For Our Postpartum Mothers, We See You!
Mother and baby pictured- Unsplash
As a woman, building a happy and healthy family is a goal I hope to achieve. However, there is something to say about what life looks like for a woman after birthing a child. I would like to preface this article by saying that while working in a patient facing setting, I have witnessed the lack of care postpartum women receive in this pivotal time. Although I may not know what it means to be a mother- for the bad and the good moments- one thing I do know for sure is that bearing children is not an easy road.
Getting an insight into people’s lives has been easier than ever, thanks to social media. Hearing other people’s daily thoughts and challenges is only a click away. As my instagram feed fills with mothers and their lives with their new addition to their family, I can’t help but notice the numbers of these women taking social media breaks because of their Postpartum Depression (PPD). The more I was on social media, the more I realized America may not adequately be equipped to help postpartum women. After reading all these posts and listening to my coworkers who are mothers, my myth that I would be untouchable to PPD, whenever the time comes, is broken. I thought that I would be so happy and grateful to have a child- that all my love for it would overtake any other feelings that may arise. However, during one of my laundry sessions deep thoughts, I realized I may actually be more likely to suffer from PPD due to my current struggle with depression because anxiety and depression are risk factors for PPD (American Psychological Association, 2022). This raised an internal red flag in me that I hope to educate myself and other women before having children.
What is PPD?
Postpartum is defined as the time after having a baby; during and after pregnancy, the body and mind go through many changes (OASH). It is common, with one in eight new mothers reporting experiencing symptoms of PPD within the year of childbirth. Women may feel sad, worried, overwhelmed, and/or anxious. They may also have crying spells, lose their appetite, or have trouble sleeping. If these feelings last longer than two weeks, the mother may be suffering from PPD. Postpartum mental health issues most commonly known as PPD, is a serious mental health condition that affects the mother’s behavior and physical health, interfering with her day-to-day life. The mother may not feel connected to her baby, might not love or even care for her baby- these feelings range from mild to severe levels.
So, let’s understand what happens after delivery. While more research is needed to determine the correlation between the drop in hormones after delivery, we know that there is a significant drop in child rearing hormones after delivery. Estrogen and progesterone increase during pregnancy but drop significantly about three days postpartum (Cleveland Clinic), .. contributing to PPD. (Lewis, R., 2021). In addition to hormonal changes, the mother may feel social and psychological changes associated with having a baby. These changes also increase her risk for PPD. Some significant examples are physical changes to the mother’s body, lack of sleep, worrying about parenting, or changes in her relationship (Cleveland Clinic). It is clear that women’s bodies and minds go through significant changes and stress during pregnancy and after delivery of her child. I can only imagine how much care these women need during this time.
Healthcare and PPD:
PPD was often perceived as a factor that limited patient engagement for postpartum mother’s healthcare (Ruderman, et. al., 2021. With a quick Google search for “postpartum depression”, I was able to find very little information on support for women suffering from PPD. Suggestions for support included recommendations for talk therapy, support groups, social support, practicing self-care, and prescribing medication to control symptoms of anxiety and/or depression..
If PPD is untreated, this can affect both the mother and baby. The mother may not have enough energy, have trouble understanding the baby’s and her own needs, has wide mood ranges, not being able to care for the baby, and would be at a higher risk for suicide (OASH). Untreated PPD will also affect the mother’s new child. Her child may have difficulty with language development, have learning difficulties, problems with mother-child bonding, have child behavioral issues such as more crying and agitation, have shorter height, and have a higher risk of obesity. Not only are women struggling internally with changes to their lives and bodies, but they are also having to navigate through a challenging healthcare system. Increasing care to women during the immediate postpartum timeline will allow for more care to be provided to women, and as a result, their children, during this critical time.
It is important America offers more care and support for these women and newborns after delivery. In 2018, the American College of Obstetricians and Gynecologists (ACOG) released a guide to optimize care for women in the immediate postpartum timeline (Ruderman, et. al., 2021). The immediate postpartum is up to 12 weeks postpartum, which is also known as the “Fourth Trimester”, this allows for postpartum care as an ongoing process rather than a single appointment. Although the idea of the Fourth Trimester is not novel, the challenges of postpartum have been more prevalent “due to rising comorbidity” and an increase in America’s complex health delivery system .
Just like anything in healthcare there are health disparities- access to more comprehensive, accessible, effective, and patient centered care is even more challenging for individuals with low income. The Ruderman study referenced above confirmed that low income, minority status, and mothers with less than high school education, are all associated with lower frequency of postpartum follow ups. Additionally, patients of low income are more likely to report unmet learning needs or are confused with how their pregnancy can impact their future health. The lack of postpartum care can also lead to decreased frequency of contraceptive use, shorter pregnancy intervals, and greater risk for preterm birth for the mother’s next pregnancy. Providing optimal and consistent care to all individuals, especially those who are at risk, is critical to optimizing postpartum care outcomes and lessening disparities.
Ruderman Study (2021):
The Ruderman study for postpartum care was performed in the Northwestern Memorial Hospital’s Prentice Ambulatory Care Clinic in urban Chicago. This study focused on clinicians and their perceived idea of current postpartum care for their patients: physicians, nurses, and social workers who care for low-income postpartum individuals. The interviewers investigated provider experience of postpartum care, with a focus on barriers experienced by patients and providers, and possible tools to maintain patients to have patients return for continued postpartum care (Ruderman, et. al., 2021). The results indicated challenges providers perceived for patients and for providers themselves overlapped. These challenges included difficulty with scheduling appointments, insurance limitations, and patient knowledge gaps. Providers indicated that potential factors that would improve postpartum care includes enhanced patient navigation of the healthcare system, access to women's health services (such as contraception), and an effortless process to send referrals to specialists.
Conclusions from this study identified that obstetric providers recognize the importance of postpartum care. However, these providers also acknowledge and highlight patient-based barriers from achieving optimal postpartum care. This study identified that the postpartum care system should be redesigned. Such factors like patient navigators and increase in resources can help enhance care during an important time of both mother and child health (Ruderman, et. al., 2021).
Although this study focused on low-income postpartum care, I like to argue that these changes for postpartum care will have a positive impact on all patients with different levels of income. For example, societal factors that affect a patient’s ability to access optimal health care were issues such as insurance limitations and the lack of access to a primary care provider. (Ruderman, et. al., 2021). These providers from the study encouraged their patients to join peer-to-peer education and support groups along with social media groups to help enhance care during the postpartum period. In the study, it was stated that community groups were ways to bring health-related knowledge to patients and improve postpartum health. Additionally, providers saw the benefit of social media groups for patient education and emotional support (Ruderman, et. al., 2021).
A Survey of Mothers in the Midwestern States (2015):
There have been other studies that confirm lack of support for women struggling with PPD. A study was conducted within the Midwestern United States for the early detection of PPD (Corrigan. et. al., 2015). It was also conducted to assess the mother's support system and how accessible access to knowledge is for the postpartum period. The data for this study was collected using a 47-item questionnaire that took approximately 15 minutes to complete and included a short form of the Social Support Questionnaire (SSQ) and the Edinburgh Postnatal Depression Scale (EPDS). Participants for this research study were recruited by word of mouth, along with certain agencies within communities that provide health care and other support to new mothers. Within the journal, the study states there was an effort to obtain participants with diverse backgrounds which included race, ethnicity, and socioeconomic status. This sample of mothers was within the Midwestern United States, the questionnaire sample was taken from June to August 2013. The conclusions to this study revealed topics of interest such as feelings of depressive symptoms, social support assessment, and professional assistance for PPD mothers. Based on the results, EPDS is a valid screening tool for women with PPD. The results indicated that in addition to using a depression screening tool, healthcare professionals should investigate the mother’s feelings within the context of this role transition.
Postpartum women should be assessed for their physical and psychological health needs as well as their current support system. This is to understand how supported this mother is or how susceptible she is to PPD. Additionally, assistance to resources should be offered, especially within low-income and within the Black community who have systematically faced and continue to face many barriers to healthcare. Within this study, it has been made clear that mothers require more knowledge of postnatal care than what is offered to them (Corrigan. et. al., 2015). As important to PPD screening, health professionals must recognize and care for PPD with accurate and supportive treatments.
Concluding statements:
In summary, it’s clear that mothers do not get enough support during the postpartum phase. Not only do women have to cope with the changes in their lives caring for another person, but they have to cope with bodily changes too. Many women struggle with PPD following the delivery of their newborn, and there is a lack of support for women who struggle with PPD. According to research, possible facilitators to help with PPD include expanding resources for patients and encouraging patients to join community groups to bring health-related knowledge to patients in order to improve their postpartum health. I hope to see a change within healthcare and to improve postpartum health outcomes, especially within this specific population of women. These changes are possible and at least postpartum health is starting to be taken seriously within our community.
About the author
Maham is a recent Portland State University alumni, receiving her Bachelor of Science in Public Health and minor in Anthropology. She is an activist and feminist, standing up for women’s rights and increasing awareness of domestic violence. As a woman and person of color, her life work is dedicated to creating mental health awareness and increasing diversity in healthcare areas. In her downtime, Maham is often painting or getting food with her friends.
