Nurturing Your Little Fighter: A Guide to Post-NICU Care for Your Baby’s Development and Wellbeing

Nurturing Your Little Fighter: A Guide to Post-NICU Care for Your Baby’s Development and Wellbeing

Welcoming your baby home after a stint in the neonatal intensive care unit (NICU) is a blend of joy and apprehension. As a parent of a premature or medically fragile infant, navigating post-NICU care might seem like yet another uncharted territory. In this guide to post-NICU care, we’ll equip you with key things you need to know—from the importance of post-NICU care for you, your baby, and family to setting up a nurturing environment at home, and lastly,  finding support and resources along the way.

Understanding Post-NICU Care and Its Significance:  Continued Development

Post-NICU care marks the transition phase post-discharge, vital for your baby’s continued development and wellness. It encompasses regular check-ins, vigilant monitoring, and unwavering support. You, as a parent, are the frontline advocate, entrusted with ensuring your baby’s progress aligns with expectations. Regular consultations with healthcare providers, adherence to medical plans, and tracking of your baby’s health, feeding, and sleep patterns are essential. Don’t hesitate to ask questions and seek clarification on any aspect of your baby’s care.  

But even before you head out of the NICU, here are tips that can make the transition home easier: 

  1. Prior to discharge, your medical team will come up with a discharge plan.  Though they will have it written out for you, rewrite in your own words/notes to have concrete clarity.  Then, repeat the plan back to your medical team to make sure the plans align.  I found this very help with my patients and learned where I might not have been clear. 
  2. Keep all medical records in a folder.  Take the folder to all appointments. 
  3. If you need any equipment, feeding tube or oxygen, check the equipment prior to discharge and have a clear contact number for the designated company in case of questions or concerns. 
  4. In some cases, you will be required to take CPR.  I would recommend that for all my NICU families. It’s a valuable tool. And, if ever the situation arises, you will have some substantial help while waiting for paramedics. Also taking CPR applies to anyone taking care of the baby from nanny to grandparents.  
  5. For visitors, please talk to your medical provider regarding safety due to the cycle of COVID, RSV and flu.  It’s ok not to have visitors if you choose. All visitors need to have an updated flu and pertussis shot. 
  6. Allow family and friends to provide food.  It’s ok for them to leave at the door.  
  7. Good hand washing prior to touching the baby for all involved.  
  8. Lastly, continue the routine from the NICU, it will help you and baby ease into the routine at home. 

Creating a Haven: Preparing Your Home for Your Baby’s Homecoming:

Crafting a haven conducive to your baby’s growth is pivotal in post-NICU care. Tailoring the environment to suit your baby’s unique needs allows a safe and nurturing space where they can thrive.  For example, prioritize a serene sleeping area, invest in a reliable baby monitor for added peace of mind, and meticulously eliminate potential hazards. Unless your NICU providing team sends you home on an oxygen monitor, this equipment is not needed.  The American Academy of Pediatrics has guidelines for if your baby goes home on oxygen: When Baby Needs Oxygen at Home.  Consider reaching out to organizations like the March of Dimes or the National Association of Neonatal Nurses for guidance on creating a safe sleep  environment for your baby.

Vigilance and Nurturing: Monitoring Your Baby’s Health and Development

Attentive monitoring at home empowers you to detect subtle changes in your baby’s well-being and address concerns promptly. Regularly assess for signs of discomfort or illness, track feeding habits, and collaborate closely with healthcare professionals to monitor growth milestones. Your vigilance ensures early intervention, safeguarding your baby’s health trajectory. Utilize resources such as online trackers or mobile apps designed specifically for monitoring preterm or medically fragile infants’ health and development.  One example is Pathways Baby Development Tracker for Premature Newborns. 

Development also dictates feeding, sleep and comfort. Your baby’s needs differ from those of full-term infants. Embrace the journey of understanding your baby’s unique cues and preferences.  Organizations like La Leche League International offer breastfeeding support and resources, including local support groups and online forums where you can connect with other parents facing similar challenges.  Here at NayaCare, we have developed a breastfeeding toolkit for the NICU graduate and encourage you to join our NICU specific facebook group, Small Steps, BIG gains for online feeding support specifically for NICU graduates.  

Enriching Development: Stimulating Your Baby’s Senses and Learning

Engaging your baby in sensory-rich experiences fosters holistic development. Sing, read, and interact with your baby, creating a vibrant sensory environment. Introduce varied textures, colors, and sounds to stimulate cognitive growth and nurture a lifelong love for exploration and learning. Explore resources such as developmental playbooks or sensory stimulation kits designed to promote your baby’s sensory and cognitive development.

Self-Care Amidst the Journey: Coping with Stress and Anxiety

Navigating the post-NICU journey may evoke stress and anxiety; acknowledge these emotions as part of the process. Prioritize self-care, lean on your support network, and seek solace in shared experiences. Sometimes in reality, words are easy to write and hard to execute.  However, we all need grace and encouragement to prioritize rest, add physical activity when able, and to be reminded that your well-being is essential for your baby’s welfare. Consider joining support groups specifically tailored to parents of NICU graduates, where you can find camaraderie, understanding, and coping strategies such as PremieWorld.  

Seeking Support:  Additional Resources for Post-NICU Care

Harnessing available resources and support networks is instrumental in navigating the post-NICU terrain. Your healthcare provider serves as a beacon of guidance, offering valuable insights and connecting you with relevant support groups and organizations. Embrace the community of parents who understand your journey intimately, providing solace and solidarity along the way. Explore online resources such as NICU parent blogs, social media groups, and virtual support networks where you can connect with other parents and access valuable information and support. Additionally, consider reaching out to local hospitals or healthcare organizations for post-NICU care programs and services tailored to your baby’s needs.

Here are some support group links for parents of NICU babies:

  • Preemie Parent Alliance: A network of support organizations for families of premature infants. 
  • Hand to Hold: Provides comprehensive support programs for NICU parents, including peer-to-peer mentoring, online support groups, and resources for coping with NICU-related stress and anxiety. 
  • NICU Helping Hands: Provides support and resources for NICU families, including NICU Family Support Specialists who offer guidance and assistance during the NICU journey. 
  • The NICU is hard on families.  Please remember, you’re not alone on this journey.  Here, at NayaCare,  we offer two services to help our families. 
  1. A NICU transition visit in which we spend 60-90 minutes in your home helping answering any medical questions, conducting a newborn exam, checking any equipment, and addressing any other concerns. The appointments are conducted by Adrienne Isaacs, MSN, NNP-BC, our neonatal nurse practitioner or myself.  Appointments are covered by Medicaid. 
  2. Free “mommy check in” call with our counselors helping mom a space to tell their story, struggles, and concerns around the NICU.   
The Critical Role of Vitamin D for New Moms and Babies

The Critical Role of Vitamin D for New Moms and Babies

Pregnancy and early infancy mark significant periods in a person’s life, demanding utmost care and attention to ensure optimal health and development. Among the essential nutrients needed during these stages, Vitamin D stands out for its pivotal role in maternal and infant well-being. In this comprehensive exploration, we delve into the critical importance of Vitamin D for new moms and babies, discussing its necessity, sources, deficiency testing, treatment methods, and the latest literature supporting its significance.

Mechanism of Vitamin D

Vitamin D, a fat-soluble vitamin, facilitates the absorption of calcium and phosphorus. 

Here’s a breakdown of how Vitamin D is used in the body.

1.Sun Exposure: When your skin is exposed to sunlight, a precursor molecule in your skin called 7-dehydrocholesterol undergoes a chemical reaction, converting it into pre-vitamin D3.

2. Conversion in the Liver: Pre-vitamin D3 then travels to the liver, where it undergoes further modification to become 25-hydroxyvitamin D [25(OH)D], also known as calcidiol. This form of Vitamin D is the major circulating form in the bloodstream and serves as an indicator of overall Vitamin D status.

3. Activation in the Kidneys: 25(OH)D travels to the kidneys, where it undergoes another transformation catalyzed by an enzyme called 1-alpha-hydroxylase, resulting in the production of the active form of Vitamin D, known as 1,25-dihydroxyvitamin D [1,25(OH)2D], or calcitriol.

4. Regulation of Calcium and Phosphorus: Calcitriol plays a crucial role in regulating calcium and phosphorus levels in the body. It enhances the absorption of calcium and phosphorus from the intestines into the bloodstream, ensuring an adequate supply for various physiological processes.

5. Bone Health: One of the primary functions of Vitamin D is to maintain bone health by promoting calcium absorption in the intestines and preventing calcium loss in the urine. Adequate Vitamin D levels help ensure proper mineralization of bones, preventing conditions like rickets in children and osteomalacia in adults.

6. Muscle Function: Vitamin D also contributes to muscle function and strength by maintaining calcium levels within muscle cells. Sufficient Vitamin D levels may help reduce the risk of falls and fractures, particularly in older adults.

7. Immune Regulation: Emerging research suggests that Vitamin D plays a role in modulating the immune system, potentially reducing the risk of autoimmune diseases and supporting immune function.

8. The relationship between Vitamin D and mental health is an area of growing research interest, with evidence suggesting that Vitamin D may play a role in various aspects of mental well-being. Here’s an overview of the relationship between Vitamin D and mental health:

  • Mood Regulation: Vitamin D receptors are present in areas of the brain involved in mood regulation, such as the hippocampus and prefrontal cortex. Studies have suggested that Vitamin D may influence the synthesis and release of neurotransmitters like serotonin, which are involved in mood regulation. Low levels of Vitamin D have been associated with symptoms of depression and anxiety.
  • Cognitive Function: Adequate Vitamin D levels have been linked to better cognitive function and a reduced risk of cognitive decline in older adults. Research suggests that Vitamin D may play a role in neuroprotection, promoting nerve growth and repair, which could contribute to maintaining cognitive health.
  • Seasonal Affective Disorder (SAD): Seasonal Affective Disorder is a type of depression that occurs at a specific time of the year, usually during the winter months when sunlight exposure is reduced. Vitamin D deficiency, resulting from decreased sunlight exposure during winter, has been implicated in the development of SAD. Supplementing with Vitamin D or light therapy, which mimics natural sunlight, has shown some benefit in managing SAD symptoms.
  • Schizophrenia and Psychotic Disorders: Some studies have found an association between Vitamin D deficiency during prenatal or early life stages and an increased risk of developing schizophrenia and other psychotic disorders later in life. However, further research is needed to establish a causal relationship and understand the underlying mechanisms.
  • Neuroinflammation: Vitamin D has anti-inflammatory properties and may help modulate immune responses in the central nervous system. Dysregulation of immune responses and neuroinflammation have been implicated in various mental health disorders, including depression, anxiety, and schizophrenia. Vitamin D’s anti-inflammatory effects may contribute to its potential role in mental health.

While these findings suggest a potential link between Vitamin D and mental health, it’s essential to note that the relationship is complex, and Vitamin D supplementation is not a standalone treatment for mental health disorders. Factors such as genetics, lifestyle, diet, and environmental influences also play significant roles in mental well-being. Therefore, further research is needed to elucidate the mechanisms underlying the relationship between Vitamin D and mental health and to determine the potential therapeutic implications. Individuals concerned about their mental health should consult with healthcare professionals for personalized assessment and treatment recommendations.

Vitamin D Needs Increase During Pregnancy

During pregnancy and breastfeeding, the recommended daily intake of Vitamin D escalates to 400- 600 IU/day, ensuring adequate support for the developing fetus and newborn.  Insufficient levels of Vitamin D during these phases can elevate the risk of complications such as preeclampsia, low birth weight, and preterm birth, underlining the significance of supplementation to avert adverse outcomes. Moreover, a randomized control trial even advocated for pregnant women taking up to 4,000 IU of daily vitamin D to prevent preterm labor/births and infections.  Talk to your OB/GYN for the right amount of Vitamin D for your individualized health and verify the amount of vitamin D in your prenatals.  

Benefits of Vitamin D for Newborns and Infants

Beyond skeletal health, Vitamin D offers a myriad of benefits for newborns and infants. It shields against infections, asthma, and eczema while potentially reducing the likelihood of type 1 diabetes. Moreover, Vitamin D plays a pivotal role in cognitive and neurodevelopment, underscoring its influence on a child’s academic performance, behavior, and overall growth trajectory. Recent studies have further elucidated the importance of Vitamin D in maternal and infant health. For instance, a study published in the Journal of Nutrition found that maternal Vitamin D deficiency during pregnancy was associated with an increased risk of gestational diabetes mellitus and low birth weight (Aghajafari et al., 2013). Another study published in JAMA Pediatrics highlighted the link between maternal Vitamin D status during pregnancy and offspring neurodevelopmental outcomes, emphasizing the long-term implications of adequate Vitamin D levels for child development (Whitehouse et al., 2012).

For infants, the recommendations for Vitamin D supplementation vary depending on the country and healthcare guidelines. However, the end goal is for the breastfeed baby to receive a minimum of 400 IU of vitamin D.  

  • American Academy of Pediatrics (AAP): The AAP recommends that exclusively and partially breastfed infants receive a daily Vitamin D supplement of 400 IU (international units) starting from the first days of life. For breastfeeding mothers, the AAP suggests they continue taking prenatal vitamins containing Vitamin D or supplement with 600 to 800 IU of Vitamin D daily to ensure sufficient levels in breast milk.
  • Health Canada: Health Canada recommends a daily Vitamin D supplement of 400 IU for breastfed infants until they reach one year of age. For breastfeeding mothers, Health Canada advises a daily intake of 600 IU of Vitamin D to ensure adequate levels in breast milk.
  • National Health Service (NHS) UK: The NHS suggests that breastfeeding mothers should take a daily Vitamin D supplement of 10 micrograms (400 IU) to ensure they and their breastfed infants receive sufficient Vitamin D.
  • World Health Organization (WHO): The WHO recommends a daily Vitamin D supplement of 400 IU for infants and children under five years of age who are at risk of Vitamin D deficiency. They also advise lactating mothers to take Vitamin D supplements if they have limited exposure to sunlight or are at risk of deficiency.

In the 4th trimester: How New Moms and Babies Can Obtain Sufficient Vitamin D

Attaining optimal Vitamin D levels during pregnancy and lactation necessitates diverse strategies. Moderate sun exposure, approximately 10-15 minutes per day, enables the skin to synthesize Vitamin D; however, precautions against excessive sun exposure are vital to prevent sunburn and skin damage. Additionally, incorporating Vitamin D-rich foods such as fatty fish, egg yolks, and fortified products into the diet can augment intake. When dietary sources are insufficient, supplements offer a reliable means of meeting the required Vitamin D levels, with dosage tailored to individual needs under healthcare provider guidance. Furthermore, breastfeeding mothers should prioritize maintaining their own Vitamin D levels to ensure adequate transfer of the nutrient to their infants via breast milk.

Breastfed babies can receive this supplementation directly. An alternative way is for breastfeeding mothers to increase her own intake of vitamin D supplementation safely to 6400-8000 IU/day.  Formula fed babies receive adequate amounts in their formulas.  When newborn feeding is from breastmilk and formula or families are transitioning from breastfeeding to formula feeding, supplementation of vitamin D should continue until the baby is receiving over 50% of nutrition from formula. 

Deficiency, Testing and Treating

Research has shown that 40-60% of the US population is vitamin D deficient.  Contributing factors include lack of foods that contain vitamin D, lactose intolerance, and usage of sunscreen. Other factors can include the ability to make/absorb vitamin D.  In terms of sunscreen which prevents skin care, most sunscreen products are activated after 15 minutes of application.  Thus, applying sunscreen right before exposure can ensure the 10-15 minute exposure needed while balancing the protection from sun exposure.  

Regular assessment of Vitamin D status through blood tests is suggested during pregnancy to detect deficiencies.. Upon diagnosis, healthcare providers prescribe high-dose supplements to rectify deficiencies, followed by maintenance therapy to sustain optimal Vitamin D levels. A combined approach involving supplementation and judicious sun exposure proves effective in addressing deficiencies and safeguarding maternal and infant health.

Take Home Message

In essence, Vitamin D emerges as a cornerstone of maternal and infant health, exerting profound impacts on bone strength, immune function, and neurodevelopment. By prioritizing adequate intake of Vitamin D through sunlight exposure, dietary sources, and supplementation, expectant mothers can optimize outcomes for themselves and their babies. Regular screening for deficiency and prompt intervention further enhance the prospects of a healthy pregnancy and infancy. With ongoing research continuing to underscore the importance of Vitamin D, it remains a key focus in maternal and child healthcare.


Aghajafari, F., Nagulesapillai, T., Ronksley, P. E., Tough, S. C., O’Beirne, M., & Rabi, D. M. (2013). Association between maternal serum 25-hydroxyvitamin D level and pregnancy and neonatal outcomes: systematic review and meta-analysis of observational studies. Journal of Nutrition, 143(5), 765-772.

Whitehouse, A. J., Holt, B. J., Serralha, M., Holt, P. G., Hart, P. H., & Kusel, M. M. (2012). Maternal serum vitamin D levels during pregnancy and offspring neurocognitive development. Pediatrics, 129(3), 485-493.

Vitamin D Supplementation during Pregnancy Part 2 NICHD/CTSA Randomized Clinical Trial (RCT): Outcomes.

The Benefits of an Ayurvedic Diet for Postpartum Health

The Benefits of an Ayurvedic Diet for Postpartum Health

As a new mother, it’s common to experience a range of postpartum health concerns including fatigue, anxiety, and digestive issues. To address these issues, many new moms turn to supplements. While supplements can be helpful in some cases, relying solely on isolated nutrients can do more harm than good. A better approach may be an ayurvedic diet. Ayurveda is an ancient Indian system of medicine that emphasizes the importance of balance in all aspects of life, including diet. In this blog post, we’ll explore the benefits of an ayurvedic diet for postpartum health and provide some helpful tips for getting started.

A More Holistic Approach Tailored to the Individual

One of the biggest benefits of an ayurvedic diet is that it provides a more holistic approach to health. Rather than addressing isolated nutrients, ayurveda focuses on bringing balance to the body and mind through food. An ayurvedic diet is customized to suit the unique needs of the individual, taking into account their dosha (individual body type) and any specific health concerns. This tailored approach helps to address postpartum health issues at their root cause, allowing for long-term relief.

An Emphasis on Whole Foods

An ayurvedic diet emphasizes whole foods that are fresh and in season. These nutrient-dense foods help to nourish the body and bring balance without relying on supplements. Focusing on locally grown produce

Eating Fresh, Seasonal Foods

Another benefit of an ayurvedic diet is that it places a strong emphasis on eating fresh, seasonal foods. This means that the diet changes with the seasons, providing the body with the nutrients it needs to stay healthy throughout the year. This approach is particularly beneficial for new mothers, who are often in need of extra nourishment after giving birth.

Ayurvedic Herbs and Spices Provide Micronutrients

Ayurvedic herbs and spices are an important part of the diet, providing the body with the micronutrients it needs to stay healthy. For example, turmeric is a potent anti-inflammatory, while cumin aids in digestion. By incorporating these herbs and spices into their diet, new mothers can address specific health concerns while also supporting their overall health and wellbeing.

Problems with Relying on Supplements

While supplements can be helpful in some cases, there are some downsides to relying solely on isolated nutrients. For one, quality and safety regulations for supplements are limited. It can also be difficult to know which supplements to take and in what doses. Additionally, supplements don’t address the importance of lifestyle factors like emotional health, exercise, and sleep.

Tips for Getting Started

If you’re interested in trying an ayurvedic diet, there are a few steps you can take to get started. Firstly, it’s important to find out your dosha (individual body type), as this will help you tailor the diet to suit your own needs. You can do this by taking

Sample Ayurvedic Meals and Recipes for New Moms

Creating an ayurvedic meal plan can be a daunting task, but it doesn’t have to be. Here are some dosha-specific meal ideas with their benefits:

Vata: quinoa porridge with cinnamon, nutmeg, and ginger (warming and grounding)

Pitta: steamed vegetables with coconut oil and cilantro (cooling and cleansing)

Kapha: lentil soup with turmeric and cumin (warming and stimulating)

For an easy recipe idea, try this kichari recipe:

1 cup brown rice

1 cup yellow mung dal

3 cups water

½ teaspoon turmeric

1 tablespoon ghee

1 teaspoon cumin seeds

1 teaspoon mustard seeds

1 teaspoon coriander powder

½ teaspoon rock salt

1 tablespoon chopped fresh cilantro

Combine rice, mung dal, water, and turmeric in a pot. Bring to a boil, then reduce heat and simmer until the rice and dal are tender (about 30 minutes). In a separate pan, melt ghee and add cumin seeds, mustard seeds, and coriander powder. Cook until fragrant, then add to the kichari. Add rock salt and chopped cilantro and serve.

Lifestyle Tips to Support the Ayurvedic Diet

In addition to changing their diet, new mothers can support their overall health and wellbeing by incorporating these lifestyle tips:

Get enough rest and sleep

Practice gentle yoga, meditation, and massage

Use aromatherapy to uplift mood and energy

Spend time in nature and with supportive loved ones

An ayurvedic diet provides a holistic approach to postpartum health that addresses the unique needs of the individual. By focusing on balance through fresh, seasonal foods, herbs and spices, and dosha-specific meal planning, new mothers can support their overall health and wellbeing in a way that supplements simply can’t match. By incorporating lifestyle tips like rest, gentle movement, and supportive social connections, new mothers can further enhance the benefits of an ayurvedic diet. So don’t hesitate to give it a try and experience the transformative power of ayurveda for yourself.

Supporting Vaginal Health After Childbirth: The Role of Estrogen

Supporting Vaginal Health After Childbirth: The Role of Estrogen

The beauty of childbirth brings along several changes, such as hormonal fluctuations that can significantly impact the body. One crucial factor affected by childbirth’s hormonal changes is vaginal health. Estrogen has a significant role in maintaining the thickness and elasticity of the vaginal tissues. Let’s delve deep into how to support vaginal health post-childbirth by understanding the impact of estrogen and other practices.

How Estrogen Levels Change Postpartum

After delivery, there is a rapid drop in estrogen levels in the body. This decline becomes more pronounced while breastfeeding, leading to dryness, irritation, and discomfort in the vaginal area. Though this is a normal physiological change that occurs in the postpartum period, thinning and decreased elasticity of the vaginal tissues can lead to microtears causing painful urination, defecation, and also during sexual intercourse.  Hence, a healthy level of estrogen is vital for maintaining proper vaginal health.

Treatment Options

Topical vaginal estrogen preparations, such as creams and suppositories, help provide localized estrogen without any systemic effects. However, oral estrogen is not recommended while breastfeeding. Be sure to consult with your healthcare provider to find the best treatment plan for you.

Additional Ways To Support Vaginal Health

There are several ways other than medical treatment that can support vaginal health. Keeping the body hydrated is one of the simplest but most effective ways to do so. Seeking pelvic physical therapy to help strengthen the pelvic floor muscles and incorporating perineal massage during the postpartum phase are few other essentials in promoting the healing of the perineum. Lastly, using lubricants during intercourse enhances comfort and reduces the likelihood of vaginal microtears.

Knowing When To Seek Help

While a drop in estrogen levels is a normal postpartum change, the symptoms associated with it should resolve within 6-12 months. However if you have these symptoms, consulting with your healthcare provider is crucial to determine if there are any underlying issues related to your vaginal health.

Take Home Message

Maintaining vaginal health after childbirth is crucial to recover well and lead a healthy lifestyle. The role of estrogen in this is undeniable, and there are several ways to support it. Along with medical treatment, keeping the body hydrated, pelvic physical therapy, perineal massages, and using lubricants during sex can aid in vaginal health. Always remember to consult with your healthcare provider regarding any concerns or symptoms to determine the best treatment plan for you. Lastly, focus on restoring elasticity and moisture to promote optimal vaginal health and enhance postpartum healing.

Need further support and guidance? Book a free consultation! 

Are you a breastfeeding mother and lost how to achieve your breastfeeding goals post-NICU?  Get our FREE breastfeeding toolkit here:  Small Steps, BIG Gains.

A New Hope for Mothers Suffering From Postpartum Depression or a Band-Aid?

A New Hope for Mothers Suffering From Postpartum Depression or a Band-Aid?

The FDA approval of Zurzuvae (zuranolone), the first oral medication, has offered new hope to mothers who have exhausted all other treatment options to cope with their postpartum depression. This is a milestone in recognizing the maternal mental health crisis that plagues our country.  The benefit of this drug is that it offers a new approach to treating postpartum depression and brings postpartum health into the spotlight. With Zurzuvae and other treatments gaining recognition in mainstream media, postpartum health is becoming an essential topic in society.  And yet, Zurzuvae is a reactive sparkling toy distracting from the root causes of postpartum depression.

One in seven women suffer from postpartum depression.  Some factors that have led us to a maternal mental health crisis include a social stigma surrounding postpartum depression, lack of universal paid family leave, childcare concerns, barriers to healthcare access in terms of equity and race, and a postpartum medical care system in which 40% of women do not attend their appointments, to name a few. We have created a system for mothers to fail, and now we are in crisis mode.     

Each of the above “lack of” could be its own book. My lens is through the medical field.  I graduated medical school in 2003. Since then, saying the healthcare landscape has drastically changed would be an understatement. Though we have attempted to create policies that support prevention (expansion of Medicaid/Medicare under the Affordable Care Act), we are constantly in reactive mode as evident by the national COVID response. 

My training continued as a pediatrician who further specialized  in neonatology and lactation.  Admittedly, until I personally tested America’s postpartum system through my own four diverse pregnancies, I didn’t realize the massive holes.  It’s a system that demanded my return to pediatric appointments mere days after I delivered with a broken body and a newborn to support.  Then, repeating the process several times in the first month in exchange for ten to fifteen minutes of infant care.  No wonder my mind fractured months later with undiagnosed postpartum depression and postpartum anxiety.

Postpartum depression is not something that can be treated with a pill alone. The current medical care system does not adequately address a postpartum mother’s healing. One underutilized and economically sound solution for preventing postpartum depression (PPD) is in-home postpartum visits.  Home visits allow for more quantitative and qualitative PPD screening.

In 2017, MIECHV (Maternal Infant and Early Childhood Home Visitation program) demonstrated an average PPD screening rate of 75 percent. The federally funded MIECHV supports more than 3,200 state and local agencies that conduct home visits via 20 different models. Economically, MIECHV programs see “a return on investment of $1.89 for every dollar spent.” Families benefiting from MIECHV home visits also report an increase in household income. According to the Center for American Progress, every $1 invested in home visiting programs yields a $3 to $5 return to society. 

Other benefits from at-home healthcare includes reduction in maternal and infant mortality and improvement in breastfeeding rates. These outcomes lead to significant reductions in health care expenses.

As we applaud the national spotlight placed on maternal mental health, we cannot overlook the systemic, social, and medical barriers that have led us here.  Concurrently, as we pour resources into scientific research, we need to economically support the real, granular issues impacting maternal mental health.  America’s postpartum healthcare system needs to change to prioritize prevention rather than glorify quick fixes.  Otherwise, we will keep placing bandages over what is none other than a hemorrhaging crisis.

  1. Postpartum Depression: StatPearls
  2. Postpartum depression risk factors: A narrative review – PMC
  3. Long-term effects of a home-visiting intervention for depressed mothers and their infants
  4. Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program | MCHB
  5. EVIDENCE ON THE LONG-TERM EFFECTS OF HOME VISITING PROGRAMS: Laying the Groundwork for Long-Term Follow-Up in the Mother and Inf
  6. Home Visiting: A Common-Sense Investment – Center for American Progress
The Economic Benefits of Paid Family Leave During the 4th Trimester

The Economic Benefits of Paid Family Leave During the 4th Trimester

What exactly is paid family leave?  

Paid family leave is longer-term leave to care for family members more commonly associated with birth or adoption.  Leave, depending upon the paid family model of care, can be partially or fully compensated during the said time period. Currently, the United States, Papua New Guinea, and a few island countries in the Pacific Ocean are the only nations in the world that do not require employers to provide paid time off for new parents. 

Paid family leave differs from the Family and Medical Leave Act (FMLA). President Bill Clinton signed this law on February 5, 1993.  FMLA is a federal law that provides up to 12 weeks of job protection, but leave is unpaid.  

On December 20, 2019, President Donald Trump signed the Federal Employee Paid Leave Act.  It provides America’s 2.1 million federal workers with up to 12 weeks of paid leave following childbirth, adoption, or fostering.  At the state level, paid family laws are being passed around the country. Thirteen (13) states and District of Columbia, at this time of publication, have laws though some not fully implemented.  Those states include: California, Connecticut, the District of Columbia, Massachusetts, New Jersey, New York, Rhode Island, Virginia, Washington, Colorado, Delaware, Maryland, New Hampshire, and Oregon. 

According to 2012 Labor Department data, one in four employed women reported returning to work just two weeks after childbirth. Pew Research results showed 17 percent of women returning to work less than six weeks after giving birth. In a poll of 3,000 working parents, LinkedIn and Censuswide found that 49 percent of women took an extended maternity break, and 75 percent wanted to but couldn’t for financial reasons. Replacing these workers costs an estimated 21 percent of an employee’s salary.

 So what are the economic benefits of paid family leave?

Advantages of Paid Family Leave

Maternal and Child Benefits 

Paid family leave has been associated with improved maternal and child health outcomes.  Mothers with paid leave are more likely to breastfeed. Analysis of California’s Paid Leave Program showed that women’s breastfeeding duration increased from two to 12 weeks.  According to Bartick et al. (2017), America could save “$17.2 billion in costs associated with medical expenditures and premature births if mothers were able to exclusively breastfeed for six months.”

Paid leave reduces neonatal mortality by 5.2 percent, infant mortality by 2.4 percent, and the under-five-years mortality rate by 1.9 percent. The Center for Epidemiological Studies-Depression found that paid maternity leave is associated with a 15 percent reduction in maternal depressive symptoms.  Paid family leave also benefits newborns through decreased incidence of low birth weight, preterm birth, and hospitalization. Long-term childhood benefits include enriched nutrition, better overall health, and early-education achievements.

Paternal and Child Benefits

Adding paid parental leave further improves outcomes in breastfeeding, infant mortality, and childhood development. Research associated with California’s Paid Leave Program shows that by adding paid parental leave, length of breastfeeding increases by nearly 18 days. 

Data from 16 European countries from 1969 to 1994 found that paid parental leave— specifically a 10-week paid leave—“correlated with a 3.3 to 3.5 percent reduction in child mortality and a 2.5 to 3.4 percent reduction in infant mortality.” 

Data from the United Kingdom shows that parental leave increases a father’s involvement in childrearing by 19 percent. Sweden’s results demonstrate that lengthened interaction between father and child increases cognitive development at six months of age.

Employers and Economic Benefits

Paid family leave after childbirth can offer significant financial advantages to companies.  Advantages included reduced rates of turnover, enhanced productivity, and engagement of employees.  Employees who have access to paid family leave are more likely to return to work after the birth of their child and express more job satisfaction, engagement, and measurable productivity.  As a result, employers benefit from less turnovers.  
According to studies looking specifically at women with paid family leave, women employees also reflect the above findings.  With more women returning to work, advantages have been linked for both individual women and families as well as the national economy.  In 2022, the Council of Foreign Relations estimated that if women were part of the US labor force at the same rate as men, America’s economy would grow by $4.3 trillion in five years.


The financial, economic, and health advantages of paid family leave during the 4th trimester are staggeringly positive.  Although many nations have adopted this strategy, the United States has not yet done so universally. It’s time for the US to follow the lead of the many other nations.  It’s time for the US to have universal paid family leave. 

Read more about these benefits in The Doctor and Her Black Bag:  How Old Fashion Care Tackles Maternal Mortality and Benefits America’s Economy.