Emily Silver
“My business partner Jamie and I worked as labor and delivery nurses at a Boston hospital, and we were always wondering, What is going on out there? It felt like this giant gap of all of this support and help in the hospital, and then, bam, they’re sending you down the elevator with your car seat, and you go home and nobody’s there! If you look at other countries, [postpartum support] is actually built into their healthcare models. I hope that through our NAPS programming, we can eventually reshape how we think about perinatal healthcare.”
Emily Silver is one of the co-founders of NAPS, a Family Nurse Practitioner and International Board Certified Lactation Consultant (IBCLC). She lives in Charlestown, MA with her 3 daughters, husband, and yellow lab, Maisey. Emily is most passionate about educating expecting, new, and experienced parents to help them meet their unique family needs. In particular, she enjoys helping families ignore the “norm” and creating a plan that works for them, especially to support mental health.
NAPS offers judgment-free parenting support from Registered Nurses through prenatal education and postpartum services ranging from newborns into the toddler years. NAPS empowers parents to trust their gut, and whether you're in a prenatal class or live support group, to one-on-one care with an RN, or in a live event, you can expect support that will help you feel confident in the chaos that is parenting.
This blog is made possible by a sponsorship from Sage Therapeutics, Inc. and Biogen Inc. All content on this page has been curated by the Mass. PPD Fund without input from Sage Therapeutics, Inc. or Biogen Inc.
January 2024 | Interviewed by Mass. PPD Fund Executive Director Jessie Colbert and Board President Ashlyn Rizzo. Edited by Jessie Colbert.
NAPS is an amazing parenting resource providing all kinds of support and education, from prenatal classes, to daytime and overnight nursing care, to a huge menu of online courses, groups, and resources through their Nurture by NAPS membership platform. NAPS and their co-founders, Emily Silver and Jamie O’Day – former labor and delivery nurses – share the Mass. PPD Fund’s values that we have got to keep it real when it comes to perinatal experience, and about the real support new parents need.
Mass. PPD Fund Board President Ashlyn Rizzo has been a NAPS client and huge fan since she attended their Pre Baby Boot Camp five years ago. Ashlyn and Mass. PPD Fund Executive Director Jessie Colbert were lucky to sit down recently with NAPS co-founder Emily Silver to talk about her experience with perinatal anxiety, an early loss in her family, and how NAPS got started and their bold vision for how we care for new parents.
Jessie Colbert: You have so many valuable experiences to share, it’s hard to know where to start. . . But since this is a PMAD survivors’ blog, can you share your experience with postpartum anxiety?
Emily Silver: I am someone who's probably always had anxiety. I first became aware of it in my 20s, and it was just a part of me that was managed. But I really felt it when I was postpartum with my first daughter, Grace, who’s now eight years old. I had a really challenging pregnancy with her. I had hyperemesis almost the entire time. In retrospect, I was probably a little depressed because I was so sick. I took an anxiety medication when I was pregnant, that was something I talked to my doctor about. I continued it when I was postpartum, but it wasn't enough.
I had a great delivery, but throughout the first year with my daughter, we had a massive lack of sleep. She had severe reflux. In retrospect, she probably had allergies. She did not like sleeping – and I do this for a living! I struggled with her, just to get her to be happy and asleep. I was really tired. And the more I had fragmented sleep – like, the really bad nights in a row — the worse I felt the next day.
That's where I started feeling very anxious. Like, having actual physical symptoms of anxiety, whether it was feeling shortness of breath, or dizzy sometimes, or chest tightness and sort of impending doom. My husband was working full time. And remember, I'm a nurse who thinks I know everything! So I'm like, I'm fine, I'm fine. I kind of was a martyr. If anybody offered me help, I usually said, I’m fine. And then I would find myself calling my mom, crying, Please come and help me! I'm so tired. I'm so anxious. It was a lot of highs and lows during that time.
I’m very open about my story, that I lost my sister to SIDS when I was in third grade. I very much remember that day. My mom tried to revive her, and as anyone knows who is aware of SIDS, the best CPR cannot bring back a SIDS baby. Okay, now it's probably connecting the dots for everybody reading: where did my anxiety stem from? Probably this trauma in early childhood. When I put my daughter to sleep, I lay there thinking, Is that going to happen to me? There was a lot of anxiety manifested around that.
In retrospect, I felt like Grace was not a great sleeper, but I was also not a great sleeper, and I fed into [the problem] a lot of times. You know, babies are noisy, they’re active sleepers. Sometimes they're sleeping and we think they're awake. There's probably a lot of times where Grace was sleeping, and I was the one waking her up or checking on her.
I do want to reiterate for anybody reading this that has feelings of anxiety, it can be really triggering when people say, What caused your panic attack? Sometimes you're like, I was literally doing nothing, I'm just trying to get through my day. Versus sometimes there are actual triggers for people, it’s like setting off an alarm in your body, and so it’s about identifying what your alarm is.
Ashlyn Rizzo: What did help and support for postpartum anxiety look like for you, especially with your second and third daughters?
Emily: For me, the two biggest things were: sleep and helpers. With my first, I didn't sleep a lot, I ran on fumes. I only called my mom out of a place of desperation rather than anticipation.
Flash forward to my second, I started to ask my husband to help in the sleep department. I also had a friend or some nursing students come on occasion to help at night so we could sleep. I set my mom up to come around a little bit more. When you have a baby, everybody's tired and everybody's working, right? So dividing and conquering, and tag-teaming is really important.
I also got really clear that what makes me anxious always came back to sleep. I didn't need the dinners. I didn't need someone to come over during the day and fold laundry. I just needed to sleep. When you look at the research around sleep and postpartum mental health, we know that having quality sleep, even a few nights in a row, can really improve our moods. And that really was the case for me.
When I went into [postpartum with] my third baby, I was like, I'm going to head off this anxiety around SIDS. I could recognize those thoughts I was worried about — that my baby’s not breathing at night — but I still was having trouble stopping them. So I decided, I'm going to hire some nursing students to come at night for four months. I made the choice to save for this my whole pregnancy. I trained three amazing nursing students who are now registered nurses who actually work here at NAPS, which is pretty cool! I was breastfeeding too, but I was making the choice to not get up overnight to pump or feed. I'm gonna roll those dice and risk dipping my supply a little bit, because the benefit of sleeping through the night so much outweighed that risk.
I felt great, and my husband felt great. We enjoyed our maternity and paternity leave. I don't feel like I struggled with anxiety the third time. I think in all three pregnancies what was also important was continuing on medication — I didn't play around with that. I had a therapist, I had people looking out for me. But at the end of the day, the biggest thing for me was sleep.
Jessie: We appreciate that you talk explicitly about postpartum anxiety (versus postpartum depression). Do you think it’s something people are less likely to identify when they’re going through it? How can we do better at sharing information about all the ways Perinatal Mood and Anxiety Disorders (PMADs) can present?
Emily: It’s really important in our education [of patients] as providers that we call it Perinatal Mental Health Disorders, because this can start in pregnancy. We don't do a great job screening women during pregnancy. Where NAPS comes in as childbirth educators is to start talking to both parents during pregnancy about what it means to have a perinatal mental health disorder. What are the symptoms? And it can't just be that first OB visit or that first pediatrician visit, we should be screening and watching parents over the first year of life. And it's not just moms, partners can experience this as well.
I think in our society, in our culture, we often refer to it as postpartum or postpartum depression. And really, it's mood changes. You could be experiencing depression – sadness, guilt, not feeling very interested in the baby, trouble concentrating. Or anxiety, what I was describing, like, chest pain, shortness of breath. All the way to panic attacks, or you can see pregnant or postpartum OCD. Or rarer, bipolar symptoms, or PTSD related to their delivery. And then postpartum psychosis, which is much more severe and requires immediate medical attention. There are all of these buckets.
And then, when we identify that someone's feeling this way, what are we doing? Unfortunately, a reality in the mental health space right now is that parents have to advocate for themselves to get help, which is really hard to do when you're experiencing these symptoms. A great place to start is education before they're experiencing this, so that if they're going through it, they already have that resource list. We all have a person that cuts our hair, we all have our primary care providers. We should all be discharged home with a therapist when we've had a baby!
Ashlyn: Totally. Personally and at the Fund, we see a big connection between moms not having very much help and support and PMADs. Your company provides so many wonderful support services. What are your thoughts on this connection?
Emily: All NAPS programming is essentially built off research to help improve maternal mental health outcomes. For example, you came to our Pre Baby Bootcamp, which is all of your prenatal education in a weekend with registered nurses. We bring in a pelvic floor expert, we bring in a mental health expert. Traditional childbirth education is often just geared towards being in labor, having a vaginal delivery, and likely some breastfeeding education. Those things are good, but it's often missing [information about] a C-section, mental health, pelvic floor, communication with your partner, pumping and bottle feeding, newborn care. We're trying to build in information on perinatal mental health disorders early on, but we also know that if you have quality education for parents, you're gonna have better birth outcomes.
You’re building the foundation of a team that's there for you when the baby's here — it could be a lactation consultation, it could be you want to talk about sleep. And then we bring in our peer support groups. We know peer support groups are really helpful for maternal mental health outcomes as well.
If you look at other countries, this is actually built into their healthcare models. There are countries where when you're discharged from the hospital, you're enrolled in a support group in your community. Because being around other parents during this time is huge — sharing your experiences, hearing that you're not alone, and then having a facilitator that can help get you into those referrals. It's another layer of support. I hope that through our NAPS programming, we can eventually reshape how we think about our [perinatal] healthcare.
Ashlyn: It’s so great. I’ve followed your business model, and I really appreciate your staying on the edge of, What else can we do for parents? Where are the gaps?
Jessie: Yes, and speaking of which, your business is growing! Can you share more about how NAPS got started, where you are now, and your vision for the future?
Emily: My business partner Jamie and I worked as labor and delivery nurses at a Boston hospital, and we worked the night shift. We became really good friends, and we loved our jobs. You have to establish trust with patients very quickly because you're walking into a really intimate moment. When you deliver patients, postpartum is a separate world. You have this amazing experience of being a part of their childbirth, and then you bring them down to postpartum and say goodbye and go back upstairs to get the next patient. Parents would look at us and be like, Whoa, wait a second, I'm never gonna see you again!?
They would often say, Now what, when we go home? So we started researching [what the resources are] specifically in Boston, and then in our country, and looking at other countries. We were always talking at the nursing station about these big ideas we had, and just wondering, What is going on out there? It felt like this giant gap of all of this support and help in the hospital – doctors and nurses and lactation consultants and pediatricians in your room all the time helping — and then, bam, they’re sending you down the elevator with your car seat, and then you go home and nobody’s there! You obviously have an appointment with your OB, but that's not for six weeks. You have that first pediatrician visit, but it's very focused on the baby.
We were like, Geez, parents are scared and they don't even know what to do. It initially started as hiring nurses and providing daytime and overnight care. And as our families grew and our experiences grew, our company grew. I went on to become a nurse practitioner. Jamie and I both went on to become IBCLCs. We went on to have six girls between the two of us. We started layering in prenatal education, lactation consulting, sleep consulting, new mom support groups, veteran mom support groups, working mom support groups. Anytime our clients had a need, we were like, We’ll do it! And being real moms ourselves, living what our clients are living in the moment.
Big picture, our next step is that we want to get to parents everywhere through our online membership, Nurture by NAPS. It's a custom, web-based app. Parents can have on-demand care at any time, all from real registered nurses or nurse practitioners. The app includes over 100 videos and courses. So instead of Googling something, come into Nurture. There's likely a quick video on it, with me or Jamie saying, This is why babies are gassy and fussy, and here's a couple things you can do. All the way to live meetups with registered nurses — jump in in real time to our Ask a NAPS Nurse board and ask a question. The curriculum keeps going, now into the toddler years, to address eating, sleep, developmental milestones, troubleshooting and transitions.
Ashlyn: I love Nurture! I’m just curious – digital is the way to reach more people, but how do you feel about balancing digital and in-person support?
Emily: I think what’s unique to Nurture by NAPS is it’s live, in real-time. There's actually a real person talking to you and answering your specific questions. And when you join a peer support group, on the screen are 10 other moms bouncing their babies, walking around in their nursing bra, and the element of not having to leave the home is really great. I really worried about this during the pandemic, when we started doing a lot of virtual lactation visits. I was blown away to see that we could still accomplish all the things we usually would.
I think getting out of the house early and often is important for mental health, so we encourage our moms to find even that one friend that has a baby that you can meet up with for a walk, or go down to the library to the free music class. It's definitely finding a balance.
Ashlyn: That’s great. After being a labor and delivery nurse and then a family NP, what surprised you the most when you became a mom yourself, and saw things from that perspective?
Emily: Breastfeeding. I thought I was an expert in breastfeeding. I helped thousands of women breastfeed, I gave them advice, I was an IBCLC. I had a lot of education in breastfeeding – textbook-type education. And then when I breastfed my first it was really, really hard. I had bleeding, cracked nipples, I had incredible pain. I thought I should be feeding on demand, but my child had reflux and babies with severe reflux do better on spaced feeds. There were things that I had told parents to do, and then when I did them, I was like, That's horrible! For example, we tell women to get in the shower and let the hot water beat down on your breasts, and when I did that, I was like, It feels like tiny knives being thrown at me! I was like, That’s not real-life advice. And so it gave me this real empathy when working with patients when it was hard, and tips on what actually works.
Ashlyn: Yeah, I knew that was going to be a challenge, but they don’t tell you how big of a challenge that’s gonna be!
Jessie: I love the line in your bio that says, “Taboo topics are just not taboo for Emily.” We’ve already talked about some taboo topics, like grief and loss and mental health. What are some other topics around pregnancy, birth, or parenting that you think we should be more open about?
Emily: I would say it starts in pregnancy. I referenced hyperemesis, and nobody really talks about that. When you show up to your OB and you say you're nauseous, they’re like, Oh, sorry, that's normal. We label a lot as “normal” in the healthcare space, and it's not always normal. Just because something's common, doesn't mean it's normal.
It continues when we bring that baby home, and how we choose to feed our baby. There's a lot of judgments with regard to whether you're breastfeeding, or combo feeding, or you're pumping exclusively, or maybe you just want to give formula, that's the best choice for your family.
We continue to not talk about mental health. It’s common to feel anxious or to be crying in those first weeks home, but let's make sure you have enough support.
We do not talk about pelvic floor enough. It’s incredible! You just grew a human for nine months, your body has had changed significantly. There are so many physical pains and ailments that women experience postpartum. There are 28 symptoms that we have, from back pain, to breast pain, to the pelvic floor, to hemorrhoids. We just don't talk about them, but they're very common. Sex after baby? Just go do it. Nobody is being real about these topics. Like, that's actually really hard.
We just have to start being real and honest. My challenge for women out there is: just start sharing your stories with your friends and family. It’ll help break stigmas down, it'll help make people realize that they're not alone. And then it helps that pushback on our healthcare system for advocacy, like, Hey, this actually isn't normal. And I'd like you to refer me to someone, or I'd like to know what my options are. What can I do to make this a little bit better?
Emily and Jamie are happy to offer a 20% discount on Nurture by NAPS monthly or annual membership to Amplifying readers – just use the code MASSPPD at checkout!