Posptartum and the Great Abyss

The postpartum period is a critical time for the health, attachment and emotional adjustment for both mother and baby.

It has become the expected norm that women are left with very little medical or care provider support/assistance in handling the many norms, transitions and stumbling blocks that present in the first 6 weeks postpartum with her and her baby.

The general exception to this rule are women who birth at home with a midwife or in a free standing birth center where the rest of the perinatal period has several (approximately 6 visits) scheduled for follow-up care for both mother and baby. In this case, a family practitioner or pediatrician is unnecessary unless a need outside the norm arises.

Sadly with the majority of American women birthing within the hospital environment, she will leave the hospital with a stack of papers, a resource list, perhaps after viewing a newborn video and be left to her own devices until that 6 week appointment with her  care provider (yes, some hospitals offer a visiting nurse once or maybe twice after birth, but is not the norm).

This is so stunning to me. Absolutely hair raising the lack of care women get. It is akin to entering the open sea with a poorly written map and expected to find the “New World” successfully and without setback.

As a doula and educator, I field emails, texts and calls from my clients and students asking questions, needing breastfeeding feedback and help navigating life.  WHERE ARE THE hospital care providers in this time?  Even without being able to offer home visits (except there could be a staff nurse, PA or NP to fill that roll), why are OB’s and hospital CNM’s not having their patients come in to the office at regular intervals post birth? For example, days 3, 7, 14, 21, 30 and then at 6 weeks? This sort of practice could address both emotional, physical needs and very well catch many other things BEFORE they become issues.

The longer I am in the birth professional, I am simply appalled by what passes as good care. No wonder so many women have recovery needs, postpartum mood disorders missed and breastfeeding problems. After months of constant contact and appointments (albeit not usually comprehensive), a woman is dropped into the abyss of postpartum without a safety net.

One practical solution is for a mother to secure a labor doula who would work with her prenatally through the early postpartum period and then hire a postpartum doula to continue care and assist in the rest of the perinatal period.

Another is for the mother to have a trusted, knowledgeable and skilled family member or friend come and stay with in her home from the birth through at least 6 weeks post birth. This person would help the mother learn to mother and not be “nannying” the baby similar to that of a postpartum doula.

Lastly, for truly comprehensive care, there is always the option to switch to a provider that offers it or one never knows what would happen if it is simply requested as part of the maternity care package of her hospital-based provider.

I hope you found this food for thought invigorating! I look forward to your comments.


  1. Tiff @ Birth In Joy on November 29, 2010 at 11:51 am

    Amen. That is all.

  2. Katherine at Postpartum Progress on November 29, 2010 at 12:08 pm

    Thank you for saying this. New mothers really are left to their own devices. We need better support!

    • Desirre Andrews on November 29, 2010 at 12:10 pm

      We do and I see no reason why hospital-based providers cannot include more visits like home or birth center providers…. There is always a way.

  3. Lauren Hale on November 30, 2010 at 9:08 am

    “This is so stunning to me. Absolutely hair raising the lack of care women get. It is akin to entering the open sea with a poorly written map and expected to find the “New World” successfully and without setback.”


    Sadly, many women are left to find the new world on their own. Sitting in a Newborn Care class is completely different than sitting at home with a screaming infant in your arms after you’ve been awake for nearly 24 hours.

    The key here would be to show hospitals how implementing an after-care program (ie, providing postpartum doulas) would increase their profits and earn them more money. If it were a billable service, then the hospital may be more inclined to provide the care.

    It’s very difficult to navigate the New World when left without a road map. Your suggestions here are a wonderful start. However, if a mother does not have the money to pay for a postpartum doula or there is not one in her area, she is still left to her own devices. This is why a hospital based program would really be the best bet for an increase in this type of service. Again, you have to show how it would raise their bottom line and increase their visibility as a trend-setting facility.

    A family member is a great idea too. Again though, there’s the financial aspect. I don’t know many women who have other family members able to up and take 6 weeks off work or from their lives to come and help.

    The entire situation is such a Catch 22 which can lead down some really nasty roads, including toward Postpartum Mood & Anxiety Disorders or worse, toward Postpartum Psychosis.

    It takes a village to raise a child but it also takes a village to care for a new mother.

    For today’s mother, the village is simply not there.

    • Desirre Andrews on November 30, 2010 at 9:14 am

      Thank you so much for your added insight. I still believe the care provider rather than the hospital is responsible for additional care and follow-up as the hospital is really a transitional facility overall.

      It is a Catch 22. It takes so many more of us for sure to help a new mother. A tribal or communal way of life facilitates better postpartum so often. We seem to forget that in our modern, western culture. We are not meant to be autonomous fully.

  4. Bonnie Anderson on January 1, 2011 at 3:29 pm

    Re: postpartum “come to see your provider” appointments.

    I would NOT have had the energy, post-Cesarean, to do so even if it were offered.

    I agree that there should be more resources available, especially to first-time moms, but I question the concept of this coming from the medical profession.

    I believe the post-partum midwife or doula care is really the best option. If awareness of Post-Partum Doula care were to be spread at childbirth education classes, perhaps more women would try to take advantage of it.

    What our society has largely lost is the extended-family support (many live far from family) and even the church support that used to be available. Even further back, NEIGHBORS used to pitch in and assist.

    Also a factor you have not addressed: the STRESS of having that six-week adjustment period culminating with a financial need to return to the work force. This same financial pressure is a good part of the reason the family, church and neighborhood support is missing.

    I know I’m posing a lot of obstacles without suggesting solutions, but… IDEAS, anyone?