I gave birth unmedicated. After, I refused ibuprofen. One week postpartum, with my husband at work, I threw my back out wielding our daughter and a 15-pound stroller down the steps from our fourth-floor walkup to go to the pediatrician. Ask the neighbors? Forget it. I got this.
I was in pain, but felt strong. What’s more, I wanted to feel strong. I hated feeling dependent on others, even if the act of being cared for was comforting. I wasn’t weak. Look at what I had just done birthing my baby! My grit had always defined me — how could that be a problem?
Well, it was. And it is. For millions of us.
We are in the throes of a toxic can-do culture, which praises strength and productivity over serenity and self-preservation. Being “strong as a mother” is the ultimate badge of honor. Today, as a postpartum doula and founder of a maternal health startup, I see it often. Here are a few examples. (Names have been changed to protect people’s privacy.):
Tessa beams as she relays being able to walk five miles one week postpartum, even if it made her bleeding much worse.
Sarah hosts company four days postpartum and feels compelled to vacuum the whole house with the baby strapped to her chest.
Eliza, unaware of what diastasis is, lives with it until her intestines fully push forth, pressing against her skin and requiring surgery.
Constance, embarrassed by painful postpartum constipation, stays quiet until it results in an anal fissure requiring medication.
Uniqua can’t sleep and has intrusive thoughts but doesn’t seek help because they think postpartum is supposed to be hard and assume this will resolve on its own.
Despite spending the most per person on health care globally, the United States lacks a standard, integrated system of postpartum care. Here, private insurance, against the recommendation of the American College of Obstetricians and Gynecologists, still typically limits coverage of postpartum care to one visit six weeks after birth — which, even before COVID-19, 40% of birth persons missed due to cultural and systematic roadblocks.
This is compounded by alarming rates of postpartum depression and anxiety: pre-pandemic, the figure hovered at 1 in 5 in the U.S. Today, there’s data to suggest the rate has perhaps doubled due to COVID-19 impacts, in addition to rising perinatal substance misuse tied to untreated mental health needs.
While our stats are screaming, our suffering is not. It often sounds like this: “I’m OK.” “I’ll be fine.” “I’ll figure it out.”
The vast majority of cultures and countries worldwide recognize that the fourth trimester — defined as anything from the first 40 days to 90 days post-birth — is a singular, special time that is prepared for and then punctuated by ritualized rest, healing practices and hands-on postpartum support (familial and/or government-sponsored). There is a basic recognition that the birth person needs to recoup and be cared for after the overwhelming physical exertion of pregnancy and birth and to facilitate bonding and the transition from “me” to “mother.” It is a normal, healthy and needed process.
So many places but the U.S. We plan obsessively for the birth, track pregnancy daily, and (outside of a pandemic year) average 15 appointments across the span of nine months. But postpartum? Well, you’re on your own.
We fill our social media feeds with happy baby photos yet we crumple behind closed doors. Our truths are only disclosed after, when vulnerability can be used as a source of strength, presented as a cautionary tell-all reflection.
Ultimately, our sliver of equality pie requires us to be strong at all costs. We have to sacrifice our bodies and psyches to hold our place in a male-run paradigm that affords us no unilateral paid rights or recovery time. Baby is first; we are last.
In the name of proving we can do it all, we’ve allowed the most heroic, awe-inspiring and complex experience the human body will go through (birth) to be minimized in fear of being labeled fragile. The system is failing us, but, I’d argue, our belief in bounce-back culture is too.
It is exhausting and subpar for all birthing people, but particularly life-threatening for people of color who face biased care and greater hurdles to both preventive and out-of-pocket services. There is no way to have this conversation without acknowledging the painful fact that racial inequalities and inequities are inherent in birth and postpartum outcomes.
According to the Centers for Disease Control and Prevention, non-Hispanic Black women die at a rate three to four times that of non-Hispanic white women. Over age 30, it is up to five times higher (for non-Hispanic American Indian/Alaska Native women as well). Even when socioeconomic status is factored in, according to the same CDC report, “the pregnancy-related mortality rate for Black women with at least a college degree was 5.2 times that of their white counterparts.”
There are many factors that make up a reproductive experience, but a country’s maternal mortality rate (MMR) is a critical — albeit worst-case — one. The U.S. has one of the highest of all developed countries and it continues to increase. What’s more, according to the CDC, nearly 60% of those deaths were preventable and 44% occurred within 42 days after delivery. After 42 days? The CDC reports that 23.6% of maternal deaths happen 43 to 365 days after birth, making it the second most dangerous period of time (pregnancy being No. 1). We may think birth is the most harrowing moment, but it is statistically the safest day of the entire perinatal journey.
“We can do better. What if we planned for postpartum like we plan for birth? What if we talked about what our bodies actually go through — openly, in real time and with mixed company?”
No one, regardless of race, ethnicity, education, sex, orientation, identity or socioeconomic status should be surprised by what happens after we give birth. Nor should they have to be deeply hurting to be seen and supported and cared for.
We can do better. What if we planned for postpartum like we plan for birth? What if we talked about what our bodies actually go through — openly, in real time and with mixed company? What if everyone had check-ins from a doula, lactation expert, and/or pelvic floor therapist as part of their routine care post-birth? What if we normalized the continuum of the postpartum experience: the good, the bad and the in between? Postpartum is incredible and powerful. It is also overwhelming, exhausting and physically arduous.
I say, let’s loudly ask for more support and services, but only if we promise to push ourselves less. Who’s with me?
Mandy Major is a certified postpartum doula PCD(DONA), founder of maternal health startup Major Care, and Philips Avent spokesperson. She holds an M.A. from Columbia Journalism School and has written for Healthline, Motherly and Prevention, among other publications. You can follow her on Instagram at @doulamandy.