Dr. Greer Kirshenbaum, PhD posed in an instagram post “What happened at your six week postpartum check up?”
Some responses include:
I felt uncomfortable and like a guinea pig.
I had my check up today and honestly it felt like a tick box exercise…. Like [my GP] was just asking me the questions to just get through it…
Well mine never happened! My [practitioner] decided not to do these anymore! When I called to enquire 13 weeks postpartum I was notified of this and was told that I’m welcome to book an appointment if I think there’s something wrong. It’s ridiculous….
My 6 week health check was shambolic. I was not asked one single question about my mental well-being (after an incredibly traumatic emergency c section) he didn’t even ask about my wound or stitches!? Just asked about contraception and did basic checks on baby…
My postpartum care differed according to care provider. After I gave birth to my first daughter in a hospital, I showed up to my six week check up with my baby. My OB looked at me like, “Why is she here?” and motioned for me to set her in the corner of the bleak exam room. Then, my legs spread, he exclaimed, “Wow! Your cervix! It’s as if you didn’t just have a baby!” It was kind of weird.
After giving birth to my second and third babies at home, our postpartum care came to us. My midwives acknowledged us as the dyad, and even beyond that, included my older child(ren) and partner. They were thorough, interested in my physical, mental and emotional state, and didn’t make any strange comments about my insides.
The postpartum experience in America is many things. Often, it’s despicable.
For one, we offer no paid leave. In fact, one in four women return to work within two weeks of giving birth. The United States Breastfeeding Committee (USBC) is urging our decision-makers to establish national paid family leave. USBC offers a simple action tool to help individuals pressure Congress to pass the FAMILY Act. Find it here.
Without a paid leave policy, it makes it easy to turn the postpartum experience into a money-maker. Concoctions touting increased milk supply and hair growth, programs tailored to bounce-back culture, postpartum hotels, sleep training programs, commercial milk formula, etc. etc. etc. are all marketed wildly.
Care, when and if there is any, is generally siloed. Our system doesn’t consider the whole human or the dyad, so most moms are left chasing around to appointments specifically for baby (ies) and separately for herself. And because too many dyads experience traumatic births, often as the result of the medicalization of birth, that many more appointments pile up (if accessible) as a reactionary remedy.
Fourth trimester care attempts to heal this disconnect and to shift our cultural (mis)conceptions about the postpartum experience, where breastfeeding is recognized as a natural progression of pregnancy and labor, where the mother-baby is cared for as one, and where the postpartum individual is regarded as both delicate and powerful.
One effort in particular, the 4th Trimester Project, part of the University of North Carolina at Chapel Hill Jordan Institute for Families (JIF) in the School of Social Work, the Collaborative for Maternal and Infant Health (UNC CMIH) within the School of Medicine, and the Carolina Global Breastfeeding Institute within Department of Maternal and Child Health at the Gillings School of Global Public Health offers a wealth of resources for both families and providers. Browse the database here.
On The Breastfeeding Medicine Podcast, Dr. Eglash interviews Dr. Malasa Kahn who provides some practical advice for practitioners on how to integrate 4th trimester care into their efforts.
Check out these individuals and projects previously featured on Our Milky Way working to improve and integrate postpartum care:
Integrating mental health services into primary care
Therapist integrates lactation counseling into perinatal mood disorder work
Announcing the launch of the continuity of care in breastfeeding support
OTs can help new parents adopt new habits, skills, and routines
Tragically for too many, the postpartum experience and lack of care is deadly. [Read Forgotten Mothers of Arkansas: State With Worst Maternal Health Outcomes Fails To Support Postpartum Mothers, Maternity’s Most Dangerous Time: After New Mothers Come Home, Black Moms are Dying. What’s the Prescription?]
MaryAnn Wilbur, M.D., M.P.H., M.H.S. wrote a gut-wrenching piece called Ms. Omega One about the death of a young, Black mother that went completely unpublicized. Ms. Omega One died just two days after giving birth to her daughter. The piece draws attention to important issues such as the coverage of gun violence and disparities in media reports which must be addressed from an anti-racism lens. Ms. Omega One’s story also reminds us why we continue to fight for policies and legislation that support families. It’s because policies and legislation shape the reality of families’ lives. Things like supporting healthy birth options, enabling paid leave, upholding breastfeeding rights, and so on, all support family bonding and mental health. By better supporting families, by honoring the beauty and messiness of motherhood, we might become a society marked by less stress, less divisiveness, less violence and fewer tragedies.
Natasha VC of the Radical Moms Union recently wrote a piece called Let us Admire the Lactating Fountains of Italy: The most powerful representation of nature in art is a lactating woman.
“The Fontana della Spinacorona is a marble representation of the mythological founder of Naples, the winged siren Parthenope. Legend has it that the siren shot her breast milk onto the flames of the volcano Vesuvius to extinguish the fire. The work bears the Latin inscription Dum Vesevi Syrena Incendia Mulcet: ‘while the siren of Vesuvius calms the flames’…I must point out how absolutely METAL that is!!??? BREASTMILK TO EXTINGUISH THE VOLCANIC FLAMES OF VESUVIUS!!!!”
The piece illuminates a time when lactating women were “thought to represent Nature at its most glorious and powerful.”
“Think about that for a minute,” Natasha VC urges. “We typically think of a postpartum woman as weak, drained, struggling. Here, the nursing mother with fountains of milk shooting from her ample breasts, puts her on par with the gods of the sky and sea. PURE, RAW POWER, que bella!”
More on the PP experience
How does breastfeeding impact postpartum depression in pre and post covid 19 cohorts
She was living but she wasn’t alive
Finding the missing puzzle pieces in maternal support
Lactation Counselor Training Course enhances PT’s practice
‘Pandemic mama’ becomes full spectrum doula
Postpartum healing lodge– Michigan Breastfeeding Network
Dark Side of the Moon documentary
Traditional Postpartum Practices and Rituals: A Qualitative Systematic Review
