During the course of my pregnancy, I developed a close relationship with my midwife as my appointment frequency increased month after month. We would listen to the baby’s heartbeat and discuss how I was feeling, what I was eating, and changes I was experiencing. Over the 41 weeks of my pregnancy, I saw my midwife increasingly often, culminating with weekly check-ups in the last month, followed by visits every three days in the last two weeks. I leaned on her in a way I couldn’t lean on anyone else: she knew me and my child closely and she knew how to allay my concerns -- categorizing them into normal weirdness vs. weirdness worth worrying about. My daughter was born following a long but problem-free induction, a quick couple of pushes, and a single internal stitch -- and with that, my relationship with midwife was basically over.
In reality, this wasn’t the last time I would see her-- we would see one another one more time for my follow-up appointment-- but the abrupt drop in the frequency of our interactions was a complete shock. Having the baby on the outside of my body was harder in many ways compared to gestation. I suddenly felt alone, no longer protected by the security of regular, scheduled, covered-by-insurance appointments to ensure that both baby and I were well. It was fully five weeks later that the recommended postpartum visit occurred. In that five weeks
I had made a thousand decisions that affected my parenting and my daughter: whether or not to breastfeed, whether the blood I was discharging from my uterus was a “normal” amount, whether my exhausted crying at 2am was depression or just sleeplessness, whether and how to return to physical activity.
My experience is common. When women are pregnant, they are seen frequently in preparation for the baby they’re gestating. But once the baby has met the world, the medical episode is considered complete, insurance stops paying for check-ups, and women are sent home to figure the rest out with whatever resources they have. The medical system is not proactive about follow-up care for women. Medical guidelines are baby-centric, evident from the high-frequency schedule of visits during the pregnancy and the high frequency of child wellness visits after the baby is born, all of which are endorsed by national pediatric and OBGYN organizations and covered by insurance. By comparison, the medical recommendations for women after childbirth have historically only called for a single follow-up visit 4-6 weeks after delivery.
On its face, this feels like a problem for women. But what compounds the issue here is that researchers are hard pressed to calculate how much of a problem all of this is because there is practically no data collected on women’s health after they have had a baby if everything stays pretty okay. We only know when the worst happens-- when women die due to pregnancy-related issues or when they come close, known as Severe Maternal Morbidity. The result: we miss a lot about what happens to mothers once they head home, baby in arms and don’t end up re-hospitalized. That’s because in the field of health services research, most of our insight about the physical, emotional, social, and psychological effects of life events comes from two major sources of data: national surveys and medical records. Our systematic review of these public data sources in the U.S. showed that
researchers do not have sufficient metrics or sources of data to improve maternal health*.
This is a significant gap in our attention to mothers because you cannot change what you do not measure. We need to do better for mothers by measuring their maternal postpartum experiences and addressing the gaps.
*Footnote: Our paper, “Identifying Significant Data Gaps and Implications For Creating Meaningful Quality Improvement” received the “Highest Scoring Abstract” award at the 2018 American Public Health Association Annual Meeting. Read more here.