The moment my daughter was placed on my chest, I knew something was wrong. Her skin had a blue-purple tinge, and she barely cried. I instinctively began rubbing her tiny body, trying to stimulate her, but she remained quiet and minimally responsive. When I tried to put her on my chest to nurse, she did nothing. My doctor quietly left the room, and soon after, a team of medical professionals entered. They quickly took her from me, saying they needed to weigh and clean her up. But I knew it was more serious than that—they had called a hospital code, signaling that they needed all hands on deck to help my baby.
My husband at the time, not fully understanding the situation, stood by, confused and worried. I watched, paralyzed from the epidural, as they suctioned her, applied oxygen, and attempted to stabilize her. Desperate, I immediately called a friend who was also a physician. I needed an advocate—someone who could keep me informed and ensure my daughter was getting the best care possible. She arrived quickly and stood beside my daughter, who was now being resuscitated.
This was the beginning of my postpartum journey—a journey that was far from what I had imagined.
As a physician, I thought I was prepared for pregnancy, childbirth, and postpartum. I had the medical knowledge and a network of health care professionals at my fingertips. But my experience revealed significant gaps in our health care system, especially in the support provided to new mothers during the postpartum period.
My child was admitted to the ICU, and during that time, my milk supply was nonexistent despite my best efforts. I struggled to produce even a few drops in the days following her birth. The hospital’s lactation consultant, doing her best, reassured me that these things take time. But my breastfeeding struggles became overwhelming, leading to deep feelings of inadequacy and worthlessness as a mother. My daughter’s traumatic birth was now compounded by a breastfeeding journey that felt even worse.
Returning home was another challenge. I remember that first drive home and how, upon arrival, a friend asked if this was the most amazing, happiest experience of my life. My half-hearted smile concealed the truth—it was anything but. I was terrified, feeling inadequate, and utterly overwhelmed. Over the next several months, my mental health took a nosedive. At both my pediatrician’s and OB/GYN’s offices, I took mental health assessments, scored high, and was told I should seek help—but no one offered direction on where or how to find it. I felt alone, with no one to turn to. Eventually, my relationships began to erode, and I found myself deep in postpartum depression. At one point, I remember wondering what it would be like if I weren’t here—if I took my baby and just left this world. The feelings were intense. My neighbor visited me frequently, sensing I needed help. She provided comfort and referred me to the resources I needed at that time. Over a year later, I finally found pieces of myself, but the journey was not easy.
After COVID, I made the decision to leave full-time emergency medicine and take a leap of faith by opening my own concierge practice, delivering care in the homes of my clients. I didn’t realize how much my own postpartum experience would influence my work. I started receiving calls from postpartum women needing urgent care, and I quickly noticed a pattern. What began as a simple wound check or concern about a fever often turned into much deeper conversations about breastfeeding struggles, back pain, and feelings of inadequacy. I remember one visit to a mom’s house who needed her C-section wound evaluated. When I arrived, she was sitting in a recliner, tissues in hand, struggling emotionally. I knew that place—I had been there. I told her, “What you’re going through feels like the absolute worst time of your life, but you will get through it. Let’s talk about what’s going on, and we’ll troubleshoot together. I’m here, and we’ll figure it out.”
Traditionally, women are seen by their health care providers six weeks after giving birth. But in those six weeks, so much can go wrong. Women’s bodies undergo significant physical and mental changes, yet we essentially throw new mothers into the deep end without a lifeguard or life jacket and tell them to swim. By the time they make it to that six-week visit, they’re often so exhausted from staying afloat that they don’t even know what to say or ask during that brief 30-minute appointment. They may be cleared for physical activity and sex, but unresolved issues—like pelvic floor dysfunction or postpartum mental illness—go unaddressed. Unresolved issues compound over time and manifest in different ways.
For me, it was struggling with constipation that wasn’t food-related but was actually a result of pelvic floor dysfunction. I didn’t fully explore this issue until two years postpartum. I had severe hip pain that started during pregnancy and persisted even to this day. Only recently did I get an MRI that confirmed a disc herniation. How many women have found themselves years later suffering, only to realize that many of their ailments first presented during pregnancy or postpartum? But because it’s so common to sweep things under the rug or save them for later, these problems often go unaddressed. What if I told you it doesn’t have to be this way? Instead of waiting for moms to present problems, why don’t we screen them early to prevent long-term morbidity?
Around the world, postpartum care looks very different than it does in this country, and I think we ought to start paying attention. France is known for its comprehensive postpartum care, which includes sending pelvic floor therapists and lactation consultants to new mothers’ homes as part of standard care. The French health care system covers these services through their national health insurance, providing support for mothers during the crucial postpartum period.
After childbirth, French mothers are typically offered several sessions of pelvic floor rehabilitation (rééducation périnéale) with a specialized physical therapist. This therapy is designed to help women recover from the physical impact of childbirth and prevent long-term issues such as incontinence.
In addition to pelvic floor therapy, French mothers often have access to in-home visits from midwives and lactation consultants to support breastfeeding and overall postpartum recovery. These services are part of a broader cultural recognition of the importance of postpartum care, ensuring that new mothers receive the support they need without the added stress of financial burden. French mothers do not have to go searching for these services—they are provided. They see value in this.
In Sweden, new mothers receive home visits from a midwife or a nurse as part of the country’s comprehensive maternal care. These visits occur within the first few days after returning home from the hospital, focusing on both the mother’s and baby’s well-being. The health care provider checks on the mother’s recovery, breastfeeding, and the baby’s health, offering support and advice as needed.
So why have we fallen behind in the U.S.? Our maternal mortality rates are among the highest in the developed world, with Black women being three times more likely to die from pregnancy-related complications. The CDC reports that about 700 women die each year in the U.S. due to pregnancy or delivery complications, and three in five of these deaths are preventable. Lastly, 33 percent of maternal deaths occur during the first week postpartum, and around 60 percent occur within the first six weeks postpartum. The highest risk of maternal death is typically in the first few days to two weeks after delivery, especially in cases involving complications such as hemorrhage, infection, or pre-eclampsia/eclampsia. But somehow, moms are first seen by a medical professional at six weeks. Does this make sense?
With these dismal statistics, there is growing mistrust of our health care system’s ability to provide safe, holistic care for mothers. My assessment is that hospitals are designed to treat the sick, not to nurture and support healthy women through one of the most challenging times of their lives. This mentality affects how we view childbirth. Traditionally, most people enter a hospital to be fixed. They come in for emergencies or surgeries. On the contrary, pregnant moms go to the hospital to deliver a baby. It’s supposed to be a joyous occasion, but unfortunately, this “fix-it” mentality can turn childbirth into a clinical condition and really does affect how we provide care. Everyone is treated according to one standard, and while personalization is possible, it is rare. Beyond the health care system, bills aimed at improving maternal care are often stalled in the legislative process. Everything around us may say, “Moms, we appreciate you,” but actions speak louder than words. What we hear is, “We see you; you are a priority, but we do not want to make major adjustments in your care.”
The blame should not just fall on our doctors. They often take the heat for the path medicine has taken. For many physicians, they went into the field of medicine to help people. Many OB/GYNs entered obstetrics to help women. They have a deep passion for what they do and want to see birth outcomes improve for moms. They may have grand intentions, but they function in a system with deep flaws dating back centuries. Secondly, our obstetricians are burnt out and carry a huge burden. They are juggling clinic duties, surgeries, patient care, advocacy, and continuing education. They set the standard of care when it comes to maternal health policy. They live and breathe pregnancy outcomes. They want to see things improve. When they are not treating patients, many of them still must remain present for their own families while trying to preserve the little time they have for self-care. Because if they cannot pour into themselves, how do they pour into others? Alone, they are not the solution to the crisis of care in this country, and the burden should not fall on them. On the other hand, midwives offer a more holistic approach to care, but they are few. Not everyone has access to these resources, and not everyone can give birth under their care. A report by the UN Population Fund, the WHO, and the International Confederation of Midwives stated that the presence of midwives across the world could prevent over 4.3 million deaths per year by 2035. In the U.S., only 10 percent of births are attended by certified nurse midwives, and likely an even smaller number by certified professional midwives who only conduct home births. So, if the obstetricians who are seeing the majority of birthing mothers are too busy to provide this level of comprehensive care, and the midwives are few, can you see that the burden really should not fall on these individuals alone to save our mothers? They are essential, but the problem needs to be fixed at the top. And if the problem can’t be fixed at the top urgently, then as a community, we need to figure this out and create systems that safeguard our mothers when they go home. We need to rethink the entire spectrum of care for new mothers. Doulas, pelvic floor therapists, lactation consultants, and mental health specialists should be an integral part of every woman’s postpartum care, not just an afterthought. These professionals should be readily available to all new mothers, not just those who know where to look or those referred by their friends.
As an ER physician, I would often find myself advocating for women who fell through the cracks of our health care system. Now, through my practice, I take the same approach. I work to create a network of care that includes several birth workers, including lactation consultants, ensuring new mothers have access to the support they need. I advocate for them during their journey. My hope is that postpartum care will look different for future generations—that women will have access to comprehensive care that addresses not just their physical health but their mental and emotional well-being as well. And that care should be a right, not an option. When we care for mothers, we care for families, and ultimately, we care for our entire society.
Phindile Chowa is an emergency medicine physician.
