Why are our healthcare systems failing postpartum moms?

By the time most women go into labour in North America they’ve become accustomed to weekly check-ups with their OB or midwife. Expectant mothers are seen at least monthly, and at some points even weekly, in preparation for delivery. So many first-time mothers are shocked when, after their baby is born, they are not seen by a medical professional for the next six weeks.

During those weeks following childbirth, there is a lot going on for the new mother—both mentally and physically. Issues arise that, if left untreated, can create long-term problems.

Author and journalist Allison Yarrow says that after the birth of her two kids, she was inspired to look more closely into the care women receive after giving birth. Her investigations turned into a TED talk she gave in the Fall. “I started researching with this question in mind: ‘Who in the healthcare system is responsible for a woman healing from childbirth?’" The answer? Nobody.

Yarrow highlights how the system currently in place for obstetrics is primarily designed to care for babies, leaving the critical work of maternal care largely ignored. “OBGYNs focus on pregnant and laboring women. Paediatricians care for babies. Hospital staff tend to women in the hospital, but not after they go home. Pelvic health specialists or urogynecologists are engaged only when there’s something very wrong,” explains Yarrow. “Our healthcare system does not prioritize women healing from childbirth, so it routinely fails them as a result.”

There is no such thing as a dedicated doctor for new mothers in Canada or the US. And in the absence of a dedicated physician, women recovering from labour and delivery are turning to paediatricians and specialists in other fields for care and support.

Jen Trachtenberg, MD, a board-certified paediatrician, American Academy of Pediatric fellow and mother of three, who has owned her NYC-based private practice for 20 years, says she often ends up treating mothers along with her real patients—the babies.

“It’s important for the mom or the dad to be healthy in order to be able to care appropriately for the child," explains Trachtenberg. "The paediatrician’s main focus is obviously the baby, but we see the mom right at the beginning either at birth or a few days later and again at two weeks and one month (postpartum). We are in close contact.”

Adds Trachtenberg, “While the OBGYN is really the doctor for the mom, and they’re making sure their patient has good emotional and physical health while she’s pregnant, after that the care just kind of just drops off.” In the U.S. and Canada, new moms are generally seen just once postpartum—at six weeks. The process includes a pelvic exam to ensure they have “healed” from birth injuries such as tearing or episiotomy scars. Often women are told they are healthy enough to resume exercise and sexual activity. But many find this routine care sorely inadequate. “In the best world, obviously, they should be continuing to care for moms and the mom’s health right after birth. There is a void there,” argues Trachtenberg.

Doulas and lactation consultants are also stepping in to fill the gap. Megan Davidson, Ph.D., a labour and postpartum doula and breastfeeding counsellor in New York City, shared her experience working with new mothers who find themselves slipping into that void.

“I have helped about 1,200 NYC families postpartum and my clients are consistently both surprised and dismayed by the total lack of structured postpartum care,” says Davidson. “My clients need help with breastfeeding and [in] chestfeeding, understanding their own healing, learning to be parents, knowing what they should be concerned about and what is not a big deal, and navigating their way through all the challenges postpartum.” For most families, hiring an expert like Davidson is the only way to find this much-needed support.

“It is not uncommon for me to speak with my clients daily, answering hundreds of questions about feeding, problems with their breasts or chest, sleeping, bathing, rashes, hormones, healing from a Cesarean or a vaginal birth, hair loss, bleeding, aches and pains, referrals to other types of help such as physical therapists, having sex again, and more in the early weeks and months of parenthood,” Davidson says.

“Often the paediatrician tells you to come back in a month, the obstetrician in 6-8 weeks. There is nothing in between except the option to call if you think something is critically wrong. And this isn’t a critique of these care providers—they are doing their jobs, often really well, but this just isn’t their job.”

Currently, the area of postpartum care paediatricians are most focused on is postpartum depression screening. A Pediatric News article from November 2017 touted the benefits of screening mothers for postpartum depression, but it framed the conversation as critical primarily because of how it could affect their babies.

“It’s essential that you screen parents for depression, particularly mothers for PPD, because of the potential negative consequences for the child,” said the article, which credited Nerissa S. Bauer, MD, MPH. “Research has shown that children of mothers with PPD are at risk for failure to thrive, and have a greater likelihood of mental health conditions, developmental delays, lower IQ scores, sleep problems, and difficulties at school.”

Paediatricians are encouraged to screen new parents and then refer them to mental health professionals for treatment, if they identify symptoms of PPD.

Some new apps can help screen and catch postpartum depression earlier in new moms. Most recently, researching at Massachusetts General Hospital in Boston introduced a free iPhone app that measures women’s symptoms of postpartum depression.

And while PPD screening a good first step, it’s still not enough to fully fill the gap. “In New York City, the only care providers routinely providing this type of comprehensive help are home-birth midwives,” says Davidson. “But home births account for less than one percent of births. The other 99 percent of parents find themselves without any real structured care afterwards.”

It is technically not an obstetrician’s job to provide much care after the birth of the baby, says Davidson, but “neither is it the job of the paediatrician to support you through your own healing.” Oftentimes pediatricians are overwhelmed by the task of triaging and referring parents who are not physically or emotionally doing well, says Davidson. “It’s [indicative] a larger problem with how we support pregnant people and parents and the enormous failings of our current system.”

Read more: Postpartum bleeding: How much blood is normal? Postpartum anxiety has crippled nearly every aspect of my life