I am blessed with four boys. Yes, it is a life filled with simple, beautiful chaos. No, it wasn’t planned and we weren’t pining for a girl.
I met my husband in college. We were long distance for medical school and then our careers landed us in New Orleans. NOLA taught me to be a pediatrician, the beauty of life, and how to drink. Tequila on the rocks with a hint of lime. Margaritas from Superior Grill or Hurricanes in the French Quarter, alcohol flowed through the rhythm of the city.
Our careers led us to Boston, where hopes of becoming a tequila connoisseur were squashed by the outrageous drink prices. Seriously, East Coast, $20 for one drink! Accompanied by this reality was the decision to expand our family and move to Denver. Here, we were blessed with three additional sons.
Six months after the birth of my fourth son, I was diagnosed with interstitial cystitis, a chronic, painful bladder syndrome. Healing required abstaining from all things wonderful — from chocolates to alcohol. Sleep, drastic change in diet, mindfulness, and reduction in stress were needed in the mist of raising four boys. Great joke, God.
But how did I get here?
In reviewing my history, all answers pointed to my postpartum period. Four deliveries had caused havoc on my body — physically, emotionally, and mentally. After each of my four deliveries, I obediently followed the medical system, hobbling diligently to the pediatrician appointment just days later. Concerns about my own healing were outweighed by the maternal instinct to make sure my newborn was healthy. Each baby had four newborn appointments while I received one six week postpartum follow-up.
This postpartum medical care structure placed a heavy emphasis on my baby’s health and caused me to trek under challenging circumstances to receive medical care. A medical system that put pressure on my doctors’ time led to missed education and diagnosis for me. Through my pregnancies and postpartum, I suffered several complications with two diagnoses increasing my mortality risk.
I am a physician. What about the other mothers?
Recently, maternal mortality has moved to the forefront of national conversation due to the United States maternal deaths ranking highest in developed countries. There’s a lot of variability state-to-state, and Colorado ranks fifth-lowest. Still, Colorado’s maternal deaths have been rising with racial disparities evident in the Native American community.
Moreover, the data does not capture maternal complications, birth trauma, or near misses. Confounding factors include advanced maternal age, hypertension, and diabetes. Plus, more common impairments such as urinary and bowel incontinence and pelvic dysfunction disorders tend to be underreported.
Two-thirds of maternal deaths occur during the postpartum period. The postpartum period, traditionally defined as the 12 weeks following birth, is now sometimes called the “fourth trimester” of pregnancy. Dr. Harvey Karp coined this term in 2002, recognizing that “full-term” babies are actually born about three months early.
Human evolution caused this disparity by favoring bigger brains and upright posture. Standing upright led to smaller pelvic sizes, resulting in early birth. Newborns now need an extra three months to adapt outside the womb, thus the fourth trimester.
Society glosses over and often dismisses the postpartum period. Pregnancy is celebrated for 10 months when the baby is growing, but after delivery, a mother is expected to breastfeed, care for older children, and simply “bounce back.” This might sound harsh, yet it’s a reality for most women.
For mothers, the first obstetric appointment doesn’t occur until six weeks after birth. A newborn, meanwhile, receives medical care just days after hospital discharge. Such fragmented, imbalanced postpartum care prioritizes infants and overlooks mothers, fueling maternal mortality and glossing over their recovery.
Postpartum obstetric appointments are changing. In its 2018 statement addressing maternal postpartum care, the American College of Obstetrics and Gynecologists advocates “that postpartum care should be an ongoing process…with visits within the first three weeks” of delivery. The group also outlines an algorithm for women with higher-risk postpartum complications. In 2021, Medicaid expanded maternal coverage for postpartum up to a year; each state, now, has to decide implementation.
Implementation steps need to take into account maternal health. Traveling from one clinic to another, lugging a car seat, squeezing in breastfeeding attempts — all while delicately handling a fragile newborn; mothers, subjected to numerous outside-the-home appointments, aren’t receiving the time and space to adequately heal, both physically and mentally.
It’s time to go beyond the statistics and create conversations around concrete solutions shown to reduce maternal mortality such as standardizing doula coverage and medical postpartum home visits. Otherwise, we will be stuck in a postpartum care model that overlooks a major player in the mother-infant dyad: mom.
Sonal Patel, MD, of Golden, is a pediatrician and neonatologist. She is founder and CEO of Nayacare
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