US healthcare professionals do not adequately prepare women for, or support them during, the postpartum period. From high blood pressure to depression, the consequences can be deadly.
As I stand up for the first time after giving birth, my newly empty belly flops downward, deflated and spent, like punched-down dough that’s been rising for hours. I tip forward unsteadily. I didn’t expect to feel so hollow and loose inside, so unfamiliar with my own center of gravity.
“Your uterus is shrinking beautifully,” my obstetrician declares as she prods my tender midsection during her final check before my hospital discharge. I had no idea it would continue to painfully contract long after labor was finished, its transformation from a two-pound watermelon back to a three-ounce pear resulting in horror movie-levels of vaginal bleeding.
In fact, during my prenatal appointments, the postpartum period never came up. And in between attempting to cram in all the college courses required to graduate before my due date and working two jobs, I didn’t have time for independent research.
Beyond the odd gory personal essay, or woo website urging appropriation of the postpartum rituals of various cultures, there is little in the way of evidenced-based postpartum self-care practices. Books and classes on pregnancy and childbirth abound, but information on this “fourth trimester” is decidedly lacking. The American College of Obstetricians and Gynecologists’ patient information page contains 40 FAQs on pregnancy, eight on labor and delivery, and three on the postpartum period.
It’s when I leave the hospital that—almost as an afterthought—I am handed a one-page information sheet of bulleted lists of how to care for myself: activity guidelines, diet suggestions, tips for breast pain, and symptoms I should seek immediate care for. My doctor (and insurance company) does not expect me to need medical support for at least six weeks.
I am expected to be capable of juggling caring for a creature adjusting to life outside the womb with recovering from the exertion of childbirth and nine months of growing another life inside of me: my skin stretched, my hormones ravaged, my own organs squished aside, my brain literally altered, my labia lacerated sideways. I even grew an extra organ just for the occasion.
At home, I am met with yet more disconcerting discomforts that I am entirely unprepared for: night sweats, achy joints, acne, hemorrhoids, backache, extreme hair loss, peeing when I sneeze, and stinging when I pee; bouts of breast engorgement that lead to infection.
My son had his days and nights mixed up: he was awake for much of the night and slept nearly all day. Breastfeeding seemed to be the only thing that calmed his colicky screaming. He wouldn’t take a pacifier or bottle, woke as soon as I lay him down; didn’t want to go to daddy at the end of the day. The myth that once baby and mother are separate entities, I will immediately revert back to feeling like myself again leaves me blindsided by the continued sense of symbiosis postpartum. It’s jarring, draining.
I’m not alone. Every participant in a 2005 study described feeling as if they didn’t know what to expect in the early postpartum period and were unprepared to care for themselves and their babies. “Because of their lack of preparedness at a time of increased responsibility and vulnerability, they were overwhelmed,” the study authors wrote. “Exhausted, feeling unwell and isolated, they struggled to adapt to new role expectations.” A more recent study found that new moms remain surprised by their postpartum symptoms, and “disappointed with the lack of support by [healthcare] providers during this critical time in their recovery.”
Women are constantly assured that pregnancy and childbirth are natural physiological processes. After growing accustomed to the many bizarre side effects of pregnancy, we assume everything that comes after must be normal too, or that at the very least we should be able to power through it.
New mothers suffer in silence with all manner of postpartum issues, from anxiety and depression to chronic pain and incontinence. Many don’t know that they can and should seek help, or aren’t sure whom to seek help from. Approximately 15% of women sustain pelvic injuries in childbirth that don’t heal. A recent Cosmopolitan article detailed the story of a woman who, after giving birth, experienced fecal and urinary incontinence for eight years without seeking medical help.
Kristin Tully, the breastfeeding and nighttime parenting expert on the University of North Carolina’s 4th Trimester Project, says there’s a “definite lack of preparation for the fourth trimester—and the maternity unit is not the place for women to learn.” Tully says their project’s goal is to “improve what information is provided and when, and how support is provided.” For starters, she says mothers need to “be given a summary of thresholds and ranges for what pain level and symptoms are normal in the postpartum period and who to contact for each issue.”
An editorial in the journal Contraception asserts that if our postpartum care practices were on par with that of other wealthy nations, where new mothers receive multiple in-home visits by a healthcare professional in the first weeks postpartum, it would go far to prevent the potentially deadly complications that can develop after new mothers leave the hospital, such as hemorrhage, infection, and hypertension.
Nearly 70% of women report experiencing at least one physical health problem after giving birth. Researchers note one problem is that these postpartum concerns are “often regarded as transient or comparatively minor,” but in fact are “strongly related to functional impairment and poor emotional health” due to their severity and cumulative nature.
For me, the collective challenges of a painful recovery, fractured sleep, and an insatiably needy newborn proved more than I could handle. Lack of sleep leads to frequent headaches and carbohydrate cravings. I’d ponder how unduly cruel it is that newborns need feeding every two hours, but adults need five hours of uninterrupted sleep for their brain to function properly. In an exhausted haze, I burned a boiled egg and got lost on the way to the grocery store; put a block of cheese in the freezer and dirty laundry into the dryer.
I recognized less and less of myself. I’d never had a temper before, but I now inhabited a state of perpetual rage: I would throw things, scream, slam cupboards and doors. I could rarely muster the wherewithal to shower, let alone leave the house. When I did, I often fantasized about driving my car into a wall or over a bridge.
A deep impression began to appear in the sofa cushion where I spent most of my time.
The worst part was that I didn’t realize I needed to seek professional help. I thought postpartum depression only manifested as sadness and frequent crying. I assumed my rage was simply another side effect; that this was just who I was as a mother. I truly couldn’t see it when I was in it.
One in seven new or expectant mothers experience depression; roughly 50% of cases go untreated. New Scientist magazine recently declared suicide “one of the biggest preventable killers” of new mothers, based on research showing lack of adequate care was likely a significant factor. Indeed, among causes of maternal death, suicide exceeds hemorrhage and hypertension.
Six weeks come and go, but my obstetrician’s office never calls to ask why I haven’t come in for an appointment. My son is nearly four months old when I finally return to her office and sheepishly admit what a dark time this has been.
“You just need to go on a date night with your husband,” she declares, stopping just shy of a literal pat on the head. I say that I think it might be more than that, so she dashes off an antidepressant prescription and hurries me back home.
According to a review of 40 studies on postpartum depression, few women proactively seek help. Most weren’t able to recognize their symptoms or were worried about disclosing them; a concern that was “reinforced by family members and health professionals’ reluctance to respond to the mothers’ emotional and practical needs.”
Improved postpartum education during prenatal visits and more support in the first weeks after birth can help ease the transition to motherhood and save lives, but not just for those with physical health problems. If it includes teaching mothers and healthcare providers how to spot and talk about depression or anxiety, it can also save the lives—and vastly improve the quality of life—of those experiencing postpartum mental health issues.