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As the coronavirus transforms the world as we know it, in recent weeks expectant and new moms have been particularly affected—and left in the lurch. Some have seen prenatal appointments rescheduled, others are afraid to go.

Mothers in New York were, for a time, forced to birth alone. New moms find themselves without the postpartum support they planned for and expected and postpartum group gatherings have been canceled or moved online.

Coronavirus has lifted some telehealth restrictions

Yet as our efforts to contain COVID-19 are reshaping public life, we are also seeing decades of healthcare policies relax overnight, bringing with them dramatic changes to the business of birth and postpartum care. For the sake of moms everywhere, I hope some of these stick around well beyond the current timetables.

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While the experience of birth and new motherhood is personal, support—from specialists and communities alike—improves outcomes and overall experiences. Lactation consultants can improve women's breastfeeding outcomes, pelvic floor therapists can help moms recover from pregnancy and birth physically and therapists can help treat postpartum depression, making a huge impact on maternal mental health. But millions of women in the United States do not have access to such providers.


Yet suddenly, in response to the urgent need to shelter in place, Medicaid, the Department of Health and Human Services and major private insurers relaxed policies that have long been barriers to prenatal and postpartum care (and care in general). Many providers are now able to practice virtually across state lines in accordance with their licensing; HIPAA enforcement has been relaxed to facilitate email, phone and video consults for professionals new to offering them; and Medicaid and insurance companies are quickly approving new telehealth reimbursement categories including physical therapy and mental health.

I believe that many elements of these changes should be made permanent, while we also need to do more to ensure that these care providers are adequately compensated for their services and time, no matter the medium.

Though virtual visits are not always perfect substitutes for in-person care, maternal care providers are often a lifeline that can make or break the transition to new motherhood. In recent weeks, through my work as a founder of a maternal care startup, I have received countless messages from new moms seeking help with breastfeeding, anxiety and lack of sleep or simply seeking validation that they are not alone. More than one new mom has described her experience as "hanging on by a thread."

I didn't give birth in the midst of a pandemic, and the transition to motherhood was still challenging. It's challenging no matter what. And it was my doula, who had been present at the birth and who came to our home after I gave birth, who helped me through it—reminding me and making it possible for me to care for myself as well as I cared for my son.

She was the one who suggested I seek support from a lactation consultant, urged me to make time for pelvic floor physical therapy (and find one that was child-friendly, so I could bring my son) and made sure I was able to focus on my mental health as I navigated an identity shift that took me by surprise.

I don't know what I would have done without her.

But my experience is not an anomaly. Becoming a mother has a profound impact on women, as does the act of giving birth.

Most new moms are:

  • Sleep deprived (which does its own number on relationships and mental health)
  • Recovering from injuries sustained from childbirth
  • Struggling with breastfeeding (which does not, it turns out, come naturally to all of us)
  • Experiencing pelvic floor issues
  • Wrestling with identity change
  • Contending with realities that don't match up with how we pictured things
  • Dealing with varying levels and degrees of postpartum anxiety (PPA) and/or depression (PPD)

Addressing the maternal mental health care challenges in our country

PPD affects 1 in 7 new mothers, according to the American Psychological Association, and symptoms can last up to a year postpartum. Yet less than 25% of the women who screen positive for PPD receive follow-up care, for reasons that range from the stigma around mental health issues to their providers not knowing where to refer them. Many therapists have reported a spike in virtual visits during the coronavirus outbreak, which is a promising indication that people, including new mothers, are seeking the help they need.

Coronavirus concerns only exacerbate these challenges. Yet long before COVID-19, we were in the midst of a maternal health crisis and the United States has had clear gaps when it comes to actually delivering on adequate maternal care due to racial, socioeconomic and other disparities. The March of Dimes coined the term "maternity care desert" to refer to the thousands of U.S. counties that lack obstetric care hospitals or providers, leaving millions of women driving long distances to seek care or else are found in the hands of general practitioners with limited experience.

Millions more women have limited access to appropriate preventive, prenatal and postpartum care in states with too few providers per birth who specialize in pelvic floor physical therapy or lactation consulting, for example. And many women simply struggle to attend appointments out of the home—that's why giving women the opportunity to have telehealth consultations with such providers is a necessity.

The changing landscape of doulas

In some ways, doulas have been disproportionately affected by the shifting landscape, as so much of their work is typically done hands-on and in-person. But the value of doula support—whether remote or not—cannot be overstated in improving outcomes for mothers.

Many doulas are approaching this crisis by embracing tools that can enable them to be present virtually for their clients. Though care from doulas is not traditionally covered by insurance (except in a few states where there are massive gaps in terms of the reimbursement offered for their time and labor) this embrace of satellite doula support is creative and welcome, and may eventually help to expand the adoption of doula services everywhere.

Pelvic floor and breastfeeding support can even be done virtually

Meanwhile, millions of mothers experience pelvic floor issues after birth and beyond, which are often best resolved by pelvic floor physical therapists. But several states have no such providers at all. Their work can be challenging to replicate virtually, but manual therapy is not necessarily required in order to be helpful. Many providers have techniques to support moms from afar, including exercise programs, teaching and observing scar mobilization.

In a recent study, 60% of mothers reported that they did not breastfeed for as long as they intended to, for a variety of reasons—issues with latching, concerns about infant nutrition and weight, worries about medications, unsupportive work policies and lack of parental leave. Support for such issues comes largely from lactation consultants, but there are only about 10 lactation consultants for every 1,000 live births in the United States—which means demand vastly outweighs supply.

In recent weeks, lactation consultants have been pivoting to do virtual consults, but some who have only ever done home visits have said it seems new moms aren't fully aware of their options here. And although the Affordable Care Act mandated coverage of breastfeeding support and supplies, in practice, actually receiving such benefits remains notoriously challenging. We have more work to do here across the board, including facilitating virtual support.

Bottom line

Getting support should not be dependent on where a person lives or if and how often they are able they are to leave their homes. Motherhood is a physiological transformation and it is clear that women who have better support before, during and after birth, do better. The fact that many women are now able to access those providers virtually will have a lasting impact.

If it is possible to have something good come from this time period, which will disproportionately impact our most vulnerable, let it be this.

When I was expecting my first child, I wanted to know everything that could possibly be in store for his first year.

I quizzed my own mom and the friends who ventured into motherhood before I did. I absorbed parenting books and articles like a sponge. I signed up for classes on childbirth, breastfeeding and even baby-led weaning. My philosophy? The more I knew, the better.

Yet, despite my best efforts, I didn't know it all. Not by a long shot. Instead, my firstborn, my husband and I had to figure it out together—day by day, challenge by challenge, triumph by triumph.

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The funny thing is that although I wanted to know it all, the surprises—those moments that were unique to us—were what made that first year so beautiful.

Of course, my research provided a helpful outline as I graduated from never having changed a diaper to conquering the newborn haze, my return to work, the milestones and the challenges. But while I did need much of that tactical knowledge, I also learned the value of following my baby's lead and trusting my gut.

I realized the importance of advice from fellow mamas, too. I vividly remember a conversation with a friend who had her first child shortly before I welcomed mine. My friend, who had already returned to work after maternity leave, encouraged me to be patient when introducing a bottle and to help my son get comfortable with taking that bottle from someone else.

Yes, from a logistical standpoint, that's great advice for any working mama. But I also took an incredibly important point from this conversation: This was less about the act of bottle-feeding itself, and more about what it represented for my peace of mind when I was away from my son.

This fellow mama encouraged me to honor my emotions and give myself permission to do what was best for my family—and that really set the tone for my whole approach to parenting. Because honestly, that was just the first of many big transitions during that first year, and each of them came with their own set of mixed emotions.

I felt proud and also strangely nostalgic as my baby seamlessly graduated to a sippy bottle.

I felt my baby's teething pain along with him and also felt confident that we could get through it with the right tools.

I felt relieved as my baby learned to self-soothe by finding his own pacifier and also sad to realize how quickly he was becoming his own person.



As I look back on everything now, some four years and two more kids later, I can't remember the exact day my son crawled, the project I tackled on my first day back at work, or even what his first word was. (It's written somewhere in a baby book!)

But I do remember how I felt with each milestone: the joy, the overwhelming love, the anxiety, the exhaustion and the sense of wonder. That truly was the greatest gift of the first year… and nothing could have prepared me for all those feelings.

This article was sponsored by Dr. Brown's. Thank you for supporting the brands that support Motherly and mamas.

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As mamas we want our babies to be safe, and that's what makes what happened to Glee actress Naya Rivera and her 4-year-old son Josey so heartbreaking.

On July 13, the Ventura County Sheriff's Department announced the 33-year-old mother's body was found at Lake Piru, five days after her son was found floating alone on a rented boat. According to Ventura County Sheriff Bill Ayub, Rivera's last action was to save her son.

"We know from speaking with her son that he and Naya swam in the lake together at some point in her journey. It was at that time that her son described being helped into the boat by Naya, who boosted him onto the deck from behind. He told investigators that he looked back and saw her disappear under the surface of the water," Ayub explained, adding that Rivera's son was wearing his life vest, but the adult life vest was left on the unanchored boat.

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Ayub says exactly what caused the drowning is still speculation but investigators believe the boat started drifting and that Rivera "mustered enough energy to get her son back onto the boat but not enough to save herself."

Our hearts are breaking for Josey and his dad right now. So much is unknown about what happened on Lake Piru but one thing is crystal clear: Naya Rivera has always loved her son with all her heart.

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