Postpartum is Not an Afterthought.

There’s been a quiet yet problematic phenomenon in the perinatal world for decades now. It isn’t the birth plan not being taken seriously (though that does happen) or parents not getting everything on their baby registry (which is a total bummer, for sure) or even parents experiencing anxiety just trying to figure out which car seat to buy (analysis paralysis is real, y’all.)

No, the phenomenon I’m talking about is that during pregnancy there is so much focus on the upcoming birth that postpartum planning, education, and support is basically an afterthought, if it’s thought about much at all beyond some vague ideas around how the baby will eat and where the baby might sleep. 

Why we miss talking about postpartum…

There are so many classes, doulas, care providers, and perinatal professionals focusing the majority of their services, education and marketing on pregnancy and the birth itself, with little to no information or support for the postpartum time. Childbirth classes might include an hour or so of time discussing the first few hours after the birth at the tail end of a multi-week childbirth education series. Most doulas are birth doulas who might offer a few hours of postpartum doula support as an “add-on” service for a birth doula package, if any. Even many “preparing for baby” classes focus solely on the infant- bathing, diaper changing, cues, feeding, safe sleep- and offer little to no information on the wellbeing of parents.

And don’t get me started on the fact that while a baby averages six to eight well-visits with their doctor in the first year after they are born, the parent who gave birth to that baby gets an average of one twenty to thirty minute visit, usually between four to six weeks after the birth… if they can even make it to the appointment.

I’m not saying that we don’t need childbirth education, birth doulas, or to focus on the birth or the baby; those are all vitally important. The issue is that we are not giving equal air time to postpartum preparation, education, and support, and instead treating it as a side-note, an add-on, or an afterthought. But the truth is, birth usually lasts just one day; the fourth trimester lasts three months, and a birthing person is postpartum for the rest of their life.

New parents need a tremendous amount of support, learning, and time to settle in as they evolve into new roles, heal from the birth, and figure out life on a whole new level.

How we talk about the first weeks after giving birth with expectant parents

To illustrate this, I have been informally polling expectant and new parents in my classes for many years to see if they have been educated by anyone- their care providers, birth doulas, childbirth educators, and others- on common postpartum warning signs, and sadly the vast majority have not.

In a follow-up question, I ask if they know that preeclampsia can occur not just during pregnancy but also into the first six weeks postpartum, and sadly, very few people know this even though it is a leading cause of maternal death.

Seventy five percent of the maternal deaths related to preeclampsia happen in the postpartum period, up to six weeks after delivery (preeclampsia.org). 

In contrast, when asked if they know what the signs of labor are, all hands go up- of course they do! Yet so few know about the things that can keep them safe and healthy postpartum. I know that in addition to having a midwife or obstetrician, most of these parents have also taken childbirth classes, written a birth plan, and/or hired a birth doula, and yet still they don’t have this basic, potentially life-saving information.

Why we need to start talking about postpartum

This has got to change. For starters, in the United States we are facing the worst maternal mortality rates in the developed world, with fifty-two percent of overall maternal deaths happening in the postpartum time (commonwealthfund.org). Many of these deaths are considered preventable, and while there is growing coverage for birth doulas through private insurance and Medicaid, there is very little for postpartum.

If we really want to address the maternal mortality crisis, we absolutely need to be making postpartum doula support as accessible to families as birth doula support. While having a certified postpartum doula in the home can’t single-handedly fix the systemic issues behind the alarming maternal, as well as infant, mortality rates, someone with professional training who is educating families and keeping an eye out for warning signs can be part of the solution, especially in the absence of any other professional in-home postpartum care in the US. 

Layered onto the lack of post-birth information and in-home support is the “back-to-normal”,  productivity-focused culture we find ourselves living in here in the United States.

Twenty five percent of new mothers and birthing people have to return to work by two weeks postpartum for financial reasons, with the majority of the rest going back by six to twelve weeks.

This not only places extra strain on physical recovery after birth, it places higher than normal levels of mental and emotional stress on families, and unrealistic expectations on the baby for sleep because parents need their own sleep in order to function in this madness.

Normalizing a restful, restorative postpartum time through prenatal education and planning, along with comprehensive postpartum support after the baby arrives can go a long way to counteract the unhealthy messaging to “get back to normal” and “be productive” that new parents are vulnerable to. When parents are feeling overwhelmed or like they are not getting it right, they need reassurance that it’s not them but the fast-paced culture that wants us to Get. Over. It. Already. 

A call to action: We need to talk about the postpartum experience

This is a call to action for all birth workers, doulas, midwives, childbirth educators, lactation professionals, medical providers, perinatal organizations, insurance companies, etc. to give postpartum planning and support equal air time with birth planning and support, instead of as an afterthought.

If you’re a childbirth educator, can you add more postpartum information and handouts? Birth Doulas, are you normalizing postpartum support by offering a postpartum plan template along with the birth plan, and referrals to postpartum doulas and classes? If you are a birth and postpartum doula, are you treating postpartum support like an add-on service, or giving it equal representation with your birth services, or working with a postpartum doula partner who can? Teamwork makes the dream work! 

Parents, if you are expecting, consider taking a postpartum specific class, making a postpartum plan, and hiring a postpartum doula. More information on post-birth warning signs can be found here along with a printable handout so that everyone supporting you in the postpartum time is aware and able to identify potential issues. May you have a restful and nurturing fourth trimester.

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