Still, you’re going to need plenty of patience, rest, and support while you heal. Here’s an idea of what to expect as a C-section recovery timeline over the first hours, days, and weeks.

Just after delivery

After surgery, you’ll remain under close observation for a few hours. At this point, you still won’t have feeling in your lower body, and you may feel woozy or shaky because of the pain medication and the shifts in your hormones after giving birth. But, barring any complications, you’ll be able to cuddle and breastfeed your baby right away. You can have baby wrapped skin to skin with you in recovery just after getting out of the operating room. This will help baby regulate their body temperature, breathing, and heart rate, and prepare them for successful breastfeeding.

The first 24 hours after delivery

After the observation period is over, you’ll be moved to the postpartum recovery area. 

In many cases, the pain medication you were given for surgery will be effective for 18-24 hours to help you stay comfortable, as the regional anesthesia numbing your lower body will wear off after a few hours. Don’t be surprised when you’re encouraged to get out of bed soon after regaining feeling in your legs. Your care team hasn’t forgotten that you’ve just had major surgery. Movement is a critical part of the healing process and helps reduce the risk of blood clots. 

Soon after delivery, a nurse will usually massage your uterus to encourage it to contract to its usual size. The firm pressure stimulates contractions, which can be unpleasant. However, it’s important because it helps prevent heavy postpartum bleeding.

The day after delivery

The day after your C-section, your healthcare team will typically remove your catheter. Walking back and forth to the bathroom will now become part of your routine. Your doctors will also remove your bandages around this time and replace them with small, sticky bandages called Steri-Strips. These strips can get wet, so you’ll be able to shower. When you do, let the soapy water run over the incision area but don’t scrub. After your shower, gently pat the area dry. 

Expect to wear a pad for the first several weeks (no tampons while you heal). After birth, you’ll experience a completely normal vaginal discharge called lochia — a combination of red and white blood cells and mucus. The lochia will be red and heavier for the first few days after birth. Then it will transition to red-brown and then to pink/brown of lighter bleeding over the following 2-3 weeks. Eventually, it will become a paler, white discharge for the remaining 3-4 weeks before resolving altogether. 

Gas bubbles can be a real pain while you wait for your bowels to start moving normally again. All the walking you’re encouraged to do should help, as can a stool softener and anti-gas medication. 

Days 3-4

Most people will be cleared to go home around this time. If you have staples rather than dissolvable stitches, your doctor will usually remove them at this time. Don’t worry; the removal process shouldn’t be painful at all. 

Before leaving, you’ll be given the full rundown on incision care, plus all the dos and don’ts during your C-section recovery. Don’t be afraid to ask any lingering questions about your healing and life with your new baby. You’ve got direct access to a team of experts right now, and be sure you know who and what number to call once your home if you need to contact a provider urgently.

The first week at home

You’re going to need a lot of support after you leave the hospital. Round up your inner circle and get specific about exactly what you need. Try to rest as much as you can and delegate tasks like errands, cooking and housework wherever possible. If it’s an option for you, you could hire a postpartum doula to come to your home occasionally to give you a break from infant care, or to do some light cleaning, or food prep for you and your family. Some doulas also provide lactation support that can be crucial in the first couple of weeks.

Don’t try to lift anything heavier than your baby for now. If you have stairs in your home, consider asking someone to help you move your essentials to the first floor so you’re climbing them as little as possible. If you were sent home with prescription pain medication, know that it is perfectly acceptable to use it as directed by your provider. You have to take care of yourself in order to be present and able to care for your baby. As you near the end of your prescription medications, you may want to transition to an over the counter pain medication. Most, like ibuprofen and acetaminophen, are safe for breastfeeding. Talk to your doctor about which is the best option for you.

A heating pad can help relieve cramping as your uterus continues to shrink. Drinking plenty of water and taking a stool softener as well as making sure you’re walking daily can help with constipation. You should also take care to nourish yourself often and well. Your body needs extra energy to heal and to produce breast milk for your baby if you are breastfeeding.

Two weeks out

Even though you still have much healing to look forward to, you can expect to feel much better at this stage. You might have a two-week incision checkup with your doctor. In the meantime, watch for signs of infection, which include warmth, redness, swelling, or oozing at the incision site, as well as fever. Call your doctor right away if you notice any of these symptoms. 

Once you’re no longer taking prescription pain medication and can use the gas and brake pedals in a car without any pain, you may be cleared to get back behind the wheel. But expect that you won’t be driving for two weeks at the very least. 

One month after your C-section

By now, moving around will likely feel much more comfortable. And you should find that the vaginal bleeding stops between now and the six-week mark. Other good news: you can usually take a bath by now if you like. And your doctor might give you the go-ahead for some types of light exercise, especially if you were active before and during pregnancy. 

C-section recovery week 6 and beyond

Congratulations! By this point, many people feel nearly or fully recovered. Your incision will have healed, leaving a scar that will fade with time. However, you may continue to feel slight discomfort or numbness at the incision site for months to come.

At your six-week checkup, your doctor might let you know that it’s okay to have sex. Keep in mind that when you are physically ready and emotionally ready may follow different schedules. Don’t rush this step and when you do decide to go for it, take things slow and steady.

Remember, everyone has their own healing timeline. So it’s crucial to listen to your body and not rush your return to normal. You’ve made it through six weeks of recovery with your now six-week-old baby. There’s so much to look forward to as your timeline together continues.

Reviewed by the Ovia Health Clinical Team

Sources

• “Births – Method of Delivery.” National Center for Health Statistics. Centers for Disease Control and Prevention. March 2, 2021. https://www.cdc.gov/nchs/fastats/delivery.html
• “C-section.” Mayo Clinic. Mayo Clinic. June 12, 2020. https://www.mayoclinic.org/tests-procedures/c-section/about/pac-20393655
• “Pain Management for C-Sections.” Yale Medicine. Yale Medicine. https://www.yalemedicine.org/conditions/anesthesia-for-c-section
• “Cesarean Birth FAQs.” Acog.org. The American College of Obstetricians and Gynecologists. 2021. https://www.acog.org/womens-health/faqs/cesarean-birth

Postpartum depression is the most common health problem of pregnancy. Up to one in five mothers will experience postpartum depression. Like other types of depression, people with PPD may have the following symptoms:

• Loss of interest in activities
• Feelings of sadness, guilt, and worthlessness
• Reduced ability to feel pleasure
• Fatigue
• Trouble learning new things, focusing, remembering, or making decisions
• Difficulty connecting with your baby
• Thoughts of harming oneself or the baby
• Suicidal thoughts

How does zuranolone work?

Zuranolone is a lab-created form of allopregnanolone thought to help improve mood and treat PPD. Allopregnanolone is a form of progesterone that helps lower anxiety and the symptoms of depression. Low levels of it after birth may be linked to PPD symptoms. 

How is it different from other treatments for PPD?

Zulresso (brexanolone) is the only other existing treatment specifically for PPD. The intravenous therapy takes over 60 hours and requires a hospital stay of two and a half days. Other depression drugs don’t usually work as fast or target PPD and can take months to show improvement.

What are its side effects?

Drowsiness, dizziness, diarrhea, and fatigue are the most common side effects of zuranolone. The treatment has an FDA box warning about the risk of impaired driving or attention while on the medication.

Is it safe to take while breastfeeding?

Study participants were asked to stop breastfeeding while part of the study. So, the effects on breast milk, a nursing baby, or changes in milk production are unknown. Talk to your provider about whether breastfeeding while taking zuranolone is right for you. 

Will insurance cover zuranolone?

As with most new drugs, some companies may pay for them, and others will not. Check with your insurance provider and ask if they will cover this drug before it is prescribed to you to avoid unnecessary costs. 

Read more

• Postpartum depression: baby blues or something more?
• Postpartum by week

Medications and vaccines

Immediately after giving birth, routine care for newborns includes a few different treatments. It can be really helpful to know more about these recommendations ahead of time!

An antibiotic eye ointment, called erythromycin, is a clear gel that is gently squeezed into each eyelid. It looks greasy, but should not cause your baby any discomfort. It helps to protect against an eye infection called neonatal conjunctivitis that can be caused by many different bacteria present in the vagina, or rarely in amniotic fluid. Neonatal conjunctivitis can cause serious complications like blindness and requires IV antibiotics for treatment. In some states, you may not be able to sign refusal for this medication, it is mandated by law. 

Vitamin K is a small injection of — you guessed it — Vitamin K. Vitamin K is essential for forming blood clots. After infancy, our bodies develop bacteria in the gut that make Vitamin K for us. But when they’re born babies don’t have this in their bodies yet. The shot gives them protection against bleeding while they develop their own gut bacteria to take over the job of making the vitamin for them. 

Not having enough vitamin K can cause bleeding issues that range from minor — like a little extra bleeding after getting a shot — to a severe condition called Vitamin K Deficiency Bleeding, which can be fatal. Many parents are curious about using oral Vitamin K as an alternative to the shot. This is an option, but because Vitamin K in this form is processed through the digestive system (instead of going directly into the muscle and being absorbed into the bloodstream with the shot), oral doses have to be given weekly and are less effective than a one-time injection of the vitamin. Therefore, they are not typically offered or recommended. 

Hepatitis B is the only vaccine recommended for newborns. It is part of a 3 dose series, which is continued at your well-baby visits. If you have tested positive for Hepatitis B during pregnancy, the routine for your baby’s care will be slightly different.

Hearing, hearts, and jaundice

Some routine testing, like a hearing screen, cardiac screening, or bilirubin scan, are brief and non-invasive. Checking your baby’s hearing, pulse oximetry, and their jaundice level are all things you can expect before going home. If there are any red flags on those tests, your pediatric provider will discuss your options and next steps (which are often just re-checking the tests at a later hour or day). 

You might wonder why it’s so important to do these tests in the first days of your baby’s life. Let’s break it down. 

Hearing test 

A hearing test is important because even a newborn baby is already learning language. If their hearing is impaired (even in just one ear) knowing and addressing it early on can make a big difference for your baby’s language development. 

Oxygen levels

A pulse oximetry test of your baby’s oxygen level in different parts of the body — usually done by putting a sticker with a red light on your baby’s hand and foot. This test can help to catch worrying heart problems that happen in about 1 in 1,000 babies and might otherwise go unnoticed. 

Jaundice screening 

Jaundice screenings, often also done with a special light placed on your baby’s skin, make sure that bilirubin levels aren’t getting too high. Sometimes instead of a skin sensor, this is checked using a blood test, collected along with the blood sample discussed below. High bilirubin levels can cause problems like lethargy, poor feeding, and in some rare extreme cases, brain damage.

Newborn screening

Newborn screening is another test that is typically done after your baby is 24 hours old. It involves a small blood sample. You might picture having your blood drawn in your arm as an adult, but this test requires a very small sample and it can be tricky to find a tiny newborn vein. So most of the time, a heelstick is used. Your baby will have their foot warmed and then a small prick is made in their heel. Some babies barely notice, others might cry. Blood is collected onto a paper form, which is sent to your state’s processing lab by the hospital. 

But why?

The biggest question is, what are they screening my baby for? And that’s a great question! The answer varies because testing is a little bit different in each state. In general, the test covers multiple conditions that a baby can be born with and are impossible to see on a physical exam. Most of these conditions have treatments that are important to start early in life, so testing is essential.

It can be helpful to check what the testing requirements and suggestions are in your area, and discuss any particular concerns you have with your pediatric provider — such as a family history of a metabolic disorder. You can look up what your state tests for here if that information isn’t provided by your hospital. If you give birth outside of a hospital, it’s recommended that you have newborn screening done between 24 and 48 hours of life. This can typically be done by your home birth or birth center provider, or at a lab. 

Reviewed by the Ovia Health Clinical Team

Read more

• Recommended immunization schedule for baby’s first year
• Baby check-ups

Cassandre is a marketing executive, mom of two, and a trained doula. We sat down to talk about discovering she had PCOS, opening the conversation around infertility, and helping other families through their family planning and birth experiences.  

Can you tell me a little bit about your family?

I come from a big family, on both my mom and dad’s sides. I’m one of five girls and grew up in a house in Brooklyn with about 20 family members — siblings, cousins, aunts, and uncles. I’ve always had a lot of kids around me (I don’t even know how many cousins I have)! 

I always knew I wanted kids. I used to say I wanted four — that was my magic number. My career was also important to me, but I knew I wanted a family. 

What role did your career play in your life? How did that influence your family plans?

Balancing family planning and my career was a challenge, but once I began dealing with infertility, starting a family became my top priority. I still worked — which probably made it harder because I was in a stressful job — but family planning was #1. The thought of not being able to have kids really scared me. 

Tell me a little more about your experience with infertility. 

I got married in my early 30s, and we waited four years to start having kids because we wanted to enjoy marriage and have fun. I recommend that to everyone, if you can!

Once we started, we tried for 6 or 7 months before my midwife recommended an infertility specialist. It took her a while to diagnose me with PCOS. I will never forget that day in the infertility specialist’s office when she told me, “You’re not going to be able to conceive naturally.” At that time, I didn’t know much about fertility treatments. I didn’t know anyone in my life who went through this because no one talked about it. I had no clue where to begin. 

No one in my family knew. Finally, my husband told me, “You have to tell your sisters.” So I finally told them and my parents. Eventually, I told everyone, in part because I wanted people to stop asking me when we were going to have kids. From that point on, whenever someone would ask me, “Hey, why don’t you have kids yet?” I would respond, “Because we’re having fertility problems.” That got them to stop asking. 

Starting IUI was emotional. I had to take shots every day. We had two cycles, the second one took, and we finally had our miracle baby!

Tell me about your pregnancy experience. 

Pregnancy was good, but it was emotional. If you go through infertility or miscarriage, when you finally do have a successful pregnancy, it’s hard to enjoy. I was so worried something would go wrong. I didn’t take any photos when I was pregnant for that reason. We moved recently and I found the one picture I took when I was pregnant. I was so happy to find it.

Once I had her, though, I said to myself, “Never again will I not share this story.” I tell everyone now. And I found the more I was honest with people about my experience with infertility and IUI, the more people reached out sharing they were dealing with the same issues. And it just continued. In my life so many people are dealing with infertility issues. All of a sudden, I became this unofficial, unlicensed infertility specialist! 

I wanted to know everything about PCOS and infertility — I dug all the way into the research, I bought books, I joined online communities — and I realized there is this whole world of people going through the same thing and no one is talking about it. Especially in the Black community. No one. 

Why do you think that is?

Black women seek medical treatment for infertility at much lower rates than their white counterparts. There is a stereotype that Black women are super fertile and have lots of kids. And culturally within the community, we do it to each other. You’ll hear Black folks say things like, “Oh she’s a fertile myrtle.” These stereotypes make it feel like we don’t have fertility problems, like we don’t do IUI. I had two friends who froze their eggs recently, and I was so proud of them. It’s an investment in their future, but there are barriers that need to be broken. 

I dealt with infertility in silence with no one. It was just me, my thoughts, and my little online communities. It was very isolating. I’m happy to see the conversation becoming more normalized now. 

Yes, it does feel like people are getting more comfortable having conversations about women’s health: periods, fertility, postpartum health, and menopause.

Yes. Education is a huge part of it, and so is listening to your body. Part of the reason I found out I had PCOS (even though it took my doctor forever to figure it out) is because I went through this period of 3-4 months where I was regularly exercising, eating well, and I lost no weight. I was breaking out (which I never do). I knew something was wrong. 

I got some regular bloodwork done at my doctor’s office. A few days later, she called me and told me that something was wrong with my hormone levels. She referred me to an endocrinologist (my fertility specialist), and that’s when we realized I had PCOS.

Moral of the story: listen to your body!

And your body changes! I had a baby 12 years ago and had all kinds of challenges, and then at 44, I got pregnant with no problems. We weren’t trying. I was done having kids. It’s so important to trust your body. Work together with your doctors, but you know your body. 

Yes, and when you’re used to ignoring pain or discomfort, that becomes your norm. 

When you’re used to needing to minimize how you’re feeling, you don’t think anything of it when you’re actually feeling pain. 

I wonder about the role that weathering plays in this fertility space too and how holding generational pain within the body might impact fertility. 

I think it absolutely does. Among unmarried couples, Black women are five times more likely to be the head of household than Black men. When you have the responsibility of providing and caring for your family, the added pressure of infertility adds another layer of stress. And stress is absolutely a huge factor in infertility. 

We tried to conceive when I was at my previous company, and it just was not happening. The moment I left and joined another company, I became pregnant. The exact same thing happened to two of my other coworkers. Stress is a major factor. 

Do you think your experience influenced your decision to become a doula?

It was a big part of it, but what really convinced me was when my sister-in-law was pregnant. Her doula was very late to the birth, she literally almost missed it. So I ended up naturally working as her doula. When I left, I started looking into doula work. I didn’t have a doula with my first, but the more I dug into it I realized I could do it and it connected with my story. Especially being about to help people through infertility — it’s such a soft spot for me. I did a training specialized program for infertility work during the pandemic. 

Tell me about the differences in your birth team for your first versus your second pregnancy. 

I’ve always gone to midwives. Because I had a midwife, I had a great birth experience. Midwives labor with you — that’s the difference between a midwife and an OB. 

And for your second pregnancy, you gave birth far from your home, right?

Yes. I live on Long Island now. It’s diverse and great, but I did not feel comfortable giving birth here. I got great OB recommendations, but there are no midwives near me. So I commuted all the way to Brooklyn for my midwife. I just made it happen. I was not going to sacrifice that part of my care. 

How has having a second baby later in your reproductive years impacted your birth and parenting experience? 

Because I’m a doula and I’ve attended so many births, with my second I felt like a complete expert in terms of what I want and didn’t want. 

Basically, you could have delivered the baby yourself…

If I could have, I would have! I knew I wanted to be induced. I had some fear about my age, but while it was unexpected, I had less fear the second time around than I had with my oldest. With my oldest, I didn’t have any information. Information is so critical. 

Now, I’m leaning on my first pregnancy, my work as a doula, and even working at Ovia. Working at Ovia while having kids is truly a blessing. I can’t count the number of times I’ve emailed an Ovia Health Coach (shoutout to Lisa and Lilly!) with a question about breastfeeding or something else. They are just amazing and have helped me so much. 

But overall, the beauty of having a baby at this age is the confidence, the education, knowing I can disagree with my midwife, knowing all my opinions; it’s been so much easier. 

Do you have any advice for someone going through a first pregnancy or feeling nervous about pregnancy for any reason? 

I’m a strong advocate for midwives, but the most important thing is to trust your body. You have to get to the place of trusting yourself and trusting your body. I was so nervous when I was pregnant with my first that my body was going to fail me. But you have to remember that your body is built for this. There may be some complications, but listen to and trust your body.

This article is part of Ovia’s Black Birth Experience series.

Read more

• Identify your advocate
• Advocate for your health by bringing a support person with you to appointments

Kami Wigginton is a sales executive. She’s also a mom to two girls, Simone and Sutton. Here, Kami shares her family building story — the unexpected twists, sibling dynamics, and her advice to other Black women and families navigating the healthcare system. 

Can you tell me a bit about your family planning journey? Did you always know you wanted to have kids?

I don’t know that “Mom” was always at the top of my priority list. Motherhood was a bit of a delayed experience because there were other things at the top of my goal list that I wanted to come first — like going off to college and starting my career. I wanted to do that before prioritizing starting a family. 

And so, for me, it was about it being the right time in life, but I didn’t know what that journey would look like — or whether it would be easy or hard. I had my first child at 31 and my second at 38 (to my surprise!). I was fortunate that both pregnancies happened naturally, but definitely not on my timeline.

Yes, for such a naturally forward-looking and career-oriented person, what was your reaction to that second pregnancy?

I am a very type A person, and I had everything planned out. We had actually just relocated from Kentucky down to Tennessee — and I had thrown away all the baby clothes. I thought it just wasn’t going to happen, and I had accepted that. Plus, the first pregnancy was hard on me, and the idea of a geriatric pregnancy alongside my career was intimidating. 

And so, we were planning on skipping the whole pregnancy phase and adopting a toddler. I set up an adoption appointment, but by the time it came around (and after six and a half years of trying), I was pregnant! God laughs at my plans! 

How did your second pregnancy compare to your first? 

As most moms know, no pregnancy is the same. But the second time I went in with my eyes wide open. And so I was prepared for it in many ways, but I wasn’t completely mentally ready to do it all over again. That said, once I got over the initial shock of the pregnancy, it was relatively easy. 

What was it like telling your daughter you are going to have another baby?

That was a good part. Simone was six at the time so she was in her baby doll stage. She welcomed it and we did all the sibling classes at the hospital. It was very cute. 

In a blog post you wrote for Ovia, you discuss feeling as though your care team wasn’t addressing your pain. You wrote: “And I kept wondering, ‘Is it me, or is it something else? Is it because I’m Black?’ Even having that thought is traumatic.” Can you tell me more about that?

Pregnancy is a unique experience where you get nine months to really know your physician, so it’s important that you build rapport and a relationship, and that you watch to see how they address your questions along the way. It’s also important that you’re not scared to switch providers if you’re feeling like it’s not a good fit. 

My primary OBs were great for both pregnancies. They respected me. But then on the day of (i.e. when things get real!) there are different players in the room. Advocating for yourself, having a voice in the room, raising your hand, it’s all okay. You have to ask the questions and listen to your body. My natural personality type and the fact that I work in the industry helped me feel informed and able to advocate for myself.

What’s your advice to someone who feels less comfortable pushing back or speaking up?

Partnership. Get someone in your family who is comfortable speaking up and who can pay attention to the signs. After all, you’re busy having a baby! A doula is a great option if you’re looking for someone who is supportive and an expert, especially if it’s your first or second time. 

And then identify your advocate. For me it was my doctor. She had me change hospitals to make sure I could deliver in the way she recommended. 

There are so many pros and cons to having babies earlier and later in your reproductive years. Can you tell me how age has played a role in your parenting, if at all?

Going into OB appointments and signing my date of birth (in the 70s) while everyone else is in the 90s or 2000s sometimes made me think, “Why are we doing this?” But the benefits are that you’re calmer and more experienced. With my second child, I felt more comfortable, had more financial stability, and just had more information about what to expect. 

The hard part is the energy now that they’re here – keeping up, staying active, and taking care of myself so that I’m here for the journey. But you’ve got to have grace with yourself.  I definitely think my older child got a different experience than my younger one is getting, but I’m not stressed about it; she has someone to play with! I’m always reminding my older daughter, “This is the little sister you prayed for! Go play with her!”

This article is part of Ovia’s Black Birth Experience series.

Read more

• What you should know about doulas 
• Advocate for your health by bringing a support person with you to appointments

Hand expression

Even if you don’t want to collect and store colostrum, learning how to hand express colostrum at the end of pregnancy is so valuable. It is much easier to learn a skill when you’re well rested and have some privacy than when it’s an immediate or urgent need just after giving birth. 

Your body starts to produce colostrum as early as 20 weeks. Some people find they leak small amounts of it or that their bra is stuck to their nipples at the end of the day. If you’re interested in collecting and saving colostrum during pregnancy, experts generally recommend waiting until 37 weeks. Your OB provider can help you create a timeline that works for you!

Hand expression can take some practice to master, and you may find that each breast needs a slightly different touch or technique. We love this short video that shows some different ways to express those precious drops. The best way to save colostrum is in very small syringes that are about 1-3 mLs in size. You can label and freeze the syringes until you’re ready to thaw and use them.  

Who does it help?

Colostrum collection can benefit many parents. Those who have experienced low supply or who have risk factors for low supply may want extra colostrum on hand to avoid excessive newborn weight loss or reduce the risk of jaundice. 

Those with gestational diabetes or who take beta blockers may want to collect colostrum to use in case of low or unstable blood sugar instead of using formula. 

Parents of multiples, babies who have IUGR, and babies with diagnosed genetic or physical differences may also benefit from having extra colostrum saved. There are a variety of reasons why it can come in handy. Talk to your provider or a lactation professional about the pros and cons. 

For some people, hand expression causes temporary but uncomfortable cramping, so it’s always a good idea to check in with your OB provider beforehand to see if there are any activities you should avoid that may cause contractions. Again, it’s generally recommended to wait until 37 weeks to try hand expression or colostrum collection.

Helpful tips

The best time to practice hand expression or collect colostrum is when you’re relaxed and not in a rush. Often people find that being warm and post shower/bath is a great time. Some gentle breast massage can help warm things up as you get started. Once a day is generally enough for practice until you get the hang of it. You may consider expressing more than once a day if you are actively collecting and storing. Keep in mind that at first, you may see just a hint of clear wetness or nothing at all.

If you’re collecting colostrum you’ll want to:

• Wash hands and have clean spoons, container/syringe ready
• Express for few minutes on each side collecting drops (aim for 10 drops and measure how much this is to make future collection easier, for example 10-15 drops might equal 1 mL)
• Date and store your colostrum in the freezer

Now that you have a little bit more information about hand expression and colostrum harvesting, you can make an informed decision about what is right for you!

Read more

All about colostrum

Breastfeeding basics

Before we get into the nitty gritty details and discuss why we generally find that hospitals with lower C-section rates are better places to give birth, let’s discuss the context. 

A note about C-sections

C-sections can be lifesaving medical interventions — for birthing parent and baby — but they do come with higher associated risks, including for the birthing person, a 3x higher risk of blot clot, hemorrhage, or infection. And they are often performed when they’re not medically necessary,

Today, roughly 32% of all births in the U.S. are delivered via C-section. This is double or triple the optimal rate. 

So how can I avoid an unnecessary C-section?

One of the most influential factors in the method of delivery for a single patient is the hospital where a patient delivers. And hospitals’ C-section rates can vary by more than 10 fold, even within the same state! So considering the hospital you choose to give birth at is your first step in preventing an unnecessary C-section. 

Why do some hospitals have higher C-section rates?

There are lots of reasons some hospitals have higher C-section rates — oftentimes, due to scheduling issues or lack of space, providers make the decision to perform a C-section when labor isn’t progressing quickly enough. 

Hospitals with lower C-section rates tend to have more supportive care cultures — they tend to welcome doula services, encourage nurses to spend more time with patients, and avoid intervening unnecessarily during labor. All of these factors are not only helpful in reducing unnecessary C-sections, they’re also just good practice.

A common C-section misconception

Even if you’ve planned to have a vaginal birth, you might think that choosing a hospital with a higher C-section rate means that you’re in better hands if you do end up needing one, but this is a common misconception.  

Hospitals with high C-section rates don’t necessarily have more experience. Rather, they may just not have the care culture or staff necessary to ensure that all interventions are exhausted before moving to a C-section. 

So, what can I do next?

By selecting a hospital with a low C-section rate, you’re taking a step to reduce your risk of having a medically unnecessary, expensive, and risky operation. 

That said, there are many factors that influence your hospital choice and birth plan. For some, a C-section is the safest delivery option. No matter how you plan to give birth, you should feel empowered to make the best decision for you and your baby with your provider.

And if you are planning to have a C-section or you end up needing one, you might find this additional information helpful.

• What happens during a C-section
• When your birth doesn’t go as planned
• C-section recovery timeline

Is home birth a good fit for your family 

The first thing you’ll want to know is if your state allows a provider to help you give birth at home. Laws vary from state to state, and there are a few states where it may be considered illegal for a provider to attend your birth at home. 

If it is a legal option in your area, you’ll then want to consider your own health and pregnancy risk factors. Home birth is generally not a good fit for those with a baby who’s not head-down, those who are having twins or a multiple pregnancy, or those who have had a C-section before. 

A lot of other health conditions or risk factors could also mean a home birth isn’t a good fit for you, like having a bleeding disorder, high blood pressure, gestational diabetes, or a history of preterm birth.

What do the experts say?

Both the American College of Obstetricians and Gynecologists (ACOG) and the American College of Nurse-Midwives (ACNM) believe that every person has the right to make an informed choice about the location for childbirth, but there is still some conflicting information. 

According to ACOG’s analysis and position statement, there are lower rates of interventions and perineal tears when birthing at home, but there are also higher risks of poor outcomes for babies born at home, like higher rates of seizures. 

In contrast, recent studies highlighted by ACNM suggest that planned home birth for those who are low-risk and working with a qualified provider is just as safe for both parents and babies. They suggest that in these circumstances, home birth might even lower some risks, like the risk of getting a hospital-acquired infection. This may be particularly significant for those who are Black, Indigenous, People of Color, or living in a rural setting. 

Though ACNM and ACOG’s opinions differ on the overall safety of home births, both organizations believe that there are certain levels of care that should be in place to ensure the health and safety of the parent and baby. This means that the birth attendant should:

1. Be a certified nurse-midwife (CNM), certified midwife (CM), or physician who can provide the care you expect during pregnancy and birth.
2. Be able to access consultation with an appropriately licensed colleague when needed for problems that may come up during pregnancy and labor.
3. Have a plan for a transfer process if you do need to have your baby at the hospital or if you or your baby needs urgent care after birth.

Next steps 

If you’re thinking about choosing a home birth, here are some questions you may want to ask your potential provider to help you make the best and safest choice for you and your family:

1. Are you a CNM, CM, or physician who is licensed by the state to practice home birth?
2. How much experience do you have attending home births?
3. How close to the hospital should I live to be eligible for home birth?
4. Is my health and pregnancy low-risk enough to be safe for home birth?
5. What supplies do I need to have at home?
6. What supplies and medications do you bring with you?
7. How do you handle potential complications or emergencies, like excessive bleeding after birth or a newborn who’s having difficulty breathing?
8. How can you help manage my pain and comfort during labor and birth?
9. How often do people in your care transfer to the hospital, and why?
10. How do they get transferred, and are ambulances available near me?
11. Who will take care of me at the hospital if I do get transferred?
12. What is the cost of home birth care, what’s included, and is it covered by insurance?

Ultimately, you deserve to make the best possible choice for yourself, your baby, and your family. 

Reviewed by the Ovia Health Clinical Team

Read more

• Choosing where to deliver
• Building a birth plan

Sources

• Cheyney, Melissa, et al. “Outcomes of Care for 16,924 Planned Home Births in the United States: The Midwives Alliance of North America Statistics Project, 2004 to 2009.” Journal of Midwifery & Women’s Health, vol. 59, no. 1, 30 Jan. 2014, pp. 17–27., https://doi.org/10.1111/jmwh.12172. 
• Hutton, Eileen K., et al. “Perinatal or Neonatal Mortality among Women Who Intend at the Onset of Labour to Give Birth at Home Compared to Women of Low Obstetrical Risk Who Intend to Give Birth in Hospital: A Systematic Review and Meta-Analyses.” EClinicalMedicine, vol. 14, 25 July 2019, pp. 59–70., https://doi.org/10.1016/j.eclinm.2019.07.005. 
• Committee on Obstetric Practice. “Planned Home Birth.” ACOG, ACOG, Apr. 2017, https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2017/04/planned-home-birth. 
• Schmidt, Samantha. “Pregnant Women Are Opting for Home Births as Hospitals Prepare for Coronavirus.” The Washington Post, WP Company, 22 Mar. 2020, https://www.washingtonpost.com/dc-md-va/2020/03/20/pregnant-women-worried-about-hospitals-amid-coronavirus-are-turning-home-births-an-alternative/. 
• Krebs, Natalie. “As Home Births Rise in Popularity, Some Midwives Operate in a Legal Gray Area.” NPR, NPR, 5 Apr. 2022, https://www.npr.org/sections/health-shots/2022/04/05/1089927028/midwives-home-births. 
• Nethery, Elizabeth, et al. “Birth Outcomes for Planned Home and Licensed Freestanding Birth Center Births in Washington State.” Obstetrics & Gynecology, vol. 138, no. 5, 2021, pp. 693–702., https://doi.org/10.1097/aog.0000000000004578. 
• “Improving Our Maternity Care Now through Community Birth Settings.” National Partnership for Women & Families, National Partnership for Women & Families, https://www.nationalpartnership.org/our-work/health/maternity/community-birth-settings.html. 

But what if you found out that BMI is not a useful indicator of your health? BMI is actually a deeply flawed calculation that was only intended to be used for populations, not for individuals.

Let’s break down the fraught history behind BMI.

BMI: The backstory

BMI (first called the Quetelet Index) was invented by a Belgian mathematician (you read that right, not a doctor) named Lambert Adolphe Jacques Quetelet in the early 19th century. He set out to find the “average man” by studying the height and weight of (mostly) European men. His work excluded women and people of color. 

BMI, a calculation of weight (in kilograms) divided by height in (meters squared), was later picked up by health insurers and medical providers in the U.S. They used various BMI categories (underweight, normal weight, overweight, obese, and morbidly obese) to determine insurability and individual health. 

Is this starting to raise some red flags for you?

OK, but does it work?

The short answer is no, it does not work and there are a few reasons why.

1. BMI was originally created to indicate population health, not to determine individual health.

Quetelet was a statistician. His intention was to collect large amounts of data to uncover population-level trends, not to assess an individual’s health or risk factors. 

2. These categories are problematic for individuals who were left out of the original studies

Given the fact that so many groups were excluded from the development of BMI in the first place, it doesn’t make much sense to apply it to them retrospectively. Further, BMI suggests that there is an ideal height/weight ratio. This is simply not true.

3. BMI equates muscle, fat, and bone

The body is made up of (among other things): bones, muscles, and fat. BMI groups all these categories together into one, treating bone, muscle, and fat the same. Not only that, but which out of these three parts of the body weighs the most? Bone. The least? Fat.

So is there a better way to calculate health?

There are alternative calculations of health informed by weight, but the issue at play here goes far beyond the biased history of BMI or its misguided application to individuals, because even weight itself is not a strong indicator of health. Research has shown that simply changing one’s body weight is not a reliable measure of improvement in one’s health. 

If you’re looking to feel stronger and healthier, there are things you can do, like starting a health promoting behavior. 

Here are a few examples of health promoting behaviors

• Setting a goal to drink more water
• Figuring out what type of exercise you enjoy and doing it consistently
• Finding a mindfulness practice that helps you tune into your inner needs
• Intuitive eating: listening to your body’s requests for nourishing food

Setting goals like these – that are based on how you feel, how your body functions, and what you personally need to be living in a healthier body – is more reliably associated with improvement in overall health. 

Providers that rely too heavily on BMI might be missing the whole picture of your health. If you’re concerned that your provider isn’t understanding the whole picture of your health, seek out a HAES (Health At Every Size) aligned healthcare provider. There are therapists, body image coaches, doctors, nurses, and dietitians who are all trained in HEAS. You deserve to feel seen and cared for by your provider, regardless of your BMI or the size of your body. 

Reviewed by the Ovia Health Clinical Team

Read more

• Pregnancy in a bigger body
• Tracking your weight during pregnancy

Sources

• Brazier, Yvette. “How Useful Is Body Mass Index (BMI)?” Medical News Today. MediLexicon International. September 6, 2021. https://www.medicalnewstoday.com/articles/255712.    
• Jackson-Gibson, Adele. “The Racist and Problematic Origins of the Body Mass Index.” Good Housekeeping. Good Housekeeping. November 1, 2021. https://www.goodhousekeeping.com/health/diet-nutrition/a35047103/bmi-racist-history/. 
• “Adult BMI Calculator.” Centers for Disease Control and Prevention. Centers for Disease Control and Prevention. January 21, 2022. https://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/english_bmi_calculator/bmi_calculator.html. 
• “About Adult BMI.” Centers for Disease Control and Prevention. Centers for Disease Control and Prevention. August 27, 2021. https://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/index.html. 
• The MNT Editorial Team. “BMI calculations and charts.” Medical News Today. Medical News Today. May 3, 2021. https://www.medicalnewstoday.com/articles/323586. 
• Devlin, Keith. “Top 10 Reasons Why the BMI Is Bogus.” NPR. NPR. July 4, 2009. https://www.npr.org/templates/story/story.php?storyId=106268439. 
• Eknoyan G. Adolphe Quetelet (1796-1874)–the average man and indices of obesity. Nephrol Dial Transplant. 2008 Jan;23(1):47-51. doi: 10.1093/ndt/gfm517. Epub 2007 Sep 22. PMID: 17890752.

Leasa Wright has been practicing yoga and meditation her entire life. She joins us today to speak a bit more about the benefits of prenatal yoga, how to get started, and why she’s so passionate about making time for a prenatal yoga practice. When she was pregnant with her first child, Leasa says, “I fell in love with empowering pregnant people. They need to feel strong and safe in their bodies.” She’s been teaching a prenatal yoga practice weekly ever since. 

While movement in general, and yoga specifically, can be beneficial at all times in your life, there’s something different about prenatal yoga. “Once I realized I was pregnant, I felt a sense of responsibility for that little being,” says Leasa. Plus, pregnancy can be hard on the body and it’s common to feel very sore if you’re not moving around every day. Prenatal yoga is a great way to integrate that movement, connect with your baby, and form a community. 

A couple safety notes before we dive in:

• Most people should wait until after the first trimester before starting a prenatal yoga practice.
• If you’ve never practiced yoga before, it’s a good idea to be a bit more cautious when starting out. Check in with your provider to make sure it’s a good fit for you. 
• To prevent injury, do all the modifications your instructor recommends and don’t push yourself. Especially if you haven’t practiced yoga before, it can be hard to know your limit, so go easy on yourself.

How is prenatal yoga different from a yoga practice for those who are not pregnant?

​​Prenatal yoga is a curated collection of customized asanas/yoga poses that cater to the shape of the pregnant body. A person’s center of gravity changes during pregnancy and they lose the ability to fold inward. This leaves a person with an unbalanced yoga practice if they continue to sit out postures in a traditional class. Prenatal yoga classes offer a balanced sequence of joint mobility exercises, seated postures, standing postures, hip openers, breathing, and relaxation exercises — leaving out the contraindicated postures, but still offering an overall, accessible, and whole body practice.

How can it benefit people during pregnancy (physically and emotionally)?

There are so many reasons to choose to participate in prenatal yoga. It offers the opportunity to connect with your baby and it gives you the chance to connect with other people who are making the same healthy lifestyle choices as you. It’s common to form friendships and build relationships in a class environment. And that community can help alleviate anxieties you may be having about becoming a parent. 

As far as physical benefits: prenatal yoga can improve your sleep, reduce stress and anxiety, and increase the strength, flexibility, and endurance of muscles needed for childbirth. Additionally, it can help to decrease lower back pain, nausea, headaches, and shortness of breath by lengthening the muscles around your rib cage. From your physical body to your emotional state, prenatal yoga can be a key ingredient to a healthy, happy pregnancy.

Where should we start?

For many, pregnancy is a time to make your health a top priority. Ensure you get plenty of sleep overnight, as a growing baby uses up a lot of energy. A well-balanced diet of nutrient-dense foods will also help to boost your energy. Finally, staying active is a key aspect of pregnancy self-care and can be extremely beneficial for managing certain symptoms associated with pregnancy.

Any advice for slowing down when the stress of pregnancy is overwhelming?

Try mindfulness, yoga, meditation, and massage to bring your mind into a peaceful state so you can cope better with the busyness of daily life. Take yourself to a place where your mind and body can be still, allowing you to focus inward and breathe deeply.

Simple things like getting enough rest, eating well, exercising regularly, and seeking support from trusted friends and family can increase your resilience in stressful times. And check in with your partner. You and your partner can act as a support system for one another during this time.

What about creating space in your day?

If you can, try to schedule naps during your day to get more sleep and restore your energy. Take catnaps during the day, even if you just rest your eyes for 15 minutes with your feet up. Book yourself regular pamper sessions at home. A night in with a favorite facemask is a lovely way to treat yourself.

Set aside time for the hobbies and activities that were a part of you before you became pregnant. And try to keep in touch with the friends who add value to your life by scheduling an assortment of standing dates with your circle. 

Any tips for integrating a prenatal yoga practice into your routine? 

A simple first step is to make sure you have correct posture at work by learning some good stretches to practice at your desk during breaks. 

Sign up for an in-person workshop at a local studio who specializes in prenatal yoga. And don’t apologize for making yourself a priority. If it’s easier, try an online yoga class so you can practice from the comfort of your own home. 

If you’re having trouble getting started or staying consistent, ask a friend to be your accountability buddy to ensure you show up to practice. 

How can people make sure they’re staying safe in their practice?

Start by asking your doctor, midwife, or doula for local recommendations. Always attend your scheduled prenatal visits and talk to your provider if you have questions or concerns about your pregnancy. They are a great resource you should take advantage of during this time.

If you’re wondering if a yoga studio offers certified prenatal yoga classes, call and ask if they are certified in prenatal yoga by Yoga Alliance, the organization that sets standards for yoga teachers nationwide. Knowledge of the dos and don’ts of prenatal yoga is one of the most important reasons you should seek out a qualified prenatal class. 

You should always avoid internal twisting, belly compression, and heated yoga classes. Any balancing poses should be done with extreme caution, against a wall.

How can I safely continue my practice postpartum?

The best way to ensure you’re ready to resume practice is to get the approval of your healthcare team first. The standard guidelines recommend waiting 6-8 weeks after birth before continuing your practice. Sometimes that can be longer, depending on your birth experience – ask your provider. 

What’s your favorite part of your yoga practice?

Community. I taught my first prenatal yoga classes during my first pregnancy and have remained connected to those mamas to this very day. You can expect to form beautiful connections with others during prenatal yoga. The bond you create with other pregnant people is one that carries into postpartum and beyond. If there’s anything a community needs, it’s to be full of strong, empowered, and supportive mothers.

Yoga has brought me strength, mindfulness, breathwork, and awareness of my body, which has helped my physical and personal growth tremendously. I am so grateful for this practice and how it has manifested itself into my life’s work.

Read more

• Prenatal pilates
• Low-impact exercise during pregnancy