The first step toward change is recognizing that there is a problem and I believe we are there when it comes to peripartum care in the United States. Research is showing that as a first world country, the US is falling short, especially when it comes to postpartum care for mothers (article).
I have experienced this first hand even with the best insurance, the most amazing OB and my own medical background. I can only imagine how poor the level of care is for mothers that are not as privileged as I am. A big step in the right direction happened in May of 2018 when the ACOG (American College of Obstetricians and Gynecologists) released new recommendations for peripartum care (article). It finally includes a visit for mom within 3 weeks of baby’s arrival versus the standard 6 weeks. IT’S ABOUT TIME! It also states that “postpartum care should become an ongoing process” and include a “comprehensive postpartum visit with a full assessment of physical, social, and psychological well-being, including the following domains: mood and emotional well-being; infant care and feeding; sexuality, contraception, and birth spacing; sleep and fatigue; physical recovery from birth; chronic disease management; and health maintenance.” Pelvic physical therapy even got a shout out!
Now the real question to ask is whether moms are actually receiving this recommended peripartum care. In a study surveying the office visits of postpartum women from 2008 to 2016, less than 50% of most recommended services were performed during a comprehensive visit and this was consistent across all insurance types (article).
I think there are many reasons for this shortcoming. First off, a comprehensive visit requires time: something most doctors do not have in our current medical system. I believe it is unreasonable to expect an OBGYN, midwife or family doctor to cover all of these areas in the 20 min they are allotted per patient. They are doing the best they can within the model that they work which means screening for life threatening conditions and moving on to their next patient.
Another reason is that mothers don’t know they deserve and need more than what they are currently receiving. I know many that are itching to get back to things so when they are given the “all clear” at 6 weeks, they are stoked! What they don’t know is that this is a disservice to their body in the long run. Many have symptoms they are experiencing but don’t know something can be done to help them, aren’t comfortable talking about it or aren’t asked in the first place. Too often, women accept that they will pee themselves when they sneeze or have pain with penetration because these common symptoms are a “consequence” of having kids. Women just don’t know that it doesn’t have to be this way.
Motherhood is also a place of selflessness. The needs of the child are prioritized and mom is often left with no time, space or energy to take care of herself. There is so much emphasis on the baby’s health and well-being, mom doesn’t realize that her health should actually come first so she can be there for her child fully. I wish more moms believed and lived by the saying “happy mom, happy baby”. Instead, most mothers sacrifice their own needs for the needs of their child. I believe its up to perinatal professionals to make sure moms know that their well being matters too. In fact, it matters first and foremost.
So here is my contribution: some education regarding what peripartum care should look like. I recognize there are many barriers to this actually happening including but not limited to socioeconomic disparities and racial inequality but I figure the first step is naming what it should be. Once more people know the destination, we can start to figure out how to get there. If you aren’t a mom or expecting to be a one in the future, please tell your friends and family. And any stranger that might listen.
Peripartum care should start with a preconception visit. It provides a space to ask questions, voice concerns, talk about fears, understand what to expect and get some basic tests to confirm your body is fit to grow a baby. This is also where difficult but ever so common occurrences like miscarriage and infertility should be discussed. By knowing about all of these things BEFORE they happen, women can be better equipped to deal with it when it is happening.
Once pregnant, the education should shift toward what to expect during pregnancy. It’s actually quite simple, expect anything and everything. But knowing this before the skin rash, insomnia, discharge, dizziness, shortness of breath etc. comes on would again be helpful. Pregnancy can be scary and it’s important for expecting mothers to know what constitutes a reason to call the nurse or head to urgent care. All of this should be covered in prenatal visits to a nurse, midwife or OB but sometimes it won’t be volunteered information. So ask questions mamas! No question is dumb. In fact you are likely wondering the exact same thing as that pregnant person sitting next to you in the waiting room. This is why I absolutely love prenatal yoga, prenatal fitness classes and group prenatal care. It’s so important to know and feel that you are not alone throughout all of this. If you are in Santa Cruz, check out Luma and Fit4Mom. We are so fortunate to have such amazing programs in our backyard. Go take advantage of it!
I have to refer to doctors, midwives and doulas for most prenatal education but when it comes to the musculoskeletal system, a pelvic physical therapist is the expert to consult. One day I hope pelvic PT will be part of routine prenatal and postnatal care but until then, it’s important you seek it out on your own. You don’t need to wait until you have pain or incontinence to see a pelvic physical therapist. Even before you’re showing, you can learn about how to engage your core, how to contract and relax your pelvic floor and how to stand properly so that when the belly is big and the system is challenged, you are better equipped to manage it and prevent pain, incontinence and prolapse. Sound like a good plan? I think so! During the later stages of pregnancy modification of exercises, sleeping positioning and preparation for delivery can be addressed. Doing so can minimize tearing, hemorrhoids, prolapse and diastasic recti. What an opportunity that is so often missed!
Ok so you have the baby. Chances are good labor and delivery aren’t going to go as planned but its a good lesson in letting go of control and expectations. All attention is turned toward baby and let me tell you, the baby always wins. But what about you? Your body has just performed a miracle! It grew a baby and now that baby is out either through a small hole or through a cut in your abdomen. In my opinion, neither are great options. If prenatal care didn’t fall short, postpartum care definitely will and this is why I am spending the time to write all of this and get it out there for anyone who wants it. Very little time goes into preparing a mama for what to expect physically after delivery. Again, I have to leave most of this up to doctors but ask the questions! If something isn’t working or feeling right, if you’re depressed and nothing brings you joy, or if you’re just wondering if something is normal, go see your doctor and ask questions! You are just as important as that baby you just made. In fact you are more important because a healthy and happy mom is going to nurture a healthy and happy baby.
What I can tell you is this, everything is going to hurt at first and pooping is going to be very painful and scary so take your stool softeners! Rest is the most important thing at first which is hard because you have a baby to keep alive and likely feel like you don’t know what you are doing when it comes to parenting. But rest. Please rest. As tissues heal and hormones level a little, a new version of your physical self will emerge. The most important thing I can tell you is this, you DO NOT have to live with pelvic pain or incontinence or anything else for that matter! Fancy diapers that look like panties or avoidance of sex does not have to be the answer! Go see a pelvic physical therapist. A pelvic PT can help guide you through low or mid back pain from lifting and nursing a baby, return to exercise safely so you can avoid injury, scar tissue release so you have less pain, so your c-section mark is less visible, so you can heal your diastasis recti, find you abdominals again, and train the pelvic floor so panty liners are no longer needed. The rebuilding process is just that, a process. And it doesn’t happen naturally, especially if you are having a kid any later than age 18. It’s hard work but if done properly, you can have a body that functions better than it did before having children. Trust me. You just need the proper guidance and support.
It’s also never too late to get the care you might have missed. Sure the “fourth trimester” is a very important time but technically, every mama is postpartum for the rest of their life. It’s never too late to work on scar tissue or strengthen the pelvic floor. We can wallow in what should have happened or what peripartum care should have looked like but instead, its best to look ahead. Spread the knowledge and know that postpartum care today was better than yesterday and will be even better tomorrow.