In May 2018 the American College of Gynecology Presidential Task Force on Redefining the Postpartum Visit published the following statements:
"...currently, most women in the United States must independently navigate the postpartum transition until the traditional postpartum visit (4–6 weeks after delivery). This lack of attention to maternal health needs is of particular concern given that more than one half of pregnancy-related deaths occur after the birth of the infant."
"To optimize the health of women and infants, postpartum care should become an ongoing process, rather than a single encounter..."
Examples of Inadequate Postpartum Care
"I had “scarring” after an amazing home birth in 2011 and had strange smells that I knew were not right for many months after the birth. I’ve had a swollen uterus which an ultrasound says is “fine” more recently but when the midwife saw my “scarring” six years postpartum at a visit she was aghast. My whole body took a toll following the birth of my beautiful daughter with weight gain around my middle section, lethargy, unnamed depression. My periods begin and end with brown blood and are usually painful."
"I had a breast abscess that took doctors multiple visits to different doctors and seeing different lactation consultants to finally get help. My OB knew very little about breastfeeding, and our pediatrician asked if I considered formula when I said I was experiencing crazy pain breastfeeding. It took a painful abscess and trip to the hospital to get it aspirated and finally be better."
"Two weeks after delivery at my checkup I told the Dr. that I had stopped bleeding and was feeling really good and could I exercise? (First baby, first pregnancy and delivery) She kind of looked at me, I couldn't tell if she was annoyed. Not sure? and said so whatever you want if you feel like you can. I didn't feel at ease with that answer but I went for a gentle yoga class a few days later, and hurt myself. I pulled something, 'down there'. I still have no idea what happened but I felt really upset afterwards because I quickly realized my body was NOT actually ready for exercise. I also had DR and a poochy belly that felt like my organs were all rearranged and like nothing was settling back into the proper place. No one to ask for help, especially not the doctor. Google ended up being my postpartum resource."
"I gave birth with midwives at a birth center. I had a fourth degree tear form my vagina to my rectum which required an OB to come stitch. It took forever for my tear to heal. I had pain and blood with every bowel movement for four to five months. Around six weeks postpartum, I saw the ob who stitched me and told her my issues. She stuck her fingers up my rectum to "check for hemorrhoids" and when she said she couldn't detect any she said that I should be fine in time and that if I still had pain/blood in another couple months, I should come back to discuss surgery. I now know that I had a rectal prolapse based on my own research. I'm almost four years pp now and feel about 80% back to "normal." Fuck that doctor for not doing more for me in a time of crisis. I believe that I had severe pp depression and anxiety (that I still struggle with occasionally) because of inadequate care. In addition to that, I bled for eight weeks straight. I suffered with bleeding and cracked nipples for weeks in the beginning of breastfeeding. I developed mastitis from a plugged duct two months pp, which turned into an abscess. I was told by the first doc that I'd have to quit breastfeeding ad that I needed surgery to receive the abscess. I got a second opinion from a female surgeon who saw me every week for six weeks to care for my wound as my abscess drained naturally and then healed slowly through her help. I breastfed through all of that and made it to 18 months with my son. I dealt with so much pain (physical and emotional) postpartum that I made my husband get a vasectomy. I didn't return to sex with him for eight months. He never once pressured me, which I am so grateful for, but that was such a long time for both of us that we were disconnected in a way. As you can probably tell, I'm traumatized by what happened to me after childbirth (as well as in the birth process) and I wish so badly that I would've known how to get the right kind of support."
"No one diagnosed my thyroid autoimmune disorder. Then when my chiropractor finally did discover it seven months later, he gave me some vitamins and sent me on my way."
"I had retained placenta for eleven weeks postpartum after a manual placenta removal failed to get all of it at the time my daughter was born. It wasn't until I was around eights weeks postpartum that it was detected and action was taken to remove it. I could have died from this and probably would have if I was not on round five of antibiotics for my episiotomy and tears. After that experience, in my opinion, it should be standard to have an ultrasound done at one week pp after every/any manual placental removal. I was seeing my ob weekly to monitor the epis/tears but nothing was mentioned about the placenta. The only question I was asked was how breastfeeding was going well and I was getting help with that so I just said it was going okay and that I'm getting help from an LC. The Dr. said low milk supply is a symptom of retained placenta and if i had known that I would have mentioned it to my ob. The best is that I "delivered" the last chunk of placenta at home in the bathroom at eleven weeks postpartum, the day before I was scheduled for my second D&C. It was about the size of a small pear. I call it the homebirth I never had. It was the least traumatizing part of the entire experience."
"Lack of follow up with my OB until the "standard" six week appt. even though I called every week leading up to it, crying and begging to be seen early because I had zero control of my bowel movements. That's completely normal we'll take a look at it when we see you at your six week followup."
"When talking to my male OB about the intense pelvic pain after I have sex (likely caused by pelvic congestion since my last pregnancy) he said that "it's not that big of a deal. It's kind of like when a guy gets blue balls."
I loved my doula but had my babies (though vaginally and medicated) a hospital with a male OBGYN. Although he was told I was pushing and about to deliver, he "was next door watching Tiger golf. (HIs actual words). The nurse delivered my son without gloves on because she was trying to get a doctor in for the delivery. He forgot I was unmedicated and not only pulled out my placenta but also began stitching me up having forgotten. OUCH. A few days later one of my stitches ripped and I had to be resewn. He said it was against his Harvard education but he wanted to do it while it was still raw rather than a year later once it was healed. I still need a repair. Something is not right. There was a complete disregard for my body and for me as a person IN that body and I know that if he had slowed down, both on the delivery table and in his office afterwards, my care would have been better and my issues wouldn't still persist.
I had second degree tears after a forceps delivery. My six week check up lasted all of five minutes where I was told I still wasn't healed properly and should hold off on sex for another few weeks... I am now eleven weeks postpartum and still in pain down there plus dealing with pp depression. My OB didn't diagnose me with PPD or give me the Edinburgh questionnaire. My daughter's pediatrician spent WAY more time chatting with me about my recovery and PPD and encouraged me to get the help I need. I saw a high risk OB and had a complicated pregnancy because of a heart condition- but next pregnancy I DON'T CARE I'm seeing a midwife no matter what.