What I Wish Every Person Knew About the Postpartum Period: A Physician’s Perspective

Despite being a women’s health physician, I was not prepared for motherhood. I remember feeling overwhelmed, stressed, anxious, bored and just not myself. I really wondered if having a baby was a huge mistake. My postpartum care consisted of a phone call from a nurse at my OB’s office and an in-person appointment- otherwise I was on my own.

In the 17 years since the birth of my daughter, I’ve been a part of many of my patient’s postpartum health- and I know that the typical experience for American mothers is far from ideal. We don’t have the home based care common in many other countries, and many of us live far from or don’t have parents or in-laws who can provide the in-home support that most new mothers need. In effect, American women are triaging their own care. This isn’t just a nuisance, it’s a real health risk for mother’s and babies. 

The fact is, women experience high levels of stress and emotional exhaustion that is overlooked and minimized because it’s not considered a “real” medical symptom like prolonged heavy bleeding or cesarean incision tenderness. Our existing model of postpartum care focuses heavily on the physical recovery from childbirth and pregnancy, which has little to do with the complicated emotions and stress that many mothers experience. Given this mismatch, it’s easy to see why as many as 40% of women miss their postpartum appointment.

For many women there is hardly any time for a woman to recover at all. Just 27% of American workers have access to paid leave, requiring many women to return to work as early as two weeks after childbirth. Given these challenges, it’s no surprise that American women have high rates of maternal suicide and substance abuse, or that 65% of maternal deaths occur after the woman leaves the hospital, of which an estimated 90% are preventable. 

The good news is that there’s a growing recognition about the need to change postpartum care. Forty-seven states have expanded Medicaid coverage for postpartum care, with others on their way, and many physicians have proactively adopted ACOG recommendations to treat the postpartum period as an ongoing process, rather than a one-time visit. However, we’re also seeing the growth of a number of companies offering postpartum solutions that are largely perpetuating a failing model. 

For one, they approach the postpartum period with a tabula rasa mindset, as though the postpartum period is a new, blank state stage where family health histories, gestational or preexisting conditions, and pregnancy complications are magically resolved or reset. This is dangerous. Rather than treating postpartum care as a standalone period, a clinically-sound postpartum solution must consider and incorporate each woman’s level and quality of preconception and prenatal care, as well as the health of her interpersonal and community relationships that directly affect her mental and emotional health.

Additionally, many of these companies only offer telehealth visits, ironically mimicking the exact episodic model that already exists for postpartum care but shifted to a virtual environment. For employers and health plans that are evaluating their postpartum benefits and available solutions, we need to understand how each vendor incorporates preconception health and prenatal care into their postpartum care, and how it’s personalized to each woman’s pregnancy, delivery, and recovery plan. Concurrently, ask how their solution determines when each woman’s postpartum period begins and “ends,” and if they are adding arbitrary or artificial gates around this period that may push women out of care when they still need it.

Postpartum care should create a continuity between what happens before and after pregnancy, not fracture an already fractured experience. As a clinician, I see a number of opportunities to improve the postpartum experience for women:

• Adopt ACOG recommendations to treat postpartum as a ongoing process
• Expand paid parental leave access so women have time to rest and recover 
• Standardize care so that primary care better integrates with ob-gyn and midwifery care
• Take lessons from One Key Question® by asking women if they plan to get pregnant in the next year to boost preconception health and improve rates of adequate prenatal care
• Give women access to clinically guided digital tools and trusted sources to understand their bodies and their health 
• Seek out providers who understand and validate your health concerns, both before and after pregnancy 
• Normalize all experiences of motherhood and parenting, not just the positive ones

The last point is one that I think we can all agree needs further airtime. One of my continued joys and privileges is practicing medicine and being able to support the women and mothers across their lives, and so many times I’ve spoken to new mothers, second time mothers, third-time mothers, adoptive mothers, and all kinds of bonus parents, and assured them that all emotions and feelings are normal. And then I tell them that despite being a practicing physician, nothing prepared me for my own postpartum periods, and I share with them how hard it was for me and a few of the things that I wish I knew then.

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Leslie Saltzman, DO is the Chief Medical Officer at Ovia Health, and the founder of the Rittenhouse Women’s Wellness Center, a groundbreaking private practice in Philadelphia, PA. Dr. Saltzman received her degree in Osteopathic Medicine from the Philadelphia College of Osteopathic Medicine, and her Master’s in Business Administration from New York University. She and her family reside in New York City.