The Void that is Postpartum Care in America

I just started reading a most phenomenal jewel of a book called After the Baby's Birth by Robin Lim. Two quotes just from the preface and opening chapter have struck me:

"...I came to see more clear how my sisters in the West could expect little or no postpartum care or support, either from health-care providers or from friends and family. The modern lifestyle, embraced by the West, sought after and imitated all over the world, has so fractured families that postpartum women today accept and expect to be isolated. [bolding mine] I wonder at a culture that decades ago put men on the moon, yet chooses to ignore the most significant life passage of women." (xi)

"All too often, the only postpartum care an American woman can count on is one fifteen minute appointment with her doctor, six weeks after she has given birth. This six week marker ends an arbitrary period within which she is supposed to have worked out most postpartum questions for herself. This neglect of postpartum women is not just poor healthcare, it is abusive--[bolding mine]particularly to women suffering from painful physical and/or psychological disorders following childbirth." (4-5)

In cultures across the world, newborns and postpartum mothers are viewed as sacred and in a vulnerable state of being of both body and spirit. As such, they are nurtured and cared for. I suspect that now that puerperal fever is largely a thing of the past due to a better understanding of germ theory, more sanitary practices, and antibiotics, that as we lost some of the physical vulnerability of this time period (mercifully, the vast, vast majority of women in the West survive postpartum), we also lost respect for the spiritual and emotional vulnerability.

There are many interesting, beautiful traditions for postpartum women across the world. "Warming" the mother is common to many cultures. Some bury warm coals under the postpartum woman's bed. Some women are to sit on a fire warmed rock every morning, and it is also common to place a warmed rock on the woman's abdomen. There are taboos revolving around certain foods, and it often requires that the mother consume only warm liquids like tea and soup. These practices not only warm the body, but the soul. Touch is also a familiar component to these rituals. In some cultures the responsibility falls to the midwife to come give the mother a massage or rebozo treatment designed to "bring the bones back together." In others, the mothers or grandmothers of the postpartum woman provide this life affirming touch. In America, we too have our warming ritual, if you are lucky enough for someone to bring you a warm blanket after birth. The difference is, whereas the aforementioned traditions go on for weeks, women in our culture are "cared for" (and I use that term very loosely) for a few days or less.

Today I was reading a post on a message board for moms from the mother of a 2.5 week old who was feeling overwhelmed, sleep deprived, and isolated, looking to reach out to other mothers. She got some wonderful suggestions, but what stood out to me was the comment from one poster that said "If you are feeling depressed, don't worry, there are many antidepressants compatible with breastfeeding." While this is certainly true, and I would never ever advise against someone going on such medications if they feel like they need them, it made me wonder if we are handing prescriptions out to women who are really seeking encouragement and camraderie. Much as a laboring woman asking for drugs is sometimes actually asking for more support from those around her, I can't help but feel like we are ignoring a mass of women when we hand them a pill instead of loving guidance and help.

I have been working as a hospital doula now for 2 weeks and have spent a few shifts shadowing another doula on the mother baby unit. What has been eye opening for me is how little rest these women are getting in their very brief stay at the hospital. I have seen mothers drifting off falling asleep while they try desperately to pay attention to the presentation of how to put together their breast pump. I have seen a mother who had a cesarean not 12 hours earlier whose hospital phone rang no less than 5 times in the 15 minutes we visited with her. This same mother was distraught and exhausted and told us she had had visitors all day long. These mothers are also struggling to get to know their baby, learn how to breastfeed and recover from birth which for many also means recovering from major surgery. What I have also noticed is while these rooms may be brimming with stuffed animals and flower arrangement, I have yet to see a care package for mom, a stack of magazines or her favorite food or drink. The focus is on coming to see the baby, and respect for the mother and her passage is lost. It is no wonder we have a whole generation of women suffering alone through isolation, a sudden, crushing loss of identity and postpartum depression.

What can we do to improve the state of postpartum care in America? I believe it's obvious we need better medical care including at least one home nurse visit in the first 2 weeks after birth. For a greater discussion of this, see Ina May Gaskin's article "Masking Maternal Mortality" in the March/April 2008 edition of Mothering magazine. But aside from that, what can we women, birth professionals, mothers, sisters, aunts, grandmothers, and friends of postpartum women do to help fill this void? And what can the postpartum woman herself do to create the support system that is so sorely lacking for them?

First, I believe we need to address the early visitor issue. Everyone loves to see and hold a new baby. But again, we are talking about women who are in the hospital for 24 hours, not getting to rest because the nurses are checking in on them and their babies every few hours, learning to breastfeed which can be highly challenging, and often recovering from surgery. We wouldn't expect to go see Aunt Sally 4 hours after her appendectomy, and the same respect should be given a woman who has had a cesarean. I propose that no visitors come to the hospital the first day, and if they do, be limited to immediate family and the closest friends for less than an hour. Remember, in most hospitals rooming in is standard, and these mothers are not going to get a full night of sleep. There will be plenty of time to meet and cuddle this wonderful new blessing once the new family is settled at home.

How can the postpartum mother enforce this? Some tips are quite simple. Don't call anyone while you are in labor except for those you want with you either at or immediately after the birth. When you do call to let family and friends know you've had the baby, tell them you will be happy to see them once you get home. This alerts them to the fact that you are not inviting them to the hospital. What about those who will show up anyway? Tell your nurses to mark you down as "do not announce" and they will not tell anyone you are there. Let them know you would like your visitors cleared through the nurse's station and have them place a sign on your door when you are resting/feeding and prefer not to have visitors. Please realize this is not a hardship for the nurses, they actually like to limit your visitors. It is their job for you to have a full, speedy recovery, and they realize that you resting is the best way to get that. They will not mind at all being your gatekeeper.

I realize this all probably sounds harsh. But I assure you that once you have given birth, you will understand more of what I am saying. And I will also tell you that the most crucial time to your postpartum healing is 8 days after birth. The more rest, relaxation, and general being taken care of you can arrange for, the quicker the rest of your recovery will go. You are not denying people access to your baby. You are ensuring that you are healthy enough to care for him/her in the very demanding weeks to come.

Birth professionals, I implore you to impress the importance of these 8 days on your clients prenatally and encourage them to set forth the rules I have suggested for postpartum visitors.

This post will continue with more tips on how to build your own network of postpartum care, but for now I must sign off!


christine chapel said...

"It is their job for you to have a full, speedy recovery, and they realize that you resting is the best way to get that. They will not mind at all being your gatekeeper."

True. True, true, true, very true. I work as a labor and delivery nurse and although I want every woman to have the experience she wants to have, sometimes I would like to step in and just say, "Try this out without having all these extra people here, you will feel so much better afterwards."

But everyone is so excited to see this baby, and they want to see this baby NOW (never mind that the little immune system isn't up to handling all these visitors NOW).

Molly said...

I think this post is really important. It's amazing how HARD it is to convince people to leave a new family alone so that the parents can bond with their baby and figure out how to be parents. It's also amazing how few of the (uninvited, unwelcome) visitors are actually willing to change a diaper, give the baby back to be fed when he or she is hungry, respect the family's parenting choices, refrain from judgmental comments and advice, etc., etc. When I had my son, I was just blown away at how (ahem) assertive I had to be with our families to convince them they had no choice but to respect our wishes. (There was a lot of, "well, he's not your baby" and, in more tense moments, "gee ... whose vagina did he just pass through?") New mothers need to realize that they may not feel comfortable learning to breastfeed and bleeding heavily without necessarily feeling like showering every day ... in front of their inlaws ... who won't let them hold their own babies. But I think most people get steamrolled, you know?

Elizabeth said...

Have to add, that I think this is one of the many improvements in care that comes with birthing with midwives (and will come with a surge in midwife deliveries). From everything I've seen as a doula and having birthed my first baby in the hospital, you do not get to rest and recover with any privacy or dignity in the hospital. You're getting interrupted by so many people so frequently, the baby is being taken away to the nursery, and it's not a comfortable environment.

In fact, visitors can make the hospital seem more home-like, which I would bet is one reason more moms aren't discouraging them even when they're not up to it. And then of course that makes it harder to discourage visitors the first few days that you're home with the baby...

I love that when I have visited women at home who have just birthed with my soon-to-be preceptor, there is a sign on the front door with orders that visitors should limit their stay, wash their hands, and do dishes/change a diaper/otherwise HELP the new parents!

Regardless of their care provider or place of birth, all women deserve excellent postpartum support. I have started encouraging moms to make "postpartum doula fund" a baby shower gift suggestion. But really I think we also need to make this an issue that we prioritize as women -- we need to be vocal about honoring this transition, we need to ask new mothers what *they* need, and we need to really stress this with the dads so that new moms aren't having to advocate for themselves as much (or be steamrolled).

I'd love to see the fourth trimester get the attention it deserves!

Emily said...

Wow, what a powerful post. Thank you for taking the time to write it!

lcsw mom said...

Thank you for this wonderful post! Post partum care is sooooo lacking! No wonder our society is what it is at this time.

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Anonymous said...

I am going through post partum depression. My baby is 9 wks old. This has been the most miserable time of my life. He's my second baby & second c-section. I had company immediately following both. This time tho my mother in law who does nothing to lift my moral came in my room with a bad virus,-cough, bronchitis, sinus infection. She grabbed a mask, gloves, one of my hospital gowns layed out for me & covered herself all up. Mind u 4 hrs after surgery & grabbed my baby. I was to out of it at the time to stop the insanity & disapointingly my husband was just to afraid to hurt her feelings. Altho she has no trouble hurting ours time & time again. I was exhausted & needed just to rest. Also when I got home it was just days before I got sick with a virus. I'm telling you I had no support as my own mother is to ill to help me & I've never been so tired in my life. I did not sleep a full night or even 5 hrs following the csection for 7 weeks. The nurses would wake me everytime I fell into a deep sleep & also during the day when I was more likely to sleep because of a restless night, I had visitors. I had vistors all most all day the 1st day. So ladies I do not reccomend this. It will wear you out wether u think so or not. & I believe that exhaustion is the "key" to depression. Especially, ESPECIALLY for women who've just had a baby. Please please try to rest the entire time you are in the hospital. Let those nurses do their jobs & take care of the baby except for when u really need to bond. Soon as you're done send him back to the nursery, turn the lights out, hold all calls & visits & sleep. I can tell you from experience. Anyone not willing to respect your quiet time is not interested in your well being. So that being the case don't give a flip about thier feelings because that baby needs you more! You need to be rested & refreshed to be the best Mommy. I am leaving this site to try & find post partum depressed moms to chat with as I am desperate. I feel lonely, I feel like the my idenity has crashed, & even as a praying God fearing woman I need the love of others to lift me up. God bless you new Moms. I really wish the best for you. Hang in there. If I can make it this far, I'm sure you can make it period!!!

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