Before I get into the meat and bones of this, we should acknowledge that many mothers preparing for a natural birth are not compelled to give birth in hospital, rather they choose to do so. The important Birthplace Cohort Study (2011) showed that, for women in the UK with uncomplicated pregnancies, home birth and midwife-led units (freestanding and alongside) are safe alternatives to obstetric units. So if you are having a straight-forward pregnancy and would rather avoid the postnatal ward, give some serious thought to the alternatives in your area. This is one of the most important decisions you will make in your pregnancy, as where you start your labour has a significant impact on the likelihood of you having a natural birth.
Now, mothers often cite postnatal ward as one of the more challenging parts of their birth experience. And I get it, I really do. At a time when you want to be tucked away at home in a bubble of oxytocic bliss, you are, in fact, sharing a room with three other mums, at least three other babies and, increasingly, birth partners, who can be a wonderful help, but also represent more bodies in an already cosy space.
In some midwife-led units, you will find that you have your own room until you go home, which is lovely. But there is still a chance that your hospital stay could last longer than you anticipated, and that you might need to spend some time on the postnatal ward. So if you plan to give birth in hospital, it’s worth thinking in advance about what you can do to make this experience easier - and maybe even enjoyable.
Here are a few tips on how to do this:
1. Spread the load - My sister said that the one thing she would have changed about her first birth was to have a second birth partner. In fact, she was supported exclusively by her husband, so that, by the time their baby was born, they were both officially pooped. Even if you want just one person supporting you at the time of the birth, if can be helpful to have emergency back up in the postnatal period. A newborn baby generally wants to be held all the time. THIS IS NORMAL. For nine months, your baby has been bundled up inside you, feeling the warmth of your body and the rhythm of your heart. Skin-to-skin after the birth keeps babies warm and settles their breathing and heart rate. Plus, why on earth would a baby want to sleep in a cot when there’s a toasty squishy human-shaped alternative? The thing is, at some point, you’re going to want to sleep, and so will your birth partner. Cue grandma or grandpa! Or sister, or best friend, or cousin… basically anyone who will be happy to just be there, awake, for an afternoon, providing cuddles and support, so your partner can nip off for some vital R&R.
Which brings us neatly onto...
Sleep - I won’t pretend that it’s easy to rest on a postnatal ward. The noise tends to creep up despite our best efforts, and there are often a lot of interruptions (e.g blood pressure, pulse and temperature checks) even if you do manage to nod off. The key here is for you and your and your partner (or grandma, cousin, sister etc…) to take it in turns. A tag team approach means that one of you can get a decent hour’s kip, using ear plugs or listening to calming music, while the other devotes themselves entirely to looking after your baby. Often hospital's have a ‘family room’, a kind of common area, where dads or partners can go for a cuddle with baby while mum has a sanity-saving sleep. Before you settle down, explain to your midwife that you are about to have a rest, and ask there is anything she needs to do with you first - many jobs can be brought forward or delayed a couple of hours with a bit of warning. Women often seem reborn after as little as an hour’s rest - remember, you are entering a new phase of your life, where it’s all about the power nap.
Letting be - Many things that happen on a postnatal ward are outside your control; the ward marches to the beat of its own drum, and, with so many people to care for, it can be difficult/impossible for staff to accommodate each individual schedule. So what can you do? Relax. Don’t make any plans, don’t tell people you will definitely be home at X o’clock, don’t make promises about what will happen the next day. If you already have kids at home, try to arrange generous childcare in advance. You cannot change the pace of the ward, but you can often arrange other aspects of your life so that pressures outside the hospital are reduced, leaving you to simply 'be' with your new baby.
Go easy on yourself - everyone will want to see you after the birth, especially if you have just had your first baby. But, at this stage, your recovery and your baby’s wellbeing takes priority. These early hours are so important, and your visitors have a lifetime to meet your baby (let's be honest, newborns don't do all that must anyway...). If you are a breastfeeding mum, it’s a good idea to limit your visitors to people you are happy to feed in front of or, if you prefer privacy, to people you can happily boot our of the room while you breastfeed. And everyone else can wait until you get home. This is your show, you make the rules!
Trust your baby - this rule applies beyond your stay on postnatal ward. For some reason, people find it hard to believe that newborn babies generally know exactly what they want. As a rule of thumb, if a baby looks hungry, she probably is hungry. So try feeding her. If she doesn’t want to eat, comfort her with a cuddle. Usually one of these two things will work, and if they don’t, then you can start getting creative. I once visited a mother at home the day after her baby was born - she greeted me with a wail, ‘His routine’s changed!’ Now, let us be quite clear, that baby never had a routine. What the mother had experienced was a first sleepy day (very common) followed by 24 hours of her baby wanting to feed pretty much all the time (equally common). This is another reason why we sometimes don’t want to send first-time mum’s home too early, i.e. during the sleepy phase. Because at some point that little one is going to wake up, and, unless you have round-the-clock breastfeeding support, dealing with that transformation at home can be daunting.
Talk to midwives and other mothers - On any postnatal ward, there will be a wealth of knowledge and experience in the form of midwives and other mothers. Our post-birth nesting instincts often make us want to retreat into our bay, close our curtains, and shut out all the unfamiliar people and practices buzzing around us. But there is a clear case to be made for getting to know some of the other mothers on the ward as they, better than most, know what you are going through, and are a potential source of comfort. Of course, some mothers (and the odd midwife for that matter) talk a load of tosh. So don't take all advice at face value. But you're an intelligent person, right? You can sort out the wheat from the chaff?
Try to see if from your midwife’s POV - From the moment you enter the hospital, midwives and doctors have a duty of care; they will not want to discharge you and your baby until they think both of you are safe and well, and this includes making sure feeding is established (the alternative is sending you home too soon and risking a readmission, which no one wants). Sometimes delays are caused by pesky but necessary admin, which bugs us as much as it bugs you. Doctors, who often have to review a woman and prescribe medication before she can be discharged, are pulled in many different directions, especially at the weekend - they simply cannot be everywhere at once. On a recent shift, I was looking after a woman who had been on the postnatal ward for a few days after having a serious infection. She had been waiting for most of the afternoon for a doctor to review and (in her words) 'free' her, but, when I apologised for this, she said not to worry, she wasn't in a rush, because when she had really needed us, we had had moved very, very quickly. And this is how is works in hospitals - emergencies go to the front of the queue, while routine tasks sometimes have to wait. If you are not sure of the cause of any delays, talk to your midwife. Frustration tends to dissipate when we take the time to really explain to you what is going on. And, I promise, if you and your baby are fit for home, we will want you out of that hospital bed and at home (almost) as much as you do!
Getting pregnant marks the beginning of a long journey into the unknown. You might spend no time on the postnatal ward, or you might be there for longer than you anticipated. Interestingly, the mum's who have the longest stays because they or their baby are unwell are often the most accepting, because they understand that the ward really is the best place for them to be. Whatever category you fall into, remember that the early postnatal period is a very small, if intense, drop in the motherhood ocean... and it too shall pass.