What happens when the healthcare system fails a physician? Dr. Sonal Patel, a pediatrician, neonatologist, and lactation specialist, has lived both sides of postpartum care. After personally navigating postpartum depression, perinatal anxiety, pre-eclampsia, VBACs, severe tears, and breastfeeding struggles across four pregnancies, she turned her experience into action.
Dr. Patel founded NayaCare, a home health clinic reimagining postpartum support, and co-founded the Center for 4th Trimester Care, a physician-led national nonprofit challenging the status quo of maternal healthcare. She’s a TEDx speaker, author of The Doctor and Her Black Bag, and a passionate advocate for paid family leave, helping pass Colorado’s FAMLI legislation.
In this episode, we’re talking about what the “4th trimester” really looks like, why even the most privileged mothers fall through the cracks, and what better postpartum care could mean for families and their babies’ sleep.
- Website: nayacare.org
- https://www.instagram.com/nayacare/
- https://www.facebook.com/nayacarecolorado
- https://www.linkedin.com/in/sonal-patel-md-12982a141/
- https://www.youtube.com/@nayacare6918
- Tiktok: @sonalpatel4tridoc
Episode Highlights:
- Dr. Patel opens up about her own postpartum journey across four pregnancies, from postpartum depression and perinatal anxiety to pre-eclampsia and breastfeeding struggles. If a physician with every advantage still fell through the cracks, what does that mean for every other mother?
- We dig into why the postpartum window is one of the most overlooked periods in maternal healthcare, what “4th trimester care” actually looks like in practice, and how Dr. Patel built NayaCare to fill the gap that families desperately need filled.
- From her TEDx stage to the halls of Colorado’s legislature, Dr. Patel has turned personal experience into policy change. We talk about her nonprofit work, paid family leave advocacy, and why fixing postpartum care isn’t just a women’s health issue. It’s a children’s health issue too.
Sleep Struggles Solved + Results Guaranteed
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Welcome to the Kids Sleep Show podcast, where we dive into the magical world of sleep and all things parenting. Join us as we embark on a journey filled with expert advice, practical tips, and heartwarming stories that will transform your little ones into sleep superheroes and empower you to navigate the beautiful chaos of parenting. I’m your host, Courtney Zenz, and I’m on a mission to change how the world views sleep and provide accessible sleep coaching resources for all families to build healthy sleep habits in their home for children and adults of all ages. As an award-winning speaker, author, and pediatric sleep expert, myself and my team of consultants work intimately with families around the world to teach healthy sleep habits to children and adults. I believe wholeheartedly that sleep is the foundation for which a happy home is built. So let’s sleep together. Hey, everyone. Welcome to this week’s episode of the Kids Sleep Show podcast. I’m your host, Courtney Zenz, and I am excited to have Dr. Sonal Patel here today to talk to you all about Nyacare and the company that she started out of living as a pediatrician and neodatologist, the experience of the fourth trimester. So welcome, Dr. Patel. I’m so glad you’re here. Thank you so much for tuning in and joining us today. Oh my gosh, thank you so much for having me. This is, I’m so excited. So I’m excited to do this conversation too. Well, and I love having guests on that bring, you know, the science side of things with the living it side of things. That’s how I very much started Tiny Transition. So why don’t you start by telling us a little bit about your background and then again, your experience, you got four kids and you kind of said, wow, this is a little bit overwhelming. So let’s start with how you got started in the space of medicine. And we’ll kind of go from there. Of course. So it actually, actually start back in college, met my now husband, college sweetheart, literally two weeks into college, he likes to say three, just because he thinks he has one more week of bachelorhood that he has, but in all honesty, it wasn’t that. And then we both went to become physicians. But what happened is that we did long distance for med school. So our relationship has gone through all the ups and downs. And it and then we embarked on being parents. And that’s really what started challenging, you know, your mindset, because now we are two physicians working training. So we initially our first one was when we were training. And I was a pediatric resident, and he was an orthopedic resident. And then our other three came after we were, you know, the grown up doctors and attendings. And I always say that I made an incredible pregnant women, pregnant woman, because if you actually look at my birth stories and trauma, you’d be like, why did you get, why did you keep getting pregnant? And I think there’s an amnesia with it that comes with it too. And I just, and postpartum killed me. And I would say people always focus on the mental health part, which I definitely had, but it was also the physical aspect of it. One of the things that they just don’t teach you is, you know, this physicality of your body changing. And, you know, we’re always told that, oh, you know, after you have a baby, you’re going to pee, you’re going to have some incontinence, ha ha ha, that’s normal. And doing the work, I was like, whoa, whoa, that is not normal. There was no education behind it. So it took me four times to figure out that something’s wrong with our system. And it was at this time, I was a NICU full fledged NICU attending. And I had my fourth and see, I’m Indian also, which is really important to this story, because in our culture, you know, my mom was a practicing OBGYN in Nebraska. And she would not take any baby or any patient that was due or on my due date because it was just an understanding that she would just come for two weeks. And then after that, it would be my mother-in-law for two weeks. It was just standard. It was just a given. And I made her do it four times. But with my fourth, what happened, I had preeclampsia. So my babies actually came before the due date, found myself in a position where I had to kind of take my kids to school, then go get care. And it was a 10 minute care. And I remember the nurse practitioner, she looked at me and she goes, oh, you’re an anatologist. You’ve done this three times. You’re good to go. And my jaw dropped because it was like a 10 minute appointment with her. But I had taken four hours to get there. And I was like, how did it even serve me? Like it didn’t. So I came back home and I said to my husband, I looked at, I was like, I just needed a weight check. That’s all I needed. And so we looked in our area and there’s Kaiser that does it, but you have to have an insurance for it. And then there’s concierge services that do it, but that’s not, that’s not, you know, feasible for everybody. And I was like, this is crazy. And then fast forward, you know, it’s been seven years since I’ve opened that company. We bring medical care to the house. And it has taught me so much. And I’ve leaned into so much of all of it. So we bring medical care. We recognize the fourth trimester. We’ve been recognizing for seven years. And now one thing that’s changed is the vocabulary. Because before, seven years ago, I was like, oh, this is the fourth trimester. And everybody would look at me like really strangely, like, what are you talking about? And literally one of my friends who is a physician, she goes, I only learned three. Was I missing in class when the fourth was discussed? But that’s how it came to fruition. I love that. And I think you’re spot on with the expectation, right? I mean, similarly to your story, I have two kids and I am a very type A person. I like to, I would say, say I’m organized and very driven. And I was always very good at my career. You know, before kids, I wanted to climb the corporate ladder and do all the things. Right. And so I think ignorantly, I thought, well, when I have my son, I’ll have 12 weeks at home and I’ll still manage my team of 40 and milk a flow like wine from my nipples and everything will be great. You know, and my son was 10 days late. He came. They induced me. That was a very smooth procedure. You know, he came. I delivered him. And my husband was sitting in the corner because it was month end. He was the international controller at eBay. So my son was born on the 28th of April. You’re in the hospital for like one night after that, like the 29th. And they let me go home. I don’t remember if it was the 29th at night or the 30th in the morning. But either way, my husband’s like, got to go to work. Peace out. We’re closing the books. And I was like, what are you talking about? Like, I have an ice diaper on. I got, you know, blood and mucus. And I don’t know what’s happening. You know, I got a baby and I’m trying to nurse. And this is a mess. And he’s like, all right, well, I’ll see you around 530. You know what I mean? And like, we didn’t have a village. I didn’t have any support. I didn’t have my mom had passed away. you know, it was like, I didn’t, I didn’t have anything. I didn’t have anyone and everybody lived away. And, you know, and it was just like, Oh, okay. Like I can do this. It was awful. Like I don’t want to say hated. Cause that’s a strong word. I don’t like to use the word hate, but I didn’t love being home for 12 weeks. I didn’t know what I was doing. I felt ill prepared. I was recovering. My body was recovering. I was trying to be in the vision of the world. perfect, right? Perfect nursing, perfect sleep, perfect, you know, perfect house, perfect garden, grass is cut, house is clean, dinner’s ready, everything’s good, you know? The 50s lady. Yeah, and in my mind, it was like, holy crap, this is not awesome. I don’t know what I’m doing, you know? And so I very quickly kind of tailspinned, and I know you talked a little bit about, which I want to talk about because I don’t think people bring it up enough and it drives me nuts, is postpartum, right? You have all these hormonal changes to your body, right? You’re also bringing a human home. And it took me a solid eight weeks to figure out like what I was doing and to start to frankly feel a bit of confidence in my journey and what I was doing. And I think, you know, we’ll talk about lessons, things I’ve learned, things I’ve done. And now how I, you know, from a practice standpoint, like how I see what you’re doing and like how pivotal it is. But I want to talk about postpartum anxiety, postpartum depression, postpartum intrusive thoughts, because that fourth trimester, that’s all there. And I don’t think people talk about it enough. Or like my girlfriend was like, Hey, bud, I think you should talk to somebody. And I was like, I went to see someone and they were like, tell me about your dad. And I was like, I’m not here to talk about my dad. My dad, he lives in like Texas. Like he, you know, like we’re, I just, I just don’t like this, you know? And I was like, okay, maybe this isn’t for me, but you know, it was just, It wasn’t a great experience, but I didn’t even understand that like postpartum intrusive thoughts were a thing and they paralyzed me. I was in my living room for eight hours a day and was afraid to basically move because I was like, what if I trip and fall and smash Max’s head on the stairs? What if I go into the kitchen to cut a cucumber and I accidentally drop the knife and it ricochets and I cut his leg off? You know, and it was like all these things where you’re like, whoa, stop. So then I just wouldn’t go in the kitchen. I would barely go to the bathroom. You know what I mean? And it was like it just almost became like so paralyzing. So can we take a minute? I would love to just understand like what this, what all of these things are so that people who are listening to this, who maybe are pregnant or just had a child are going, oh, that’s me. Yeah. So before we even start that, but do you see the dichotomy of our experiences? I had all the health and I still suffered. You had no village and you still suffered. And so you know, there is something going wrong, right? Like there is something not, we are not addressing the fourth trimester in a very meaningful way because we’re two extremes and we both were suffering. So that makes you scratch your head. It’s like, wait a minute, we’re doing something totally wrong here. So the, and I like to step back and say why I call it the fourth trimester and postpartum and not postpartum, because if you see every trimester, your first, your second, your third, you are treated as a pregnant woman together. Your health is connected to your baby’s health. Also from a medical perspective, because that’s where the lens I’m bringing in within the first, second and third trimester, you have so many more medical appointments. You just do. And then you have the baby and there is this physical separation and you literally have for yourself one appointment and then you are thrown into the realms of the pediatrician to go there like almost weekly. And you are not together. So we call it dyad care, because it is if I and I can spend a whole hour kind of talking about how, and we’re going to talk about postpartum anxiety and intrusive thoughts and stuff, and how paralyzing that health could be. But then on the same seesaw, you’re supposed to be breastfeeding this child, right? And you’re like, wait a minute. So in the fourth trimester because it is to understand that medically they’re still so intertwined, like we cannot separate that. And then I take it one step further and I go, it’s postpartum is what we’re trying to prevent. So what does that mean? I’ll say it again. It’s postpartum is we’re trying to prevent. We’re trying to prevent the postpartum depression. We’re trying to prevent the postpartum anxiety. We’re trying to prevent the breastfeeding difficulties. We’re pain. You know, we don’t even talk about that. We’re trying to prevent the high divorce rates that we see when you have, you know, a baby. That’s what we’re trying to prevent because as a pediatrician, it’s all about prevention and not reaction. So when we look at the mental health aspect, particularly in the postpartum world, and I was an anthropological major in college, So this is kind of coming full circle. I always say, let’s look at it evolutionary first, and then we can add the science behind it, right? So when we look at it from an evolutionary standpoint, when we say, when we look at other mammalian animals, we say, when is our babies independent? And that’s defined by when they can find their own food, right? That’s independence. So if you talk about a giraffe, right? A baby giraffe is born in two hours, and they’re already nibbling on a leaf. So they’re totally independent there. But our newborns are so dependent upon us, particularly in the first three months. And you can kind of say that, OK, you know, at six months, we can kind of call them independent because they’re starting to crawl and or they can grab food and stuff. But it’s not technically until one year that they’re dependent or independent, sorry, independent. So then you’re like, wait a minute. So why did we create a system where, you know, our babies are so dependent on us? Well, the thing is that evolution wanted us to walk. And if you actually look at a one year old head of a baby’s head, if we were supposed to deliver that, we would still be on all fours. So what evolution said was like, okay, you know what, if you’re going to walk, and you’re going to walk upright, you have to have the pelvis brim be smaller, and you have to have the pelvis brim be smaller than your baby’s head has to be smaller. And then your baby is not fully developed. So they’re so dependent upon us in the fourth trimester in particular. So going back to that, the other thing evolution wanted us to do was stay up at night, right? Like everybody’s like, why are the babies up at night? Well, have you ever been to the zoo during the day? Okay, when are you supposed to go to the zoo? Morning or dusk, because your predators are out at night. And predators are more during the day. And you’re not supposed to go in the afternoon because everybody’s asleep. And there is science behind prolactin circadian rhythm that every mom that you talk to is like in the afternoon, they’re super tired. But at night, they might have a terrible, terrible night cluster feeding all night, babies awake all night. But in the morning, they’re not as tired as one should be. So that’s prolactin that’s working in our breastfeeding bodies. And the other thing is that milk is geared for melatonin more so so babies can sleep at night. So it’s just so amazingly fascinating. Now, when you come to postpartum depression and anxiety and everything like this, we’re supposed to have emotions, right? We have been taught that we’re not supposed to have emotions. Every intrusive thought is like, oh my God, I postpartum depression. I must have postpartum anxiety. I must be clinically not stable. But we’ve done a really poor job of explaining that. I feel like I’m going to take full credit for the medical society for that piece of it. And I kind of equated back to diabetes. Okay, so how does it equate back to diabetes? Every molecule, every cellular level, it needs glucose, i.e. sugar, to function. When you give your body too much sugar, it becomes dysfunctional. And then we labeled it as a disease, meaning now You have diabetes because you’ve given your body too much of an element that it doesn’t need. So the same thing with our postpartum depression, anxiety, and everything like that. It’s not that we are saying that you cannot be sad. It’s not that we’re saying you can’t have these emotions. When we kind of screen you guys there, it’s like we want to make sure those emotions that you’re having is not debilitating you. And I think when we change that mindset to be like, oh, I’m okay to have those emotions. But when it’s debilitating me, then we have, quote unquote, disease, then we have postpartum depression, then we have postpartum anxiety. And it’s also not to dismiss the other part of it, that if it’s like, if you are continually having intrusive thoughts, like you said, you were paralyzed. Well, that’s disease. Right? Like that’s, that’s not healthy for you or the baby, but it’s also not to say that if you have one thought that’s fleeting in a day that, oh my God, you have postpartum depression, you have postpartum anxiety. And that’s also can become paralyzing in itself. Yeah, absolutely. I mean, I think it’s, it’s worth to mentioning like that all of it is okay. You know what I mean? It’s okay if you can even recognize that something is different. Like some people, I was just away for, you know, as we were sharing quickly, my daughter had her Irish dance world championships and one of the moms, her sister just had a baby and she was asking me questions. The baby’s four weeks old and the mom is hallucinating. That’s how tired she is. Like, so she’s like, was, she was talking to the, her, her mother. So the baby’s grandmother who happened to be in Chicago with us. And they were asking me all these questions. I was trying of helped them over the course of a couple of days and she was already feeling better. But she, she shared how she was talking to her daughter. The baby was home and you know, they live, we’re outside of Philadelphia. And she said, I literally was scared. I was talking to my daughter and she’s like, mom, I’m starting to see and hear things. And the mom was like, I will be there in an hour. And basically like dropped everything and went and took the baby and was like, you need to go lay down. And she couldn’t sleep. Cause it’s like, you know, she just, it’s not as easy to just lay down and pass out, but she was so tired and so overwhelmed. Her husband was traveling or I forget if he’s in the military or something. I don’t know them like well, but he’s not around right now. And he’s traveling for work and she’s, she was having all these like hallucinations and like, that’s not healthy either. You know what I mean? So it’s just like, when you start to look at like this period of, you know, that fourth trimester where, you know, if you’re nursing exclusively, there’s a pressure to have that be a perfect experience. And it’s, it’s a hard experience as a lactation counselor myself and somebody who has a scale that I, you know, for my second child knew to get, because to your point, you, in order to get a weight check, you have to leave your house. And if you’re unsure what baby’s transferring, how do you know if they’re eating enough? And then my kids were always very tiny. They still are. They’re 99% head, 1% height and weight, both of them, you know? So like I dropped from one to percent to zero and they’re like, your baby’s failure to thrive. I’m like, can we calm down with that term right now? Okay. I’m pumping every three hours. I’m nursing every three hours. I’m up every two to three hours at night, fully feeding for 35 minutes. Like I’m doing everything within my body’s ability to feed this child, you know, and sometimes you’re kind of flying blind on some of those things that you don’t know. Like, should I have a scale? Can I get like, you know, so I want to talk a little bit more about Nyacare, like that scale, right? Like helped me 10 years ago before you existed, right? To know like, okay, baby just ate on the left breast and they ate on the right breast and they got five ounces. So now I know that for that feeding, they got five ounces. Great. And like some of it’s a numbers game to know that like they’re getting what they need to thrive. But a lot of parents don’t have that, right? So you came out with, in 2018, Niacare, right? So you now come into the home and I wanna talk about the things you do because you can, as a doctor, you can also screen for like some of these things where when you come in, you’re like, And that’s a red flag, right? Of something that might be going on so that the person get the appropriate type of care or referred out or depending on the situation, right? But like, talk about what you bring into the home because all of this stuff is, again, not talked about enough but it’s also like, it needs to be explained as to like what you’re doing and why you started this company to help these different challenges that parents face because it’s like, I’m a, like I said I’m kind of a proactive person. I was like, all right, I gotta figure this out. And then when I had the second kid okay, I’m going to do it this way. And we’re going to try to do it this way. And I did feel better because I had a bit more confidence, but still the second one came and you’re like, Oh, Oh, the second one comes and it tells you that you have not done anything right. Like it’s just a given fact. So like talk about night care. I want to help people understand like what you saw this gap and went, wait a minute, we have this fourth trimester and yet I have to leave the house and do all things. It’ll be four hours to get out of the house for a 10 minute wait check. Right. Yes. So the real impetus, well, the real impetus initially was like, this is stupid, like that part of it. But seven years now, it’s along the journey. And I’ll tell you exactly what we do. But what the pushing is maternal mortality crisis in America. And we do have a concrete maternal mortality crisis. And when we call it a crisis is because we are one of the most first world countries and we have the highest number of maternal deaths. And when you look at maternal deaths, it’s happening after birth. The majority of them are happening after birth. And we’ve already alluded to the fact about how much medical care you get pre-pregnancy or in pregnancy. And then now post where, you know, that six week appointment literature shows us as only 40% of women actually go there. And then the other thing to add to this whole picture is like, okay, big deal, 40% don’t go there. But one of the rising diagnosis in women’s is chronic pelvic pain. That’s one of the rising diagnosis. And when you kind of go back, it stems from the postpartum fourth trimester piece of it. So when we come into the home, our first of all, our appointments are 60 minutes long. New parents are 75 minutes is just a given because it’s all this stuff. And you’re absolutely right. Once you walk into that house, first of all, someone is so in survival mode and they’re very vulnerable and they’re inviting you into their space. So I take that with such huge gravity because like it’s, you’re inviting me to your space when you are literally struggling for everything and anything. And then our appointments will start, I become the pediatrician. So it’s complete medical care because whatever I can do in the clinic, I can do at home, even jaundice checks and even in-home phototherapy. So we work company that does in-home phototherapy, I don’t have to go tell you to go to a lab because I will draw the lab there at the house. And then so everything is contained at the house for the baby. Then for the mother, we actually screen them. And that’s going to lead to the things that we’re going to discuss later in maternal mortality part of it. And we’re going to do the OB screens, like the bleeding, physical recovery. So the first appointment is really focused on physical recovery because we want that pelvis, right, to start healing from the get go, right? Like I’m not like, we’re not going to wait until six weeks, because now we’re already behind. So we focus on pelvic recovery, you’re bleeding, we take your vital signs and vital signs are huge. And we’re having this national study that we’re doing, because we know in the first when remember, I said that most women die after birth. And if you look at the first six weeks, it’s cardiovascular. And one of the easiest thing to do cardiovascular is get your blood pressure and kind of see where we’re going with them. Then we have built in feeding sessions because I like to keep it feeding. I am lactation. Also, I do assess for tongue ties. I do all of this. I’ve done OMT training to help with this. But sometimes medical reasons is where you cannot exclusively breastfeed because there’s a medical reason behind it. And there might be times where, you know, people are like, this is my second or third time mom that I’m meeting for the first time. And they’ve already decided because of their initial journeys, that they’re going to supplement with formula. Well, we got to talk about mixing formula and preparations of that too. So if I just call it breastfeeding, that really curtails the broader conversation of, okay, how is feeding your baby? And actually, I’ve learned so much for my patients, because the dads, first of all, the dads are always there, because they don’t have that, you know, for their worst schedules, and stuff like that, they can do it. And the dads have like been like, well, no, feeding is a family event. It’s just not for the mom. So I’m going to be taking part of feeding. And then it’s also feeding of the mom. So we can bring that in there because nutrition is huge. We push water so much, we push it, but we forget to tell them nutrition. And if you’ve had a C-section, that’s not 400 extra calories that we’re taught, right? You’ve had a major abdominal surgery, that is 1800 for a baseline, you got to put that surgical recovery calories in there. And then you got to put that 400 calories of breastfeeding in there. So sometimes it’s close to like 2500. So even 3000, you know, and people get so paralyzed that, oh my god, I can only do 400 calories. It’s like, but you had a C-section, like it’s abdominal surgery. So feeding is also feeding the mom and why that is important. Then we talk about safe sleep because infant mortality is super high. And one of the reasons is because of safe sleep, but what people don’t talk about is reduction of risk. They is this idealistic, you know, I said, I have AP American pediatrics, and then the ABM, which is American breastfeeding of medicine. And yes, ideally, you want to do ABCs. Let me just say that again. Ideally, you want to do ABCs. But there’s a reality of the fourth trimester. And what you don’t want to do is have a baby sleep on you. And then you’re sleeping on the couch. And a lot of families will break up the night with the dad. But don’t you think the dad is also sleep deprived? You know, so we literally open talk about safe sleep and how we can in their space reduce risk harm. And that’s what we’re trying to do. And then lastly, I talk about prolactin naps. So this is something key that a lot of, and this is where the science comes in. And once I introduce prolactin naps to my families, it’s a game changer. And you’re just like, so, and I’ll get into this a little bit more. And then obviously leftover questions and stuff. I’ve had grandparents be in there. And it’s just, I love my home visits, because it’s them opening up to me, okay, me opening up to them, me recognizing and I’ve had every time delivery. So I can sit there and empathize with everything. I’ve had the natural I’ve had the C section about the V backs with the grade three, grade fours, grade twos. Like I’ve had everything underneath the sun. So it’s easy to empathize with like, No, I got it. I know exactly what you’re doing. So that’s how these appointments differ from your traditional let’s go into the clinics. And right now I’m actually working with the clinic here that recognizes the values. So through their insurances, we can start covering their appointments. So sometimes it’s only one appointment that’s needed, but it’s, it’s amazing. And there’s, it’s a whole program too, because at the second one, everything I’ve told you gets repeated for the second week visit as well. But then we start talking about relationships at second week and how to do that. And then the third visit is talking about, you know, at six weeks, now we’re going to your six weeks appointment. Now, what are we going to ask at the six weeks appointment? So yeah, it’s a whole program built in. Well, and I think it’s so exciting just in like the past couple days and full coverage. I have not read the article yet, but I saw something when I was at the airport flying this weekend that I believe it’s United healthcare is now going to start covering doulas. And so I haven’t read the article yet. You know, if you’re going to write me back, I’m like, yeah, blah, blah, blah. But it, like, I just saw it quick and I was like, okay, I got to read that when I get home, you know, but I think it’s like becoming a little more recognized, like sleep consulting. People look at what I do and they’re like, oh, you’re sleep training a newborn. I’m like, absolutely not. Like I work with kids of all ages. I am identifying tongue ties that are missed. I am finding GI issues just in the conversation through my experience that I have done this for 12 years, you know, and you know, it’s like, there’s other components. You can absolutely help a person thrive through that fourth trimester with education and understanding. We don’t give parents any education. They come home from the doctor and they go, good luck. You have a baby. There’s no manual. It’s like, okay, well, did you know they need to sleep every 45 to 60 minutes? Do you know they need 24 to 32 ounces of milk in a given 24-hour period? Do you know that they need typically between 68 and 72 degrees Fahrenheit? Here’s how you dress the baby for sleep. And here’s why at eight weeks you should stop swaddling because if they roll and they don’t have the neck control, they can suffocate. There are so many things that parents don’t even understand in coming home. And it’s such a deficiency even in the third trimester where I feel like there’s such a big opportunity to educate parents on the reality. You’re still not going to understand sleep. A baby should wait to eat overnight. You should have a bit of challenge, but like to your point, there are ways you can manage and mitigate some of it to offset some of the challenges. My husband and I did dream feeds for the first eight weeks. So we introduced a bottle the day we got home from the hospital. I would pump at seven after I fed the baby, put them to bed at seven. I would go to bed. After I pumped, he would get up at 10 or stay up. We always had kids during March madness. So it was very easy for him to stay awake washing basketball. And I would go to bed and he would be up till 10. He would go in and wake either of our kid up, bring them out, give them a bottle of either breast milk or formula. Depends on the day it was and, you know, how that week was going. And he would birth them, put them back down. Then he would go to sleep and I would get the next wake up, which was somewhere between one or two. So I slept from kind of 730 to two. He would sleep from 11 to six and we were both functioning. And it was just something that worked really well for our family that I talked to parents about. I know sometimes people don’t want to introduce a bottle that early. They’re worried about nipple confusion. I will tell you in the practice I’ve had for a long time, like that’s not a problem in the experience my clients have had. I know the Internet may tell you differently and different people, but as a lactation counselor as well, like people need to understand, you know, also things that they might be missing or that the doctor might be missing. And you can probably speak to even like the lip and tongue ties. Like I had a four month old that came to hire me to help with sleep. And I was like, you’re, you’re literally getting two ounces of milk in a bottle. Like that’s not, that’s not normal. At four months, a baby should be able to take more than two ounces. So something’s wrong. And it took a couple of days for us to figure out, like the baby had a lip and a tongue tie that they just missed. And it’s hard getting your fingers in there to see what’s going on when a baby’s, you know, a couple of weeks old is hard. Their mouths are tiny and it’s not always something easily identifiable. But like, if you understand some of those things that you should be looking for, which you guys will, I’m sure do when you’re in those in-home visits, like it is just so, I don’t know, it’s like empowering because you can fix some of this stuff with education and helping parents to better know how to be prepared. And so I do hope that like these insurance companies start to cover more and more, like we get, we do secondary like reimbursements back so people can book sleep consulting services. And then we provide the invoice and the medical letter of necessity. And then they submit an out of network claim. And many times it’s covered, you know, but it’s just we’re not clinical. But on the clinical side, the challenge is that doctors aren’t teaching clinical challenges with sleep because it’s not a clinical sleep issue. It’s all the other variables that are causing the sleep deficiency. So it’s you’re sort of in this middle where it’s like you’re sort of in limbo as a parent going, well, wait a minute. Do I need to see a sleep medicine doctor? No, it’s. that’s not the, you know, a clinical sleep study. I think, I think what we do is we focus too much on baby sleep and not parental sleep. Yeah. And we, as a society don’t have even taught ourselves how to sleep, right? Like we just haven’t. And then we are trying to control something that we can’t control. Cause for example, developmentally, a newborn is supposed to be up every 40 to 60 minutes, right? And then they will have, they will start establishing sleep cycles where they will sleep through the night. But then boom, you, I hate calling it a regression because it’s not a regression, it’s a progression because they are so developing, right? Their brain is so developing. So you’re going to have that. And then boom, they start daycare or they get their first cold. And I’m so sorry, but if you have a good relationship with your mother, you still want your mom. I still want my mom at this age, when I get a little sick, and I call my mom’s like, Oh, I’m sick, right? How would you not expect a four month old to not be tied to their mama? Because that’s all their security that they know. And then you have the first teeth coming in. And there’s so much happens in the first year that I think we need to stop shifting so much energy on our baby sleep and figure out how we can get sleep better. And it could be we’ll talk about prolactin naps from the get-go, but it’s hiring someone like a doula to help you achieve that sleep at night, right? Because you’re investing in your own health because we know sleep is such detriment to, you know, when our kiddos are older and everything. And so I think that speaks more volume to the society that we live in. And not only, you know, everything is focused around the baby, like from the baby shower, right? Everything is about the baby. It was like, well, what does the mom get? Oh, she got everything for the baby, right? Like your baby shower list. From the medical lens, right? The minute the baby comes out, it’s all about the baby. The mom gets one visit after postpartum. I remember I got a checklist. The doctor’s like, do you want to do X, Y, Z? I’m like, who checks yes? Who checks yes in this appointment? This is so ridiculous. Like, you know what I mean? Like, wow, this is the maternal healthcare. Are you going to harm yourself? Yes or no on a checklist. And I was like, okay, well. And so I, as a pediatrician, why that is so important to me, why is the maternal health so important to me is because I know in literature that if the foundation has cracks, will have delayed infant development, the milestones are not going to be met. Then as children, this is that little Johnny that can’t is having outbursts in, you know, school because poor little Johnny has never been modeled how emotions look like. Because mom has not had ability to do these emotions and to be able to handle it. And then we see direct data with our adolescents that if a mom has suffered in the postpartum period, they’re at higher risk for mental health. Yeah. So why am I focusing on the baby when I really need to focus on the health of the mom? Because here’s the thing. I don’t guarantee successful breastfeeding. That’s not my guarantee. I guarantee empowerment of you to realize that what you’re going through is actually correct. And also the empowerment to be like, no, I don’t need another set of diapers that cost 30, $40. But could you give me a pot to put into my doula services? Could you help me with a night nanny? Could you support me? Can I get a cleaning lady? Right. And that’s the conversations that I’m I’m starting to like really push for is like, can we stop training the babies, quote unquote, training, and I agree with you what you just said, you don’t ever train a baby, a male human can be trained. But can we really look at the foundation, because then we’re recognizing where the babies are developmentally in the first year, I’m sorry, like, you know, it’s actually a joke. And I know it’s there. But my oldest is 20. My youngest is 11. I still get sleepless nights, because someone wakes me up because they’re like hungry, or, you know, they’re sick, or my teenager has gone out. So I think that adage is true that you don’t truly ever sleep. But there’s more to that, right? It’s like, it’s not that you truly never sleep. It’s just that you have to realize there’s certain pockets of parenting that comes that will not allow you to sleep. But we really should focus about how we can train you to get better sleep. I know I joke now I’m like, I sleep better now as 45 with two kids than I ever did in my twenties. Like I am asleep at nine and up at five. And to your point, like, I want my kids to, I’m always, I tell parents all the time, you should always be accessible, not excessive. Right. And when my kids come in, in the middle of the night and go, I had a nightmare. It’s like, oh, okay. Like what, what’s going on? Like, let me walk them back and I’ll sit there and like, okay, tell me about it. You know, put your light on. Right. Like I want my kids to always know. But then it’s also helpful for me because I emulate that, like our phones do not come upstairs. There are no devices in the bed. We have a bedtime set every night. You know, and it’s like as a parent, we try to emulate some of those behaviors that we want our kids as they grow now, you know, to kind of adapt to. Because it’s just sleep is the foundation for which the house is built. And I will live on that. Exactly. No, I totally agree with you. I totally agree with you. But you we have to look at sleep from the mom’s side. Like, I’m just going to say, right? Like, how do we achieve that for the mom? Because, yeah, if the moms don’t get sleep, I’m sorry, the household falls apart. So it’s just a given, right? Like, the other day. So when you were talking about prolactin naps, like, explain what it is, because some of our listeners may have never heard that term before. So I want to explain it and help them understand, like, what is that? And what does it mean? And let’s dive into that a little bit. Yes. And I’ll call it the Dr. Patel prolactin naps. Okay. So we know when, when, you know, the first week of breastfeeding is just all over the place because, you know, you start having your colostrum and then your milk comes in and your boobs are like, oh my God, I’m like a porn star. You know, like, just be serious with it, right? And then you’re leaking from everywhere, but they’re too big and you can’t get it out. Or now you add in a C-section with IV fluids and your milk hasn’t come in for three, four, four, five days. And you’re just worried because your milk hasn’t come. You know, it’s just a hot mess. It’s just up and downs of a hot mess. And some of it is what it’s supposed to happen. And some of it is like it’s pushing us. And when you talk to lactation, it’s like when they when a woman always complains about, oh, my milk supply has gone down. The first thing they do is like, oh, start pumping at night. and there is science behind that and that science is prolactin so when you deliver your baby the placenta so we have to actually go back to pregnancy the placenta is an organ which is like a fascinating organ it’s only made for one purpose it’s only made for that particular pregnancy isn’t that crazy and then it goes away and then you have a next pregnancy it’s only made for that pregnancy. And so that placenta spits out a hormone progesterone. And as the pregnancy goes throughout, progesterone increases from baseline. So upon perceptions around 40 and upon the 10 months where you deliver, I call it 10 months, stop calling it nine weeks. It’s not, it’s not nine months, it’s 40 weeks, do the calculation. It goes eight times higher. And comes from the placenta. Well, progesterone also starts suppressing prolactin as well. So prolactin starts coming around the third trimester. So you have the capping of the progesterone and then finally your prolactin is like going a little bit. So that’s why around 38 weeks we can start harvesting colostrum and it doesn’t interfere with, you know, premature labor and everything like that. So now what we have is we need that progesterone to go away because we’ve got to start nursing right away. And we need that prolactin to go because we need that nursing to happen. So when we deliver our placenta, get this nonsense, right? Like I just need to put this in context. All that progesterone goes away. So you’re back to baseline. That’s a hormonal crash that we talk about. That’s why we like, it took us 10 months to build this up eight times our baseline. And all of a sudden I switch, it goes away. And it goes away because we need that prolactin to start shooting up to make milk. That’s why I always say we need to be seahorses. I’m sorry, we just needed to be seahorses. We were not at the table when we were being designed. Like we were just not at that table. Well, it’s funny, I joke because our, I have a rare genetic mutation called CDH1. So I had my entire stomach removed, my gallbladder removed in the double mastectomy about eight years ago. And so I live fully without a stomach and my intestines essentially attached to my esophagus. And we joke because I’m like, I’m a seahorse. And so our little like unofficial mascot is the seahorse because they also are the only animal without a stomach. There you go. See, there you go. Like it’s all full circle. It’s all full circle. Like I said, we just have to be seahorses. So when prolactin goes up, it has a circadian rhythm. So when I say circadian, it means it has a cycle that goes with day and night. And in the first week when we can lean in, so I tell my parents two weeks, like if you work with me, this is two weeks. The circadian rhythm is that in the morning, it’s super high. So that’s when you will wake up because all it also does, it makes you stay awake. So that’s why you’re nursing all throughout the night and you’re not falling asleep. And in the morning, when you are, you know, had a rough night with cluster feedings and stuff like that, you don’t feel that bad. You’re like, oh, okay, I can conquer the day. Then what prolactin does, it starts coming down and dipping in the afternoons. And then it starts rising back up again at nighttime, right from the evening on to the nighttime. So that dip is your you can sense your body, you’re like, Oh my God, I am so tired, right? And if you’re a pumper, and you’ve decided to pump, you will notice there’s a difference about the output that you get in the mornings, you’re getting a couple of ounces in the afternoons, you might be getting drops. And then it goes into your mind that you’re not producing enough. And that’s not the case at all. It’s prolactin, because when we look at how much you produce, it’s in the 24 hour period. I always equate it to if you had a big breakfast and a big brunch, you’re not going to have a big lunch. And we come from a bottle culture where we need to see three to four ounces per feed. And you’re like, well, that doesn’t how that works. Like breastfeeding doesn’t work that way. Yeah. And then again, going back to evolution in the afternoon, what is everybody doing in the animal kingdom? They’re napping. That’s why you don’t go to the zoo in the afternoon because you’re not going to see any activity. And so you lean into that prolactin. And so for my families, it’s how, And then the bigger thing comes like, how can I help? Right? Like everybody’s and then the moms are like, I don’t know how you can help. So for the first two weeks, what we do is focus on these prolactin naps for the mom. So if you have grandma coming over, if you have a friend coming over, just do a contact nap with the baby. Then the mom goes to a different room because every mother knows that the minute that baby makes a sound, they’re like, Oh my God, my poor baby, right? Because you’re so interconnected. But the baby’s like snoring and sleeping away because babies make so much noise. They don’t care. And so what we’re doing is we’re protecting one, at least one REM cycle for them without baby. So you go without baby, you sleep. Hopefully we can get in two in, but we’re actually getting one in at least. And we are promoting that physical recovery because sleep is very important for physical healing and repair. It’s also protecting mental health because right now we have from the get go, we know sleep is the number one indicator of having mental health issues. But we’re just there. And then everybody knows that, oh, no, you know, mom’s going to sleep and I can come up in the afternoon and I’ll just hold the baby. And that’s how you’re helping moms out so that at nighttime they’re able to wake up and do it. And I have a lot of case scenarios I can talk to you. I remember one mom particularly. She’s like, I have a lot of anxiety, but she was trying to sleep at four or five o’clock, but you can’t because prolactin is starting to rise and it’s going to make you not stay awake. And what do people do? They start scrolling. That’s what they do. They have on their phone and they start scrolling and you’re like, no, no, no, let’s just shift it to the one, two o’clock. So that’s why if you have another child, you’re like, well, and your community is asking, how can you help? Oh, could you please pick up little Johnny? Poor Johnny. Johnny’s always in my scenario. little Johnny gets it. But Johnny could be picked up by your friends at that time, you know? And so that’s what it starts off from the get go is prolactin naps. And they are so beneficial in mental health, physical healing, and protection of breastfeeding. So that’s why I was like, nope, everybody prescribed you work with me. It’s Dr. Patel’s prolactin naps. That’s what you’re going to do for the first two weeks. Oh, that’s amazing. And I think the village, right? Like finding the village. Like I, I know I have a lot of conversations with clients all over the place. Right. And sometimes we talk about the safe sleep and they’re like, you know, education and such. It’s for a different topic, but I think the understanding their support, right. In some capacity, sometimes it’s going to be with your family and friend unit. Sometimes it’s going to be with a virtual family, right. In different ways. So I want to talk about how, like, I know there’s in-person visits in the Colorado area, right? But then talk to me about like the virtual visits and just different things like that that you offer and how folks can find you and what they can do to reach out and look for support. Yeah. So the, there’s many ways and you’re absolutely right. So as you can see, I have like literally devoted my life to this now. And there’s a lot in this brain that cannot be encompassed within, you know, just even my own visits. Like it just cannot be encompassed. So we’ve actually, this is one thing is like, I never knew the power of technology. I’ve seen the dot com era. I’ve seen YouTube come through. I’ve seen social media come through. And you know, when Facebook was introduced, it’s like, oh, it’s just a good way of connecting. And now with the next big thing coming on is AI, right? And what we’re going to do with AI is we’re going to control AI before AI controls me. And one thing that I cannot do is, you know, I can’t, I can’t clone me. Like I can’t be like, you know, and I only have certain amount of times in the days, but I know the information that I’m providing is just so invaluable with the education piece of it because it empowers moms to believe in themselves. So we’ve actually created a virtual AI provider and it’s called Naya, N-A-Y-A. the web page of it is absolutely free. It’s always going to be free. It is the when we when you go on the landing page, it’s going to say it’s curated by me is because I have a team myself, my nurse practitioner who we also as a NICU doc, we’ve actually created a whole weight for our NICU families to achieve their breastfeeding journeys to because we’ve seen that as a gap as well. We have a pelvic physical therapist on there and our mental health therapist. And so when we say we curated it, we shift through tons of evidence-based information and really kind of put it. So we do talk about safe sleep on there. We do talk about safe sleep seven. We do talk about bed sharing on that aspect of it is because, you know, it’s, I’m tired of shielding this education from everyone. And so it is absolutely free on the web app or the webpage part of it. The app is coming out. It’s going to be phenomenal. It’s going to be an ecosystem and I can’t wait for it to come out. It’s probably going to be coming out. My team tells me by Mother’s Day. So look out for it then. But it really is giving you a resource that you can go to that, you know, the brain behind it, because sometimes we get scared of AI. We’re like, AI is coming, but who’s the brain behind it? Well, here’s the brain like you. And then through that, you can do virtual consults with me if you want. But the first thing is the education, like within a year, hopefully, you know, I talking to you and be like, no, it’s every mom knows instead of going to Dr. Google, go to Naya. And then the coolest thing about it is you can actually log into as a mom, the dad or other. And so we’ve had fathers log on to it with grandparents log on to it with nannies. I’ve actually made myself a nanny once and logged on to it. And it’s using this next big generation of a tool and giving the right type of resources to families at their fingertips at two o’clock in the morning. You know, I had a mom who told me that, you know, my baby accidentally fell out of my arms and I was so scared. And instead of going to Dr. Google, I went to Naya and it was that it like you literally are talking to my brain for that. And so then through that, you can get a virtual consult if you care to do more of the care. But, you know, the first step is and it’s free because I’m tired of companies trying to materialize off of way off of survival mode. Yeah, you know, you can’t. And then also has your tracking in there. You can track your feeds. You can track your breastfeeding, your output. It tells you developmental milestones what’s coming up. Like, come on, do we really need an app that is going to charge you for that? Like, I’m just so tired of that. Right. That’s why I do so much stuff in this space to your point of education. Like it shouldn’t be a 1% that get this thing, right? Like everybody deserves access to quality education. And people say to me all the time, like, why do you give away so much for free? Why do you do all these trainings for free? And like, because everybody deserves good sleep. Every child is going to be different. And your situation does sometimes need, in many cases, some aspect of one-to-one answers because your situation is unique. But everybody deserves that baseline and should have access to the information that you can trust. You know what I mean? And to your point, like, come to Dr. Naya and know, like, what you’re getting is evidence-based, foundational for whatever the situation is that you’re experiencing, which I think is just fabulous. So I will definitely make sure that in the episode, all the show notes have the links out there. Folks can check it out. And, you know, when we share the episode, we’ll also share all of that across socials, too, because I think knowledge is power. and helping people to know in their pregnancy. And then after they deliver baby that, you know, someone like you and what you’re doing is out there because I just think it’s so crucial to what they’re doing, so. – Well, thank you for recognizing the value in it because I totally agree with you is that, you know, it’s, don’t go to Dr. Google, like, and mom groups, I mean, I love mom groups for the support, but they have all opinions and to individualize to their version what it’s needed. And so it’s, you know, I’ve, Naya was always my boy’s name also, I mean, my girl’s name, because I have four boys. And so it’s really, it is very dear to me. It is. And I’m constantly working on it. It is my other baby. And it’s just been phenomenal, the response that we’ve already gotten, that people really feel like they’re talking to me because it links with my YouTube channel. And it talks like me. In our first rendition, we actually had to make it less verbose. I was like, okay, we are talking way too much. So, yes. No, it’s so cool. I’m excited to check it out as well. And certainly we’ll share everything. Take a minute, tell people where they can find you. And then thank you so much for coming on today, Dr. Patel. It’s really been exciting because it is a gap and I’m so excited to address it. And I think more people need to know about it. Well, first of all, thank you so much for having me because this is a platform that, you know, this is the only way that we can get things out there to be like, Hey, there is something that exists. So you can find me on all socials. I am a TikToker. I don’t do the dances, but I’m on there. That’s Sonal Patel, try doc, something like that. Just Google it. On Instagram, we’re at Nyacare. Facebook is Nyacare too. That’s N-A-Y-A care, C-A-R-E. We’re on LinkedIn and then our YouTube channel as well. It’s just Tik Tok that have a different name, but the other ones are all on there. Yeah, that’s good. Yeah, I’m so excited. Okay, well, we’ll share all the notes. Thank you so much for coming on. And I hope our listeners that are both expecting or maybe with their first or next, we’ll tune in and check it out. So yes, definitely. Thank you for having me. One more thing before you go. Don’t forget to subscribe, leave a review, or share this episode with someone you know who could use a little more sleep in their life. For tips and resources, be sure to visit us at tinytransitions.com or follow us across social media. Here’s to better sleep, brighter days, and healthier, happier families.
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