During Rachel Wagner’s first pregnancy, the Federal Hill resident and elementary school teacher was lacking a network of new moms in the area to lean on.

“I didn’t have a group of pregnant friends to ask questions, so I was just Googling things,” she recalls. “I had all of these questions—about delivery, what it will be like to have a human come out of me.”

Three months after her daughter was born, while on an extended leave from teaching, Wagner saw an ad for a free fitness class for moms at the park down the street. Offered by Fit4Mom Baltimore City, a local franchise of a nationwide prenatal and postnatal fitness program, the eight-week course introduced Wagner to physical and mental wellness for new moms—and to the community she had been missing.

“I met my first mom friend who had kids the same age,” she recalls. “Going through that with a group of women was very powerful, and they are still some of my best friends to this day.”

The experience was so powerful, in fact, that in the eight years since, Wagner has become an advocate of the importance of finding a network of women as support throughout every stage of motherhood.

“Once you’ve gone through it, you just become willing to help everyone,” says Wagner, who purchased the Fit4Mom Baltimore City franchise in 2015. One of five franchises in Maryland, Fit4Mom Baltimore City offers six programs, from the prenatal-focused Fit4Baby to Stroller Strides, designed for moms with their kids in tow. “It’s comforting to hear from someone who has already been through it. And us moms are very much trying not to keep any surprises from the pregnant mommas.”

The Baltimore area is home to a wealth of resources for growing families, from top healthcare providers to support for parent and baby before, during, and after birth.

WHAT TO EXPECT: BY TRIMESTER
You’re pregnant. Congratulations! Now what?

Schedule your first doctor’s appointment for week seven or eight of pregnancy, says Dr. Shillena Peters, an obstetrician at the Baltimore Washington Medical Center and a Baltimore Top Doctor. You can start taking prenatal supplements right away, ideally one with iron included, and should stop smoking or drinking alcohol.

“Find a doctor you trust and feel comfortable with,” she says. “This is your pregnancy, you should feel like you enjoy the doctor and get something out of each visit.”

Expecting families should think about the care and delivery experience they envision to decide on the healthcare team they prefer to work with for the delivery (see our sidebar on providers for more info).

At the first appointment, the provider will conduct a sonogram to establish the pregnancy and estimate the anticipated due date. “You get to hear the heartbeat, and it gives them that reassurance that, ‘Yes, I am pregnant,’” Peters says. Additionally, the provider will typically order a blood test, confirm up-to-date vaccinations, and recommend genetic testing to identify any abnormalities.

Peters uses the first appointment to give women an overview of what to expect during the pregnancy, from the frequency of doctors’ visits—every four weeks until about week 26, then every two weeks, and then weekly from week 36 until delivery—to changes in diet.

She recommends writing down any questions you have in between appointments and bringing them with you. That way, Peters says, “when you come to the visit, we can have a discussion about
what is concerning you and you feel like you’re being heard.”

In the first trimester, from weeks one through 12, fatigue and nausea is very normal, Peters says, but tends to resolve itself by weeks 16 to 18. “Hard candy, ginger ale, nausea bands—these are all strategies to help cope with the symptoms until they improve,” Peters says.

Traditionally, finding out the baby’s sex is part of the anatomy sonogram at 18-20 weeks, but some providers, including those through Kaiser Permanente, offer genetic testing at 11-12 weeks that includes finding out the sex of the baby. “Patients love that they are able to find out earlier,” Peters says.

The first trimester is also when parents should begin researching and selecting a pediatrician, Peters adds, since they will need to bring the newborn to its first appointment just days after birth.

The anatomy sonogram is a big milestone in the second trimester, which takes place from weeks 13-26, Peters says. “They get to see the baby in full form with a detailed sonogram and have confirmation of the sex, but also can see the heart, brain, and all the different structures,” she says.

As the baby grows, moms should adjust their caloric intake, too, consuming an additional 300-450 calories daily in the second and third trimesters.

By the third trimester, from weeks 27-40, providers finalize plans for the delivery, including options for pain management or bringing in outside support like a doula, who provides physical relief, emotional support, and mental preparation for the birth journey.

Planning for the birth should be a collaborative process, Peters says, and she encourages patients to have a plan but stay flexible, especially when it comes to decisions like whether to get an epidural, a pain management procedure where a local anesthetic is injected into the space around the spinal nerves in the lower back.

“I tell patients to go in with an open mind—you’ve never been pregnant before or delivered before,” Peters says of pain management. “The anesthesiologists are there, you can ask questions, and they will go over risks and benefits of the epidural, and the decision is up to [the patient] to decide if they want to or not. We support them in terms of whatever they decide.”

Most importantly, Peters emphasizes women should see their doctors as part of their team, and not hesitate to reach out to them with questions or concerns. “We want our patients to trust us because the goal is to have a healthy mom, healthy baby, and safe pregnancy.”

GEARING UP FOR BABY
Where should new parents begin preparing for their baby’s arrival in a $30 billion baby products industry, where new innovations and brands target growing families each year?

“At a boutique like Wee Chic, everyone is an expert,” says owner Bridget Quinn Stickline, who opened the Green Spring Station store 14 years ago. “Not only are they parents themselves, but they are immersed in the product category. They can help to distill options for your needs and dispel myths for first-time parents.”

The diaper pail? “Nobody uses it,” she says of the trash cans designed to lock in diaper odors. It’s one of many products moms are told they need, but often find they don’t use. Another culprit: the wipe warmer. “We never see a second-time mom buying any of them.”

While parents may opt to register for bigger purchases like the car seat or consumables like diapers and wipes at chain stores, it’s worth it to go to a local boutique for clothing, Stickline says, which stocks higher-quality products and has expert staff to help guide new parents.

“Cottons are not made the same,” she says. “You’re going to be washing it very frequently, and the more you wash it, the more it breaks down.” Look for comfortable fabrics that hold up well, especially for the everyday basics.

“Often, we think about it backwards and spend on fun going-out outfits and scrimp on the onesie, but the onesie is going to be washed six times in a week,” she points out. “If the fabric isn’t high quality, it’s going to get pilly, uncomfortable, and scratchy on your baby’s skin.”

While higher-quality fabrics are more expensive, they have a longer lifespan, too, allowing parents to consign or save the pieces to use again for a second baby.

One of the most frequent questions Stickline gets from shoppers is about sizing. “There’s a lot of mental math involved,” she says with a laugh, pointing out that parents should account for seasons and climate as well as the baby’s growth when purchasing clothing. That’s where an experienced sales associate comes in handy.

Parents should expect to get primarily 3-6 month and 6-9 month sizes as gifts, but should stock up on a few newborn (up to 8 pounds) and 0-3 month footies and onesies so they are prepared to come home from the hospital and for the first few weeks.

“They don’t warn you before they grow,” Stickline says. “You go to put that onesie on and it’s like, wait a minute, what happened? It’s nice to have the footie pajamas ready to hop into for the next size range.”

Apparel brands have innovated new closures in recent years, Stickline says, like magnetic closures and two-way zippers that open at the neck and the foot. “It makes dressing and undressing much easier when you have lots of other things you need to manage.”

While online registries and retailers like Amazon offer convenience, shopping in person ensures you’ll get what you expect. “When you do this kind of shopping, having an expert in front of you is really valuable,” she says, cautioning against showrooming, where consumers look at products in a brick-and-mortar but then purchase them from large online retailers. “Spend the extra money, then if something goes wrong you can go back and they can help you.”

Over 14 years, Strickline and her staff support their customers as their families grow. “We meet people pregnant, then they come back with their baby and toddler,” she says. “We get to know them
like family.”

AFTER DELIVERY: THE “FOURTH TRIMESTER”
After the American College of Obstetricians and Gynecologists called for redefining postpartum care in 2018, an increasing number of practitioners are placing increased emphasis on preparing expectant mothers for the time between birth and 12 weeks postpartum, also known as the “fourth trimester.”

“It can be a tumultuous time and it’s an important time to put focus on,” says Eliza C. Gould, a certified nurse midwife (CNM) with Women’s Health Associates, a practice with two physicians and 10 midwives practicing out of St. Joseph’s Medical Center.

“You have just delivered the happy hormone factory called the placenta. There is quite a fluctuation of hormones. Especially for first-time moms, adjusting to a new way of being can be challenging.”

Add to that the physical recovery from delivery, sleep deprivation, and mental and emotional struggles ranging from trouble breastfeeding to postpartum mood swings or depression. “I really encourage communication, both with your partner and with your providers,” Gould says, noting that her practice often brings new moms back for a follow-up appointment two weeks postpartum, although common practice in the industry has been to wait six weeks.

At Indigo Physiotherapy, many of founder Dr. Samantha “Sam” DuFlo’s patients come to her practice during the fourth trimester. DuFlo is a doctor of physical therapy and certified Pelvic Rehabilitation Practitioner. The pelvic floor physical therapy practice advocates for whole-body health and caring for women’s bodies so they can feel good during and after delivery.

“We prep so much for labor and birth,” DuFlo says. “But you’re pregnant for around 40 weeks, you might be in labor for eight hours, and then you have a baby, so really preparing your body and your mind for that transition postpartum is integral—not just preparing for labor.”

While several weeks of pelvic floor physiotherapy is standard postpartum care for women in countries like France, New Zealand, and Ireland, “Our culture has really normalized so much of this as something women just have to deal with—like leaking when you sneeze, having pain, scar tissue, or the ‘mommy tummy’ postpartum,” DuFlo says. “There’s a fine line here—we want body neutrality and acceptance of our body, but also, while those things are very common, they’re all things that can be treated.”

As one of only seven countries that doesn’t mandate any paid maternity leave—the Family Medical Leave Act just requires 12 weeks unpaid leave—there can be cultural pressure to “bounce back” and return to work and other normal activity as soon as possible, DuFlo says.

“If you have surgery, it can take you perhaps a year to recover,” DuFlo says. But, comparatively, most women are cleared to return to normal activity six weeks postpartum. “We’re not always looking at these huge physiological changes that have happened in their abdominals, their hip muscles, their glutes,” she adds. “Getting people back to a physical autonomy where they feel really good in their body and they can do what they want to do, is really important to us at Indigo.”

Ana Rodney wears many hats. As a doula, poet, activist, and mom, Rodney is also the founder of MOMCares, a program that provides postpartum support to black mothers in the NICU. Her work, in general, delves into a topic that rarely gets acknowledged: the maternal health and mortality of black women. We talked to Rodney about how her personal experiences were as the catalyst for starting the organization and why it has become her mission to save the lives of black mothers and children.

How did MOMCares come to be?
I’ve been a doula birth worker for 11 years now and, since 2014 when my son, Aiden, was born, I’ve been doing the Neonatal Intensive Care (NICU) work. First, I had to live it and now I’m standing in and holding space for moms in the NICU. Aiden spent four months in the NICU, two months in the Pediatric Intensive Care Unit (PICU) and we only moved to the PICU because we encountered some discrimination and bias during, and right after, the Uprising.

After he came home, I decided that I needed to process what happened when I was in the NICU. During my pregnancy I was fat, black, single, and while in the NICU I decided to stay with my son. Then all of a sudden, I became unemployed and all of that gave rise to its own bias in the care and I ended up feeling unsupported and appearing unsupported while in the NICU.

I started a healing circle, talking to moms about birth, trauma, and self-care and then I was awarded seed money, through Baltimore Corps’ Elevation Awards, and MOMCares expanded. We built out a suite of services to support moms based on my experience and what I have seen in the NICU. For example, providing transportation to and from the hospital. We provide services like that, and we also provide advocacy in the hospital.

Does being an artist inform your work in the medical community?
I hope this doesn’t sound morbid, but there’s artistry in our pain in that everything is connected. As a writer I have always felt like, if you could see the vision of what I was saying, then I then I have done my job. When I go into a board meeting, or when I go into a hospital, or when I talk to a group of people, I am still very much using words to paint that picture.

But now that that picture is around the black maternal health crisis, and mothers dying, and babies being underserved in the black community, I definitely use that to my advantage. By using my way with words, I am able to drive it home to people who don’t have to think about that every day. They don’t have to think about that when they go into a doctor’s appointment or when they’re driving down the street. They don’t have to think about what role their identity plays in their survival.

NICU advocacy is not new but the work you are doing to address the narrative for women of color is what has been missing. What challenges do you face while doing this work?
There are a couple of things that have been difficult, I think on the one hand being so connected to the work and committed to the work, but also having a 4-year-old that doesn’t care about the work can be hard at times. Mom guilt is a bitch and it’s hard to be out here doing the battle cry for moms of black families and then come home and Aiden’s like, “I’m hungry” or “You didn’t play with me enough today.” So that’s difficult.

As far as actual deliverables, it has been two years this month since my sister died. We were pregnant that at the same time, and she had a health issue that was very small, an issue with a gallbladder that started right after she gave birth. It was neglected because she didn’t feel like she had support and she died suddenly. At the same time that she passed away, I was also holding space for a mom that I just helped deliver a little girl and her baby passed away. So, I’m helping a mom go through something that I can’t fathom while dealing with the guilt of not being able to help my sister the way she needed. My sister was a part of my work and it’s difficult to be like, “Of all the people that I wanted to save, that I wanted to help, that I wanted to impact, I did not.”

This work touches everybody in such an acute way, but I signed up for it. I signed up to do that. And it’s one of the reasons why I went through the grief training with Roberta’s House—because I know that the work I am going to be doing will involve some level of grief, and I need to be equipped to handle that.

What advice would you give for future social entrepreneurs and activists?
Get organized. Organize because your passion is important, but you can ignite someone else to want to support you and if you don’t have the capacity to respond to them, it’s like you didn’t say anything. Make sure you are ready to jump when it’s time to jump and trust yourself. There’s a reason why you have approached whatever work it is that you’re doing. There’s a reason why people are listening to you and engaging with you. So you need to trust yourself before you can ask anybody else to have confidence in you.

What’s in the immediate pipeline for Ana Rodney and MOMCares?
I will be releasing Energetic Motherhood in March, a book that tells Aiden’s birth story. The book reveals the process I created to foster a bond with my son after his premature birth and my being deprived of common mother’s rites of passage. We also have a giving campaign to collect donations to continue to bring services to more mothers well into the New Year. I am also currently accepting speaking requests for speaking engagements and cultural competency presentations.

Where do you see yourself in the next 10 years?
I would like to be recognized as a national advocate for black mothers around birth and maternal health. I’d like for MOMCares to be a national and international name in the fight to correct the crisis of maternal health in this country.

Our daughter is set to arrive this month and I’m slowly realizing that we are, for real, about to have two kids under two. We’re about as prepared as we can be, and now it’s just a waiting game. I’ve been thinking a lot about the Lou’s birth and trying to remember what we needed, what we forgot, and what our friends brought us that made all the difference.

If you’ve got someone in your life who is expecting, I’ve compiled a list of suggested items to bring over when you meet their progeny. Be mindful that the first few weeks of parenthood are an exhausting, wonderful, confusing fever dream, so keep your visit short and don’t give anything if you’re expecting a thank-you note.

(And if I’m your friend who is expecting and you’re coming to visit us, please bring watermelon popsicles and stay for a while because I will be hopped up on painkillers and in need of a constant rotation of people to talk at.)

Seltzer water:
Before breastfeeding, I didn’t know it was possible to be thirsty while chugging water. When you are someone else’s sole source of nutrients, it feels like someone coated your insides with Scotchguard and you’ll never be sated again. Histrionics aside, when friends showed up with my favorite flavor of La Croix or a few big glass bottles of mineral water, I poured a glass over ice and lemon and felt more like a grown-up human and less like a bathtub drain. Showing up with some “not tap” water is an inexpensive and extremely useful way to make a new mom consider renaming her baby after you.

Food!
During Towson University’s spring 2008 semester, I had the good fortune to fall into platonic love with my best friend Lauren. The relationship paid off in spades when she turned her passion for cooking into a career, thus enabling me to brag about the joys of having a chef close to my heart. After I had Lou, she showed up unannounced with bags of groceries and spent an entire day cooking, packaging the food in Tupperware, cleaning my kitchen, keeping me company, and just generally making me feel happy that I transferred schools and met this culinary fairy godmother.

You can give a similar gift to your new mom friend without all the hard work. Get a few people together to spring for a week of food from Gundalow Gourmet (they’ll tailor the menu to her needs and drop the meals off in pre-portioned Tupperware—it’s amazing). You could also consider a Whole Foods or Uber Eats gift card, or simply call ahead and ask what she’s craving.

Booze!
I really surprised myself and my community by not wanting to drink alcohol until Lou was five or six weeks old. When my typical desire for wine returned, I was grateful to have a few bottles from friends already chilling in the fridge. My husband had popped a few bottles over the course of the first month—it’s not easy for dad’s either—and it was nice for him to have a little stockpile without needing to leave the house. Bring something you know both parents like, and feel good knowing your contribution will be enjoyed at the exact right moment they require some adult time.

Flowers:
This one doesn’t really need an entire paragraph, right? Bring something beautiful for her to look at that doesn’t poop at 3 a.m. or require the use of nipple shields. Bonus points if you toss the flowers in a simple glass vase. Super bonus points if you get up early and create a bouquet from Local Color Flowers’ Saturday morning studio hours.

Diapers, etc.:
This one is for family and close friends. Call the new mama and say, “I am standing in Target/Giant/CVS and I need you to tell me exactly what you need.” It can be really hard to suddenly accept help from every well-meaning person in your life, and telling her that you’re already at the store—and she just needs to say the words—takes away a lot of pressure and guilt.

Hand-me-downs:
It’s difficult to know exactly what your baby will need until you’ve gotten home and realized you really didn’t need that bottle warmer, but could very much benefit from a Rock’n’Play. If you’re a mom of slightly older kids and still have infant supplies in good shape, shoot your friend a text and ask if there’s anything she opted not to buy that you could drop off. We were foolish enough to think that we didn’t need a bassinet—I think we assumed Lou would sleep in his nursery even though I couldn’t stand up unassisted the first two weeks. So friend generously lent us hers. She saved us money and time, and gave us the added gift of getting to swap early parenting stories with someone who knew what we were going through.

If more kids are in your future, make sure to indicate you’d like it back. If not, it’s okay to tell your friend that it’s hers to pass on to the next mom, or to donate when she’s finished with it.

Something for the other kid:
You can opt to bring a small present for the newly displaced child instead of continuing the gift parade for the mom and baby. Crayons and a roll of brown paper (we recently taped brown paper to the entire surface of our coffee table and Lou has never been happier and we’ve never had more free time), dolls, sticker books, or Magna-Tiles are all good gifts for younger kids. For older kids, a $20 Amazon gift card gives them the freedom to pick something themselves and requires the attention of a parent to help make the purchase (which is what they really want anyway). Anything to make that transition to newfound sibling-hood all the easier.