“Moms can let outside influences really affect their internal well-being, when they forget what their original goals were. And let other people, whether that’s grandparents, friends, or other parents, influence them. So, what I’ve found works for me, is to write the goals down and to keep reviewing and changing them as needed. Most importantly, really have that conversation with yourself. Before any outside influences have the chance to affect your decisions,” Dr. Rachel Blake, board-certified Obstetrician, Gynecologist, and Maternal Health Advocate.
If you look at Motherhood purely by the numbers, the stats don’t look good. Although we’re responsible for most of the unpaid labor, like childcare, eldercare, and household work. We still face wage and leadership gaps in the paid workforce and suffer greater health and wealth disparities.
We’re in an escalating health crisis for Moms. In part, because of rising maternal and infant mortality rates. And outcomes for women of color, and those from marginalized communities, are even worse. But social determinants of health, like the conditions we live and work in, are now considered an important part of the maternal health equation.
There’s a lot about the Motherhood journey we can’t predict or control. But we can stay informed, follow best practices and radically self-advocate. Here’s how to keep your health interests in clear focus, through the wild ride of pregnancy and beyond.
Advocate For Your Preferred Scenario
After many years of practicing as an OBGYN, Rachel welcomed her first baby in the past year. And it’s given her new perspective on how Moms experience the process.
She said, “It was great because I knew what to advocate for and what things I could let go of. So, feeling empowered helped me understand how I can better empower my patients when giving birth. Particularly, my patients of color and those who are minorities.”
And Stay Flexible if the Plan Changes
“I always encourage my patients to make what I call birth preferences, rather than a birth plan. So, for example you can say ‘I want this done when everything is going correctly.’ Or ‘this is absolutely what I would not like.’ Because like anything, birth teaches you that the plan is not always what ends up happening.” Although Rachel is a credentialed expert in this field, she followed the advice she gives patients, and had a doula for her own son’s birth.
Have Someone you Trust Support the Process
Rachel explained, “I encourage people to have someone, who is ideally not their partner there to advocate for them. And to remind them of their preferences and be a liaison. Whether that is a grandmother, professional doula, or friend.”
She explained, “So, they’re your eyes, ears and honestly your brain during that process. Because your decision-making brain is often in a different place. It’s a visceral experience and you need someone to help remind you what your preferences were.”
Be Strategic About Pain Management
Rachel said, “Every birth and Mom/baby pair is different. I knew that I wanted to hold off on getting an epidural either for the entire labor or until later in the labor. Because I felt that was very important, I focused on other ways to relieve pain.” Although we often know ahead of time, there’s pain involved in giving birth, we may not learn there’s some discretion over how it’s managed. So, if you’re pregnant, even if you’ve been through this process before, revisit your options.
If Possible, Enlist Support from Your Partner
Rachel explained, “My husband and I reviewed alternatives to relieve pain beforehand like being in the tub or shower. So, he knew the massages, hip squeezes, and different stretches.”
She added that even if your preferences are non-epidural ways to manage pain, you’ll still get asked about your options in the heat of delivery. “If that is your preference, set yourself up to succeed. And tell whoever is offering you those interventions during delivery, ‘I’d rather not,’ or ‘I’d prefer to wait.’ Because it is their job to offer and suggest. But it’s also your job to remember what your preferences are and have someone help remind you.”
Document Your Ideal Scenario
Rachel encourages her patients to start with what they want. “Write down what the ideal situation looks like. Who is going to be with you during your pregnancy and delivery? What would be your ideal delivery outcome? And how would you like to feel afterwards, in that first six weeks postpartum? I think of it as such a sacred time so, I wrote everything down.”
It’s easier to honor your intentions, when they’re clear and visible. So she encourages patients to write the details. “Because your brain is going through enormous changes, in pregnancy and postpartum. So, you often have to remind yourself what your original plan was. Such as, ‘this person will be helping me with this thing.’ And ‘there’s this other person I will need some space from.’ Because let’s be serious, you know there are people you need space from postpartum.” Amen!
Care Doesn’t End When the Baby Arrives
Rachel said, “I have the most touch points with my patients when they seek care in pregnancy, postpartum and perimenopause. In between those times, women often lose that care for themselves. Because they’re caring for others.”
Many of us stop thinking about our gynecological needs after kids. Yet, there’s this ocean of time between postpartum and perimenopause. She added, “So, one of the things we’re identifying in Chamber of Mothers, where I’m on the board, is recognizing that you can be a Mother and caregiver. Including to your parents, neighbors or siblings. So, I’m reminding my patients that at least every year, I should see them for an exam and check in.”
You May Need to Push Against the System
Many of the health inequities we face, before and after kids, are structural. Maternal health intersects with the public health, insurance, and labor policies, that influence it. The Chamber of Mothers, which is how I met Rachel, is doing amazing work. They advocate for Mothers’ rights including regular ‘fly ins’ to meet with US policy makers in Washington, DC.
Rachel explained, “Unfortunately the way our medical system is set up, we’re only supposed to see patients six weeks postpartum. It’s tough with the pressures hospitals face around billing so we get people in who are high risk, who really need to be seen more often. But I think the average person needs to be seen more often as well.”
To Remain Vigilant About Your Health
There are many reasons that self-care for Moms, remains way-down post-pandemic. But medical care, like self-care, is essential. Rachel said, “For patients who had any complications during pregnancy, like high blood pressure or diabetes, I can explain we need to continue monitoring them. And I’m able to get their attention more. But for folks who were fortunate enough to have straightforward births, they’re more convinced everything’s going to be fine. And think they don’t need follow up, which sounds like a great thing, but sometimes it is not the case.”
And Take Preventative Measures
Maternal mortality, during and in the year after childbirth, is at an alarming high. Not to mention, the ongoing mental health crises of anxiety, depression and postpartum depression, disproportionately impact women. So, make sure you see your doctors, often to address mental, physical and emotional health.
Rachel explained, “Even if it’s not me, I encourage patients to be seen by some provider. Whether it’s a family medicine provider, or general practitioner, at least once a year. And to focus on cervical cancer prevention with pap smears. Breast cancer prevention, with mammograms. And colon cancer prevention, which is now recommended to start in your forties. So, use prevention and early detection to maintain your health.”
Many thanks to the talented Dr. Rachel Blake, MD!
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About Dr. Rachel Blake:
Dr. Rachel Blake MD is a board-certified Obstetrician-Gynecologist based in Boston, MA. She is a fellow of the American Congress of Obstetrics & Gynecology (ACOG). She completed undergraduate at Princeton University, and received her medical degree from the Warren Alpert Medical School of Brown University. She completed residency training at Beth Israel Deaconess Medical Center, affiliated with Harvard Medical School.
After residency, she continued to work at Beth Israel as an Attending physician and an Instructor of OB/GYN at Harvard Medical School. She recently started seeing patients at East Boston Neighborhood Health Center, and is focused on community health, combating health disparities, and serving the city’s underserved populations.
She also conducts telehealth consults through Maven Clinic, the largest digital patient care platform focusing on pregnancy, postpartum, and pediatrics. She is a board member of Chamber of Mothers, a nonprofit focusing America’s priorities on mothers’ rights. She is also a member of Brown Medical Alumni Association Board of Directors, and a consultant for Tinyhood, a patient education platform that focuses on pregnancy, birth, and parenting.Tags: Birth and delivery preferences for Moms, Healthy postpartum, mental health for moms, Self-advocacy in pregnancy