The Sorry State of Postpartum Care in America

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Written By Robby Macaay

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It used to be taboo for moms to talk about their postpartum struggles. Today, not so much. In fact, it’s quite the opposite: it seems like everyone lately is talking about the difficulty of the postpartum period. On Google, if you search for “celebrity postpartum stories,” almost every result yields an article about famous moms discussing things like postpartum depression, anxiety, psychosis, and even pelvic prolapse. In March 2023, Brittany Mahomes, wife of Kansas City Chiefs quarterback, Patrick Mahomes, shared a warning with her 1.9 million followers, writing, “Just a daily reminder. Once you have kids please take care of your pelvic floor. Seriously.”

This normalization has been a net gain for society. We, as a culture, needed to destigmatize talking about the postpartum struggle to improve maternal well-being. But as two psychologists specializing in women’s health, we’ve recently come to a surprising realization: maybe all this normalization has a dark side. In our culture’s noble attempt to encourage talking about postpartum pain and illness, we have inadvertently normalized the experience of postpartum pain and illness.

Today, we find ourselves in a societal and medical climate that views postpartum health issues as an inescapable part of early motherhood. But this resignation runs counter to a wealth of research indicating otherwise. Many postpartum health issues, such as mood disorders, urinary incontinence, and metabolic dysfunction, can be effectively treated, or in some cases, entirely prevented. By over-normalizing the discussion of postpartum struggle, we have limited the much needed, broader discussion around early and preventive care.

A 2016 study with Columbia University found that teaching high-risk mothers essential parenting skills after giving birth significantly reduced their likelihood of postpartum depression. By learning to comfort their infants, understand their parenting influences from childhood, anticipate postpartum challenges, and practice mindfulness, moms not only saw improvements in their mental well-being but also witnessed their babies crying and fussing less. Other studies have shown that pelvic floor health issues—widely assumed to be a “normal” occurrence following childbirth—can be reduced or prevented through basic pelvic floor muscle training with a physical therapist.

Research like this suggests that there is much more we can be doing to prepare new mothers for the transition to parenthood. But we’re not. In the U.S., there’s a striking gap in the time and resources allocated towards pregnancy versus the postpartum period. While a woman might visit her OBGYN 10-15 times during pregnancy, she’ll typically only visit once during the postpartum period. And while it’s commonplace for an expectant mother to take a birth education class, it is virtually unheard of for her to receive postpartum education.

Read More: Suffering Shouldn’t Be a Normal Part of Womanhood

For early intervention, few examples are more relevant than postpartum thyroiditis, which occurs when the immune system mistakenly attacks the thyroid gland, causing it to be inflamed. This condition, developed by 5% of women, can be effectively treated with medication if recognized early. However, it often goes undiagnosed because patients assume that the symptoms—unwanted weight loss or gain, fatigue, and anxiety—are all part of the “normal” postpartum struggle, rather than a treatable issue. This assumption often gets reinforced by medical doctors, who may tell new moms that their symptoms are “just part of what happens.” The result of delaying treatment is not inconsequential: for approximately 20%of diagnosed patients, the condition is permanent.

In a cultural and medical landscape that views postpartum hardship as normal—as an inescapable, predetermined outcome—doing more to prepare for postpartum seems like a moot point. It’s no surprise that 88% of women feel unprepared to navigate this period, with more than a third of new mothers developing a lasting health issue after giving birth, and over 40% of new mothers developing a pelvic floor disorder. These numbers are not an inevitability; they’re an institutional failure.

In her bestselling book, Hormone Intelligence, doctor and midwife Dr. Aviva Romm writes, “Common and normal are different. Just because so many women experience something doesn’t mean it’s inherent to our biology–being a woman is not a diagnosis.” Women’s health issues are often treated as an inherent part of being female, rather than conditions warranting serious attention, research, and systemic overhaul. In this way, the over-normalization of women’s health issues—especially in the realm of postpartum—has allowed our broken institutions to remain comfortably broken.

To meaningfully fix the current state of postpartum care, multiple systems need to be redesigned, from government policies to standard medical protocols. For most of us, though, the thought of overhauling these systems can feel impossible and disempowering. But there is something we do have power over: our narratives. It is essential that we shift from a narrative that over-normalizes the postpartum struggle to one of preventative care—one that refuses to accept it as normal. We need to leave behind the notion of, “That’s just how things are,” and replace it with, “It shouldn’t have to be this way.”

In this refusal to normalize the status quo, it helps to take inspiration from countries around the world. In New Zealand, after giving birth, moms can stay at a local birthing center, free of charge, where they will receive one-on-one care for them and their babies. They will also receive free in-home cleaning and laundry services. In South Korea, eight out of 10 new mothers will stay at care centers, or a Joriwon, after giving birth. At these postpartum care centers, they’ll experience fresh meals, childcare classes, pilates, massages, and facials. While the government does not cover the cost of their stay, the ubiquity of Joriwons in South Korea is emblematic of a culture that doesn’t simply resign to a difficult postpartum recovery, and instead, honors this period as sacred.

Normalization serves an important purpose: to destigmatize and educate, to extract truth from the shadows and cast it in the light. In the U.S., the postpartum struggle needed an era of normalization. But we should view this era as a steppingstone rather than a destination. The next great frontier in postpartum health must be anchored in the idea that the status quo can—and should—change.

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