With the omicron variant forcing hospitals to make difficult decisions once again about what care to provide, Covid-19 must not again defer postpartum care. Postpartum follow-up care is essential health care, and we should be expanding rather than constricting access. The experiences of women who gave birth during the early days of the pandemic make that clear.
I gave birth to my youngest daughter in March 2020, just as our state shut down. Things rapidly changed as I attended my final prenatal care appointments and entered the hospital to deliver her. New restrictions meant I had to attend prenatal appointments without my partner, and I was limited to a single support person once it came time to give birth.
The onset of the pandemic disrupted any progress toward this new paradigm for postpartum care in the U.S. by undermining access to even a single postpartum check at six weeks.
We were discharged early, just 24 hours after Lily was born, to limit our risk of exposure to Covid at the hospital. Despite the extraordinary adaptation that this unprecedented crisis demanded of our health care system, I consistently felt that my health care providers and the health care system as a whole were committed to caring for my baby and me.
That changed when I left the hospital. I had never felt more alone. Even in normal times, weekly visits in late pregnancy give way to a profound lack of attention to women in the U.S. after childbirth. A single routine postpartum visit at six weeks leaves women otherwise largely on their own to cope with physical and emotional challenges that vary in severity, from postpartum pain to depression to breastfeeding challenges.
As a researcher who studies the transition to parenthood, I’ve always wished that mothers in the U.S. could have the same access to greater support and follow-up care that women routinely receive in other high-income countries. Instead, with the onset of the pandemic, access to even a single postpartum visit was reduced, and pre-existing disparities in postpartum care along racial/ethnic, geographic and income lines were exacerbated. Endemic racism, provider shortages in rural areas and lack of insurance are just a few of the factors that contribute to lower access to care that the pandemic has magnified.
My six-week postpartum visit was conducted by telehealth. It lasted a scant handful of minutes. Rather than being assessed and treated by a clinician, I was asked to self-diagnose. Questions like, “Do you think the tearing you experienced during birth is healing well?” felt impossible to answer. “I… think so?” I responded, unsure and desperately wanting a professional opinion.
I was struggling emotionally, too, dealing with the compound effects of sleep deprivation, early parenthood, and the losses and uncertainty incurred by the pandemic. But the message I received was very clear: We really don’t want to bring you in, and you should only ask to be seen if your need is truly urgent. I didn’t feel equipped to make that call. I certainly didn’t know how to balance the risk of long-term consequences of failing to properly heal against the risk of catching Covid during the visit and bringing it home to my family.
In the last year, I’ve interviewed dozens of mothers like myself who gave birth early in the pandemic about their experiences. From my interviews, I know that mothers across the U.S. faced similar barriers to accessing in-person postpartum care, and for some, the costs were substantial.
A first-time mother who said she experienced postpartum depression told me, “It took a lot for me to feel like I could advocate for myself for an in-person appointment. And then when I felt like the hoops just kept being put in front of me, it was incredibly discouraging and really hard on me emotionally and for my own mental health.”
Another mother says she experienced a rare complication from an epidural injection. She said her health care providers downplayed her pain and discouraged her from seeking in-person care, delaying identification and treatment of nerve damage. She told me, “It was very frustrating… in the meantime, it went from numbness to extreme pain… and I am still dealing with it [a year later].”
Our experiences were collateral damage stemming from guidelines released by the Centers for Medicare and Medicaid Services in mid-March 2020. The guidelines recommended postponing nonessential medical services to preserve resources for Covid response but did not define “essential.” Many health care systems opted to delay postpartum follow-up or transition postpartum appointments to telehealth.
The American College of Obstetrics and Gynecologists recognizes the weeks following birth as a critical period for maternal and child health that sets the stage for long-term health and well-being. The organization recommends that postpartum care should be an ongoing process, not a single encounter. In 2018, its Committee on Obstetric Practice together with its Presidential Task Force on Redefining the Postpartum Visit, announced that all women should have contact with their health care provider within the first three weeks postpartum, to be followed by continuing care tailored to each woman’s needs.
Unfortunately, the onset of the pandemic disrupted any progress toward this new paradigm for postpartum care in the U.S. by undermining access to even a single postpartum check at six weeks.
We are now at another tipping point as the omicron variant contributes to a record high number of cases. Again, health care systems must identify which services must be delayed to get through the current wave of the pandemic. To be sure, this is not an easy task. But the experiences of mothers who gave birth early in the pandemic and the recommendations of the nation’s leading professional membership organization dedicated to women’s health care make clear that postpartum follow-up care is essential health care and must not again be deferred.