Everyone knows that after you have a baby, you schedule a 6-week follow-up visit. The American College of Obstetrics and Gynecologists (ACOG), however, has recommended that we change that. Rather than one 6-week visit, they want a 3-week visit, supplemented, with “more frequent contact … as needed through additional visits, phone calls, even texts.” They also recommend an assessment at 12 weeks postpartum, to “talk about mood and emotional well-being, infant care and feeding, sexuality and birth spacing, sleep and fatigue, physical recovery, and chronic disease management.”
A visit sooner than 6 weeks could have saved me a lot of blood, sweat, and tears. Literally.
With every single one of my children, I was back in the doctor’s office several days after birth. Twice I was terrified my stitches were breaking (I had nearly fourth-degree tears with both, which were excellently stitched by my OBGYN. They were not breaking, and I needed her to tell me that. Her response, once we had become outside-the-delivery-room friends by baby number three, was a sigh and a “you looked at them, didn’t you?”). For baby number two, I had very, very heavy bleeding and a possible retained placenta that could have been easily handled with an in-office ultrasound (“You aren’t retaining a piece of placenta, sweetie, you’re just bleeding like a stuck pig”), rather than a harrowing ER visit.
Before six weeks, I had PPD. My thyroid blew out. I was nursing two kids at once from baby #2 on. I was living on elimination diets to alleviate babies’ reflux. I could have used someone to point me in the right direction of an attachment parenting community; I could have used someone to point me towards a La Leche meeting whose members didn’t care that I had a used diaper bag. Someone could have talked me into vaxxing my children on a regular schedule.
An earlier postpartum visit would have been a godsend to me, and to many other mothers.
Tamika Auguste, M.D., an OBGYN at MedStar Washington Hospital Center and co-author of the ACOG opinion, tells Parents that, “I believe the continuum of care for women is what has been lacking.”
No shit. I had severe gestational diabetes with my last son, and could have used some help, you know, coming down from that, as well as from the severe hyperemesis I suffered from each kid. I know a friend of mine, who dealt with the same combination but in a much more brutal fashion, could have used the same help before six weeks.
And don’t get me started on sleep.
We chose to co-sleep, which saved us a lot of nighttime wake-ups. But that doesn’t work for everyone, and most new parents are total mombies. There’s a reason we joke about moms and coffee. Someone needs to talk to them about ways to cope with sleep deprivation — before six weeks in. That someone should have a medical degree, because who better to discuss sleep deprivation that people who have been through residency, amiright?
But why the changes? According to Parents, the ACOG says more women are likely to die after birth than during childbirth in the US, and that problems like PPD and breastfeeding issues are more likely to be resolved if they’re addressed before the 6-week visit.
But all this stuff requires better coordination between specialists and insurance companies. In my case, it should have meant getting me into see a thyroid specialist sooner. Their first opening was months away, and in the meantime, I had to cope with exhaustion, dry skin, and mild depression, all while caring for a newborn. I needed to see a psychiatrist sooner than they could slot me in.
Insurance companies also don’t want to shell out for more visits. As one doctor told Parents, “In the current system of care, obstetric care providers receive a bundled payment for prenatal care, birth, and routine postpartum care. It’s a tough sell for providers to add additional visits if there is no additional reimbursement.” Basically, your doctor would be providing extra care for nothing. And as the friend of an OB, I can tell you they’re already overrun and overworked. They may desperately want to provide you the care you need. But they simply may not have enough hours in the day to give it and still have some semblance of a life without mentally cracking.
We used to have a traditional 40 days of rest after birth, during which our moms and friends would come help us. We’ve lost that. I think I had maybe a few days, and then everyone disappeared, and I was left with this small screaming human who I still couldn’t believe they let me leave the hospital with. Six weeks is too far away for help. We need something sooner and we need it as soon as possible. In addition to care, OBGYNs can be a valuable resource in helping mother find villages, Parents suggests, through connections such as parenting classes, La Leche League, and Mommy and Me classes. Basically: they can help you make mom friends, which you desperately need.
Those folks in your internet birth group won’t cut it when your baby has a blow-out and there’s barf in your hair and you’re wondering if you should still be bleeding at five weeks. You need help. And that help should come from a doctor — at sooner than six weeks. Even if it’s just a text from a nurse. You need reassurance. The medical community should provide that. And it’s coming. Slowly but surely, it’s coming.
In the meantime, all you can do is pester the hell out of your OBGYN. If they’re like my fantastic doctor, they’ll make time for you. Even if it’s just to sigh at you about your stitches. Again.