It's not enough to have a birth plan – you need a post-natal one too

Lying, sore, swollen and shell shocked on bloody sheets after the birth of my first son back in 2015, I had a creeping realisation that I no longer mattered.

Although it was classed as a natural spontaneous labour, it felt anything but. I’d gone into it at around midnight on the Monday night and didn’t give birth until Wednesday morning.

I’d been put on a syntocinon (the artificial oxytocin they use for induction) drip, which made me feel like lightning was ripping through my body, and I’d barely slept for 36 hours. I felt like I’d been flattened by a steam-roller.

The moment my son was handed over to me, I not only felt relief but also an overwhelming rush of love. Midwives fussed around me and I was given the heavenly post-birth tea and toast.

Yet, once I was transferred to the postnatal ward, things changed. I felt neglected and like a nuisance if I asked for help with breastfeeding, or clean sheets, or assistance when my back was spasming and my calf swelled.

Health assistants came in periodically to ‘milk me’ – which was excruciating – but, other than that, I didn’t really see anyone.

As a pregnant woman, I’d felt seen, listened to and cared for. This changed the moment I became a mother. That isn’t right. And that’s why I believe people who are pregnant need post-birth plans, as well as birth ones.

Because although so much emphasis is placed on the birth, and it can indeed be a transformative, and even transcendental, experience, it is usually a matter of hours or – at most – days. Postnatal is forever.

Throughout my pregnancy, I had constant contact with healthcare professionals, checking on me and the baby I was carrying. It wasn’t perfect but I felt I had somewhere to go with any concerns.

I had a detailed birth plan, where I’d indicated preferences such as not announcing how much I was dilated and a quiet, calm birth environment, and I felt supported with these choices.

The aftermath was a different ball game; my health and wellbeing became a mere footnote to the main subject: my son.

Unsurprisingly, I was in his thrall too. So wanted, so teeny, so precious. But while even I was directing my attention towards him, no one was focused on me.

I felt vulnerable, alone and a little frightened. This was my first rodeo. The birth had been much more tense and medicalised than I had expected and I had a little guy who I was struggling to breastfeed. I had no plan for this bit.

I was in hospital for three nights after my first son was born, as I had had gestational diabetes and his blood sugar needed monitoring, and that brief stay was not conducive to rest and healing. As well as being sore from my stitches, I was still bleeding and breastfeeding was incredibly painful and would remain so for months.

I wasn’t sleeping and I honestly felt broken. I didn’t recognise myself in the mirror, partly because of a puffy face but also because I was going through what I now know is called ‘matrescence’ – that huge identity shift that happens when you become a mother.

I worried that the Day Three weeping wouldn’t stop. I was desperate to get home, to peace and privacy – where I hoped my husband would coddle me. The overwhelm and discomfort in hospital were compounded by a lack of care. That’s not to say midwives don’t care, most do (very much), there’s just not enough of them.

At home and on the precipice of postnatal depression, my husband took matters into his own hands and hired a private midwife a week after the birth. She came twice to the house, debriefed the birth with me, going through my notes and explaining why certain actions might have been taken, as well as talking with me about how the birth affected me emotionally, and checked me over properly.

‘Be kind to yourself, yield to the tears and enjoy the smiles,’ she instructed, as she reassured me the rollercoaster of emotions I was on was perfectly natural.

With this boost, I booked a lactation consultant and a women’s health physio. The physio was really positive and made me feel I was being proactive with my health – and finally getting the breastfeeding sorted felt like a huge achievement.

A delivery of microwave meals and a spa voucher from friends in those early weeks helped put me back on my feet and I began to take long walks by the sea to rid me of a slightly claustrophobic feeling. The gentle exercise helped me get fitter and stronger and eased the intense exhaustion I felt from the sleepless nights.

I grew in confidence as a mother but I knew, if and when I did this again, I wanted a proper postpartum plan in place.

Private midwives, lactation consultants and physios were costly, but I was filling a gap in provision for myself and I was privileged enough to do that.  

But a proper postnatal care pathway should be available for everyone. I feel so strongly about this issue that I have since campaigned for better postnatal care, and have written a book. Your Postnatal Body is the book I wished I’d had and contains practical advice and cost-free ways of nurturing yourself after birth.

We need to arm women, and birthing people, with the information they need to make their landing into motherhood less bumpy, particularly with postnatal care being – well, broken, right now.

The 2022 Maternity survey report by the CQC highlights the falling standards in postnatal care, with women only being able to access help on the postnatal ward 57% of the time – down from 62% in 2019.

I have interviewed many postnatal women and the words ‘forgotten’, ‘traumatised’ and ‘alone’ come up time and again. Is it any wonder we have such high rates of postnatal depression, PTSD and pelvic health issues and low rates of breastfeeding?

Your postpartum plan could include a hospital bag with items for your recovery (Piles cream! Arnica! Eye mask!) as well as organising a community meal train and having helpline numbers on speed dial.

After recurrent miscarriages, I finally welcomed my second son in 2020. I had a birth plan and the best postpartum plan you’ve ever seen, complete with postnatal doula, a ‘squad’ WhatsApp group made up of local friends willing to help with food and childcare, and my husband primed to deter visitors at rest times.

Then lockdown happened and I watched my carefully crafted plan go up in smoke. However, what I missed out on in community support, I made up for with pyjama days and a ludicrously low bar on housekeeping.

A postpartum plan is not a panacea, but it is a start. Many women are told ‘all that matters is a healthy baby’ but mothers matter too. We deserve to recover from the rigours of pregnancy and birth, and to thrive.

Not only because we must fulfil our new demanding role but because we are still the same worthwhile, autonomous, vital human we were before. Although with our changing hormones, brains and bodies, we can feel anything but.

Lyanne Nicholl is the author of ‘Your Postnatal Body – a top to toe guide to caring for yourself after pregnancy and birth’. Available at online bookstores

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