Postpartum Care in the USA

   

      So anyone who has been around me lately knows that I have been thinking a lot about the state of postartum care in the USA. And frankly I am appalled. The overwhleming majority of women in the USA will stay in the hospital for 24 hours and then have one postpartum visit six weeks later. This is the standard for postpartum care in the US. Compare this to the frequent prenatal screenings women recieve throughout their pregnancy. This is despite the reality that the overwhelming majority of pregnancies are low risk and remain uncomplicated.
        The postpartum period is both clinically and socially a crucial time in a woman's life. Socially, the transformation is obvious. A first time mother moves from a pregnant woman to a mother. A woman with multiple children will have their family life changed with the addition of a new baby. She will have to adjust to the new role of mother and her relationship(s) with sexual partner(s) may be changed dramatically. She will have to learn how to feed, clothe, change and soothe a new baby
with needs of it's own. It is pretty hard to overstate how significant the postpartum period is for bonding and the beginning of a new life. Unfortunately, most women recieve little to no maternity leave in the US leaving them having to both work and bond with their new baby. This is probably on of the main reasons that despite the overwhelming majority of women choosing to try breastfeeding, drop off rates are high. It is simply too difficult to balance work and motherhood in the US. In addition to caring for a new infant, women's bodies and emotions change significantly in the postpartum period. Women deserve access to health care providers in this period who can help women navigate the social changes in the postpartum period and to answer any questions they might have about both themselves and their infant.
       Clinically, the postpartum period is also very important. Childbirth is a major event that comes with some potential increase clinical risks. It is important to emphasize that most pregnancies and labors will go well, but their are some potential risks in the postpartum period. These include; mastitis, infection of sutures or Cesarean scars, late postpartum hemorrhage, inappropriate uterine involution and postpartum depression/psychosis and more mild problems such as fatigue. Most of these postpartum issues are preventable with postpartum assesment but can lead to dangers if unrecognized. For example, mastitis is easily prevented with a proper breastfeeding latch, but if unrecognized can lead to a generalized infection which can require hospitalization to fix. Mastitis generally will not develop within the traditional 24 hour hospital stay and generally before the six week postpartum visit. We are doing women a huge disserve in our current health care paradigm for postpartum care
        Recommendations: It is hard to even begin to imagine a health care system in the US that truly provides for women's postpartum needs because it is so far from our grasp. To begin with, all family members deserve paid leave for the postpartum period. This would greately increase breastfeeding rates, decrease stress and improve family bonding. Second, women deserve access to health care providers throughout the postpartum period. Postpartum standards and screening tools need to be developed that focus both on the social, medical and family aspects of the postpartum period. I will provide and overview of some possibilities in a future blog post.