Pregnancy and Infant Loss Resources

Pregnancy and Infant Loss Resources

While October is International Pregnancy and Infant Loss Awareness Month, these resources are needed throughout the year. Parental mental health is a priority for the NayaCare team and access to care and support through loss is a critical aspect of parental care. The resources below are primarily available throughout the United States, but there are some that are specific to Colorado. If there are additional resources that you or someone you know has found helpful, let us know in the cooments.

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Partnering up with Midwives

Partnering up with Midwives

National Midwifery Week, created by American College of Nurse-Midwives, is October 3-9.  This week celebrates midwives and midwife-led care. Visit to learn more. We, here at NayaCare, want to recognize our community midwives and their support in helping redefine postpartum care. We would especially like to recognize The Birth Center of Boulder in our continued partnership.

But what exactly is a Midwife and how does NayaCare’s model fit with midwifery care? 

What is a Midwife? 

A midwife is a health professional who provides care for mothers and newborns around childbirth.  Though usually associated with pregnancy and childbirth, midwives are also trained for women’s care throughout their lifespan.  

According to the definition of the International Confederation of Midwives, which has also been adopted by the World Health Organization and the International Federation of Gynecology and Obstetrics:

“A midwife is a person who has successfully completed a midwifery education programme that is recognised in the country where it is located and that is based on the ICM Essential Competencies for Basic Midwifery Practice and the framework of the ICM Global Standards for Midwifery Education; who has acquired the requisite qualifications to be registered or legally licensed to practice midwifery and use the title midwife; and who demonstrates competency in the practice of midwifery.”

Historically, the word derives from Old English mid, “with,” and wif, “woman,” and thus originally meant “with-woman,”.  The word refers to midwives regardless of gender. Male midwives were often referred to as accoucheurs. 

In the United States, the American College of Nurse-Midwives (ACNM) is the professional association that represents certified nurse-midwives (CNMs) and certified midwives (CMs). Midwives can practice in hospitals, maternity units, birth centers, private practices, and communities.  However, midwifery scope of practice is different from state to state due to individual state laws.  Depending on the midwife or practice setting, insurance to self pay are the payment models. 

How does NayaCare’s model fit with midwife led care? 

In the state of Colorado, a certified, credential midwife has independent practice and can see both moms and babies up to 6 weeks.  Standard newborn medical care requires 3 visits (2-3 day, 2 weeks, 1 month) during those 6 weeks.  Working with our midwives, as the pediatrician component, we conduct our visits within 24-48 hours after the first midwife appointment, 3 weeks, and then 5 weeks.  We, midwives and NayaCare, both can conduct the congenital heart disease screening, bilirubin levels, and state newborn screens.  Hearing screens are conducted by the midwives. We evaluate oral anatomy, address any tongue/lip tie issues, and are able to handle anterior tongue ties.  

This system allows for several things to happen. First, moms are continually supported during the 4th trimester.  Second, newborns have a designated pediatrician receiving pediatric care in the first week post birth. Issues that have risen include jaundice, heart murmurs, anterior tongue ties, and congenital skin lesions.  Third, in the mutual goal of supporting the dyad, the midwives and NayaCare, are in constant dialogue to elevate the 4th trimester for each mom-newborn-family.  

We are thankful for the opportunity to work with our community midwives.  Our care model and midwifery are complementary.  Revolutionizing postpartum medical care is a symphony of care models coming together with the goal of valuing the 4th trimester. 

Happy National Midwifery Week! 

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Newborn Sleep in the Fourth Trimester

Newborn Sleep in the Fourth Trimester

Newborn sleep in the 4th trimester has become so complicated.  Sacks versus swaddles, hats versus bare head, bassinet versus cribs and family beds.  Even terms such as co-sleeping and bed-sharing become confusing. All parents are thriving for optimal safe sleep for their newborns and ultimately themselves.  In order to understand newborn sleep, we need to take into consideration the 4th trimester.

The 4th trimester is the postpartum period, traditionally defined as the 12 weeks following birth. Dr. Harvey Karp coined this term in 2002, recognizing that “full-term” babies are actually born about three months early. Human evolution caused this disparity by favoring bigger brains and upright posture. Standing upright led to smaller pelvic sizes, resulting in early birth. Newborns, now, need an extra three months to adapt outside the womb, thus the fourth trimester. 

Why swaddling? 

Newborn sleep during the 4th trimester can be affected by the Moro or startle reflex. Evolutionary this reflex was a protective mechanism to defend newborns against prey.  Now, in the comfort of homes, the startle reflex can cause unnecessary wakings.  Therefore, swaddling is recommended until a newborn can start rolling over, a developmental milestone that occurs around 4 months. 

Benefits of swaddling also include mimicking a womb, providing deep pressure touch, and help with colic and gas. Newborns can gravitate to their side during sleep, which is normal. Try to reserve swaddling for sleep.  This way, inadvertently, you are setting up a sleep bedtime routine.  Sometimes swaddles help with soothing a distressed baby due to gas or over stimulation and tiredness. 

A favorite choice for swaddling fabric is muslin, soft against newborn’s delicate skin.  Other blankets that can be used are large receiving blankets or swaddles that are sewn with pre-folds, velcro or zips.  

Do you have to swaddle?  Or the most common question I get asked is that my baby, a Houdini, always escapes the swaddles–now what?

First, you don’t have to swaddle. Another option is a sleep sack.  A sleep sack is adding an extra layer to the baby without using a blanket.  Nowadays, you have an option of a single swaddle, sleep sack, or even a swaddle sleepsack! 

Does my baby need a hat? 

Contrary to popular newborn pictures, healthy term newborns do not need a hat.  Since thirty percent of heat escapes from a baby’s head, hats in healthy term newborns can cause babies to overheat.  Another reason, hats tend to fall out and can increase the potential for SUID (sudden unexplained infant death). Therefore, ditch the hat.  If your baby is premature, hats are helpful with temperature regulation two to three weeks after coming home.  

Where should my baby sleep?

Just a basic question though steeped in controversy.  Before diving into the answer, let’s define terminology around co-sleeping and bed-sharing. These two words often get intertwined regarding sleeping next to newborns. 

Co-sleeping is sleeping in proximity to your newborn that includes room sharing and bed-sharing.  Bed-sharing is physically sharing the same space your newborn sleeps in including a bed or a sofa.  Co-sleeping is a natural human behaviour that promotes breastfeeding and infant development.  American Academy of Pediatrics (AAP) recommends and supports co-sleeping upto a year.  Bed-sharing can lead to an increased risk of neonatal deaths and SUID, previously known as SIDS (Sudden Infant Death Syndrome). 

Just recently as of January 2020, the American Breastfeeding Medicine (ABM) revised their protocol around bed-sharing. Under the right circumstances (no smokers, no prematurity, no sofa, bed on floor,and breastfeeding) ABM supports bedsharing that leads to increased breastfeeding duration.  This is in stark difference to AAP who still currently denounces bed-sharing.  Side note:  Both organizations consist of Board-Certified Pediatricians. 

Therefore, what should I do as a parent? 

First, always practice safe sleep methods regardless of placing the baby in a bassinet, co-sleeper, crib, or even bed sharing. Safe sleep methods included placing babies always on their back, no smoking or smoke exposure, no loose blankets, crib bumpers, toys or items in the designated sleep space, and a firm sleep surface. Next, be open with your pediatrician about your decision.  As objective medical providers, we might unearth other issues such as postpartum anxiety.  Lastly, even if you start bed-sharing, try to wean towards co-sleeping in separate spaces, allowing everyone a restful sleep. 

Bed-sharing is only allowed if you are breastfeeding.  Other parameters include no smoking, no alcohol, and your baby cannot be premature or low birth weight.  If you qualify and still want to bed-share, the research based guidelines are thus: 1. Place the firm mattress on the floor and away from walls to prevent wedging of the infant.  2. The sleep order is baby and mom. Mom needs to be in a C-curved position termed “cuddle curl.” Dad can sleep elsewhere.  3. Babies should still practice safe sleep techniques such as sleep on backs, sleep sack, no blankets, soft toys or pillows around the baby or mattress.  And yes if you want to practice this way, then you have to follow ALL these guidelines, absolutely no shortcuts. 

Read my complete article on how I handled newborn sleep in the 4th trimester published in Scary Mommy here.  Feel free to reach out with any questions! 

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An Open Letter to the Colorado Legislature re: HB 21-1232

An Open Letter to the Colorado Legislature re: HB 21-1232

From a Maternal Health and Pediatric Physician: reasons why we, Physicians, are against Colorado HB 21-1232.

I am a Neonatologist and Pediatrician with a focus on delivering high quality care that supports maternal mental health.  I have been a resident of Colorado since 2009. I feel it is important to publicly share my opinion regarding Colorado House Bill 21-1232 since it will impact my service to my patients.  

This bill addresses rising health care costs by creating a Colorado Public Option.  I support a Public Option; however, the way this bill is written it will close private practices in Colorado and will consolidate primary doctors to work within large hospital systems only or move. Primary doctors consist of pediatricians, internists, and family practice.  Physicians serving your community and dedicated to providing preventive care to you and your family.  Losing our primary care doctors will be a loss to Colorado.  Before diving into the logistics of the bill, let’s start with some background: four years ago I left institutional hospital care and opened NayaCare, a newborn specialty clinic that comes to you. In my role as a Neonatologist, I worked at a local hospital.  Over the years, I noticed more of my time devoted to patient medical documentation, attending meetings surrounding how to increase revenue via billing, and learning the complexities of insurance.  I had less time for my patients and more energy directed on creating earnings.  Leaving the hospital system and focusing on direct primary care including those with medicaid support brought me back to why I became a physician in the first place – caring for my patients, not the hospital’s volume targets or insurance company bottom lines. 

Unlike many of the private practice and hospital-based practices, NayaCare managed to care for our patients throughout the pandemic without issues of people being unwilling to come in for office visits. Our in-home, come-to-you care model was already structured for the health and safety of our patients. In addition, we utilized telehealth visits to further care for and protect our patients during this vulnerable time. 

Lastly, a note on how health insurance actually works.  You, the patient, pays into a policy that supports your family.  We, the physicians, are under contract with insurance.  When you come to see us, we bill the insurance company for our services delivered.  The insurance company, then, decides if they feel our billing/coding/charting suited their service model and pays us accordingly.  We usually receive the reimbursement 2 months AFTER your service has been completed. Those insurance payments keep our office open, lights on, and staff employed.  If we are not timely in our submission of claim of service, we can lose the money.  This is why many clinics have opened a dedicated billing department.  Moreover, if we challenge the payment back, we are usually caught up in months of debate, time taken away from our patients.  Oh, and here is the kicker, some insurance companies can take back the money that was already allotted to us for the service rendered up to 7 years after the service has been completed.  See, this is why we don’t like insurance either. 

The bill, which is presented in a complex and convoluted manner, is ill-founded and the consequences of the precedence being created by it are not fully understood by the front-line physicians it directly affects. However, what is immediately made clear with this bill, physicians that do not comply with the participation mandate will be fined and eventually subjected to hearing defending their decision and medical license, putting all private practices and direct primary care physicians at risk of closing or moving. The only option for Colorado patients will be to seek care under large corporate hospitals and care groups that are more concerned with their bottom lines than the quality of patient care. 

Also, highly concerning are the advisory board composition which includes only ONE physician seat and an insurance commissioner who has total veto power over the advisory board and who is appointed by the governor every 4 years. How will this board and commissioner model protect patients from a bill that is more concerned with special interests and the business of medicine versus the care of the people of this state? 

Again, as mentioned above, I support the theory of a Public Option.  This bill, at the bottom line, will drive doctors away from Colorado.  I encourage our legislators to create a Public Option that actually serves Coloradans.  From a patient perspective, insurance that brings quality care, removes burdens to access care, and renders coverage in wellness services to support preventive medical care.  From a physician’s perspective, insurance that removes the cost and administrative burdens of insurance.  Insurance that pays us on a timely basis and also is clear on service rendered and reimbursement given, no hidden tricks.  A Public Option that does not deny care and places burdens on patients and physicians to defend the medical care decisions.  

In a world of innovation, remove the barriers for the physician patient relationship.  Stop creating more administrative, red tape layers and squeezing our time away from our patients.  Stop making hurdles and mandates on how we should serve our patients. Stop dictating to us how we need to practice medicine and threatening us with penalties and medical license revoking warnings.  Stop feeding into the business of medicine.  Start supporting physicians and patients rights to deliver and receive quality medical care.     

To learn more about this bill, click here.

To contact your Senator, click here

Bath time:  How often should I bathe my baby?

Bath time: How often should I bathe my baby?

For new parents, this is a constant ask and worry if they are doing the right thing.  Commercials depicting a smiling baby lathered in gentle bubbles is an image most parents want to replicate.  And like any aspect of parenting, there is the ideal image and then reality.  

Newborns actually don’t like baths for a couple reasons.  One, the bath environment is too cold.  Getting out of a warm bath and hitting the cold air is not pleasant.  Second, newborns like to be reminded of their womb; bathtubs can invoke the startle reflex in which babies get alarmed, stretch out their arms, and recoil.  The startle reflex is actually an evolutionary defence mechanism from preys.  Not a pleasant reminder when you should be relaxing.  Going back to the happy baby bath commercials, next time, notice that those newborn are actually developmentally older  babies. 

So, are baths really needed for newborns?

Actually, no. At least not every day. Infants do not get dirty enough to require daily baths, and daily bathing will dry out their skin. Through the first year, three baths a week is more than enough.  Also remember, the umbilical cord stump needs to fall out prior to the first bath.  Sponge bathing is appropriate for newborns.

To ensure a better bath experience for both parents and babies, do the following:  Warm the room in which you bathe to 75° F.  Gather towels, soap, a diaper, and clean baby clothes before you start. It is often easier to bathe your baby if you have two people doing the job.

Fill the sink or bathing tub with water that feels comfortably warm to your elbow, but not hot. Put in enough water to cover your baby so they don’t get cold. Gently ease your baby into the water holding  securely in your arm.

There are a couple of different ways to hold your baby for a bath and you can choose what is more comfortable for you. One way is for your baby’s head to rest in the bend of your elbow or on your forearm with your hand holding her arm securely. The other option is to support your baby’s head in your hand and have their body submerged in the bath.

Wash your baby’s face and eyes with water only, no soap. You may add a bit of mild hypoallergenic baby soap to the bath water and wash their body. You can wash their hair next. Scrub baby head with a soft nail brush (you can take the brush that is used in the hospital to wash your baby’s hair.) Scrubbing your baby’s head with a little soap and this brush twice a week may help prevent cradle cap. Don’t forget to clean in the creases and under the neck. 

You can also wash your baby’s hair after drying her from the bath. Wrap her in a warm towel (heated in the clothes dryer) to help keep her warm. Hold her head near the faucet, and wet and wash her hair. Gently dry thoroughly getting creases as well. 

Many newborns have some areas of dry skin that go away on their own. During the newborn stage, babies usually do not need additional lotion on their skin. Some babies have skin that is very dry and splits, especially around the ankles and hands. You can put olive oil, Vaseline/Aquaphor, or A‑D ointment on those areas. 

If you want to use lotion, choose one that does not have perfume or dyes, such as Cetaphil or Eucerin. Bathing and soap are drying to your baby’s skin, so don’t bathe your baby too often and use only a small amount of soap on your baby’s skin.

Just like any experience with parenting, if it’s too overwhelming to bathe then there are alternatives such as sponge bathing your baby.  

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Now is the time for postpartum home visits

Now is the time for postpartum home visits

I ring the doorbell, waiting patiently outside.  I hear a weak “coming” and some shuffling.  Who greets me is a mother in her robe, hunched over at the waist, supporting her protruding postpartum belly.  Her hair is disheveled.  Her mask is revealing exhausted eyes with attempted mascara to look a “little freshened up,” she confesses a little later.

“My husband is just getting the baby; please come in.”

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