Postpartum care: why it’s neglected and what we want to do about it

Something that’s hard to really understand until you go through it yourself is just how difficult and isolating the postpartum period can be. After your body and life go through these transformative changes, you’re left with a little human you now have to take care of — and new questions and concerns seemingly by the minute: Why is nothing soothing this crying baby? Is it normal if your baby hasn’t pooped for a few days? How do you make sure you’re feeding the baby enough if you’re exclusively nursing? Are those “baby blues” actually postpartum depression? 

No one tells you what postpartum is really going to be like, and no one prepares you for it enough. That includes the U.S. healthcare system. You’re left pretty much on your own for six whole weeks during a time when your hormones are all over the place, you’re sleep deprived, and you’re overwhelmed to a level you’ve never experienced before. And a time when over half of maternal deaths happen. It just doesn’t make sense. 

After Millie CEO Anu Sharma had to identify for herself that something was seriously wrong only 36 hours after being discharged from her hospital birth, she and our founders realized just how many of the failures in how we experience postpartum care are actually built into the healthcare system itself. Keep reading to understand what these failures are, why the system was set up this way, and what Millie’s going to do about it.

The state of postpartum care in the U.S.

1. You’re left alone when the complication rate is the highest.

Over half of maternal deaths happen in the first year postpartum: 19% between one and six days postpartum, 21% between one and six weeks postpartum, and 12% during the remaining weeks in the first year. Since life-threatening complications like severe bleeding, high blood pressure, infection, and cardiomyopathy can arise in those first six weeks, it’s an especially critical time to closely monitor the health of birthing people.

Despite that data, the standard model of care in the U.S. is to discharge birthing people after delivery and tell them to return once around six weeks. Although newer guidelines suggest adding an earlier visit at the 2-3 week mark and ongoing care beyond that, this isn’t a requirement (yet).

Why the six-week mark? A 2018 Committee Opinion from the American College of Obstetricians and Gynecologists suggested the reason might be an outdated assumption: that birthing people have the ability to take a 40-day “convalescence” (rest and recovery) period with their infants. While that may have been true in the past, in the modern context, people could be back to regular programming long before they see their healthcare providers. Considering the fact that 12% of maternal deaths happen after six weeks postpartum, standard care begins too late and ends too early.

Before and after six weeks, there’s little proactive monitoring and communication. Birthing people have to figure out for themselves when it’s time to reach out for help — and they might not know what to look out for. On top of the demands of having a newborn, this can lead to anxiety and feelings of vulnerability.

2. The care you do receive doesn’t match up with this profoundly human and complex experience.

Under current standards, there’s a one-dimensional focus on providing clinical care though pregnancy and postpartum. There is little discussion, if any, about what to expect postpartum, how to care for newborns, and how to even approach infant feeding. We go through this transformative experience — and then it’s “see you in six weeks for your postpartum check-up!”

This leaves it to birthing people to try to meet their own needs as they navigate the postpartum period and early parenthood — a stressful and friction-filled process of piecing together a patchwork of solutions with apps, books, blogs, forums, doulas, friends, family, or specialists (many of which they’ll pay for out of pocket). 

Not knowing what to expect, and not having clearly outlined next steps if certain issues do come up, just add to the anxiety when levels may already be at an all-time high.

3. You have to leave the healthcare system to get the resources you actually need.

Some of the providers that can be the most helpful postpartum — like therapists, postpartum doulas, lactation consultants, and night nurses — aren’t always part of the clinical care equation. If a birthing person wants more than a prescription from their doctor or a quick visit with a hospital-based lactation consultant, they’ll likely have to find providers on their own. 

The result of this and all of the other barriers we’ve covered is that overwhelmed new parents may have to navigate their physical health and recovery, emotional needs, and newborn care demands with minimal preparation or support from dedicated professionals. We see this show up in high rates of perinatal anxiety and depression, as well as the high rates of maternal mortality and morbidity in the first year after birth. Add to the picture unaffordable childcare, the frequent lack of paid family leave, and health insurance gaps and you’ve caught a glimpse at the realities of new parenthood in the U.S.

Why is postpartum care so neglected?

This is a huge question, but these are a few of the many contributing factors:

• Maternity care in the U.S. is hyper-focused on clinical care. Emotional support and guidance, which are incredibly vital needs in the postpartum period, aren’t at the top of the priority list. 
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• Our healthcare system is much more reactive than it is proactive. When the emphasis is on reactive clinical care, that often means a standardized approach that leaves little room for individual needs or questions.
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• Care comes down to what insurance will cover. This means labor and delivery, plus 13 office visits (each only about 15 minutes long) starting at around eight weeks. Breaking down the total visits, that’s 12 in the prenatal period and only one postpartum — with very minimal proactive monitoring between visits.

Looking at all of this together, we have a standardized, reactive healthcare system that limits care to what’s seen as necessary from a medical perspective — and excludes the proactive care, emotional support, and education we need during the postpartum period. But just because that’s how things have been doesn’t mean that’s how they have to continue.

We’re here with a solution: the Millie care model 

We do postpartum care differently at Millie. Through the first year of your child’s life, you’ll get more of what you know you’ll need and things you don’t even know you’ll need yet:

• A home visit days after childbirth: Within days of getting discharged from the hospital, your Millie care team will visit you at home. This means earlier access to support and no figuring out how to get to the clinic with a newborn.
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• Tech-enabled proactive monitoring: Beyond the home visit, you’ll have daily health check-ins and remote monitoring to promote early detection of any complications that could arise in those first six weeks.
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• A network of experts who can help: We know postpartum care doesn’t stop at the clinical. We’ll connect you with our robust network of lactation consultants, pelvic floor therapists, acupuncturists, and more — whatever you need to support you.
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• A peer community you can lean on: You won’t have to toggle between Facebook groups and forums to find people who get it. Share your experience, ask questions, and get advice from others who are going through the same things at Millie’s community events and in our app.

Millie is designed to give you the care ecosystem you need postpartum, from the clinical to the educational to the emotional. Our care model reflects what we wish we had during and after our own pregnancies. Because we all deserve care that delivers what we actually want and need — and helps us decrease the likelihood of these all-too-common complications.