Introduction
Today we’re going to dive into part two of my podcast with my personal midwife, Mandy Rojas. In last week’s episode, we talked a lot about standard care versus working with a midwife, as well as the labor and delivery experience. In this second half of the interview, we’re going to discuss the fourth trimester.
I truly believe that postpartum aftercare is one of the most neglected pieces of having a baby. Mandy and I discuss what postpartum experience should look like postpartum depression and how to avoid it, the resources you should be planning for while you’re pregnant to have an aftercare, and more.
Beyond Labor and Delivery: Uncovering the Neglected World of Postpartum Care and Support
I hope this conversation helps shed some light on what really goes down in those first six weeks. As a new mom, let’s be real. The sole focus tends to gravitate towards the new baby, and the mom’s healing process gets neglected. What if we flipped the script and made sure that we nurtured the mom first so she can focus on the baby?
So we’ve talked about the difference in the hospital experience and birthing experience.
Can you give a breakdown of the experience with care, prenatal care as well as postpartum care, which to be real, folks, when you give birth in a hospital, there is no postpartum care. Let’s just say that well, let’s just say that out the gate.
But what is the difference? Because the same thing that you were talking about with insurance. What I personally noticed because I was in standard care for the first half up in New York was every time you go in, they want to do a sonogram. Why, folks? Because sonograms cost $400 – $500.
So what are some of the big differences when it comes to that, as well as, like, testing that you guys do and stuff like that?
OB offices book 35-50 clients daily. Midwives provide more personalized care, education.
Mandy:
Yeah. So in OB offices, they’re booking out between 35 to I think I’ve seen all the way up to like 50 clients a day. And so that alone is crazy to me. I think I would lose my mind if I had to see that many people a day.
But because the overhead of an OB practice is so high, they have to. And because the insurance reimbursement for prenatals, I think these days it’s global maternity, which is like $35 or $40 a prenatal, they have no choice but to see a certain amount of patients and hours so that they’re able to keep up with their overhead. And so midwives like me, we don’t have as much overhead.
My overhead is high for my practice, and that is because I have birthing centers. If I just had a small home birth practice, it would be much less. But the birthing centers, they can get kind of costly. But you’re booked out for an hour with your midwife every single time, and that’s regardless of your insurance.
It doesn’t matter if you’re a medicaid mom or a cash pay mom or a commercial insurance mom or whatever. Every single mom gets 1 hour with the midwife. Now, if you’ve ever been to a prenatal in an OB office, I mean, it’s like ten minutes.
You sit there in the waiting room for an hour, waiting to see the doctor. Then you sit in the office for an hour waiting for the doctor to come, and it is your turn. They walk in, Hi, how are you? Measure your belly, listen to the heartbeat. Okay, see you in two weeks, or whatever it is. There’s no education.
They’re not talking about your diet. Well, hello. If it’s your first baby, you probably don’t know what eating for pregnancy is.
Or you don’t know that. I love these moms that come in and they’re like, oh, I’m eating fruit. I eat fruit all day. And I’m going, okay, well, that’s sugar, and we’re going to grow a huge baby just eating fruit.
So let’s talk about how we can get some protein into your diet. But new moms are like, what do you mean fruit? Fruit is not good. I thought fruit was good for the baby. And I’m like, well, yeah, good in moderation, but it’s also sugar, just like carbs. A lot of moms, especially at the end of pregnancy, they’re guilty of binging on carbs, and carbs will turn to sugar.
We can’t do that if we want to grow a baby that’s proportionate to your body. And so if you’re never educating the moms about eating for pregnancy, how important exercising is walking. I tell my moms, even if all you do is take a 30 minute walk a day, it’s better than nothing. Or a walk around the block, it’s better than nothing. It’s only going to help your delivery be that much smoother.
One of the main reasons why you [Maren] ended up with a great delivery in the hospital is because you are in such great shape. When Tina told me that you had already delivered, I was like, oh, yeah, she’s in such great physical shape. There was never a doubt in my mind that wherever you birthed at, it was going to be relatively fast.
And so if the provider is not spending the time with the patient to educate the patient, a lot of moms like you that are RH negative don’t even know what Rhogam is. They walk in, they’re told, you have to do this. We’re giving you a shot today. They take the shot. They don’t even know what this is.
They don’t even know what they’re injecting in their bodies whatsoever. And so because the doctor said to do it, whereas a provider like me I’m like, okay, well, I see that your blood type is this, and this is what medical science advises, but we can talk about this, and we can see what your preference would be.
And then most moms that are in midwifery care want to be educated on both sides of it and let it be their decision, not, I’m not doing anything to you. I’m doing this with you, as opposed to an OB practice where it’s, this is how we’re going to do things. They walk in, even if you need a Rhogam shot, the person that does your vitals, draws your blood, weighs you, checks your urine, none of that is your provider.
Related Episode: My Rhogam Rebellion
Maren:
I know, it’s wild.
Mandy:
Yeah, that’s a little medical assistant that they’re paying about $12 an hour to be basically their little minion or do person, and then you see your provider for all of ten, maybe 15 minutes, if you’re lucky. And then they wonder why women don’t have confidence to birth, why they don’t believe in their bodies, why do they not understand what’s going on?
So many women walk away from their hospital birth and go, this was the most traumatizing day of my life. They don’t even understand it. And then they come and meet providers like me. Well, why did this happen? Why did that happen?
Well, did you ask any of these questions? Did your provider educate you on any of this stuff? Did you take any classes? Did you have a labor support system? No.
Okay, well, I’m not surprised that it was the most traumatizing day of your life then, because people don’t even realize I have a lot of people that say, well, why can’t my husband be my doula? Oh, God, your husband knows you intimately. He does not know birth intimately. Right. And that’s the thing. Your husband is going to make decisions based upon emotions.
You need somebody that’s taken their emotions out of it and that can stand there and advocate for you, educate you, fill you in on what’s going on, knows your birth preferences, has counseled you, spent time with you, educated you.
All of those things play a role in the outcome 100%. I had a lady in here the other day. She goes, well, my medicaid paid for me to go to the hospital, and I didn’t have to pay for one penny. And I said, and what happened?
She goes, I had a C section. I go, well, you got what you paid for nothing. Nothing. You invested nothing. So what did you expect you were going to get? And that’s another thing. People say, oh, a doula costs $1,000 or $2,000 or whatever it is these days, okay, but you got to pay for it, right?
Midwifery Care vs. OB Practices:
“If the provider is not spending the time with the patient to educate the patient, a lot of moms like you that are RH negative don’t even know what Rhogam is. They walk in, they’re told, you have to do this. We’re giving you a shot today. They take the shot. They don’t even know what this is. They don’t even know what they’re injecting in their bodies whatsoever.”
~ Mandy
Maren’s personal experience with midwife and team during the postpartum period
Maren:
And I can vouch for that 100% because especially in the postpartum piece, obviously, we know through prenatal and labor and delivery that your team’s there. But folks, when you go to a hospital and say you’re there for a day, two, whatever. And then they send you on your merry way. That’s it.
You don’t check in with that doctor for six weeks. We came home on a Thursday afternoon and the hardest night of mine and Nick’s life because I remember we didn’t know because the hospital was a perfect example. Oh, she might have a tongue tie. Meanwhile, I’m calling Mandy. And this is the beauty, right? When you have a team. I’m calling Mandy in the middle of the night. I’m like, I’m bleeding.
The baby won’t stop crying. She’s like, all right, Maren, let me get my clothes on. I’ll be there soon. And the first thing that she noticed when she came into our home was that this baby’s dehydrated and she has a severe tongue tie. We need to get this addressed immediately, right away. And she did. And she had the contacts and the resources.
We got it done that day. I had donor milk from a mom that she knew and trusted. I had Tina, my doula, at my house as I know all of my circle because that’s the beauty of having a midwife, right, is all of their resources.
So literally everyone that I’m connected to between my midwife, my doula, my photographer, my chiropractor, they’re all interconnected and all work with one another. That’s the beauty of having these types of communities. And they were all checking in on me. I had a lactation consultant in my home because the one at the hospital… forget it. Useless, right? Yeah, absolutely useless.
And, you know, whether it was Mandy or one of the other midwives at her practice, I was calling them like, I didn’t know I’m a first time mom. I didn’t know that little girls basically have a Mensis. So I’m calling them like, what is this blood?
Well, you know and so they’re educating me on these things. And you don’t get that with standard care. And I’m laughing now, and I’m laughing about how you said about like you’re in and out because literally you’re spending more time in the waiting room than you’re actually getting care when you’re at standard care.
And I remember Nick, he pretty much came to every single appointment, whether it was in standard care or once I was in Florida with Mandy and I remember him being pissed. He was pissed. He was like, Are you kidding me? We waited in this waiting room for 45 minutes, an hour, and we’re in and out. That’s it.
And mind you and this isn’t to shame my OB in New York because I’ve been with her since I was 18 years old. We had a very good rapport. But there’s just certain things because it’s a big practice. That’s what they have to do.
And another prime example know, Mandy, when you sit down and you weigh these pros and cons and everything has a risk benefit analysis, but ultimately she’s saying, this is your baby, so it’s your decision. Whereas when you’re in a big practice. I’ll never forget I asked my OB, like, her opinion on whether she was down for the crown with the flu shot and the DTaP.
And I was like, no, but I asked her about the COVID shot. You could tell she basically, in not so many words, said, actually, she did say this. This is a direct quote. There’s not enough research for me to endorse it. That’s what she said. Right? And she did mention about the J and J, how it doesn’t have the mNRA.
And meanwhile, I’m sitting there, I just wanted to hear her answer because I already knew what my decision was. But when I asked her if she could write me an exemption for my workplace because she said no.
And it’s because, folks, she didn’t want to have this scarlet letter. Her practice is a bunch of doctors who are affiliated with the biggest hospital on Long Island, and it’s a big group, so she can’t. She literally can’t.
And so I think that that’s important for people to know is like, even if some of these OBGYNs want to do the right thing by you, because in their hearts, they know at the end of the day, they’re not going to put you – random patient number 37 of the day. They’re not going to do it for you and put their entire practice, their entire livelihood at risk.
Mandy:
It’s big pharma. Yeah, it’s big pharma. That’s all it is.
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Maren:
Now, if I am a new mom and I’m pregnant, and I’ve decided, hey, I want to forego standard care, what are things that you think people should look for when they are essentially interviewing a midwife? Because it is a relationship, so what should they look for? And what are some red flags that you’re like, okay, you probably shouldn’t go with this midwife?
Choosing the best midwife for you
Mandy:
Yeah, well, anybody that promises you any sort of an outcome, you definitely want to run from that know, I always know. This is the thing. We live in Florida, right? We get hurricanes. How often do we have these hurricane scares? And everybody prepares their house and they fill up with water and fill their gas tanks up and buy all this stuff that they may or may not need or whatever, and then the storm doesn’t come, right?
They’re not mad the storm didn’t come, but they were prepared. But if the storm does come, they’re glad they went out and bought all of that stuff and invested in all of those things, right? Like gas in the car or flashlights or whatever it is.
And so my philosophy is always, like, prepare for war, hope for a fight. And some of these babies do fight me, let me tell you. But anybody that’s promising you any sort of a definitive outcome I do not believe is a realistic provider, because unless they’re promising you a C section at the hospital on 2-22-22, because that’s the day you want your baby to be born, and that’s the outcome you want, okay, great.
Then go with that. But if you’re trying to have, say, a water birth or an unmedicated experience or one of those types of things, we can educate, we can make recommendations as far as doulas and support and that kind of stuff, but I cannot guarantee you anything.
And I think I said before, sometimes the moms get so pissed off when they end up at the hospital or whatever, and it’s like, it is my job to keep this a safe situation. I have nothing to gain by a bad outcome except a lawsuit.
I do not want any bad outcomes. I want you with your baby in your arms at the end of all of this, by whatever means. And I don’t like the term healthy baby. Healthy mom. That’s all that matters. And I think I said this to you when you were postpartum. Like women, you’re allowed to grieve the loss of the birth that you envisioned. Give yourself permission to do that.
It’s not… healthy mom, healthy baby. Yes, of course that’s what we want. But you’re also allowed to be disappointed or sad. Let those emotions be there. It’s the women that try to suppress and try to act like, oh, everything’s so great, and whatever.
They’re the biggest PPD candidates because they just suppress, and they suppress and they suppress until they can’t suppress anymore, and then they just hit a bottom, and there’s so much going on in that period of time. You’ve just had a baby.
Your vagina is swollen. Maybe you have lacerations. You’re bleeding like a stuffed pig. You’re trying to breastfeed. If you’re a new mom, you just don’t even realize everything that’s going to be going on. You see these ads of this beautiful mom with her hair and her makeup all done and laying there with the birth baby perfectly folded, and everybody’s got a big smile on their face.
I’m going, I never looked like that after giving birth. No. When the reality of it is, you’ve got a diaper on with an ice pack in it, probably a few stitches, right? You’re spewing milk out of your breast. You’re trying to get this whole latching thing down. You’re weeping. It’s a mess at that moment. None of these ads are realistic. They’re annoying, to be honest with you.
Social media: Consuming, upset, gratitude, postpartum care
Maren:
Well, that’s social media in general, right? And I remember being that mom who, in pregnancy, you’re saving this post. You’re saving that post. You’re consuming all of this content, and you have this visualization of what it looks like, and it all goes out the window when you go through it yourself.
And I remember being so relieved when you said that to me, because I know that you knew, because of the relationship we had built, that you knew that I was upset. Yeah, I was grateful for you to make that call, literally, and say, listen, this is what needs to be done.
But ultimately, it was upsetting because I wanted Paulina, my photographer there. She wasn’t allowed in the hospital. Mandy wasn’t allowed in the hospital because you could only have a certain number of people.
I wanted my team there, and I just had to mourn that. And I had to realize it’s okay to be upset that it didn’t go. That was so and I really had to train myself to focus on the gratitude of yes, of the experience, of I basically got trained how to do this in a hospital because of all of the appointments I had with Mandy leading up to it, to how to advocate for myself.
But then I really leaned into, wow, look how amazing this postpartum care is. I have these women literally in my fingertips, texting them because I was so overwhelmed, because in fairness, too, and I want everyone to kind of understand this is like, you can have all the friends, sisters, cousins, your mom, your mother in law, whatever, had a baby, especially if it’s like someone who’s older, right? It’s different, bro.
My mom had me 35 years prior. So things are different, and they can even be different just in a span of a couple of years. And even as a mom, you may be having your second or third child, each of your children and your experiences is going to be different.
And so when you have someone who, like Mandy said, not that they don’t care about their moms, of course she does. This is her passion and what she’s been called to do. But at the end of the day, she can be that sounding board of there’s no emotion attached to it in that, like, hey, we need to do XYZ, and she levels you out.
And that’s the importance of having a midwife. And I cannot speak highly enough of, yes, the prenatal care is amazing, obviously, the labor and delivery, but it’s the postpartum care when women are most vulnerable to all of that.
Mandy:
There’s not enough talk about the fourth trimester. When you go into the hospital, you have your baby there, they say, okay, I’ll see you at your six week checkup. By the time six weeks has come and gone, most women have already given up on breastfeeding because they didn’t have the support or they’ve dealt with the lactation consultants in the hospital, which I just had one the other day tell one of my moms that she needed to bottle feed until her milk came in because she didn’t have any milk.
And I’m going, God did not grow a whole baby and forget the milk. I promise you, it just doesn’t work that way. And thank God she reached out to me, and I was able to say, okay, let me get this lactation consultant over there.
Let’s figure out what’s going on. Her baby did happen to have a tongue tie, all of these kinds of things. But by the time you get to six weeks, I mean, you’ve already had to deal with all of it on your own.
And that’s the thing that I don’t understand. It’s like, especially if you’re a new mom and you’ve never breastfed before and you don’t know what a tongue tie is or what dehydration looks like or whatever, your baby could have already died. True. It’s crazy to think about and literally.
Mandy:
Like that scenario if you weren’t here, we had no idea. We just thought babies cry. But I knew that that cry was a different cry. That cry was not anything but I’m in pain, I’m hungry, I’m literally starving. It was wrong.
And that, to me, is the most important part. And you mentioned about the six weeks, and I’m telling a couple of my friends who are first time moms, and they’re pregnant, and I am trying to help them advocate for themselves with maternity leave. And I said, Let me explain something to you.
When you get to six weeks, that’s when you finally start to feel kind of like yourself, kind of I don’t even mean like 90%. You’re at, like, 25%.
Mandy:
The tip of the iceberg, right?
Maren:
Because it goes so fast and there’s so much newness in your life. And if you don’t have that support, that little tip of the iceberg, you’re not even going to see it because you’re going to be so lost.
And I think about how so many women, like you said, give up breastfeeding, have postpartum depression, go on antidepressants, they don’t let their bodies heal, so they’re bleeding for way longer than they need to be. And it’s such a dang shame. So my thing is, I’m advocating for you to get a midwife for postpartum care.
Mandy:
And so that’s the other thing, too. People don’t even understand that we do stuff like that. I’ve had moms like, I have a mom that’s had three pregnancies with me. They’ve all ended in C sections.
Her baby was breached the first time, so she elected to have a C section. And then the second time we tried for a VBAC, it didn’t work out. So she decided that she wanted to go to the hospital and have another C section. Then she got pregnant for the third time. She goes, Mandy, I want care with you, and I just want my C section. At the end of all of this. She’s like, I’ve already tried it twice. It didn’t work out for me.
While I love midwifery and I will always mourn the loss of not being able to give birth vaginally, I just don’t want to put myself or my husband through that again. Totally understandable. And so she comes to me the whole pregnancy, when we get down to the end, we schedule the C section, and then she comes back to us for postpartum. And the reason why she does that is because she needs the village. She needs support.
Her first baby, she was so depressed that the baby was breached and that she had to have the C section and all of that. I was there when she had the baby. I took the placenta with me because we hadn’t discussed placenta pills and all of that.
And she said to me she was very weepy and depressed and whatever, and I just encapsulated her placenta and drove it over to her house. Didn’t even ask her. And I said, we’re going to do placenta pills. She goes, you have my placenta. I’m like yes. I took it home from the hospital, which is not a very uncommon thing for me.
Most people think I’m nuts, but because we didn’t have that conversation, I’m like, well, we can’t get another placenta, so I’m just going to keep it. And so she didn’t even know all of that. But then we got her on placenta pills.
We got her in with a trauma therapist to talk through her trauma and what she wished and all of that that she didn’t get. And she was able to heal all of that little by little within those six weeks, whereas the doctor that did the C section should see him for six weeks. Oh, how are you doing? Nothing.
The Importance of Postpartum Support:
“And so she comes to me the whole pregnancy, when we get down to the end, we schedule the C section, and then she comes back to us for postpartum. And the reason why she does that is because she needs the village. She needs the support.”
~ Mandy
Maren:
Yeah, no one ever checked in with me. I got a letter from the hospital, but that’s it. No one followed up.
Mandy:
You got a bill, right?
Maren:
So in a situation like that, how does she schedule that? Because I would imagine some practices don’t even want to take her. Just knowing that, hey, it’s a one and done situation. Like, see you on whatever date.
Mandy:
Yeah. So she pays the physician that’s done. It’s been the same physician for all three pregnancies, but she just pays him to do her C section separately. They just schedule it. He knows that she’s seeing me.
We do what we call collaborative management, which is where I kind of keep him in the loop of things. I send him copies of all the records, all of that. Then when we get down to the last few weeks of pregnancy, okay, so and So is ready to schedule her C section. What day would you like her to come in?
And then we just schedule it from there. But she pays him separately to do her C sections with a doctor that I have a relationship with and also she has the preferences. I want a gentle c section. I want a clear drape so I can see my baby when it first comes out. I want skin to skin in the OR.
I don’t want my baby given formula or taken away from me. Anywhere my baby goes, my husband goes, that kind of stuff. Because she has me and I have this relationship with this doctor. We’re able to accommodate all of those preferences with the doctor ahead of time so that we’re not scrambling around trying to go, oh, can we please have skin to skin?
Can I please breastfeed my baby before you take it to the NICU? For obviously not knowing all these things. Funny enough, there was some administrator that used to work at one of the local hospitals in Palm Beach, and that hospital used to not have a NICU, and they had, I think she said, an 85% vaginal rate. And then that hospital got a NICU.
And all of a sudden, all these C-Sections started happening. And all of a sudden, all these babies needed to be in the NICU. Okay, well, that’s how the NICU makes money. That’s how they stay open. They find reasons to put the baby in the NICU. They find reasons to do C-Sections. They find reasons to scare parents. They find reasons for all of this stuff because how are they going to keep the NICU open, right?
Maren:
They need the bodies.
Mandy:
Right? And that’s terrible.
Maren:
If we haven’t convinced the listeners to get a midwife after this, I don’t know what else we could do. Right. I just appreciate, obviously, you as a friend and for coming on here and sharing all your knowledge, because I want to encourage women to trust their bodies that they were born to do, literally.
You were literally born to do this and not to be fear mongered and to advocate for yourself and your baby. And I just can’t… where can people find you, Mandy, on your website?
Mandy:
Yeah. So on Instagram I’m @palm_beach_midwife. On Facebook, I’m Gift of Life Pregnancy Services. My practice here in Pensacola is the Pensacola Birth and Maternity Center. We’re building that website right now. And then my website is Palm Beach Maternity Center. So yeah. All over the map.
Maren:
She wears a lot of hats, folks.
Mandy:
I know
Maren:
But that’s the beauty of knowing you and working with you is that you have learned how to network.
Mandy:
It’s a privilege. I am so grateful that so many women and that God trusts me to keep women and babies safe. And it’s not anything I take lightly.
Conclusion:
Postpartum aftercare is often neglected: It’s no secret that pregnancy and childbirth can be physically and emotionally challenging for new moms. Yet, postpartum care is often overlooked or insufficient in standard hospital settings.
Mandy highlighted the importance of nurturing the mother first so she can better care for her baby. Midwifery care prioritizes comprehensive postpartum support, addressing physical and emotional needs and ensuring a smoother transition into motherhood.
Share your birthing story with me at [email protected].
