Generations of women have carried the burden of pregnancy and silently endured the trauma of childbirth. Books have been written about how much nature demands of a new mom when she nurtures another life.
But despite reading all the books, going to all the appointments, getting all the tests, and taking all the vitamins, women enter motherhood with a body that feels broken and in a culture that tells them to “bounce back quickly.” They say after six weeks you’ll feel like your old self again!
Women have an average of 28-36 doctors appointments during their pregnancy. They are used to seeing a medical provider every 1-4 weeks. There is talk of what to eat, how to sleep, daily exercise, and so much more. The doctor is always one call away. Every few weeks, a doctor checks your weight, talks to you about your concerns, and offers advice. It’s like walking a trail with markers every few yards. Even if the journey is hard, there is guidance and support, and you feel heard every step of the way.
There is also a sense of support from society. Everyone loves the bump. They talk about the pregnancy glow, your cravings, and the baby shower. There are incredible baby tracking apps, amazing maternity clothes, and every Pinterest-worthy nursery item conceivable.
Even if you feel miserable inside, there is an appreciation for what your body is doing. Until you get to childbirth. As soon as the baby is born, It’s time to wrap things up and put the mess away.
Whether you gave birth after four hours of labor or 40, whether you had a planned c-section or emergency, whether you suffered tears or bled heavily, whether you feel confident or not; barring a very few medical reasons, most women are sent home after 48-72 hours of childbirth. Bleeding, sleep-deprived, anxious, and barely able to comprehend anything beyond basic life functions, the new mom is left alone to fend for herself. If pregnancy was like walking a trail, discharge from the hospital feels like the cliff at which a mom is abandoned.
American healthcare has a gaping hole when caring for a new mother. Most developed countries invest in a continuum of support for new mothers.
In Denmark, a midwife calls the day after discharge, and then a healthcare provider comes to the house within 4 to 5 days. In Britain, a midwife often visits home to check in on the new mother.
In the Netherlands and Belgium, a maternity nurse comes to the home to provide a minimum of 24 hours of care within the first eight days after discharge. For Swedish mothers, breastfeeding counseling is covered by insurance, and midwives conduct as many home visits as needed. Finnish baby boxes with the whole slew of goodies for mama and baby are world-famous. France offers in-home postpartum care, and all birthing parents automatically receive a referral for pelvic floor therapy.
So why are we so deficient in this most basic medical care?
In America, The only post-childbirth contact with a healthcare provider is at six weeks, which is often a quick pelvic exam and discussion about birth control. This outpatient visit is rushed and often much too late to address any breastfeeding issues. The majority of insurance plans do not cover any lactation consultant services. There is also no screening for mental health conditions after discharge from the hospital.
We conveniently forget how much change a woman’s body undergoes during pregnancy and often discount postpartum. Hormones change drastically right after childbirth and continue to change through breastfeeding, return of menses, and weaning. These changes have very significant and lifelong physical effects on a woman’s body.
Studies show that these hormonal changes can affect nutrition, sleep, mood, sexual desire, and a general sense of well-being. With as many as 1 in 5 mothers suffering from mental health challenges, isolation and lack of support (both physical and financial) is much to blame. Lack of nutritional guidance, especially for women who suffer from gestational diabetes and anemia, can have lifelong consequences.
And as if the psychological struggle isn’t enough, physical struggles are real too. Research suggests that upwards of 30% of women still have pain with intimacy at their 6-week checkup, 50% are still experiencing bladder leaks, 70% suffer from back/body pain, and some 10% have pelvic organ prolapse (falling organs outside the vagina). Yet, none of these women are supported and helped regain their strength, confidence, and function. Those who complain are often told that “it’s normal” or just “part of motherhood.”
As a postpartum pelvic therapist, less than 20% of my referrals come from Ob/Gyn practitioners. Most of the women I see in my clinic are the ones who decide to take matters into their own hands and look online or in support groups for help.
And while I am thankful for the camaraderie that moms have towards each other, it is very clear that the medical system routinely fails new moms. Pediatricians take care of the baby, and obstetricians take care of pregnant women. No one cares for the new mom. In the American healthcare system, Baby is the candy, and mom is just the wrapper (to be discarded).
This large gap in the quality of American maternal healthcare has been known and documented for many years. In fact, in 2016, ACOG ( American College of Gynecology) released a statement emphasizing that all women should contact their obstetrician-gynecologists or other obstetric care providers within the first three weeks postpartum. And then, at six weeks, they should receive a comprehensive postpartum visit that “includes a full assessment of physical, social, and psychological well-being, including the following domains: mood and emotional well-being; physical recovery from birth; chronic disease management; and health maintenance.”
As a healthcare provider working primarily with postpartum women and being a new mom, I can confirm these guidelines are not being followed. Most women feel unsupported with breastfeeding challenges and do not get referred to pelvic floor physical therapy. The majority are never screened for nutritional deficiencies or offered any mental health support preemptively.
Overall, the United States spends the most money in the world on healthcare per person. But the way we fail to a new mom who brings the future generation into the world is disheartening.
