to contain COVID-19 are reshaping public life, we are also seeing decades of healthcare policies relax overnight, bringing with them dramatic changes to the business of birth and postpartum care. For the sake of moms everywhere, I hope some of these stick around well beyond the current timetables.

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While the experience of birth and new motherhood is personal, support—from specialists and communities alike—improves outcomes and overall experiences. Lactation consultants can improve women's breastfeeding outcomes, pelvic floor therapists can help moms recover from pregnancy and birth physically and therapists can help treat postpartum depression, making a huge impact on maternal mental health. But millions of women in the United States do not have access to such providers.


Yet suddenly, in response to the urgent need to shelter in place, Medicaid, the Department of Health and Human Services and major private insurers relaxed policies that have long been barriers to prenatal and postpartum care (and care in general). Many providers are now able to practice virtually across state lines in accordance with their licensing; HIPAA enforcement has been relaxed to facilitate email, phone and video consults for professionals new to offering them; and Medicaid and insurance companies are quickly approving new telehealth reimbursement categories including physical therapy and mental health.

I believe that many elements of these changes should be made permanent, while we also need to do more to ensure that these care providers are adequately compensated for their services and time, no matter the medium.

Though virtual visits are not always perfect substitutes for in-person care, maternal care providers are often a lifeline that can make or break the transition to new motherhood. In recent weeks, through my work as a founder of a maternal care startup, I have received countless messages from new moms seeking help with breastfeeding, anxiety and lack of sleep or simply seeking validation that they are not alone. More than one new mom has described her experience as "hanging on by a thread."

I didn't give birth in the midst of a pandemic, and the transition to motherhood was still challenging. It's challenging no matter what. And it was my doula, who had been present at the birth and who came to our home after I gave birth, who helped me through it—reminding me and making it possible for me to care for myself as well as I cared for my son.

She was the one who suggested I seek support from a lactation consultant, urged me to make time for pelvic floor physical therapy (and find one that was child-friendly, so I could bring my son) and made sure I was able to focus on my mental health as I navigated an identity shift that took me by surprise.

I don't know what I would have done without her.

But my experience is not an anomaly. Becoming a mother has a profound impact on women, as does the act of giving birth.

Most new moms are:

  • Sleep deprived (which does its own number on relationships and mental health)
  • Recovering from injuries sustained from childbirth
  • Struggling with breastfeeding (which does not, it turns out, come naturally to all of us)
  • Experiencing pelvic floor issues
  • Wrestling with identity change
  • Contending with realities that don't match up with how we pictured things
  • Dealing with varying levels and degrees of postpartum anxiety (PPA) and/or depression (PPD)

Addressing the maternal mental health care challenges in our country

PPD affects 1 in 7 new mothers, according to the American Psychological Association, and symptoms can last up to a year postpartum. Yet less than 25% of the women who screen positive for PPD receive follow-up care, for reasons that range from the stigma around mental health issues to their providers not knowing where to refer them. Many therapists have reported a spike in virtual visits during the coronavirus outbreak, which is a promising indication that people, including new mothers, are seeking the help they need.

Coronavirus concerns only exacerbate these challenges. Yet long before COVID-19, we were in the midst of a maternal health crisis and the United States has had clear gaps when it comes to actually delivering on adequate maternal care due to racial, socioeconomic and other disparities. The March of Dimes coined the term "maternity care desert" to refer to the thousands of U.S. counties that lack obstetric care hospitals or providers, leaving millions of women driving long distances to seek care or else are found in the hands of general practitioners with limited experience.

Millions more women have limited access to appropriate preventive, prenatal and postpartum care in states with too few providers per birth who specialize in pelvic floor physical therapy or lactation consulting, for example. And many women simply struggle to attend appointments out of the home—that's why giving women the opportunity to have telehealth consultations with such providers is a necessity.

The changing landscape of doulas

In some ways, doulas have been disproportionately affected by the shifting landscape, as so much of their work is typically done hands-on and in-person. But the value of doula support—whether remote or not—cannot be overstated in improving outcomes for mothers.

Many doulas are approaching this crisis by embracing tools that can enable them to be present virtually for their clients. Though care from doulas is not traditionally covered by insurance (except in a few states where there are massive gaps in terms of the reimbursement offered for their time and labor) this embrace of satellite doula support is creative and welcome, and may eventually help to expand the adoption of doula services everywhere.

Pelvic floor and breastfeeding support can even be done virtually

Meanwhile, millions of mothers experience pelvic floor issues after birth and beyond, which are often best resolved by pelvic floor physical therapists. But several states have no such providers at all. Their work can be challenging to replicate virtually, but manual therapy is not necessarily required in order to be helpful. Many providers have techniques to support moms from afar, including exercise programs, teaching and observing scar mobilization.

In a recent study, 60% of mothers reported that they did not breastfeed for as long as they intended to, for a variety of reasons—issues with latching, concerns about infant nutrition and weight, worries about medications, unsupportive work policies and lack of parental leave. Support for such issues comes largely from lactation consultants, but there are only about 10 lactation consultants for every 1,000 live births in the United States—which means demand vastly outweighs supply.

In recent weeks, lactation consultants have been pivoting to do virtual consults, but some who have only ever done home visits have said it seems new moms aren't fully aware of their options here. And although the Affordable Care Act mandated coverage of breastfeeding support and supplies, in practice, actually receiving such benefits remains notoriously challenging. We have more work to do here across the board, including facilitating virtual support.

Bottom line

Getting support should not be dependent on where a person lives or if and how often they are able they are to leave their homes. Motherhood is a physiological transformation and it is clear that women who have better support before, during and after birth, do better. The fact that many women are now able to access those providers virtually will have a lasting impact.

If it is possible to have something good come from this time period, which will disproportionately impact our most vulnerable, let it be this.

This is how we’re defining success this school year

Hint: It's not related to grades.

In the ever-moving lives of parents and children, opportunities to slow down and reflect on priorities can be hard to come by. But a new school year scheduled to begin in the midst of a global pandemic offers the chance to reflect on how we should all think about measures of success. For both parents and kids, that may mean putting a fresh emphasis on optimism, creativity and curiosity.

Throughout recent decades, "school success" became entangled with "academic achievement," with cases of anxiety among school children dramatically increasing in the past few generations. Then, almost overnight, the American school system was turned on its head in the spring of 2020. As we look ahead to a new school year that will look like no year past, more is being asked of teachers, students and parents, such as acclimating to distance learning, collaborating with peers from afar and aiming to maintain consistency with schooling amidst general instability due to COVID.

Despite the inherent challenges, there is also an overdue opportunity to redefine success during the school year by finding fresh ways to keep students and their parents involved in the learning process.

"I always encourage my son to try at least one difficult thing every school year," says Arushi Garg, parenting blogger and mom of a 4-year-old. "This challenges him but also allows me to remind him to be optimistic! Lots of things in life are hard, and it's important we learn to be positive during difficult times. Fostering a sense of optimism allows kids to push beyond what they thought possible, like biking without training wheels or reading above their grade level."

Here are a few mantras to keep in mind this school year:

Quality learning matters more than quantifying learning

After focusing on standardized measures of academic success for so long, the learning environment this next school year may involve more independent, remote learning. Some parents are considering this an exciting opportunity for their children to assume a bigger role in what they are learning—and parents are also getting on board by supporting their children's education with engaging, positive learning materials like Highlights Magazine.

As a working mom, Garg also appreciates that Highlights Magazine can help engage her son while she's also working. She says, "He sits next to me and solves puzzles in the magazine or practices his writing from the workbook."

Keep an open mind as "school" looks different

Whether children are of preschool age or in the midst of high school, "going to school" is bound to look different this year. Naturally, this may require some adjustment as kids become accustomed to new guidelines. Although many parents may wish to shelter our kids from challenges, others believe optimism can be fostered through adversity when everyone is committed to adapting to new experiences.

"Honestly, I am yet to figure out when I will be comfortable sending [my son] back [to school]," says Garg. In the meantime, she's helping her son remain connected with friends who also read Highlights Magazine by encouraging the kids to talk about what they are learning on video calls.

Follow children's cues about what interests them

For Garg, her biggest hope for this school year is that her son will create "success" for himself by embracing new learning possibilities with positivity.

"Encouraging my son to try new things has given him a chance to prove that he can do anything," she says. "He takes his previous success as an example now and feels he can fail multiple times before he succeeds."

There's no denying that this school year will be far from the norm. But, perhaps, we can create a new, better way of defining our children's success in school because of it.

This article was sponsored by Highlights. Thank you for supporting the brands that support Motherly and mamas.

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This is my one trick to get baby to sleep (and it always works!)

There's a reason why every mom tells you to buy a sound machine.

So in my defense, I grew up in Florida. As a child of the sunshine state, I knew I had to check for gators before sitting on the toilet, that cockroaches didn't just scurry, they actually flew, and at that point, the most popular and only sound machine I had ever heard of was the Miami Sound Machine.

I was raised on the notion that the rhythm was going to get me, not lull me into a peaceful slumber. Who knew?!

Well evidently science and, probably, Gloria Estefan knew, but I digress.

When my son was born, I just assumed the kid would know how to sleep. When I'm tired that's what I do, so why wouldn't this smaller more easily exhausted version of me not work the same way? Well, the simple and cinematic answer is, he is not in Kansas anymore.

Being in utero is like being in a warm, soothing and squishy spa. It's cozy, it's secure, it comes with its own soundtrack. Then one day the spa is gone. The space is bigger, brighter and the constant stream of music has come to an abrupt end. Your baby just needs a little time to acclimate and a little assist from continuous sound support.

My son, like most babies, was a restless and active sleeper. It didn't take much to jolt him from a sound sleep to crying like a banshee. I once microwaved a piece of pizza, and you would have thought I let 50 Rockettes into his room to perform a kick line.

I was literally walking on eggshells, tiptoeing around the house, watching the television with the closed caption on.

Like adults, babies have an internal clock. Unlike adults, babies haven't harnessed the ability to hit the snooze button on that internal clock. Lucky for babies they have a great Mama to hit the snooze button for them.

Enter the beloved by all—sound machines.

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As a mom, I say the phrase 'let me just…' to my kids more times a day than I can count.

Yes, I can help you log into your class, let me just send this email.
Yes, I can play with you, let me just make one more call.
Yes, I can get you a snack, let me just empty the dishwasher.

I say it a lot at work, too.

Yes, I can write that article, let me just clear my inbox.
Yes, I can clear my inbox, let me just finish this meeting.
Yes, I can attend that meeting, let me just get this project out the door.

The problem is that every 'let me just' is followed by another 'let me just'... and by the time they're all done, the day is over, and I didn't do most of the things I intended—and I feel pretty bad about myself because of it.

I wasn't present with my kids today.
I didn't meet that deadline.
I couldn't muster the energy to cook dinner.
The house is a mess. I am a mess. The world is a mess.

It's okay, I tell myself. Let me just try again tomorrow.

But tomorrow comes and tomorrow goes and the list of things I didn't get to or didn't do well bears down on my shoulders and my heart, and all I can think is, "I am failing."

And I think that maybe I'm not alone.

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