Discovering motherhood: What goes on inside a postpartum care centre for new moms?

A suite at Fortis La Femme in the posh GK II area of New Delhi. (Express Photo by Rinku Ghosh)

At Fortis La Femme in the posh GK II area of New Delhi, this new mother is availing of postpartum (post-delivery) care services. This is the “baby blues” phase, the most physically challenging and emotionally fragile stage of a woman’s life when hormonal fluctuations induce anxiety, depression and guilt about whether she can match up to new responsibilities and expectations. This is the time when she needs sensitivity and a support network around her. The 31-year-old image consultant had not thought about having a child till her biological clock started ticking. She felt inadequate, nervous, anxious, worried about whether she could handle the additional responsibility of nurturing a new life. “These first few days of guided initiation into motherhood gives a modern woman the agency to transition into a new role without negating her old one. The team here has helped me catch up on my sleep, understand how I am to reorient herself and get some much-needed support. Google is confusing and your family just gives you old wives’ tales. None of them could teach me at what angle I had to hold the baby for feeding, how to help him latch on to me while changing sides, the diet I need to follow and how to manage when I return to work. The baby is important to me but I realised that I had to feel happy and confident about our journey together. I think this elongated postpartum programme is a necessity not only in the big cities but everywhere,” says Nirula.

Not too far away, at Apollo Cradle Royale in GK I, 34-year-old Sana Masood, who has had her baby after battling PCOS (polycystic ovary syndrome) and hypothyroidism for seven years, walks into a yoga class after an “ask me anything” session with a mental health expert. “I had anxieties about birthing itself. I was concerned if my PCOS would affect my lactation, whether the baby would grow healthy enough. I feel safe here talking to the gynaecologist and psychologist who know more about me than my family. Along with physical stamina, I build my mental stamina here. After ten days of sessions, I do not have panic attacks anymore,” she says.

HOW POSTPARTUM CENTRES HELP

Birthing centres are now hand-holding new mothers after delivery with curated programmes which involve a few days stay in hotel-like accommodation, with luxuries and pampers like a private candlelight dinner, fashion shoots and spa sessions, as well as curated medical guidance from gynaecologists and paediatricians. Nurses watch babies around the clock, attendants have an annexe to themselves, the nutritionist prepares a customised diet plan for the mother, a counsellor eases her into processes of childcare, making them look doable, a physiotherapist gets her up and moving with postural therapy and a mental health expert helps her through the lows and triggers as her hormones take time to stabilise. What’s more, a counsellor also trains japas or nannies to help the mother through the much-needed 35 to 40 days of healing. This phase helps them transition from hospital to home seamlessly.
Of course, all these come at a huge price tag over and above the Rs 1 to Rs 5 lakh birth packages lasting up to three days. The longer the stay, the steeper the bill with room rents varying from Rs 14,000 to Rs 60,000 per day, depending on whether you are in a premium room or a residential suite. While high-end postpartum care centres or joriwons in Seoul offer 21-day staycations, in India, prohibitive costs mean mothers can just sign up for four to six-week follow-up services.

A cafeteria for new moms at Apollo Cradle Royale. (Photo: Special Arrangement)

WHY WOMEN NEED POSTPARTUM CARE
Dr Meenakshi Ahuja, senior director, Obstetrics and Gynaecology, La Femme Fortis, has been one of the pioneers of the holistic motherhood concept. “A lot of women’s postpartum problems, when they are stretched thin both emotionally and physically, could easily be solved if we began with an antenatal facility that would feel not like a hospital but a social hangout and meeting point, which would be safe for women to discuss pregnancy. We also prepare them for the post-delivery phase, stretching from 21 to 40 days. During this time, women should be confident about handling the baby on their own and prioritise self-care to be strong and healthy. With proper nutritional, psychological, medical and lactation support during this transitional phase, a woman will actually be able to enjoy motherhood rather than seeing it as another role to play by the book,” she says.

In her long years, Dr Ahuja has identified some triggers beyond hormones that make a woman the most fragile and vulnerable. “She feels the attention goes from her to the baby when she also wants reassurance of her self-worth, particularly from her family. She requires that extra care and sensitivity, being tired all the time. Since paternity leave is limited, who’s there to help you in a single unit family? Most women need a patient listen rather than being told their blues will blow over simply because every other woman has had it. I have had patients’ families asking me why counselling is necessary considering maternal depression is a common thing and not a disease,” she says. She even recalls how she has had single mothers come in and extend their stay for that initial prop-up.

DIET, BREAST MILK AND OTHER MYTHS

Divya Dhawan, a nutritionist at Apollo Cradle Royale, who customises diet plans, finds how most new mothers are overloaded with food by family to build milk reserves for breastfeeding. “The truth is you just need an additional 350 to 500 calories a day, which can be easily settled by adding an extra chapati here, a bigger bowl of dal and so on. Overeating leads to obesity even before a new mother can shed her maternal fat,” says she.

Her colleague and lactation expert Vandana Sarkar works with mothers who may have their babies in NICU (neo-natal intensive care unit) because of birth complications like jaundice or edema if they are pre-term. “Anxiety and worry about the infant’s condition elevate stress levels, which in turn impact milk production. Most mothers go through guilt syndrome in such situations. So our job is to help a mom understand her own triggers, relax in stressful situations and help her pump milk,” says Sarkar who guides all her patients online for three weeks. “Some women tell us upfront how they want their breastfeeding routine to be and when they want to stop. Six months are ideal for breastfeeding and it can be done with some smart planning. Breastfeeding, even for a short time, is beneficial. This knowledge gives a woman agency to decide what’s best for her baby,” she adds. Dr Anita Sharma, lactation consultant at La Femme, feels that breastfeeding fears are the biggest reason for a woman’s postpartum depression. “Most women are told they are not making enough milk. Fact is a mother has to learn to watch her baby’s urine and stool output as well as the weight — an infant loses about ten per cent of body weight in the first two weeks. If these are within parameters, she is making just about enough milk. Many women are told not to feed till her milk matures in the first two days when fact is, early milk or colostrum is nutrient-dense and forms the baby’s immune system. For a pre-term baby, a mother needs to be taught how to pump adequately so that milk production doesn’t go down,” she says.
This guilt of not making enough milk is a negative signal to the brain that stalls milk formation. In fact, Dr Sharma calls in fathers during her postpartum session to teach them how to hold the baby after the feed to keep the continuity and the baby secure. “That’s why nowadays we are calling breast-feeding chest-feeding where the father or caregiver can position the baby and feed expressed milk from a customised bottle,” she says.

WHY POSTPARTUM CARE IS EXPENSIVE

Dr Ahuja, who is spreading awareness about why women need postpartum support at community camps, feels expense is a crucial factor that is tilted against this crucial aspect of women’s health. “About 90 per cent of insurance policies don’t cover postpartum care, provisioning for just 48 hours after delivery. No matter how big your package, there’s a fixed sum for birthing, Rs 50,000 to Rs 1 lakh. All services are out of pocket expenses. Till financing options become affordable, postpartum care will only be seen as a frill, not a necessity,” says Dr Ahuja. And yet, it can transform maternal health and take away a mother’s biggest fear of not being good enough.