Postpartum Care in the U.S., Are New Parents Getting the Support they Need?

Postnatal recovery is a delicate time when parents are learning to navigate infant care while simultaneously recovering physically and emotionally from birth. In the U.S., the first postnatal check-up usually happens six weeks postpartum. Postpartum care is is not standardized in America. There is not a general consensus on postnatal care; leaving many parents feeling unsupported and lost after baby’s arrival. Even though America spends the most money in the world on healthcare, without a standard for postpartum care, the U.S. ranks last in maternal outcomes in comparison to other wealthy nations. “To say we are behind other countries in care, services and support is almost negligent. We are failing families. Period.” Mandy Major postpartum doula PCD (DONA), cofounder of Major Care

In the United States there is, however, a consensus on the benefits of prenatal care. Pregnant people are provided with dozens of prenatal check-ups by their care providers. Most care providers agree that comprehensive prenatal care creates more successful maternal outcomes as well as healthier babies. The focus, nonetheless, is on birth and birth plans. This leaves a huge gap in antepartum care, or preparation for the postpartum period. Other countries take a different approach to antepartum care; they provide standard access to both educational and medical support for parents.

We can learn from the example of other countries that have greater maternal outcomes. For example, in the Netherlands and Belgium, postpartum planning begins around 34 weeks. In Spain, parents are provided with monthly visits to a community midwife to assist in this preparation. In Finland, the birthing person is given access to intensive prenatal care if they require the assistance of a social worker, psychologist or physiotherapist. This type of approach provides a solid foundation for parents who are preparing for the postnatal phase.

In the U.S. the birthing person is expected to take care of themself and report any issues to their care provider. There are no follow-up visits after they leave the hospital, unless there is an 'issue.' Parents are not given a baseline of what is ‘normal’ during the postpartum phase. It can be challenging for someone who just gave birth to self diagnose any issues while still learning how to care for a newborn. Without guidance, education or routine check-ups a new parent may miss potential problems in their recovery phase.

“Developed countries with the lowest maternal mortality rate consistently have one thing in common; routine check-ins at home.” Mandy Major. France offers in-home postpartum care and all birthing parents automatically receive a referral for pelvic floor therapy. In Sweden, midwives conduct as many home visits as needed within the first four days after delivery (additional visits available after 4 days). In the Netherlands and Belgium new parents will have a maternity nurse come to their home and provide a minimum of 24 hours of care within the first 8 days after being discharged from the hospital. In Denmark, a midwife will make a follow-up phone call after discharge and then at home health visitor will come to the home within 4 days. These countries provide new parents with supportive care after their delivery. This practice ensures that parents are well informed and guided during a most vulnerable time.

Resting and slowing down is a hard sell in the U.S. Many parents over extend themselves and try to do too much during the postpartum phase. They are cooking, cleaning and caring for their families without outside help. An independent American spirit coupled with lack of formal support undermines their recovery. “Everything that a new baby needs a new mom needs.” Kimberly Ann Johnson author of The Fourth Trimester. A postpartum person needs a constant food source, soothing touch and rest just like a new baby. Taking time for a rest period is highly beneficial for both parent and baby. It allows time for physical recovery, emotional bonding and breastfeeding success. This can only be accomplished with assistance from others.

So how do new parents find the support they need? Although the options in the U.S. are limited, there are options. New parents may consider hiring a postpartum doula. Postpartum doulas are trained in assisting families during the postpartum phase. They are able to assist the family with emotional, practical and informational support. They can help with breastfeeding, newborn care, meal prep and even emotional support. Another option would be for parents to hire a midwife as their care provider. Midwives are highly trained in delivering babies, but they also provide prenatal and postnatal care. Most midwives offer routine check-ups during the postpartum phase. They provide 5-6 postpartum visits during the first six weeks to ensure that both parent and child are thriving. Their model of care is different from that of a doctor. They are there as a coach to help with breastfeeding, new born care and mental health. Both these alternatives may not be suitable for everyone, but educating new parents on the importance of planning for the postpartum phase is helpful. Gathering the assistance of family and friends is vital to their success during this transition. Also, reaching out to their care providers when something doesn't feel right is key.

New parents do not have the luxury of waiting for the system to change in order to find the care they need. Educating them on options and alternatives to the current model can provide a more supportive transition. Setting new parents up with proper care and aid will create more successful maternal outcomes and healthier babies.