The current structure of pre- and postnatal healthcare in America spans only 10 to 12 months altogether. Most pregnant women receive prenatal care for about eight to 10 months while they carry their babies, followed by a six-week postpartum appointment. However, a woman’s postpartum recovery lasts well beyond six weeks after the birth of her baby, as most mothers will tell you. If it took you almost 10 months to grow a baby, your physical recovery will likely take at least that long.
Every woman’s experience of pregnancy, labor, delivery, and postpartum is different, and not every woman’s experience necessitates additional healthcare beyond the six-week appointment. Some mothers adjust to their new normal by six weeks after birth and increasingly feel stronger and healthier, while others don’t. Sometimes, a mother might feel fine at the six-week appointment, only to have issues surface later. It’s problematic that standard postpartum healthcare does not match the variables in women’s recovery timelines. The fact remains that, according to many medical offices and insurance companies, you are no longer a postpartum mother after six to eight weeks.
If you have had a negative postpartum experience, you’re not an outlier. Every woman heals differently, but pregnancy and childbirth are hard. Every mother can undoubtedly benefit from additional nurturing during at least the first year after giving birth. You deserve holistic, woman-centered care that focuses on deeply replenishing you in every way after the hard, body-breaking work of sheltering, nurturing, and bringing forth another human being.
The Tide May Be Changing
The last few decades have seen an increasing awareness of the needs of postpartum women, such as with growing resources and treatment for postpartum depression and anxiety. It is widely accepted now that postpartum depression and anxiety in the mother can surface at any time in the first year after birth – and new research suggests that it can present even years beyond that.
Also, in May 2018, the American College of Obstetricians and Gynecologists published a committee opinion recommending changes to the current structure of postpartum obstetric care. The new recommendations include an initial assessment of the mother’s health within the first three weeks after birth, followed by a postpartum visit at 12 weeks and as many times as necessary in between.
It’s problematic that standard postpartum healthcare does not match the variables in women’s recovery timelines.
The need for longer availability of postpartum care is getting more attention even on the federal level. Medicaid postpartum coverage currently lasts only 60 days, but individual states may request a waiver that extends coverage for up to a year after birth. Some states have already been approved, and many other states are requesting extensions.
While growing awareness and resources are essential, the medical care available to most postpartum women is still deficient. Healing from pregnancy and birth takes time and is multifaceted, and postpartum physical health resources can be hard to find. The good news is, if you find yourself postpartum with confusing, uncomfortable, or painful physical symptoms, you can still advocate for much within the current healthcare setup.
To optimize postpartum health and to treat postpartum symptoms, you can ask your OB-GYN or your primary care physician about the following feminine health areas. Bring up these topics during your first six weeks postpartum, at your six-week postpartum checkup, and at any time during the first year postpartum (and beyond).
1. Hormone Level Testing
“It’s just your postpartum hormones” is both the truest and the most unhelpful response anyone can give you postpartum. It's true that immediately after delivering the placenta, your elevated levels of estrogen and progesterone from pregnancy drop dramatically, and oxytocin and prolactin increase. Within only five days postpartum, estrogen levels can drop to 100 to 1,000 times lower than what they were at delivery, and it can take up to six months or longer for hormones to adjust to and consistently remain at pre-pregnancy levels.
However, “it’s just your hormones” doesn’t account for the fact that there are things you can do to support hormone balance, and it doesn’t acknowledge that some women’s hormone levels may struggle to be or stay within the normal range. Fluctuating and abnormal hormone levels can affect multiple aspects of your health, and there may even be a correlation between hormone levels and postpartum depression.
Getting your hormone levels evaluated through a personalized lens can give you and your provider crucial information about whether your body needs extra support during this time, such as with lifestyle and nutrition changes or prescription hormone therapy. Your provider may understandably discourage you from a hormone panel too early in the postpartum days because, again, your hormones are still normalizing which can skew test results. But it doesn’t hurt to ask for a screening (or screenings) to check levels throughout the first year postpartum.
2. Yeast Balance
Speaking of hormone fluctuations, the elevated hormone levels in pregnancy make pregnant women especially susceptible to yeast infections. Postpartum women can be susceptible to yeast infections too, due to the vulnerability of the postpartum healing process, the drastic hormone changes, and the added factor that some women need antibiotics during delivery. Postpartum yeast can commonly present itself both in vaginal yeast infections and thrush.
Don’t hesitate to ask your provider for recommendations on how to support healthy levels of yeast in your body, such as with a probiotic supplement or with dietary and lifestyle changes. You can also ask for vaginal yeast swabs or other yeast cultures, especially when being treated for other symptoms or when going on an antibiotics prescription. Antibiotics are often necessary for postpartum infections, but antibiotics can also sometimes trigger yeast infections. With a yeast culture before starting antibiotics, your provider can tell if yeast is already present and thus be prepared to treat both infections. You can also ask if certain antibiotics are more or less prone to cause yeast infections so you’re proceeding with full knowledge and preparation.
Antibiotics are often necessary for postpartum infections, but they can also sometimes trigger yeast infections.
3. Personalized Nutritional Guidance
When you’re pregnant, your baby gets all nutrients from you, by way of the placenta, so pregnancy can take a significant toll on a woman’s body and nutrient stores. It’s not surprising that it’s easy for women to end up very nutritionally depleted after pregnancy. Postnatal nutritional depletion can last for years if it's not addressed. It can be a culprit in many common postpartum symptoms and can lead to other health problems.
The good news is that postnatal depletion is not a problem without a solution! Even small steps will help, such as continuing to take high-quality prenatal vitamins and making sure you are eating enough. Your provider may not be a nutritional expert, but asking questions about personalized postpartum nutrition is a good place to start.
You can ask your provider for bloodwork to check your levels of micronutrients, for recommendations about nutrient-dense foods, and how many calories you specifically should be getting every day. Be sure to discuss how much sleep and exercise you’re getting, any lifestyle changes you’ve made recently, and any food allergies or sensitivities you have. All of these details may help indicate what nutritional deficiencies you may be experiencing, even without the bloodwork.
4. Physical Strength Exercises
A lot of myths surround postpartum exercise, and new moms can feel pressure to get back to their pre-baby weight. However, the main thing you should focus on as a postpartum mom is gently strengthening your body after it was weakened during pregnancy and birth.
A quick internet search will pronounce kegels as the magic fix to every postpartum ailment, but kegels may actually worsen some symptoms. Physical exercise and recovery guidance should be tailored to you specifically, which is why it’s best to discuss postpartum movement with your provider.
Ask your provider for personalized recommendations on what kinds of exercise to focus on, especially at different mile markers postpartum. What kind of movement is best for you at two months after birth? Eight months? If you are experiencing pain or discomfort, be specific about what you are feeling (no matter how awkward) and ask for targeted exercises or whether you should be resting. Rest has its place during the postpartum time! Listen to your body and to what your provider (not to the internet or body-shaming narratives) say is best for you.
You are your best advocate, and with some well-informed questions, you can begin deeper healing right in the office of your regular provider. Your provider may not be an expert in any of these areas, and going to a specialist may be necessary, but self-advocacy will always pay off. Be empowered to pursue real, complete healing in your health journey. You deserve it.
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