Postpartum Care in the U.S.

August 13, 2020

You may have heard that postnatal care in the United States is lacking, compared to other economically similar countries, and even many others that are not. Unfortunately, this is found to be true in multiple studies and certainly anecdotally speaking.

 

 Many women enter the postpartum phase having no idea what to expect, especially for first time parents. This is further exacerbated by pain, sleep deprivation, lack of adequate maternity leave and often lack of support.

 

Although the postpartum phase is often filled with joy and excitement over your new arrival, it is often also associated with postpartum depression and anxiety, pain, fatigue, bleeding issues, lactation issues, confusion, fear and stress over money and time away from work. Postpartum depression occurs 10-20% of the time while at least 70-80% of new birthing parents experience baby blues (Langdon, 2006).  About1/3 of people experiencing postpartum depression will have pathological anger towards the child, which can affect the child’s behavior and happiness for up to 14 years.  Fatigue is also common, with 76% of birthing parents reporting it at two months postpartum and many for up to three years (Cheng, 2006). 

 

While many countries offer up to a year maternity leave (including all northern and western European ones), the United States fall drastically behind. There is not national maternity coverage and only 14% of workers have a right to paid leave (Major, 2020). Furthermore, while it is typical in the majority of other countries to have 30-40 days of secluded quiet time after birthing, the United States has a tendency to encourage new parents to be up and moving quickly, attending social gatherings and overall getting back to normal. 

 

According to the CDC only about one third of babies are still breastfeeding at one year and only about half at six months. This is occurring despite the fact that several organizations, including the CDC and WHO, recommend breastfeeding for at least a year for ultimate health. An early end to breastfeeding is often due to maternal stress, lack of access to a lactation consult and decreased maternity leave. 

 

On top of the more commonly discussed issues like postpartum depression, lack of maternity leave, and lack of support with breastfeeding and infant care, there are many less talked about issues to. It is common for new parents to experience anxiety, changes in self-esteem, difficulty with sex, excessive or painful postpartum bleeding or periods, lack of connection to their baby, marital challenges, increased stress and oh so much more. Although the American College of Obstetricians and Gynecologists (ACOG) recommend that physical, psychological, social, sexual and infant care issues should be addressed in postpartum visits, they often are not and one third of women report that their concerns were not addressed at their six week follow up (Cheng, 2006). In large, six week follow ups consist of a vaginal exam and contraceptive discussion. This is a sharp contrast to other countries that will provide in home support in the first week with continued check ins for up to one year. 

 

In an ideal world, new parents would have a quiet place where they are tended and supported to allow for time to heal, properly bond with the baby and establish breastfeeding if desired. This is not only very important for the health of the parent, it sets the baby up for a healthy start as well. 

 

What Can I do?

It is difficult to advise when everyone’s situation is so different, but there are some things most people can do. Optimally you would start planning this around 34 weeks pregnant. 

 

  • Consider who will be around after the baby is born to help support you. Postpartum doulas can also help at this time if that is an option for you. 

  • What can you do now to simplify the first several weeks? Perhaps pre-making meals, getting ahead on household projects and needs or stocking up on household essentials if it is affordable to you. 

  • Gather up supplies. You know you need things for the baby but don’t forget about you too! One of the best gifts I received was a bag complete with essentials such as peri-wash, nipple cream and bean bags that can be placed in the microwave and then your bra to facilitate letdown.

  • Have a good lactation consultant at the ready, bonus if they are an IBCLC, to help with any lactation issues that arise. 

  • Know your risks. If you have pre-existing medical issues, including anxiety or depression, talk to your practitioner about added things to look out for. 

  • Be prepared! Take classes, read books, talk to trusted parents that have been there, and learn all about what you might expect. People are often afraid to talk about the nitty gritty so find that honest friend or practitioner that can give you all the details. 

  • Be easy on yourself. Carrying a baby and recovering after is hard work. You don’t have to be perfect. Don’t let others perfects social media posts fool you, everyone goes through something. 

  • Ask for help when needed. It’s OK to ask for help and totally OK to say if you are struggling. Reaching out is being strong and is doing what is best for you and your baby. 

 

 

And yes, acupuncture is great for the postpartum phase! Acupuncture can help with pain, mood, bleeding issues, cramps, digestive issues and so much more. Many people know that Acupuncture and Chinese Medicine are useful for fertility issues and maternal support, but many do not know of the huge benefit after birth. As always, we welcome your questions and comments!

 

 

 

Cheng, C. Y., Fowles, E. R., & Walker, L. O. (2006). Continuing education module: postpartum maternal health care in the United States: a critical review. The Journal of perinatal education, 15(3), 34–42. https://doi.org/10.1624/105812406X119002

 

Major, Mandy. (2020). What Postpartum Care Looks Like Around the World, and Why the U.S. is Missing the Mark. Healthline parenthood. Retrieved from: https://www.postpartumdepression.org/resources/statistics/#:~:text=The%20reported%20rate%20of%20clinical,the%20year%20after%20giving%20birth.

 

Langdon, Kimberly. (2020). Postpartum Depression Statistics. Retreived from: https://www.postpartumdepression.org/resources/statistics/#:~:text=The%20reported%20rate%20of%20clinical,the%20year%20after%20giving%20birth.

 

 

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