Sad State of Postpartum Care in the U.S.
Why am I writing about the uniquely U.S. state of postpartum care and recuperation?
When a woman carries a baby and gives birth, her body undergoes great changes. There are visible signs of those changes, but that only shows a very small part of what her body has done.
Her blood vessels have changed in order to accommodate twice the blood volume. Her lung capacity has changed, and it will take most of a year for it to return pre-pregnancy way of operation. Her muscles separated for the expansion of her womb, joints and connective tissue all became looser in preparation for delivery. All of her abdominal organs were relocated and have to move back into their regular location. Her brain has even changes and is now hyper aware of another life depending on her. Her body is making milk and feeding a baby 24/7. Do you realize how many calories (think energy burning) it takes to lactate alone?
That is a lot of changes!
It takes longer than one week to recuperate from pregnancy and birth.
When did we decide mothers don’t really need time to recuperate after birth?
Postpartum care and recuperation: what it is not.
- Recuperation after childbirth is not 1 week of suppers brought in by friends.
- It is not a time for everyone you know and all of your family to come for a visit.
- It is not a time without post birth care instructions for mom or for baby.
- It is not mom doing laundry, housekeeping, or errands as usual.
- It isn’t one visit to your doctor or CNM at 6 weeks after birth.
- It is not meant to be a time of pure survival.
Postpartum care and recuperation – what it is:
- Mom should be given information about bodily functions following birth.
- Mom should be given information on newborn’s bowel and urine output and changes following birth
- Mom should have information on infant development and growth spurts.
- Mom should be given consistent information about and support for breastfeeding
- Mom should be given information about resting her pelvic floor and pelvic floor recuperation in the form of at least two weeks of bed rest with baby.
- Think more like 1 month of meals
- Mom should be given clear stitch or wound care instructions
- Mom should enjoy herbal baths for healing perineum after vaginal birth (check with care provider)
- Mom needs easy access to prepared healthy snacks and lots of water
- Mom and dad need sleep, lots of sleep
- Mom needs help with shopping, housekeeping, and with older children.
- Mom’s care team should understand delayed hemorrhage and signs for concern including emotional signs.
Why the concern?
Recently, I was talking with a woman who was really struggling emotionally after having her baby. Her baby was induced at 37 weeks using pitocin for non-medical reasons. She was back at work part time as a personal trainer 3 weeks after giving birth. After going to the gym that morning, she said she felt like her insides were going to fall out. The truth is they just might fall out! Her pelvic floor needs time to recuperate! Her emotions need time to stabilize, and her body needs time to rest.
In the United States, we now have an epidemic of postpartum depression. This should not be. Part of it is the use of medications such as pitocin. PitocinC is associated with increasing the the risk of postpartum depression by 30%. Part of it is exhaustion. Part of it is due to lack of recuperation time. Part of it – as much as 30% – is a sad lack of postpartum support. This is mostly a United States issue. We can do better, and our mothers certainly deserve better.
Historic and cultural perspectives:
Lack of postpartum care is relatively new in the history of giving birth. I’ve had a few clients from different countries in Africa. In each culture, following birth the mother and baby are taken care of for 4 months. Either they go to her mother’s or mother-in-law’s to stay or one of them comes to her. Dutch women are provided about 2 weeks of postpartum doula care following birth. In the early days of our country, women in the community provided postpartum care to the new mother for two months managing her household and preparing her meals. It lasted longer if needed.
One of the most important areas is basic postpartum follow-up. Mothers say they feel a big gap in care following giving birth. Home birth midwives do this the best. Usually, there are about 4-6 visits within 6 weeks of birth. CNM’s usually work in the hospital. While you enjoy more personalized relationship, their standard of care is usually a 6 week postpartum follow-up. The same is true for most obstetricians. A few have a standard of care that includes a two week follow-up. Ask your care provider, and seek a care provider that has two week follow-up if possible. Please understand that the lack of U.S. medicine’s postpartum visits does not mean you are recovered. Even if you are feeling well, your body is still recovering.
Postpartum depression, adrenal fatigue, and exhaustion shouldn’t be what to expect next after having a baby. Your recovery needs support. What can you do to support your best postpartum period – which is a year, not 6 weeks? Here are some ideas:
- Hire a postpartum doula (shown to successfully reduce postpartum depression by 30%) Ask how long she supports. Postpartum recovery and depression don’t respect calendars.
- Plan during pregnancy for how you will eat for a month after giving birth. Trust me it is much harder than you think. There are ready meals from Whole Foods, personal chefs, meal delivery services, freezer meals can be prepared beforehand, grocery stores with delivery or pick-up at the door services. You will have the added benefit of not having to take your newborn into a store during flu season, etc.
- Plan what person (other than you 😉 ) will do specific regular household chores and errands. Is your friend going to the store? Ask her if she could pick up a few things for you.
- Plan on having those people around you who will support your postpartum recovery and minimize those those who may not.
- Plan small social interactions
- Plan for how you will get rest during the day and at night.
- Learn about infant development. An ounce of education can prevent a pound of uncertainty.
Mothers need to be cared for and supported as they care for their babies. It’s time to change the paradigm and acknowledge that having postpartum care is not a sign of lacking in mothers. The lack of postpartum care is a more a sign of a lacking in our culture. We can and need to do better.