Should Americans Be Concerned About Postpartum Care?

by Parent Co. February 14, 2017

I struggled to keep up with the nurse at the pediatrician’s office as she led us down the hall. Why was she walking so fast? Didn’t she know I had just given birth?! Being out of the house felt like being on another planet. I couldn’t understand why I should be dragging my brand new baby and my postpartum body through the clinic at all. My legs felt like Jell-O. I had the worst brain fog ever. I was hungry, thirsty and severely sleep deprived. I was flushed and sweating as I attempted to answer all the questions about my baby. Just a few days ago this tiny little person had still been a part of my own body. And yet in those early check-ups, I felt excluded from this recent childbirth process. I knew this was routine newborn baby care. But everything about it seemed wrong. All I could think about was how much I wanted to be at home in bed. And that’s exactly where I should have been. Our country is a fantastic place to be a mom. But our culture lags behind compared to other developed countries when it comes to postpartum care. A University of Salford study has shown that complete recovery from childbirth can take up to a year. Yet, many mothers are expected to be fully functioning and back to pre-baby responsibilities within six weeks. We often have to seek out our own resources for breastfeeding support or specialized providers if we experience complications. We have accepted the postpartum care available to us as standard practice. But it’s time that mothers really evaluate their postpartum care needs and take action to be given the care we deserve. And we can learn a lot about how things could be by taking a look at how other cultures take care of mothers after childbirth.

Beliefs and practices of other countries

If we follow the best practices of some other countries, we could conclude that the only place a new mom needs to be during the weeks (yes, weeks!) of the postpartum period is in bed with her baby. In the Netherlands, most births occur at home. As a part of their mandatory private medical insurance, mothers are provided a kraamverzorgster for usually 49 hours over eight days. This maternity nurse is responsible for helping the mother bond with her baby and oversees her recovery. She provides much-needed breastfeeding support during the first few very challenging weeks. And she works with obstetricians and midwives should complications arise. While the Netherlands is unique in maternal home care as standard and covered by insurance, a culturally accepted postpartum rest period can be found in cultures around the world. Mothers in China, Mexico, and Bali, for example, are expected to stay in bed recovering and bonding with their babies for up to a month while family members and friends manage the rest of the house. In the U.S., even if our families and friends support our recovery after childbirth, our culture doesn’t view it as a priority. So even if we are encouraged by those around us to rest we often still feel we must be back up and running our households as soon as possible. If we need to see a healthcare provider or lactation consultant, we usually see them in an office. Such emphasis is placed on the baby’s health, the mother’s is often overlooked.

Why it matters

My son’s pediatrician told me, “Happy mom, happy baby,” after taking thirty seconds of his appointment to ask how I was doing. And she was absolutely right. Studies show that when a mother is suffering from mental illness, her baby’s social, emotional, language, attention, and cognitive development are adversely affected. 15-25% of women in the U.S. develop postpartum depression. The statistics are similar in other developed countries. So, it may seem that emphasis on postpartum maternal care makes little difference in postpartum depression rates. It is logical to conclude, however, that because we receive extreme societal pressure in the U.S. to be back to “normal” six weeks or less postpartum, the numbers do not reflect the mothers suffering from mental illness in silence. The stigma surrounding mental illness and fear of being seen as a “bad mother” prevent many women from being honest with themselves and their doctors. Contributing to our prevalence of postpartum depression is the pressure for American moms to breastfeed without in-home support once they leave the hospital. We often hear that “breast is best” and research supports that philosophy. But many women cannot or do not breastfeed for a variety of reasons which takes a toll on their confidence and mental health. Providing thorough, in-home breastfeeding support as standard postpartum care would both increase breastfeeding success and reduce rates and severity of postpartum depression. Mental health isn’t the only factor to consider. While other countries take steps to ensure physical recovery goes smoothly in the first couple weeks, American women often don’t see a healthcare practitioner until six weeks postpartum. Even then, a pelvic exam is not performed unless a woman thinks there is cause for concern. She has little way of knowing what’s going on with her uterus or pelvic floor muscles. And while maternal mental health statistics may be somewhat difficult to solidify, mortality rates taken from the WHO 2013 report are more concrete. Sadly, they reveal that the U.S. has shocking maternal mortality rates compared to those of other developed countries.

2013 Maternal Mortality Rates

	Maternal Mortality Ratio (per 100,000 live births)	Number of Maternal Deaths
Netherlands	6	10
United Kingdom	8	60
Germany	7	47
United States	28	1200

Let that sink in for a minute: 1,200 women died during childbirth in the U.S. in 2013. A friend of mine is finishing school to become a midwife and women’s nurse practitioner. She sent me some resources for this article in an email and stated, “Basically, it’s a big problem.” After reading statistics like that I couldn’t agree more and I hope others will too. It is a very big problem. Healthy mothers mean healthy children. Healthy children become intelligent, productive, compassionate citizens. Taking care of women during and after childbirth is an obvious step to take to improve many of the challenges our society faces. Unfortunately, the next few years could very possibly see a drastic downturn in government support for appropriate healthcare. It’s up to us to take responsibility for seeing that women and children get the postpartum care they deserve. Fortunately, there are quite a few things we can do individually and locally to make a difference with this important issue.

What we can do about it

Education

Take some time to become informed. Reflect on your own childbirth and postpartum experiences or those of mothers you know. Think about how things could have been different and the impact it would have made for both mom and baby.

Here are some great resources to get you started:

"The First Forty Days" by Lori Bregman "Mothering the New Mother: Women’s Feelings and Needs After Childbirth" by Sally Placksin Mothering the Mother by Mothering The Home for Natural Family Living

Postpartum Doulas

Our U.S. equivalent to the kraamverzorgster in the Netherlands is a postpartum doula. More and more women in our country are understanding the importance of having an unbiased, unrelated professional help in the home during recovery. Unfortunately, this much-needed service can be pricey. But, it’s definitely worth researching in your area to find the available providers. And if you really want to make a difference, consider becoming certified as a doula.

Speak Up

Have a discussion with your healthcare providers and let them know your concerns. Talk about some of the mortality statistics and get their input on what could be improved. Let your local and regional representatives hear your voice. Get the community involved in establishing a group of professionals dedicated to postpartum care. And if you don’t want to stop at the local level you can send your concerns to the Obama Foundation. Changes could really gain some momentum if enough people speak up about the benefits of improving how we care for our mothers. Just think, instead of struggling to keep up with nurses in clinics we could (and should) be receiving care from the comfort of our own homes. By becoming informed and making changes lives will be saved. It’s time we take matters into our own loving, nurturing, strong mama hands and demand the care we deserve.

---

---

Also in Conversations