This Is Not Acceptable!

Body: 
 
During a recent postpartum support group, I was hosting, I found myself exclaiming “This is not acceptable!” I was ashamed as a medical provider, and incensed as a mother.
 
I was responding to a story told by a woman I had not previously met, who attended my group at the urging of her friend. During this support group, both I encouraged both women to talk about their birth stories.
 
Both women had complications before and during labor, many interventions, and their babies both had to stay in the NICU. One had her baby at the hospital where she planned to deliver, but the other was out of town on business when she experienced preterm labor, and she delivered in an unfamiliar hospital away from home.
 
There were many things upsetting about her story, as a medical provider. But this stood out—she had never had a postpartum follow-up visit with a provider, even after having a cesarean section!
 
I was in absolute disbelief. She had major abdominal surgery, which sets her up for complications like bleeding, blood clots, fluid changes, and pain. If this was an appendectomy, she would have been seen, but because she was a postpartum woman, and she was not considered a priority.
 
But why?
 
As someone who has seen plenty of women’s complaints downplayed by their providers, I shouldn’t be surprised. But as an advocate for women to have safe postpartum care, I am incensed.
 
NPR recently released an article detailing how postpartum complications are not being taught to postpartum women. I hope that discharge is just not the best time for new moms to learn (for example, they may be sleep deprived, just want to go home, worried about newborn weight gain, etc.). But it may simply be that instructions about postpartum complications overlooked by overworked medical staff.
 
As a result of this article, my team now reviews life-threatening postpartum complications with all of our clients, and we discuss symptoms that constitute an emergency.
  • Pain in your chest
  • Obstructed breathing or shortness of breath
  • Seizures
  • Thoughts of hurting yourself or your baby
  • Bleeding that is soaking through one pad/hour, or blood clots the size of an egg or bigger
  • Incision that is not healing
  • Red or swollen leg that is painful or warm to touch
  • Temperature of 100.4° F or higher
  • Headache that does not improve, even after taking medicine, or bad headache with vision changes
The complications above can be indicative of a pulmonary embolism (blood clot in the lungs), other blood clots, postpartum pre-eclampsia, and postpartum mood disorders.
 
I was astonished by this woman’s story because there was no coordination between her local OB provider and the medical staff in the city where she delivered. If she was given a follow-up appointment at discharge it was not explained to her. Because her baby was born so prematurely, he would be in the NICU for a couple of months, and she was essentially homeless after discharge. With issues like this to be concerned with, she may have missed a piece of paper that was given to her.
 
Having delivered very early, she had not yet had her shower and had no baby items, she did not have items for herself that were not business attire, and she was not able to accept packages at the temporary apartment she eventually rented via Air B&B. In addition, the apartment was one mile away with no transit system, she had to walk to and from the hospital each day to spend the day in the NICU or pay for a cab.
 
The only solace in her story for me, was she was in a medical facility for most of the day, every day when she visited her baby in the NICU, so if she had a seizure, stroke, or blood clot at least she was close to the emergency room and other medical personnel.
 
And the icing on the cake—since she had already delivered the baby, she wasn’t allowed to see her provider as soon as she returned home (at 8 weeks postpartum). She had to wait to see her OB for a gynecological appointment that she still had not had as of the night I met her! My midwife was especially upset about this part of the story when I was relaying this to her, during my own appointment.
 
Why did this happen? The optimist in me feels that she fell through the cracks. Even though the medical team here in Chicago was aware she had delivered, they did not coordinate care for her. The feminist and pessimist in me feels—this is yet another example of a woman being treated like a second-class citizen.
 
Either way— this is unacceptable! We need to do better. I have clients who have had friends that have passed away, or know of someone who has passed away, after childbirth in this country, in this decade. We have to do better for these moms, and show them they are still valued by our society.