TRANSCRIPT EPISODE 27 – All About Pregnancy & Birth With Dr. Nicole C. Rankins

Transcript episode #27:in home newborn care & breastfeeding support with dr. sonal patel

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00:01                                  In this episode, I'm talking to a pediatrician who does in home newborn and lactation visits.

00:11                                  Welcome to the All About Pregnancy and Birth podcast. I'm your host, Dr Nicole Calloway Rankins, a board certified Ob Gyn physician, integrative health coach and creator of The Birth Preparation Course, an online childbirth education class that will leave you feeling knowledgeable, prepared, competent, and empowered going into your birth. Quick note, this podcast is for educational purposes only and it's not a substitute for medical advice. See the full disclaimer at www.ncrcoaching.com/disclaimer.

00:46                                  Hello and welcome to episode number 27 of the podcast. Thank you for being here. So today on the podcast I have Dr. Sonal Patel. Dr. Patel is a pediatrician and neonatologist, also the mom of four boys. Through her personal and professional experience, she noticed holes in the way postpartum care is delivered and she founded Naya Care, a newborn specialty clinic and this is a unique model of in home care for newborns for that first month a baby's life. She also combines it with having a lactation consultant in her practice. She herself is also trained as a lactation counselor. She has a mental health counselor and her practice as well as a psychiatrist. She is very passionate about bringing improved postpartum care, making it really comprehensive both for babies and moms and she does this one mom at a time now. I really found the model of care that she provides very interesting. She's going to talk about how she does in home visits in that first month after birth and these are one hour in home visits typically, as well as being available by text message if need be. She also talks about what to look for if you're interested in in home care. We talk about how she helps families transition to their regular pediatrician and then she just has lots of great tidbits of advice for moms for things like why you should let go of guilt, why you should take a break, how you should be supported. So you are really gonna learn a lot from this episode just like you learn from every episode.

02:39                                  Now before we get into the episode, I want to remind you if you are not on my email list, then you should be. I send out a weekly newsletter that contains a dose of information to help you have your very best pregnancy and birth. I always include some inspiring information to help with that oh so important mental health and wellness piece of pregnancy. And then I also include a helpful tip. It can be something like nutrition, maybe epidurals. It may be exercise, so I cover lots of different things. I keep the newsletter short and sweet so it's not terribly long to read. And the newsletter's also the first place where I announce new things like specials on The Birth Preparation Course and I don't offer those very often. So no spam ever. I don't sell your information. I keep the emails to about once a week, occasionally twice a week if I have something major going on. But if you're not on the list, then you definitely want to be on the list cause it's the best way to stay in touch with me. You can join the list by going to www.ncrcoaching.com/email, that's www.ncrcoaching.com/email or you can just go to my website and there are plenty of places to sign up there.

03:58                                  Nicoel: All right, so without further ado, let's get into the episode with Dr. Sonal Patel. Hi Sonal, thank you so much for being here. I really appreciate it. You have a really interesting story in the way you practice and I'm sure the listeners are going to learn a lot.

04:11                                  Sonal: Well thank you for having me and for the opportunity to let your listeners know about it.

04:16                                  Nicole: Yeah. So how about we start off by having you tell us a little bit about yourself and your work and your family.

04:22                                  Sonal: Definitely. So my name is Sonal Patel. I am a pediatrician and I did further training in neonatology. I moved to Denver, Colorado in 2009 with my husband and then one son and I practiced NICU for seven, seven and a half years. And during those time periods I went and had three more kids.

04:47                                  Nicole: Wow. So what are the age ranges?

04:52                                  Sonal: So my youngest is four, then there's a seven year old and nine year old. And then my oldest is 13. They're all boys. So that's always a very interesting household I live in and I guess I live with five boys and I always say I want to feel like I'm living with five girls now. That's part of what led me to what I'm doing currently is that only my own personal experience with postpartum seeing NICU moms with postpartum just led me to believe that there was a better way that we can offer postpartum care in the United States to be more complete and to actually value the fact that the mom just had a baby.

05:38                                  Sonal: And so that's what led me to develop Naya Care, a newborn specialty clinic that serves the Denver Metro area. It is a home-based clinic. And what we essentially do is after a baby is born, routinely, what happens is when after one to two days, they go to their pediatrician's office. And unfortunately in this day and age, those are like 15-20 minute slots and you can't really get much in it right. You can't address everything, especially with a new mom who has so many questions, you can't address all of that. And one of the biggest things is lactation and breastfeeding, to make sure it's all going well. And so what happens routinely, it's like, okay mom, you have these issues, why don't you go to the lactation group? So what happens in the first week is that we're trotting these moms and babies kind of all around town because usually they'll deliver the hospital, then they go to their pediatrician's office in this one area and then they go to lactation group most likely in their hospitals and for the first week, that's what we're doing in moms to make sure that they established breastfeeding.

06:46                                  Sonal: And in this day and age, I think we've had such a huge cultural shift. I mean obviously being a pediatrician and focusing most of my career into nutrition, there's an importance of breastfeeding. But if you look at it, the first week is so important to establish it. You know, you just don't get up with a newborn and go, you have to plan for, yes, I do plan couple of hours beforehand. You want to make sure, like, what if the baby gets hungry on the way? What if this happens, what if that happens? And even more a seasoned Mom kind of will, I mean they go through it and so they kind of know a little bit about it, but these new moms have no idea. And, and that's what I mean.

07:32                                  Sonal: Even as a seasoned mom with my fourth baby, I just remember I had so much on my plate. I literally, in order to get on time to my physician's appointment, and mind you, I didn't even see the physician that day. I just saw an RN and that's what really prompted me. I mean, it took me three hours to make sure everything was ready. My kids were all settled, you know, like all the i's are dotted and t's are crossed. So just looking at it, that led me to all this research and I realize a lot of European, Japanese and Australian countries actually have such a high quality of postpartum care in which they will send out either an RN or a midwife that is experienced in lactation and do the home visits in the house. I've had a couple of friends who have delivered in Denmark and they've just said, there is such a stark experience with somebody coming to your house daily and that they experienced versus here because she had one baby here and one baby there and she goes, I would take Denmark's system over anything.

08:38                                  Sonal: It was just more supportive, just the postpartum part, so it was just like, well, why can't we do that here in the states? Like why can a physician not go out with lactation bundled up so it becomes more of a meaningful visit all at once. I'm in, there are some programs here like Kaiser, if you're living in a state that is heavy with Kaiser, we, we do have Kaiser here, but it's a very limited population. They do send out their nurse, who is at minimum of lactation educator to the house. And then there's some federally funded programs. However, there's always like a stipulation, like you have to be either low income or you have to be African American or you have to have your just your first baby and you have to have teenager mom. And it's like, you know, every mom has, every mom with every baby is different and experiences is different.

09:35                                  Sonal: So it's, it's just such, we're just offering it to very subset of women. And it was my fourth. I needed the most help it was my fourth. So what we do through the home health is I go out, I'm actually lactation CLE, and I've just really dedicated all my life for breastfeeding.

09:57                                  Nicole: So what's a CLE?

09:57                                  Sonal: It's a certified lactation educator and so the actual highest level is an IBCLC. It's an international board certified lactation counselor. I have so many years of breastfeeding, not only personally, but actually helped develop a breastfeeding program for the premature babies, which we're on a side note trying to launch it in different NICUs around the area that I didn't want to do an IBCLC though I had that hours. And the only reason was I'm tired of taking a board exam.

10:30                                  Nicole: Right.

10:33                                  Sonal: I'm so tired of it and I commend all those women who are out there who are mds that are going through it. Cause I know the process. But for me personally was, you know, I'm done with that part. Like I'm part of the breastfeeding medicine. I get their journals. I rather would spend my times doing that than actually learning something and sitting for the board exam again.

10:58                                  Nicole: You have all of the education and training without the title.

11:02                                  Sonal: Yes. And that's why I just went ahead and got the seal II part of it because it leads like people know that. Yeah, it's, I have some investment in it and then when they actually work with me, they're like, oh, you know a lot. I know.

11:17                                  Nicole: So you go and see moms in their home within the first week after birth?

11:23                                  Sonal: A couple of days actually.

11:24                                  Nicole: Oh, okay. Okay. Okay.

11:27                                  Sonal: The first two to three days after post hospital discharge.

11:31                                  Nicole: And you see them that, how many times do you see them?

11:31                                  Sonal: It depends. So the whole program is four a month essentially. So in the state of Colorado they require two newborn screens. Some state only required one newborn screen and the newborn screen is a tool that is used to detect any metabolic or genetic diseases that can have preventable interventions that can lessen outcomes. For example, hypothyroidism, you know, you can give 'em if you have congenital hypothyroidism, you give them Synthroid and their neurological symptoms are diminished. So in the state of Colorado, we need to do two of those. So I usually go to the two to three day and they come in packages and sometimes the moms just want that, especially the seasoned moms and sometimes they do that and they're like, oh no, please could you come back for the second week visit as well and conduct that at home, so I don't have to go out again and do my newborn screen at the clinic.

12:35                                  Nicole: Gotcha.

12:36                                  Sonal: And then regardless of if they pick the one or two visits, they, every one of my moms has a mandatory phone call at one month with myself or the counselor and we, we screened for postpartum depression, um, with that. And so that's just mandatory cause I've suffered through it and I just don't want anybody else coming into what I had to go through.

12:58                                  Nicole: Absolutely. So, yeah. And when you go see moms in their home, how long are you there?

13:04                                  Sonal: I'm there about 60 to 75 minutes, depending upon if it's a completely new mom versus, you know, if it's an experienced mom who just really needs additional care and their home and it's so rewarding because now I can actually tailor my advice to their environment. It's like, hey, where do you usually breastfeed? You know, let's go there. You know, and usually the dads are there and usually there's other support systems that they have in play. Their moms or their, sometimes their mother-in-laws are there and you can just tell them advice also to help that mom. So for example, one thing I do teach dads on the side is, so in my culture, infant massage is always incorporated. Like my mom came and did it to my kids, you know, part of our culture. And so then I can teach them a couple of things with infant massage that are very simple to do. But now my dad has something concrete to do. He's learned the couple of stretches and that allows mom to be like, then I can be like, hey, you know, mom's going to breastfeed then mom, you are going to go away and you're gonna take your nap, dad, you're going to do this in this position and you're going to, so usually also in the first week we deal a lot with jaundice and every kid has some degree of jaundice.

14:24                                  Sonal: So you can say, well, here's where you get the best sunlight, so you know, for five to 10 minutes with a diaper, expose them, do these infant massages. And so that becomes a really like a concrete thing that dads can do. And that's, you know, with the mentality of men, they, they want to help dads or so want to help, but they just don't know how sometimes. And so to give them something concrete to do rather than, you know, just change the diaper, but something that they feel they're contributing to and it's really helpful. And then like there's sometimes too, you know, with, with, you remember when you're having a baby, you just want everything in control. And especially type A, people like us, we just want everything like for us to be in control. So then you can tell the moms and be like, no, listen, grandma's here, so let her do this. And Grandma's sitting in the back and saying, nodding her head. She's like, yes, please tell her to give up some of this stuff for me. You know, and so it just becomes, it becomes a really neat way to help the whole family out. And the underlying, my message always this, you support the moms, everything falls into place. But also with moms to allow them to a little like go a little and to be like no you can take that nap or you can let grandma do the dishes and don't feel guilty about it. Like it's okay you can pay them back later. Like four, six months later, give them a nice dinner. But for that moment, let them help you.

15:57                                  Nicole: Yes cause they're there for that.

16:00                                  Sonal: Cause sometimes you know like we, and I think I've, I've been victim of this too. Like I don't, I didn't let my mom or my mother-in-law do the things. I wish I would have been more up front to be like no I can't do this. Like this is too much for me as as opposed to being exhausted at the end of the day all the time.

16:19                                  Nicole: Yeah. So do you do any like blood work or blood tests that need to be done if needed and in the home?

16:27                                  Sonal: Yes I do. So mostly the, the most amount usually is for bilirubin. And so you do just do a heel stick for that. And I have a partnership with a local lab here where we can get the results same day results.

16:42                                  Nicole: Oh Wow.

16:43                                  Sonal: Yeah. And then the other one is just the newborn screen, which is also a heel stick. So majority of these ones are just heel sticks that you have to do.

16:50                                  Nicole: Okay. And then of course, I'm guessing you have a scale or something cause I know weight is an issue.

16:56                                  Sonal: Yes. It's literally the whole clinic. So I have the scale, I have obviously the stethescope, I have the Otoscope, everything just comes with me. Very portable.

17:09                                  Nicole: So it's like you can just do the newborn exam, everything right there.

17:14                                  Sonal: Yes. And then my lens is coming from an ICU setting too. And there's actually really neat thing in Colorado I think. And honestly this is my, I don't know about other states just cause I haven't looked into it, but I know in Colorado they, they passed a law that every baby and within 24 hours needs to be screened from a congenital heart disease perspective. So that, and that goes on their birth certificate. So any of those major cardiology, cardiac diseases I would have had in the past, put babies back in the hospital and cardiac shock are now actually screened before the baby can even leave. And if they fail the screen then they get an echo.

17:54                                  Nicole: Right.

17:55                                  Sonal: So one of the biggest things that we all worried about is now in the state of Colorado that's been alleviated. So in most, in majority of the cases what you walk into is a healthy newborn dot. Who, you know, who needs help with breastfeeding and a mom who just needs a support.

18:12                                  Nicole: Gotcha. Gotcha. Okay. Yeah. So you said you yourself do lactation and you have a mental health person. Who else is on your team? Do you have other folks that work with you?

18:22                                  Sonal: Yes. So I contract with other lactation people in the community. So why reinvent the wheel when there's some really good ones in the community as well? So sometimes when I, when I can't do, or sometimes new moms also there's an option to add just a lactation person visit, exclusively just for lactation since I will, and if I get too busy it's like, hey, could you please do that visit exclusively? So they, that's all they focus on is location. And then the other person, and we haven't had to use her yet, which is awesome. It's, and I think the beauty is why we haven't had to use her is our psychiatrist. And it's, it's because we...

19:04                                  Nicole: I want to stop for a minute everybody and look. Well she's just said she's excited that she doesn't have to use the medical professionals. Like we're not always trying, you know, pushed medicine and things like, yeah, we're trying not to in some cases. So you're saying you don't have to use the psychiatrist very often?

19:23                                  Sonal: No, we actually haven't had to use her at all. So far. What we've found is, and this is what research has shown, is that if you can support, so we offer the, like I'm one of those, it's like I'm not just going to do the one visit, I'm going to follow you and follow you until I make sure that you're okay. Cause for moms even I'm texting and their like, babies are four months and they're seeing their own pediatrician and it's just, I just find, and again, research support is that if you can support the moms in a good way and a good way, meaning addressing their needs and making sure that they're comfortable with all their needs, then you actually are preventing the anxiety and the blues or you're actually finding it out earlier. You're like, you know, you're aware at the two week mark, you know, your blues are there, you're still crying a lot. What's going on and you know, and then the three week mark there to start like, you know, I really don't think that you're, you're doing as well as you're saying. And then, then they kind of just open up and be like, yeah, I just don't feel this. And you know, at the one month, especially like I've had a lot of moms been like, all I do is breastfeed all I feel like.

20:36                                  Sonal: And then you give them the permission to go and get their nails done or the permission to be like without the baby. That's the biggest thing because then you have to realize, I like, you know, you've been taking care of this human for now 11 months, like a lump. Think about it. Like you have to carry her pregnancy. You have been so invested in it and so it's okay for you to go for 30 minutes to an hour to go get your nails done thing. Giving them the permission to do that is it's been like, oh I can, yes, you can go to Target.

21:10                                  Nicole: Gotcha. So it sounds like you have a really like, individualized approach and just it's really all about support. In that crucial period. Cause, I mean, I have to be honest, obstetricians certainly don't do it right now. We should, but I'm ashamed to say that we don't, you know, right now for the most part, people see their ob doctor not until six weeks later.

21:34                                  Sonal: But that's how the system is set. Right? That's how, you know, like we had just this year we had, um, and again, the pediatricians are so taxed also, right? Right. Cause now they're like now A&P and ACOG I believe just came out said, oh, you know, we should really be screening, you know, the dads or the significant others and you're just like, well how can I do this in 15, 20 minutes? Like that's ridiculous. Like you're asking so much of me. So, yeah, our system is, does not help support US support what we need to do the best that.

22:09                                  Nicole: Exactly. Yeah. Yeah. So if a family is thinking about how, if they want an in home pediatrician, where, where can they even go to look for one?

22:20                                  Sonal: So actually just Google it. You'll get surprised in your state how many pediatricians are people are out there doing it.

22:30                                  Nicole: So it's more common than, than we realize?

22:33                                  Sonal: I think there is a subset of people that are there. I know a doctor in Ohio that does it as well. And the more I am doing it, I'm getting exposed in it. So there's another, I believe she's a family med medicine doctor that is going to be starting her practice in Arizona. And she's like, I totally want to incorporate this because as a family medicine, I've honed it into this aspect of it. And so I get, I get people not a lot, once in awhile, every one month or two months I'll have a physician calling me. It's like, hey, how are you doing this? You know, and physician Facebook's things too. And I'll say that. And people are like, oh, this, this doctor meaning me is doing this in Colorado.

23:22                                  Nicole: I'm in the Richmond Virginia area and we have someone who does it around here. I was surprised. It's not something that I knew existed. So, yeah, definitely a great option. So women are thinking about this. What are three things that you recommend they should ask about or look for when they're considering having an in-home pediatrician visit for that first week or so?

23:44                                  Sonal: First of all, ask what the visit actually will look like. How long will it take? So if the pediatrician says is going to be like a 30 minute visit, I know from experience that no visit last 30 minutes.

23:56                                  Nicole: Okay. So you're saying at least an hour you think around it?

24:01                                  Sonal: Yes. I think if that pediatrician is providing that service, then definitely make sure it's a pediatrician, an MD. The reason I say that is just because I don't know what all the laws are around the different states and I don't know, I don't know the capacity of other people's training. But to have a pediatrician then, I mean that's the best advice because that's the lens that I'm looking at. You know, so, and lactation is important because unfortunately we're at a point in our time where everything's latched onto breastfeeding. If you, if you can breastfeed, you're a successful mom. If you can't then you're a failure. And I'm like, that is just absurd.

24:43                                  Nicole: It is.

24:44                                  Sonal: But yet, but that's what we're, what we're living. And so you have actually built in lactation or they can help you for the price, get a lactation person that they trust because some of those lactations are, are, are very diverse and just like how you interview a pediatrician, just see if you ask the questions about, you know, what are your thoughts on x, y and z? Meaning what are your thoughts on breastfeeding? What are your thoughts on co-sleeping? What are your thoughts on, you know, all of that stuff and see if they, if those answers fit what you are feeling. With the whole co-sleeping thing, I always say that it's so disservice to the moms to be like, okay, you can't, you can't fall asleep. Right? It's like, come on, think about it. Why is it the mom's responsibility for everything that like the dad? Like, just tell somebody, cause I had a c section and I had a terrible, my second one, I had such terrible grade threes and fours and oh my God, it was almost like, I mean it was a uterine infection and all that big mess that comes along with it. And I would sideline nurse because I was the most comfortable to me. Well sideline nursing is literally on a bed. Right? Guess what? I would fall asleep but it wasn't on me to make sure my baby was okay. I would tell my husband or I would tell my mom that was there, it's like, hey, I'm going to go lie down and breastfeed. Could you please come check on me? You know, cause it's like, that's just, it's like why do I have to do everything?

26:12                                  Sonal: Like why do I have to make sure that I'm sidelining I put, and the other thing I would do, especially during the daytime, would be put alarm on my phone just to make sure I wake up or then I can call somebody to help me. But I'm suffering here. I always say a c-section is, you know, it's abdominal surgery with a baby attached. So it'd be so hard for me to keep coming up and down from that bed. So to use my resources that are around me, especially the dad to be like, hey dude, I'm going to sideline. I'm probably gonna fall asleep because I'm tired. My body is recovering. If I do fall asleep, could you please move the baby from here.

26:48                                  Nicole: That makes lot of sense. You know, I hadn't even had any thought about that and I think it's great that you're like, you don't want to like shame women or scare when women, you want to give them factual information and then practical ways that they can address things.

27:04                                  Sonal: Yes. And I think that's what it is. And then, yeah, can you just, you kind of this whole idea of bed sharing and co-sleeping you kind of eliminate it because as a pediatrician we know that leads to deaths, and like as an ICU Doctor, I've seen the back end of it, right? So you don't want anybody to be in that position. But you have to understand the reality of when a mom goes. I think maybe that's why I was blessed with four different types of deliveries because I saw it, you know. Like I saw what a c section recovery looks like, I saw what a grade three and a floor with uterine infection looks like. I saw what a natural delivery look like. You know, like I saw all the different types of it. Why is it always on me? Like I carried this baby, right?

27:50                                  Sonal: People are around me trying to support me and help me. Exactly. For example, in my culture in India, there's some parts of the village where a woman doesn't get out of bed for 11 days and what happens? A baby's brought to her to feed and then the baby's taken away and all the household chores and everything is done by the, by the women around her and, and that kind of support. So it's all she has to focus on is I'm going to recover cause I just had a baby. So it's that kind of approach. You can't just put everything on us and then be like shocked that we have postpartum depression or anxiety or anger or our relationship with our husbands or our significant others are falling apart. So let's, let's kind of really use the tools that we have.

28:38                                  Nicole: So, the co-sleeping thing got me distracted from the question. Yeah. So, asking about, you said making sure they have lactation support, making sure it's a nutrition and the length of the visit. So those were the three things that for sure that they should ask. Okay. So then once they're seen in the home, how do you transition families to ongoing pediatric care?

29:01                                  Sonal: So again, this is from the ICU lens. So we always used to have the babies in the NICU and then when they left we would tell the pediatrician, hey, this is what's going on, this is how the baby did, and all sorts of stuff like that. And so that's how I view it. I just view it as an extension of hospital care because most pediatrician practices now, they don't actually see their babies in the hospital anymore. It's usually the newborn nursery or the NICU doctors seeing them. So for a month the care comes to me and then it's an easy transition to the pediatricians and at the end of it I tell the pediatricians, hey, everything is fine. Or hey, we need x, there's this that just please be aware.

29:41                                  Nicole: Okay, so you're with them and maybe I missed that. So you're with them for that first, that whole first month, you're in touch, texting and available and all that stuff. Okay.

29:51                                  Sonal: Yeah. Right.

29:51                                  Nicole: That's awesome. So can patients expect that their insurance will pay for this type of service or should they expect that they're going to have to pay for it out of pocket?

30:00                                  Sonal: I actually am investigating that answer right now. I don't know. For me personally, it's a fee for service payments. And, um, the way that I do it is that I know there's a lot of lactation people here that do private practice and people pay out of pocket for them. So I just see what their charges are and add about $30 to $50 more to that. So in this way it's like, well you're getting a medical doctor and lactation for x amount.

30:31                                  Nicole: Gotcha. Okay. So right, and insurance has all of these tricky things and you guys, it's hard on our side, especially when you're doing these different or unique models to make it work with insurance. So you may have to pay out of pocket, but this is another great thing that I think you can ask for on, I'm all about asking for what you need. So like in your baby registry, if you want to ask for, can I get a little bit of a donation towards having a postpartum Doula or a postpartum pediatrician come to my house? Like yes, the clothes and all those things are great, but just think about asking for some different sorts of services. This would be a great gift for somebody to give you for sure.

31:08                                  Sonal: Yes, definitely. Yeah. Yeah.

31:10                                  Nicole: So what do you feel like is the most rewarding part of your work?

31:15                                  Sonal: Just really going to the homes and people actually welcoming me with open arms and it's, it's just amazing and helping that family out. So it's one of my stipulations is after two weeks, the mom and the significant other have to go on a coffee date. It's just because you, you, you start that thinking, right. So it's like, and I don't ever say dinner or lunch because just, it just seems very overwhelming. And then you never know, like, you know, your baby's hungry, your boobs get big again. Like, but a coffee date is 15 to 30 minutes. And to step outside and enjoy that and actually allowing and giving permission to people to do that and seeing the reward behind it and be like, Oh, you know, Dr. Patel, we really enjoyed that. Thank you so much. Or I just feel like a brand new person and knowing that, you know, you helped that person out because at the end of the day, you're just a doctor.

32:12                                  Nicole: But the thing is, you're redefining though what a doctor does. I mean, you're obviously like more than just the medical piece. You're looking at how they connection between mom and baby is so important. And how as a pediatrician and a NICU doctor, you're playing a role in making that whole family healthy actually. So it's just a really, you know, refreshing way to look at care and it's great that you've figured out a way to do that.

32:44                                  Sonal: I think we all strive for that, don't we?

32:46                                  Nicole: We hope so. So yeah, for sure. Absolutely. We want to be able to, take that more holistic approach and it's more than just like checking weight or like, well, like you said when you went to that fourth visit and the nurse came and just like put your baby on the scale and you know, seeing you later kind of thing. We've kind kinda been backed into that model, but it doesn't have to be that way. Yeah. So what would you then say is the most frustrating part of what you do?

33:15                                  Sonal: That it's not more common.

33:22                                  Nicole: Yeah. Yeah, absolutely. And then what if you had to pick, like what are you the most passionate about when it comes to care caring for women and children? And that may be hard for you to answer about one single thing, but is there any particular issue that really, really gets you going when you care for women and children?

33:41                                  Sonal: I think postpartum depression is just because I've suffered through it and I'm a pediatrician and I asked my pediatrician for help and they weren't able to help me and you know, and the first time I suffered it was with my second baby, I suffered from it. And I just believe depression is just a misnomer though. I think it's a broader subject than that because I didn't even realize I was depressed, but in my mind I was mentally checking things off and be like, oh, I did this for my son and I did this for my son. I did this for my family and, but I wasn't connecting with my world. So if you were an outsider who really didn't know me, you couldn't tell me I was depressed. And then the second one, I had a lot of anxiety and I didn't realize that was also part of that umbrella.

34:25                                  Sonal: So I think it's, I think postpartum depression, when you add the word depression there, it just sounds like, like that's all you should have. You know? And some people have never, I've never had a depressive mood symptoms before at all. And, and I don't know what depression feels like or looks like, but here's two incidences where one was probably more of a depressive mood and I just didn't realize that not connecting to my world was like a big deal and the anxiety part of it. And that's part of it too. So that gets me going. And I think that's, that's the reason that looking at the research and saying that, oh, you know, if you provide the support it can prevent this. It can have a healthier transition. The fourth trimester as you know, there's so much data out there about the hormones and stuff like that, so we can ease that transition. It doesn't have to be so black and white.

35:22                                  Nicole: Yeah, absolutely. And then you talked about it a little bit already, but how have your personal experiences as a mom influenced your work as a pediatrician? I know I talk about how as an Ob, my first daughter was eight weeks premature. She had Duodenal Atresia and was in the NICU for a month. So I went through all that and of course that colors how I am as an obstetrician now having a preterm baby. How has your experience as a mom influenced your work?

35:52                                  Sonal: One breastfeeding does not define you as a mom. I've had four different experiences. My first one was an absolute failure. And I'm a pediatrician. It was my fourth one, I realized my body just gives up in nine to ten months. Because my kids are eating more, they have transitioned early to more table foods and I mean I wanted to make that magical one year that everybody talks about. And I remember what I had to do there, but then when I reflected back, it's like, wait a minute, they were getting enough milk. I just didn't realize it. And so, and then also with breastfeeding, some women are over producers, some women produce right amount and some women are under producers and we just have to kind of support everyone's journey and not like chastise them if they want to supplement. And that's what it is. It's supplementation. So let's kind of get away from everybody... I'm so happy that everybody approaches breastfeeding, but some women really struggle with it. So let's back off when they start struggling and it's okay. Like I've had a mixture of women myself, one woman I'm having working with now, she doesn't breastfeed, she just exclusively pumps because her baby, despite all the lactation interventions that we've done, still bites her, and her nipples are raw to the bone. Like really that's what the enjoyment we want from women to have from breastfeeding? So now it's like, okay, well I will nurse her when she's happy. So I enjoy that bonding part of it and then I can pump and you know, at the end of the day you're getting breast milk in the baby. So it's totally okay. So and that that's like my biggest thing right now.

37:40                                  Nicole: Gotcha. If you had to pick like your one favorite piece of advice that you would give to expectant parents, what would that be?

37:49                                  Sonal: There's a hundred ways of doing something and of parenting. Choose the way that's best, keep your babies healthy, safe, and at the end of the day that's what matters.

38:01                                  Nicole: Oh, that's perfect advice. I really like that. There's no like one right way to do things. You've got to figure out what works best for you and that seems to go through your whole approach. It's obvious that you take a very personalized and individualized approach and you're very passionate about what you do for sure.

38:18                                  Sonal: Well thank you. And I think it's just my experiences. I mean dealing with it and it's just, you know, you just see it. You just see if you can just allow women to have the permission of being like, yeah, this kind of sucks.

38:36                                  Nicole: Okay, did everybody hear that? Because you will, as a mother, I guarantee you, you have a moment where it is not like roses and flowers where you're just like right in this moment, this sucks. And that does not mean you're a bad mother. It doesn't mean you're, you know, unhappy. But it's just that permission to experience that and know that that is okay. That's a big deal.

39:03                                  Sonal: And give you permission to be real. I want to go get my nails done and raise a baby. Right. Just leave. Leave.

39:10                                  Nicole: Yes. Yes, absolutely. For sure. So where can people find you if they happened to be in your area and they're more interested in your services or are you on social media or anything like that?

39:22                                  Sonal: Yes, so my website is Naya Care, it's www.nayacare.org and I'm on Facebook at Naya Care Colorado. And then on Instagram, @nayacare. And I think my Instagram account is, it's fun for me. It's because I highlight pregnancy and postpartum stories in their rawest forms and these women have allowed me to publish their stories and I really enjoy that one. And then, yeah.

39:55                                  Nicole: Well I will link to those in the show notes guys, so be sure to look, look out for those. Sonal, I really appreciate you being here and giving us all this great information. It was a really fun conversation.

40:06                                  Sonal: Thank you so much for having me. I did enjoy it myself too.

40:09                                  Nicole: Yeah, okay. Right. I'll talk to you later. Okay.

40:11                                  Sonal: Okay. All right.

40:12                                  Nicole: Bye. Bye. So again, it wasn't that a great episode packed with tons of useful information on a model of care that I think is really interesting and helpful and I hope does start to catch on for sure in the United States. Now, after every episode I do something called Nicole's notes where I take my two or three top takeaways from the episode and tell you what I thought. Okay. So here we go. For Nicole's notes for this episode.

40:40                                  Nicole: Number one Sonal talked about releasing it control and not being super woman at postpartum. There's a little bit of pressure, I think, in our society. You know, you're supposed to do all the things and, and be all the things and take care of everything and really you just need to let people help you postpartum. That postpartum support is so important both for your physical healing and your mental healing. So do not feel like you have to do everything and be super woman postpartum. Let people help you.

41:19                                  Nicole: Number two, I liked how she talked about it should not just be your responsibility to take care of the baby. Everything doesn't have to be on you. And that example that she gave of co-sleeping and saying, telling your partner or your mom or somebody, hey, come check on me. I'm breastfeeding. If I fall asleep, you know, make sure the baby's okay. Like it doesn't have to be just your responsibility to care for the baby, get other people involved. And again, that goes back to that postpartum support. Now I was also talking about support in terms of things like, you know, washing clothes or cooking or grocery shopping. So you can focus on the things that you, that you want to do, but also don't be afraid to ask for help with the baby too if you need to. I also liked incidentally with the co-sleeping that she talked about how she meets women, where they are. We know from evidence that co-sleeping does increase the risk of death for babies. And sadly, unfortunately on the medical side we have seen those horror stories where women have fallen asleep and had that awful incident happening, happening of a baby passing away. However she understands the realities of it and that sometimes that it just happens. So I like how she talked about meeting women where they are as well, just as an aside.

42:41                                  Nicole: And then the final thing that she talked about was how taking a break from your baby is okay and maybe not just okay, but actually healthy and needed in order to help you be and feel better and just kind of get back to yourself a bit more with this new normal of having a newborn. I loved her idea of a coffee date. I feel like lunch or dinner can feel like more of a big production. It's going to be an hour, maybe two hours, but like a coffee date where you going grab a cup of coffee or a dessert date where you just go and grab some dessert. That doesn't have to be long. It's not quite as involved. You could even take the baby if you can't get a break from the baby, but just even getting out of the house and getting some fresh air can be very helpful.

43:36                                  Nicole: All right, so that's it for this episode of the podcast. Be sure to subscribe to the all about pregnancy and birth podcast in iTunes or wherever you listen to podcasts and I would most certainly appreciate it if you leave a review in iTunes. It helps the podcast to grow by helping other women find the show and I often give a shout out on the podcast to people who leave reviews, so please I'd really appreciate that review in iTunes. Now next week I am going to do an overview of pain management options on the podcast, all of the pain management options that are available to you in labor from non-medication options to IV pain medications to nitrous oxide to epidurals. I'm going to talk about the risks, the benefits, the pros, the cons of each of those methods. So come on back next week. And until then, I wish you a healthy and happy pregnancy and birth.

44:38                                  Today's episode is brought to you by Women's Wellness Coaching by Dr. Nicole Calloway Rankins. Head to www.ncrcoaching.com to check out my free one hour mini course on how to make your birth plan as well as my comprehensive online childbirth education class, The Birth Preparation Course with over eight hours of content and a private course community. The Birth Preparation Course will leave you knowledgeable, prepared, confident, and empowered going into your birth. Head to www.ncrcoaching.com to learn more.

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