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The Postpartum Gap

I’ve spent a lot of time this week reevaluating my plan for postpartum follow-ups. There is a significant and unfortunate gap in the care women receive in the weeks following birth. Often times in the last trimester of pregnancy, women receive one check up after another. Birth day finally comes and goes and within a week’s time, those check-ins have suddenly come to a screeching halt. Your hospital sent you home with a spray bottle, some pads, and a “see ya in 6 weeks”. Your husband and doting family members have gone back to work and resumed their normal lives. But you? Your life has changed drastically and that can leave moms feeling quite isolated. Don’t get me wrong, I know that this is a special, blissful time and newborn snuggles are pure joy- but this time can also be rough and mothers need support more than ever during this vulnerable time. Postpartum, at its best, can be really hard. Unfortunately, our model of postpartum care is just not enough. As both a mother and a birth worker, I’ve seen first hand just how long that 6 weeks (and beyond) can be. Women are often left to themselves to assume whats normal and what’s not during the postpartum period, many times even seeking out their own resources for support and specialized providers. Even greater than the physical aspects of postpartum, is the side no one wants to talk about - postpartum mood disorders. Many women go on about their lives, not seeking help, because the stigma attached to these disorders is often too great. Our societal perception of how motherhood should look is failing mothers and we are doing them a disservice by not talking about it.

Let me share some postpartum facts with you-

1) Baby blues vs postpartum depression

Baby blues in postpartum are pretty normal for lots of women. In the first two weeks after birth, roughly 70-80% of women experience some type of blues. These can be feelings of worry, crying, sadness, exhaustion, moodiness, and fatigue. For most women, these feelings begin to subside in the first few weeks and emotions begin returning to normal. But what about the ones who aren’t feeling back to normal? About 15% of women experience true postpartum mood disorders, often labeled as depression or anxiety. Many of these women experience feelings of worry / guilt / crying that interferes with their daily life, trouble sleeping, emotional numbness, disinterest in others, withdrawn, etc.

2) Risk factors matter

When it comes to postpartum mood disorders, your history matters. Things that put you at a higher risk-

  • History of anxiety or depression

  • Traumatic birth

  • Difficulty breastfeeding

  • Family history

3) There is no set timeline

You can be months out from your babe’s birth and develop a postpartum mood disorder. Certain life changes, circumstances, etc. can trigger PPD. This is one of the many reasons why continuity of care is important.

4) Women oftentimes aren’t even screened

I realize this doesn’t apply to all providers and that there are definitely strides being made, but sometimes there are no screeners done. I talked with a mom recently who was screened at 2 weeks. I was happy to hear this. But do you know when I was screened with my last baby? At her 6 month appointment. Fortunately, I’ve had a wonderful postpartum with her, but what if I hadn’t? Six months is a long time to go without being asked any questions.

5) Symptoms can vary

I personally went undiagnosed for far too long because my symptoms didn’t look like what I thought they should. To most people, I was functioning normally, but I was drowning on the inside. This may be the case for some women, while others may be suffering from irritability, anxiety, OCD, or in the most extreme cases - postpartum psychosis.

6) The impact runs deep

What’s going on with mom can have developmental impacts on baby and the family unit. This is a scenario in which “healthy mom, healthy baby” actually holds a lot of truth. One study showed that the developmental impacts on infants of mothers with PPD included low social engagement, difficulty self-regulating, and greater stress reactivity.

7) It’s okay to need help

It’s okay to get help. It doesn’t make you a bad mother or a failure. In fact, it makes you a better mother and encourages other struggling mothers to do the same. There are a variety of options available such as medical treatment, counseling, and support groups.

The unfortunate reality is that there is a gap in postpartum care here in the US. Postpartum care should be more than vaginal exams and contraception education. Our assumption that mothers will “land on their feet” or that things will “just come naturally” often lead us to failing women. When I read about on-going, hands on postpartum care in other countries or in the midwifery care continuum, I can’t help but think of how much women would benefit from change in our model of care. We aren’t there yet and have a long way to go, but what can we do to stand in the gap for women? We can break the silence and reverse the stigma of PPD by being honest. We can ask moms more meaningful questions than if they have a “good” baby or not. We can be transparent about what motherhood looks like beyond social media. We can be more intentional about checking on them after baby just as much as we do before baby. Stand in the gap for the postpartum moms in your life.

Here are a few suggestions-

  • Drop off a meal

  • Invite her over for coffee (she needs out of the house)

  • Take her coffee

  • If she crosses your mind, send her a thoughtful text (she probably needs it)

  • Ask her how she is feeling

  • Encourage her

  • Listen to her

  • If you can’t help, direct her to someone who can (expecting her to find the right lactation consultant, chiropractor, counselor, etc can feel really overwhelming)