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Happy Halloween Week!

Today we are addressing “Ghostpartum,” which may sound like a Halloween ghoul or goblin, but is actually a term used to describe the postpartum period where many do not receive appropriate care as they transition from pregnancy to parenthood. In fact, according to the American College of OB/GYN (ACOG), up to 40 percent of postpartum folks do not even seek postpartum care.

While healthcare professional organizations like the ACOG are doing their part encouraging practitioners to advocate for postpartum care, this article is meant to help individuals advocate for themselves and advocate for any pregnant person and new parents in their lives.

Who is in your care team?

  • Friends and Family can help with new infant care, help out around the house (make a meal, do laundry), take care of older children (take them on an outing), and provide advice and emotional support (especially if they are parents also).

  • Primary maternal care provider: The OB/GYN, certified nurse midwife, midwife or women’s health nurse practitioner who provided prenatal care should provide a postpartum check within the first 3 weeks after delivery, and a comprehensive check up at no later than 12 weeks postpartum.

  • Infant Health care provider: A pediatrician, family physician, or pediatric nurse practitioner should be lined up to be the primary care provider for your new baby.

  • Primary Care provider: An OB/GYN or primary care physical should help manage any ongoing health issues like diabetes, thyroid issues, high blood pressure, and depression.

  • Lactation Support: Professional lactation consultants (IBCLC) can help with any feeding issues. Community organizations including La Leche League (https://www.llli.org/), connect mothers and families with education, encouragement, and information- their organization includes IBCLCs, lactation counselors, peer educators, and peer support via community support groups.
  • Pelvic Floor Therapist: A trained pelvic floor therapist can help you return to activities/exercise safely, improve pelvic floor strength, flexibility and coordination, address any pelvic pain (pain with sex, toileting), incontinence (bladder and/or bowel), prolapse, scar tissue sensitivity, as well as improve posture and provide education on body mechanics with childcare. We recommend every woman receive at least 3 visits postpartum.

Common Postpartum Issues

The transition from pregnancy to parenthood can be tough. Labor and delivery is physically exhausting

in and of itself, and having a new person to care for can be overwhelming. Here are some common postpartum issues to look out for and don't be afraied to bring up with your healthcare practitioner.

  • “Baby blues,” depression, anxiety, irritability and mood changes
  • Pain with sex and perineal pain- according to some studies, 41-89 percent of women have dyspareunia or pain with sex within the first two to three months postpartum. Twenty-four percent have persistent dyspareunia six months later.
  • Family planning and questions about birth control
  • Low libido
  • Incontinence
  • “Falling out feeling,” in the vaginal canal or visible prolapse
  • Pelvic floor dysfunction
  • Pain at site of vaginal tearing or episiotomy
  • Sleep deprivation and fatigue
  • Postural pain with feeding and lifting/holding baby
  • Hormone issues
  • Vaginal dryness
  • Lactation issues

Racial, Ethnic, and Income Disparities in Access to Postpartum Care

  • Black women are three to four times more likely to die from pregnancy-related conditions such as cardiac issues and hemorrhage and to bear the brunt of serious complications as well. That risk is equally shared by all black women regardless of income, education or geographical location.

  • According to the Centers for Disease Control and Prevention, nearly 60% of maternal deaths in the United States are preventable and most (44%) occur within 42 days of the postpartum period.

  • Self-advocacy is important for women of color. According to the American College of Gynecologists, implicit bias may affect the way obstetrician–gynecologists counsel patients about treatment options such as contraception, vaginal birth after cesarean delivery, and the management of fibroids. 

  • Doula Care can help, people with doula support are two times less likely to experience birth complications and four times less likely to have a low-birth-weight baby, according to this fact sheet by the Southern Birth Justice Network (https://blackmamasmatter.org/wp-content/uploads/2019/03/2019-Doulas-Access-1.pdf)

Takeaways and general postpartum recommendations:

  • Ask for support- Many cultures prescribe a 30–40-day period of rest and recovery after labor and delivery, with the parents and newborn surrounded and supported by family and community members. Ask for support -- food trains and support for day-to-day household tasks as well as emotional support. It’s also great to have other parents around who have navigated the journey between pregnancy to parenthood and who can offer stories, tips, and understanding.

  • Assemble your care team before you have the baby- Have a list of family, friends, and healthcare providers that you can contact when you need extra support, and know who to contact if any health issues come up for you or the baby.
  • Schedule your postpartum visits in advance- it’s important to prioritize your health and healing as well as your new baby’s. Ideally have contact with your maternal care provider within the first 3 weeks postpartum and at least one comprehensive postpartum visit no later than 12 weeks after birth.

  • Advocate for yourself and bring up any issues relating to sexual health, incontinence, prolapse, lactation issues, anxiety, and depression with your maternal health provider. Ask for a referral from your maternal health provider.

  • As a partner, friend, or family member- offer to help and remind your new parent friends to take care of themselves as well as their new baby.

References

Rahman, S. (2019). Ghostpartum: Why Many Women Don't Get the Sexual Health Care They Need. Retrieved from: https://blogs.scientificamerican.com/voices/ghostpartum-why-many-women-dont-get-the-sexual-health-care-they-need/

McDonald EA, Gartland D, Small R, Brown SJ. Dyspareunia and childbirth: a prospective cohort study. BJOG 2015;122:672–679.

ACOG Committee Opinion No. 729 Importance of Social Determinants of Health and Cultural Awareness in the Delivery of Reproductive Health Care. (2018).  doi:10.1097/aog.0000000000002459 . Retrieved from: https://journals.lww.com/greenjournal/Fulltext/2018/01000/ACOG_Committee_Opinion_No__729___Importance_of.42.aspx

American College of Obstetricians and Gynecologists (ACOG). (2018). ACOG Committee Opinion: Presidential Task Force on Redefining the Postpartum Visit The Committee on Obstetric Practice. Retrieved from: https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Optimizing-Postpartum-Care

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      I wanted to let you know that my pelvic floor held strong and gave me no trouble whatsoever in my trail race this morning (12 miles)! In a way, I felt like I ran better than ever because my core feels so rock solid from all the exercises you have me doing. That was especially valuable on the technical downhill - I just flew down the trail because I had confidence in my balance and form. Thank you for helping me get back to doing what I love. -- A.W., age 32(completed Post-partum Renewal...

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      I was hopeful but frankly skeptical when the doctor treating me for Interstitial Cystitis recommended that I go to Heather for physical therapy. Medication and diet helped control my IC symptoms, but I had never heard of physical therapy being used to treat IC. The education and treatment I received from Heather was a revelation. She explained that the pain I experienced with IC had helped create a cycle of muscle guarding which affected the entire pelvic area. I had no idea of the amount of...

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