I could feel myself backing up into the corner of the room as a newly postpartum family sat sprawled out on the bed talking with my mentor and sage midwife, Ciska. I was trying to shrink, make myself as small as possible; I was an alien observing the overwhelming and unfamiliar emotions flooding the room.
Everyone was crying. The new mother was sore, exhausted, milk just starting to come in. The new dad was gingerly holding his baby with the sweetness and unfamiliarity of not knowing exactly how to hold on to this squirming new creature. The baby was wailing and hated the scratchy velcro straps around her hips and legs, a common sling used to help rectify newborn hip dysplasia.
“Oh sweetie,” said Mom through tears, glancing over in my direction, “Everything’s fine. Just normal stuff.” I tried to tamper the surely wide-eyed, terrified look in my eyes and scooted a few feet closer. I watched with awe as Ciska skillfully and easily asked about aches and pains, breastfeeding, sleep deprivation, and navigating splitting baby care between the new parents. These parents were three days postpartum, right when the “baby blues” can really start to hit. Everyone’s exhausted, no one has slept in at least the last three or four days, and the reality of life with a new baby is starting to sink in.
Roughly 80% of new parents experience the Baby Blues, periods of feeling overwhelmed, completely out of your element, and having immense emotional highs and lows. Most of these feelings resolve by about the two week mark, but its when they don’t that we see the Baby Blues morph into postpartum depression or anxiety. All the studies we have tell us that we do a terrible job of taking care of postpartum families–medically, emotionally, socially.
Up to 20% of birthing parents experience postpartum depression, and roughly only 15% of those ever receive treatment. Most large practices see women for postpartum rounds at the hospital, which, even in the best case, last about 15 minutes and are focused mostly on the birthing parent’s physical well-being. We then release new parents with their tiny cargo into the world until their six week visit with some loose guidelines on when to call and some big red flag warning signs.
I sat with a woman four weeks postpartum last week, other young children running around her ankles, pulling things out of drawers, her postpartum screening score (a tool with which we use to diagnose postpartum depression) through the roof. The lines under her eyes were almost as deep as the folds of the blanket surrounding her month-old infant.
“I don’t know about that, I really think I’m fine. I’m just tired, that’s all,” she kept insisting to me again and again. Her insurance doesn’t cover counseling. She isn’t open to using medication. Her support network lives on the other side of the country. I have a thirty minute visit to discuss the benefits and risks of starting medication and common misconceptions about postpartum depression, while also assessing her stitches, discuss breastfeeding problems, bleeding, figure out a birth control method, conduct a full exam and a pap smear if she needs one.
We are letting our postpartum parents out of the plane without a parachute. Not to mention the sparse care we give to new parents, I often have patients calling my office for notes to go back to work 10 days, two weeks, three weeks after giving birth because we live in the only industrialized nation not to provide any paid parental leave to new parents. It almost seems like a cruel joke that we wonder why our postpartum depression rates are so high and our breastfeeding rates are so low when we, as a society, do absolutely nothing to support new families in one of the greatest transitions that they will experience.
I take all this in, hold it close, and think about what my own postpartum experience will be like. I have the incredible luxury of a partner who is willing, able, and excited to care for our baby once I go back to work. I will be honest though. Most days I am completely terrified of missing out on my budding family’s life, the little milestones and small joys, and I think of the long days and nights I will spend with a breast pump instead of feeding my baby while I care for other people’s families.
So how do we fix this? Below is my Postpartum Wish List. Some of them feel pie-in-the-sky unrealistic, some would simply be expansions of current programs that I see offered to (or can be afforded by) some, but only those with means.
- Fully paid parental leave for the gestational parent and their partner (if they have one) like every other industrial nation (compare to other country’s policies here)
- Postpartum doula support for the first few weeks to help with laundry, cooking, cleaning, and errands
- In-home postpartum visits by a nurse or midwife at 3 days, 1-2 weeks, 3-4 weeks, and 6-8 weeks.
- Universal, free access to groups like PEPS (Program for Early Parent Support), which, according to their website is “a session of 12 weekly PEPS meetings brings parents together to share the joys and challenges of parenthood and develop confidence in their own abilities. PEPS stands apart from other new moms groups or dad groups by providing ongoing neighborhood-based resources and peer education, facilitated by trained volunteers. During one of the most vulnerable periods for new parents, PEPS provides immediate and accessible support, creating “extended families” that often last a lifetime.
- Single-payer insurance which would fully cover counseling services for parents needing counseling for either postpartum depression or anxiety or for the transition into parenthood.
- Once parents return to work, in-office, free childcare that can continue to nurture breastfeeding relationships and family bonding.
- Comprehensive sex-education, universally available and accessible contraception and abortion services to help ensure that every child is born to parents who are ready, willing, and able to care for them.
I imagine a world in which I get my wish list fulfilled and think of all the joyful, strong, and confident families I would see at my six week visits instead of so many where I feel as though I am sticking my finger in a dike.
Reproductive justice has many points it addresses, but encompassed in its definition is the full care of families when they do chose to have a child. We have yet to see paid parental leave and many of the other things on my wish-list emerge into reality, or even to be discussed in most spheres. So for now, I’ll keep dreaming, talking, and agitating for a world in which my wish-list is a reality.