Just days after giving birth to her fourth child, mama Taylor Magee (@thatndgirl) took to Instagram to share in a now-viral post about how mothers often feel like an afterthought after delivery.

"You see your doctor for one 6-week postpartum check-up and then you don't check in again for an entire year," Taylor writes.

Her story resonated—because she's absolutely right. In most cases, the standard of care for postpartum mothers is just one paltry visit six weeks after delivery, then nothing further until the annual well-woman checkup a full year later. In contrast, prior to giving birth, pregnant people are initially seen by their providers monthly, then every two weeks starting in the third trimester, then weekly in the final month as their baby's due date approaches.

But those weekly appointments stop as soon as the baby is born, when the focus is placed primarily on the infant. Your baby will likely have at least two pediatric visits prior to that six-week mark. (And who has to take the baby to all those doctor appointments? The onus usually falls to the mama.) As a mother, it's as if you've been unceremoniously cast aside and forgotten. As a testament to this fact, maternal mortality is highest in the first 42 days (six weeks) after giving birth.

We are failing mothers.


Taylor writes:

"In the midst of taking newborn pictures in the hospital, Justin candidly captured me in all my "new" mom glory.

Mesh undies, big ole pad, engorged breasts, sexy nursing bra, chomping on ice. The reality of motherhood.

During pregnancy, people are always asking you if you need anything. You see your doctor every month, then every two weeks, and then weekly until you deliver.

After birth, it's easy to feel like an afterthought.

You're here, just having created, grown, and birthed an entire human — and all of the sudden you're put in the background. All the attention is now placed on your tiny human. Which, don't get me wrong, makes you feel completely grateful! But you're still here. Bleeding. Swollen. Cramping & contracting (yes you still do this after labor). Emotional about your first postpartum BM and nobody cares.

You see your doctor for one 6-week postpartum check-up and then you don't check in again for an entire year.

This is motherhood.

There will be many moments that you don't feel confident. There will be many times when you really need help that won't be offered. But you're going to get through it because mothers are strong. "



The six-week visit is too little, too late.

Your pregnancy is over, but your transition into motherhood is just beginning. In the days and weeks following birth, you'll go through an eye-opening number of changes, from postpartum bleeding (lochia) that can last for a full six weeks (or longer) to the onset of lactation (see: painfully engorged breasts), to a lack of consistent sleep (qualifying as serious sleep deprivation), to head-spinning hormonal shifts (estrogen and progesterone plummet almost immediately). Let's also add to that list: healing from a C-section or perineal tear and any issues that arise while breastfeeding.

Asking birthing people to navigate all of those changes on their own for six long weeks without medical support is, frankly, appalling.

It's also important to note that the six-week visit coincides with the time that many working mothers have to report back to work—especially those doing shift work or working at low-income jobs.

Here's what we should be doing.

The frequency of postpartum checkups should—at the very least—match newborn pediatric well-visits, which, according to the American Academy of Pediatrics, looks like:

  • One visit within 3 to 5 days of birth
  • One visit at the first-month mark (4 weeks)

Some pediatricians also recommend a 2-week well-visit.

In 2018, in conjunction with the Presidential Task Force on Redefining the Postpartum Visit, the American College of Obstetricians and Gynecology (ACOG) put forth new guidelines on optimizing postpartum care:

  • "To optimize the health of women and infants, postpartum care should become an ongoing process, rather than a single encounter, with services and support tailored to each woman's individual needs."
  • "It is recommended that all women have contact with their obstetrician–gynecologists or other obstetric care providers within the first 3 weeks postpartum."
  • "This initial assessment should be followed up with ongoing care as needed, concluding with a comprehensive postpartum visit no later than 12 weeks after birth."
  • "The comprehensive postpartum visit should include a full assessment of physical, social, and psychological well-being, including the following domains: mood and emotional well-being; infant care and feeding; sexuality, contraception, and birth spacing; sleep and fatigue; physical recovery from birth; chronic disease management; and health maintenance."

But these are still just guidelines—recommendations, not policy. Most insurance companies still will only cover that single six-week appointment. To make the required industry-wide sea change, we'll need these guidelines reflected in policy changes in order to get insurance companies to buck up and cover the costs.

We can do even better.

Offering in-home visits should become the norm, as it is in numerous European countries. Even telehealth checkups would go a long way in establishing a more convenient time and space for mothers to seek support, without leaving the house or requiring childcare.

Many midwives and postpartum doulas already offer in-home visits and more frequent check-ups, of course. But the issue here is that plenty of families are required to pay for these services out of pocket, which can get pricey fast—and simply isn't an option for some.

Until policy catches up with these vital changes, that leaves scores of mothers left to their own devices, without the support of the medical community.

"This is motherhood," writes Taylor. "There will be many moments that you don't feel confident. There will be many times when you really need help that won't be offered. But you're going to get through it because mothers are strong. " We couldn't agree more.


Sources:

American Academy of Pediatrics. Healthy Children. AAP schedule of well-child care visits. Updated Oct. 26, 2018.

McKinney J, Keyser L, Clinton S, Pagliano C. ACOG Committee Opinion No. 736: optimizing postpartum care. Obstetrics & Gynecology. 2018 Sep 1;132(3):784-5.

Paladine HL, Blenning CE, Strangas Y. Postpartum care: an approach to the fourth trimester. American Family Physician. 2019 Oct 15;100(8):485-91.