Navigating Postpartum Care Can Be Tricky…
In this episode of Learn With Less, Ayelet sat down with Arianna Taboada, a maternal health consultant for businesses and entrepreneurs. Arianna holds a Masters of Social Work and Master of Science in Maternal & Child Health, and was introduced to the maternal health field as a public health professional working with new mothers in some of the most vulnerable situations women can find themselves in: living in poverty, leaving abusive spouses, navigating a new country and language — all while they experienced pregnancy, postpartum, and tried to make sense of the resources available to them.
We discussed:
- The status of postpartum care (and how the US falls short of international standards)
- Maternity leave as a human rights and economic equity imperative
- Arianna’s best tips on what you can do to ensure you have access to the postpartum support you need (both clinical and psychosocial support)
- A little known way you can leverage your baby’s pediatric visits to get YOUR mental health needs met
- Arianna’s favorite resources to share with expecting and new parents
Resources Mentioned in this Episode:
Paid Leave for the United States (PLUS)
Postpartum Planning Workbook from Arianna Taboada
New Mom Mental Health Checklist from Postpartum Progress
Postpartum Support International
Connect With Us:
Ayelet: Facebook / Instagram / Pinterest
Arianna: Website / Facebook / Instagram / LinkedIn
Text Transcript of the Episode:
Ayelet: So today I am speaking with Arianna Taboada, a maternal health consultant for businesses and entrepreneurs. Arianna holds a Master’s of Social Work and Master’s of Science in maternal and child health, and was introduced to the maternal health field as a public health professional, working with new mothers in some of the most vulnerable situations women can find themselves in: living in poverty, leaving abusive spouses, navigating a new country and language – all while they experienced pregnancy, postpartum, and tried to make sense of the resources available to them. Arianna, I think that your work is so important, and you bring so much passion and gusto and intelligence to an extremely complicated field. So I’m so excited to have you on the show today. Welcome to Learn With Less!
Arianna: Thanks. I’m so glad to be here and very glad that we’ve connected in the past few weeks.
Ayelet: Me too. It’s very exciting. So I have asked you to come onto the show today to speak to us, really, about postpartum care and how new and expecting parents can get their mental health needs met. But first, why don’t you just go ahead and tell us a bit more about you, and how you actually got into the work that you’re doing today?
Arianna: Sure. So, one of the funny things that people, or that people always find funny when I talk about it is that I worked in maternal health long before I was actually a mother. So, you talked about my background and in clinical settings, I was in mental health settings, and in the U.S., In what we call “safety net systems.” So, health centers and clinical settings that provide services to primarily the Medicaid population. So people who are below a certain level of the federal poverty line, and therefore have access to services that are reimbursed by the federal government and, and states to some extent.
Uh, so this was all pre-baby for me. And from… Started in health centers in 2002, and I didn’t have my kid until 2016. And at one point I did end up pivoting a little more into the research side of things. So, instead of doing direct patient services, I was on the side of evaluating programs and implementing new programs and quality improvement in services. And I went into private practice in 2013 and have been doing that for the past few years. So that is, kind of, in a nutshell how, how it happened. And obviously once I was in private practice, I also had my own for – the personal and professional collided, and I became my own client, in other words.
Ayelet: Yeah. I’m super familiar with that! Yeah, it’s great. So well, let’s dig right in. So, I wanted to just sort of start by telling a bit about my story, because my experience with postpartum care is not typical. I myself was in an interesting position during my “birthing years” we can call them, because I spent my first pregnancy, birth, and postpartum months and years after my first child was born, in the UK. And I spent the majority of my second pregnancy living in Germany, and I had my second child in the US so we actually ended up hiring a home birth midwife to cover the last 10 weeks of my prenatal care, the birth, and the postpartum care – partially because we only qualified for emergency health insurance for the first 30 days of our, I think you call it repatriation.
And at that point I was actually 30 weeks pregnant, so that was not going to fly. And then partially because I really wanted access to very good postpartum care. You know, someone coming to my home to check on me, as I’d had in the UK, thankfully, cause I, I did have complications with my first. So now, I understand, that this is not the standard of care in the U S, so let’s hear a little bit about that. Tell us about the status of postpartum care and how the US compares to international standards.
Arianna: Sure. So I’ll, I mean, it’s a big question. For people that have had babies in the US you might already know that the standard is pretty, the bar is very low in the US. Essentially, there, since the formalized maternity care system in the US it has been a kind of six week postpartum visit that only about 60% of mothers even make it to.
Ayelet: And it’s not in your home, it’s somewhere else, right?
Arianna: You have to get up from wherever you are lying with a baby clinging on you, and make your way to this visit. And so that really varies from state to state, in urban versus rural geographies. And in terms of how realistic it is that people even make it to that postpartum appointment. There was a shift last year in the federal recommendations. So the American College of Obstetrics and Gynecology developed a set of postpartum guidelines that are greatly improved from that six week, one time checkup.
Ayelet: In 2019, we finally have guidelines!
Arianna: Right! But, and again, they’re recommendations. So what we know in healthcare settings is that recommendations take a long time to trickle down and actually be policy. And then once their policy, it takes a long time to trickle down and be standard practice. So we’re probably a good 8 to 10 years away from any kind of quality postpartum care in the US and especially compared to international standards, where four visits within the first six weeks is standard. And there’s also a long list of things that should be covered in those first four visits.
And it ranges from the physiological recovery, which in the US is kind of the only thing that was checked on in those first, in that six week appointment. So basically, is mom healing? And the international standards recommend covering that, but also social support, psychological support, emotional wellness, and kind of the full scope of what you need to be well postpartum.
Ayelet: Yeah. Seems pretty standard. Yeah. Okay. As it is now, it feels also very much like maternity leave is this, like, added benefit or like a super bougie option that women are lucky if they, say, work at a company that values it. I would love you to get on your high horse and tell us your thoughts about maternity leave and where you think we should be going. And if you have any ideas about how we, how we can get there and how we can help get there?
Arianna: Sure. So again, just to set a little context on what the very low bar is in the US… We, during the Clinton administration in 1996 was when the Federal Family and Medical Leave Act was signed in as a bill. And so what that means is that certain companies, large companies who have over 50 employees, are required to not give someone’s job away for 12 weeks after birth, and allow someone to take 12 unpaid weeks of leave. And that’s it, that’s all we have. Uh, there are some states that have implemented state leave policies where essentially, similar to how part of your paycheck is taken into state taxes, you pay into a state disability leave policy, and you can request to dip into that money when you have a baby. So it’s six weeks of partial pay for those who have a vaginal birth, eight weeks of partial pay for a caesarean birth.
And it is based the percentage that you get of your income is really based on how much you make. So a lot of people make a very small percentage, are given a very small percentage of their income during that leave. So you and I are both in California, California has that, for example, Rhode Island has it. And New York has a version of it. I believe a few other states are rolling out their, their state level policies.
So again, when we look at the international comparison, where it’s pretty standard for new parents to have paid leave, wage replacement, and also a, I won’t even call it generous amount of leave, like a normal amount of leave. So, you know, it ranges widely country, to country and UK. Your experience might have been a lot of people, mothers have have a full year of leave. I mean, Canada, there’s a full year in like all the Nordic countries, and the U S is one of three countries in the world that doesn’t have – and the only industrialized high income country that doesn’t have a paid leave policy.
Luckily there are folks on the ground working to change that. So actually here in our neck of the woods in San Francisco, the only advocacy group that’s specifically around paid leave exists. And they’re seeing actually support from, bipartisan support, essentially for a policy that will be like a first iteration of a US paid leave policy. And they’re seeing it as possible in the next few years. So by kind of their goal is by 2022 to get, to get a bill passed. So we might see some real change happening in the next few years.
Ayelet: Woohoo! Any recommendations for basic things that people can do to get involved in that?
Arianna: Yeah, so that organization is called paid leave for the US – PLUS, for short. And they have a great website where if you are an organization or if you are kind of interested in, in changing policy at the organizational level, they have workshops you can attend. And then if you join their newsletter, essentially as they get ready to propose bills, you can sign your name on as a supporter. So those are two great ways to use… Everyone’s busy. So use a little bit of the precious time you have to…
Ayelet: Yeah! We are also talking to often new parents or people who work with new parents. So yes, quite busy, but, but Hey, I mean, sometimes it feels good to be useful!
Arianna: And those things you can do pretty easily from your phone.
Ayelet: Yeah. Awesome. Thanks. Okay. Well, let’s take just a brief break to hear a word from our sponsors. And then we’re going to get into a few tips from Arianna about what you can do to ensure that you have access to the postpartum support you need!
Ayelet: Okay. Arianna, let’s get into the gold. We want to know what are your best tips for new or expecting parents to ensure they have access to the postpartum support they need, both on a clinical level and on a psychosocial level.
Arianna: Sure. So again, until… I’m all for like top down and bottom up approach, and until we have a policy and kind of the infrastructure for a positive maternity leave and postpartum experience, I really believe in doing it yourself in the absence of that. So creating, creating a system that can match these international guidelines and get your physiological, mental health, psychological, emotional needs met – and your, like, basic material needs, basic human needs.
And so for me that often looks like helping people walk out their support systems, like walk through, map it out on a piece of paper, identify your local support. So that might look like friends and family, people you already know that you can make specific asks from. And then from the wider network, it might be like looking up resources in your community that are specifically for new moms, for new families.
Sounds like you did some of this, it’s finding someone to fill the gaps, right? Finding a professional whose services exactly align with what you need and setting that up. It’s… I find it really interesting to visually map out support networks, because if you are identifying that, like, I actually don’t have anyone that I can ask for, for, you know, for making sure that I have meals and something to eat for the first few weeks when I do not plan to be cooking, then that’s an indicator of actually that might be a specific ask that you need to find someone to fulfill.
Whether it’s a family member from afar who can set up a meal train or getting meal prep support and hiring someone to do that. So I, for this exercise, it’s one of the things that I do with everyone, with all my clients. And I’m happy to share a kind of free download that folks can use to DIY it. It’s literally just how to map out the postpartum support map. Awesome. We are going to link to the show notes to that. Can you give us the link right now? I can, let’s see. Hold the, I might need to go look it up.
Ayelet: Oh that’s ok – I’ll put it in the replay of this in the community, and we can put it in the show notes later on. That’s no problem. Alright, keep going. That’s great.
Arianna: Well there’s… So one aspect is, is mapping it out and then there’s, there’s the filling in the gaps. And so that I found really helpful to actually, especially if this is first baby, to talk to people who have been in your shoes recently, and not have to reinvent the wheel in terms of, like, spending hours on Google, figuring out what exists. So talking to two or three people and doing kind of “informational interviews” for, for new parenthood and postpartum, if you will, is another great tool.
Ayelet: That’s so my style!
Arianna: Yeah. But you’re basically crowdsourcing all of the things that people have done recently. And, you know, if you can remove the barrier of having to find stuff yourself, I think it does make it that much easier to put in a strong plan.
Ayelet: Absolutely. Yeah. I understand that you have a special tip sort of a little known way that you can leverage your baby’s pediatric visits to get your mental health needs met. Will you give us the goods on that?
Arianna: Yeah. So maternal mental health is another one of these like woefully inadequate systems we have in the US. And so really the mechanism that we have is that postpartum visit, which again, if only 60% of women are even getting to, then…
Ayelet: Right, and that’s six weeks in! There’s a HUGE amount of stuff that happens in those first six weeks. That’s crazy.
Arianna: Yeah. And the scope of that visit is usually just physiological, right? Exactly.
Ayelet: But the baby is going to their well-baby visits.
Arianna: Yes, baby is going to, well-baby visits. So there’s, I’ve found there’s essentially a new mom checklist that you could fill out prior to one of those well baby visits and you bring it with you, and you share it with their provider. Now, their provider is not your provider. So there’s still a handoff that has to be made to get you connected with services.
But that is the most frequent point of contact with the health system that a new mom has. And so even though, you know, the mentality is like, “Oh, they’re, they’re here for my baby. Like, I’m, it’s not a place where I can get my needs met.” If that’s the entry point into the system, I’m all about using it.
Ayelet: Absolutely! So you have a download on your website. That is that checklist. Is that right?
Arianna: I’m happy to share it. It’s from, it’s actually created by Postpartum Progress, which has since I believe, like shut their doors or narrowed their services. So the handout still exists and I can share a link in the show notes, but it, yeah, so it’s basically a way to say, “Hey, I know I’m here for my well baby visit. And I also want to let you know that I am not feeling great,” and it gets the conversation started.
Ayelet: Yes. So important. That’s awesome. And such a great resource to share. Let’s hear some of your other favorite resources that you like to share with expecting and new parents.
Arianna: Sure. So another one on the mental health side is Postpartum Support International‘s helpline, which you may have heard me talk about.
Ayelet: You and others. Yeah. It’s a great, it’s a great thing that exists.
Arianna: So it is essentially a volunteer-run hotline. So it’s a number that you can call at any time and a train volunteer will either pick up or will, if you leave a voicemail, will call you back and be able to help you identify what supports for your own mental health would be helpful.
So they do a little bit of their training to do a little bit of crisis management, but also they have access to a directory and can look up based on your zip code and location, who are the in-person resources and they can directly connect you with them.
So there, you do get, what’s called a warm handoff where it’s not just like, here’s the name of some people, go reach out to them. It’s like they make the email introduction. They provide the local person with your phone number to call you back. And…
Ayelet: Wow! I actually didn’t realize that it was that. Wow, that’s amazing.
Arianna: Yeah, so that is a wonderful, you know, if, if you don’t have a well baby visit coming up or it just, that’s not the place you want to bring it up. This is a place specifically for new moms whose whole mission is to connect you with mental health supports in your local area.
Ayelet: That’s amazing. Are there any other resources that you’d like to share?
Arianna: I mean, I kind of mentioned it as we were chatting earlier, but I am a huge fan of the meal trains. So both for pregnant women, new moms in your life, offering to set up a mail train and also in your own pregnancy, identifying someone in your life who can organize a meal train for you. I mean, at this point, there’s very easy kind of online systems you can use to have people sign up for meals, but I think there’s, there’s like no match for, for having food provided for you and your family for those first few weeks.
Ayelet: Totally. And then another, like a thing that if you’re in the mind space or you’re able to do it beforehand, if you don’t have people, I actually like stockpiled a bunch of stuff in my freezer for, for after, while I was still pregnant. That’s another, you know, little hack.
Arianna: Right, yeah, some meal prep or even, you know, meal delivery services. There are so many of those these days per preferably, one of the ones that are like already cooked when they deliver it.
Ayelet: Yeah, seriously! Obviously, I think the meal train has a more social component, which is nice – should you want it right? Or you can be specific about, “here. Just leave it on my doorstep. I will get to it when I can.” But yeah, no, that’s, that’s so important.
Well, thank you so much, Arianna. And thanks to all of our participants of the Learn With Less® Curriculum Online Program who are here, listening live, as a benefit to our membership community. We are going to continue the discussion and open up for a Q&A session with you guys in just a minute. But for everyone listening from home or on the go, thank you so much for joining us. And we will see you next time.
