I became a 4th trimester traveling physician to transform postpartum care
Our system does not adequately address the medical struggles postpartum mothers face. I’m trying to make changes, one home visit at a time
My name is Sonal Patel. I am a pediatrician further trained in neonatology, as well as a lactation specialist, and now a fourth-trimester traveling doctor on a mission to change medical postpartum care. I want to ease the medical burdens of mothers and families entering the postpartum period (now referred to as the fourth trimester). The US medical system is not set up to adequately address the medical struggles mothers face. My professional experience in witnessing postpartum mothers in the neonatal ICU and my own experiences—navigating four rounds of fourth trimesters, courtesy of my four sons—gave me this insight. Now, I’m on a mission to reduce the US’s maternal mortality crisis through my company, NayaCare, which delivers medical postpartum home visits.
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What happens in a postpartum home visit
My visits always begin with a knock. Some days I am greeted by a new dad just getting his bearings, other days by big brother wagging his tail, toddlers excited to show me their new toy or mothers. Once inside, I look around for a hard surface to serve as an exam table. Just like the old-fashioned doctors that did home visits, I lug a black medical bag—a fortuitous find on a shopping trip.
My medical bag houses items to replicate a traditional outpatient clinic. From stethoscope to pulse oximeter, each device is individually disinfected and placed on the sterilized weight scale. After five years, this preparatory process has become second nature. The medical visits can be conducted in a living room packed with delivery boxes containing diapers, breastfeeding parts, or a newborn swing. Some choose a kitchen table adorned with congratulatory flower bouquets and unopened mail. And then there is always the nursery, housing a rocking chair, crib, changing table and bedding, all thoughtfully themed.
The home visits are 60 minutes encompassing a complete newborn medical exam, breastfeeding session, and time to address parental questions. Then, the attention is turned to the mother and her health. We talk about her birth story, her current needs, her support system, and screen for medical and mental issues. If there are any concerns, we coordinate care with her OB-GYN.
Related: How to advocate for yourself at medical appointments
Postpartum care needs a revamp
As a physician, the concept of US medical postpartum care was not foreign to me. But maybe it was because now I was older, or more exhausted, or maybe I just needed four diverse personal birth experiences to realize the massive holes in our medical postpartum care.
My pregnancies were great overall, but postpartum tore me apart physically, mentally and emotionally. Through my combined experiences, I had one C-section, three vaginal births after C-sections (VBACs), one unmedicated delivery, grades 2,3,4 perineal tears, uterine infection requiring antibiotics, blood pressure issues, breastfeeding struggles, postpartum depression and postpartum anxiety.
After each delivery, I would numbingly hobble to my newborn appointments, peri bottle in hand with an extra set of diapers for him—and me. But all care was focused on him; I was just a food vessel. In the first month after delivery, I attended up to four newborn appointments.
When I voiced concerns for my own physical and mental health, all I received were empathetic looks.
Related: A postpartum plan is just as important as a birth plan. Here’s how to make one.
The need for postpartum home visits
Why do we need postpartum home visits? The simple answer with a complex reason is America’s dismal maternal mortality rate. And to better understand, we need to examine the current postpartum healthcare system.
Collectively, postpartum OB visits are changing. In its 2018 statement addressing maternal postpartum care, the American College of Obstetrics and Gynecologists (ACOG) advocates “that postpartum care should be an ongoing process… with visits within the first three weeks” of delivery. The group also outlines an algorithm for women with higher-risk postpartum complications.
Related: ACOG guidelines push for postpartum checkups sooner and more often
The impetus for this change? Maternal mortality. America’s maternal mortality rate of 32.9 maternal deaths per 100,000 live births ranks last in industrialized nations though spending the most in healthcare dollars. Of these maternal deaths, the latest data reported in March 2023, showed that 22% mothers die in pregnancy, while 78% die after birth, with 25% in the first week of delivery. Four in 5 deaths are preventable.
Racial disparities are evident, heavily skewed to Black and Indigenous mothers. Among Black women, maternal mortality is 3 times higher than that of their white counterparts. Extrapolating the data further, a Black woman’s higher education level and socioeconomic status does not protect her from these alarming disparities.
The leading cause of maternal deaths are also different between races. White mothers are dying from suicide while Back mothers from cardiovascular causes. Industrialized nations that boast low maternal mortality rates all have universal medical home visitation programs in the fourth trimester.
Though ACOG’s statement addresses maternal health, mothers are still subjected to numerous outside-the-home appointments. Traveling from one clinic to another, lugging a car seat, squeezing in breastfeeding attempts all while delicately handling a fragile newborn; mothers are struggling. Women aren’t receiving the time and space to adequately heal, both physically and mentally. America’s current postpartum care model overlooks a major player in the mother-infant dyad: the mom. And it’s time we put moms back in the picture.
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