There is life before children – and then life after children, punctuated by a plethora of changes – physically, emotionally, socially, professionally, energetically, spiritually, and intellectually. The learning curve in becoming a mother is enormous. It’s why Anne Crittenden’s powerful texts, “The Price of Motherhood”, and “If You’ve Raised Kids, You Can Manage Anything,” pack sizeable truth punches that bring society to task about the uphill battle mothers face for equality and basic financial security.
But the real heart expanding truth is, becoming a mother, especially in our current healthcare system, is often disabling and incredibly disempowering, even dehumanizing.
That precise line in the proverbial sand when a woman becomes a mother, though it is the one where many women say they truly learned the meaning of love, is also the one where the healthcare system, and their support systems, fails her. This is a dark reality too long overlooked and under-attended to because women’s health takes a backseat to men’s health, in terms of research, treatment methods, access to care, cost for that care, and chronic disease and persistent pain management. The truth is, women’s health has too long been neglected, particularly in the United States.
How does society continue to take without giving to mothers?
In the United States and many other countries, motherhood is met with outright neglect by both society and its system. While global maternal death rates are decreasing worldwide, the US has defied the trend with ever-increasing maternal death rates.
The truth is giving birth in the US is risky, where the average American woman has a higher chance of death, as does her newborn, than in any other country in the world.1 Between 2000 and 2014 the maternal mortality rate increased in 48 American states by 26.6%.2 An American mother’s risk of death is higher than in Iran and Turkey.1
Contrast this outcome with those in France, where women are provided, courtesy of their healthcare coverage, with no-cost postpartum physical therapy services to help them rehabilitate their lady bits – including improving everything from sexual function and satisfaction to pelvic pain and urinary (and even fecal) leakage. The average amount of care included in a French woman’s healthcare plan ranges from 10-20 visits. Yes, the French value their health (and sex life) enough to know to invest in what’s good for them (postpartum health), including good food and wine.
Mothers need attention after birth, not just for catastrophic life-saving care, but for quality of life. The medical staff or well-meaning family members who says, “Oh, but at least you have a healthy baby,” after a mother experiences a difficult labor, is not being helpful. It perpetuates a societal norm that even if a mother’s quality of life, and life itself, is destroyed, that it’s okay because the baby is fine.
Who then, is left to care for that child? The traumatized and injured mother. Who stands to suffer the MOST if a mother is not well enough to care for her child? The child, the family, and society as a whole.
It is not enough to be alive. Quality of life is incredibly important.
Women spend years, sometimes decades of their life, preparing for, growing, and giving birth to, recovering from (again and again depending on how many children she has), and nurturing the next generation through their first helpless 1-2 years of life. And yet, in the US, mothers only get a single visit at 6 weeks, and some get no postpartum care at all. In that visit, they are checked for life-threatening issues, but are not required to screen for postpartum depression, nor are the practitioners allowed the time or are even comfortable with screening for in-depth birth-related musculoskeletal, urogynecological, and neuromuscular injuries and trauma that contribute to serious long-term issues such as sexual dysfunction, organ prolapse, an abdominal split, pelvic floor dysfunction, and incontinence, for starters.
In today’s culture pregnancy is celebrated right up to birth – and then, that’s the end of it. Moms are just expected to spring back into step, with some moms even showing up to work mere days after giving birth. They are expected to jump back into sex with their partner, happy, frolicking play time with their older child(ren) and new baby, and a satisfying return to work. The rare high level female executives in the US who give birth aren’t helping either – suggesting that women can merely work harder or assert themselves more aggressively to maintain their rung on the corporate ladder, while they have their private corporate nurseries custom decorated to their liking and get to call the shots. This is both rare, and a complete farce against the average working mother.
Valerie Young, Huffington Post blogger says it best,
“Alone among industrialized nations, we (mothers) have no guaranteed paid leave policy for childbirth, adoption, illness, or even the occasional sick day. Our federal pension system only accounts for paid work, leaving women with the short straw after time out bearing and raising children, tending to ill parents, spouses, or other family members. We do most of the unpaid work in the home, and when we are employed outside the home, our income trails men’s by as much as 40%. We lack anything near equitable political representation, we don’t occupy our fair share of board room seats, CEO suites, or participate proportionately in the distribution of financial assets around the world.”
Further, a Harvard study firmly places America at the bottom of the barrel for mother support. “Out of 168 nations in a Harvard University study last year, 163 had some form of paid maternity leave, leaving the United States in the company of Lesotho, Papua New Guinea and Swaziland.”3
This (expectation) is a shameful nightmare and must change now.
Good News for Moms
The truth is pelvic physical therapy SHOULD begin prior to and immediately following birth, and should continue for several weeks or months after birth. And for mothers who didn’t receive any pelvic rehabilitation, good news, you can STILL rehabilitate and recover after birth.
As a mother of three, I think it is high time that those without the experience of motherhood stop trying to tell mothers how they are supposed to live, parent, work, exercise, seek healthcare, and pursue work/life balance. Instead, it is time for mothers to start reaching out and helping other mothers.
THE 5 BIGGEST MYTHS that need BUSTING about RECOVERY AFTER BIRTH:
Mothers bounce back after birth.
Umm, No. We are human beings who have grown new human beings. We who have given birth are the experts. Let us speak and better yet, please do not speak for us.
Moms, you know your body best. Better than anyone. A healthcare provider who does not listen to your concerns is a RED FLAG. Remember, your healthcare provider works for YOU, not the other way around.
Mothers should speak up for, and advocate for other others.
I cannot tell you how many times I see men (and women) “experts” speaking about what a mother needs. “Just sleep when the baby sleeps.” “Just relax and don’t worry about the housework.” “It will all work out,” they say, “just take more time for you.” (cue steam release from ears)
No one knows better what a mother needs as a woman and human being, than a fellow mother, and no amount of well-meaning platitudes will actually help a mother who is in DIRE need of a nap, decent sleep at night, a shower, and a hot meal that hasn’t been rewarmed 3 times.
There are men and women filling up panels – advisory committees, conferences, healthcare podcasts, boards of directors – where not a single one of them is a mother. Mothers are underrepresented in policy and decision-making at almost every level in the public and private sector.
Mothers cannot expect to be respected or appreciated in society if we are ABSENT from the table.
Mothers must be given the opportunity to serve other mothers and speak for us as a collective community, instead of having positions filled with those who aren’t mothers, or worse, aren’t even parents. I don’t know if I would even trust a person to speak to me about work/life balance, for example, if they weren’t a fellow parent or better yet, mother. We need to be supported by those who have traveled the journey of all the joys and trauma of motherhood, everything from incontinence at the most embarrassing moments, breastmilk leakage in a public place, anyone?, sexual dysfunction, painful urination, to the most transcending moments of joy, like soaking up that newborn smell, seeing your baby smile when you walk in the room, or hearing your baby laugh for the first time.
Mothers are able to return to the full demands of work outside the home after 6-12 weeks
Ahh, that’s also a NO.
Lay off that alternative fact already. An expectant mother has just grown and delivered another human being into the world – whether she does it in an office building or at home while scrubbing toilets and chauffeuring older children, is irrelevant – she never LEFT work. In fact she worked harder because she went to work while growing another human being.
Qualitiative research has shown that women need up to a full year to recover from giving birth. And that only accounts for physical recovery, not the psychoemotional or social concerns or needs a mother may have. Plus, this doesn’t take into account the additional physical requirements needed to care for an infant during a time when a mother can’t even sit on a hard chair without pain, or they leak urine or feces while changing out a load of heavy, wet laundry or while trying to muscle a carseat into position. Have you tried wrestling a carseat into position before? It’s hard enough when you are ABLE to control your bowel or bladder. Or, trying to recover while chasing older siblings (typically pint-sized toddlers akin to little drunk people wandering around your home.) Have you ever tried reasoning with a drunk person, even a happy one? You get my point.
Healthcare is not a human right and you have a choice to become a mother.
Excuse me, but the future of our planet depends on the willingness of WOMEN TO GIVE BIRTH. If we (mothers) all stopped giving birth, perhaps that may spur the rest of society to action – to actually take care of mothers instead of providing lip service only.
Healthcare is a human right, but somehow for mothers, society has forgotten to grant access to it. Postpartum physical therapy is a BASIC need that is low cost and should be readily offered in exchange for populating our planet and raising the next generation that will take care of you (whether or not you had children) when you are old and unable to care of yourself.
Put simply, mothers cannot put their bodies back together on their own.
A mother’s request is actually quite simple, and I daresay has yet to be addressed as the global health crisis it presents. A mother’s plea for a basic human right comes in two parts:
- Please treat us (mothers) like human beings. We are not a “vessel” and we are not simply “carriers” with no human rights.
- Please provide access to basic, quality of life normalizing postpartum services. This would include pelvic physical therapy and related services of at least 10-20 visits
PERSONAL NOTE: If I hadn’t been a women’s health (pelvic) physical therapist and sports medicine/orthopaedic athletic trainer, I would have had ZERO CLUE how to rehabilitate my LAUNDRY LIST of injuries and trauma after giving birth, and what’s more, after three pregnancies, some of them more difficult, all of them which left me with permanent injury (which is about “normal” for every mom). Some mothers don’t even know that their injuries are in fact injuries. They may think that urine or fecal leakage is just “normal” after giving birth because their mother or their grandmother suffered from it. Some may think that sex is supposed to hurt after birth, or that back pain is just a “part of having given birth.” None of these things are true. Although these injuries are COMMON, they are never NORMAL.
What’s worse is I would not have even known I had a right to ask for physical therapy after birth to help correct these things. Most women do not know, and they suffer needlessly because of it. It is time for that suffering to end, and get mothers the help they deserve.
We have postpartum standards of care in the US and other countries.
Definitely NO. There are NO POSTPARTUM STANDARDS OF CARE for helping a mother recover from birth in the US, and in most ALL other countries as well. Let’s GET TO WORK to change that. One 2014 study in Ireland looked at 872 women at fifteen weeks postpartum and one year postpartum. At one year, 73% of them had urinary incontinence, 49% had fecal incontinence, 14% had pelvic organ prolapse, and 58% had sexual dysfunction that continued to persist at one year postpartum. Of all those different diagnoses, more than 71% of those women had multiple diagnoses. I even think these reported statistics are low because in most countries postpartum outcomes are not even being evaluated, much less reported. This is, in large part, due to the lack of international standards of care.
Your birth injuries and trauma will fade with time and you’ll recover naturally, just like giving birth is a natural process.
Wow, that is the BIGGEST MYTH yet. No, postpartum problems do NOT end just because your child is ___ years old or because a woman is peri-menopausal or no longer in childbearing years. And no, birth trauma just doesn’t disappear.
A women is (or should be) considered postpartum until her issues related to birth are resolved and well managed. I have treated patients who had 26 year old children and even older – and they were still having problems related to or caused by birth. What’s worse – those problems are made worse because they received no care, which means MANY of the issues women suffer from later in life are PREVENTABLE. Just because your mother or grandmother suffered from pelvic pain, incontinence, sexual dysfunction, back pain, pelvic organ prolapse, and hernias (just to name a few), doesn’t mean it’s NORMAL or RIGHT. You don’t have to suffer.
One more MYTH to bust – and perhaps the most important one of them all.
BONUS MYTH TO BUST: Postpartum depression (PPD) rates are low, so it’s not a huge concern.
NO! PPD is a public health threat that must be dealt with, because it affects not only mothers but children and families as well. The rate of PPD is on the rise, moving from 10% to upwards of 21% And like unreported postpartum outcomes, postpartum depression is much more common that statistics reveal. Let’s deal with it. Depression is also correlated with pain, and the presence of pain “negatively affects the recognition and treatment of depression.” This finding means mothers experiencing any postpartum pain (and most all new mothers do) are at much higher risk for depression. Risk and incidence for postpartum depression also doesn’t end as a newborn becomes a toddler. Mothers can be at risk for postpartum depression through the toddler and middle school to teen years. My own clinical experience with helping postpartum mothers in physical therapy practice and interviewing hundreds of mothers through the years, supports what may seem like common sense to many – that the stress of parenting and the new identity of motherhood (for which society provides, especially in the US, little to no support for) can take an overwhelming toll on a mother’s sense of well-being and her health. Simply put, motherhood alone, without the added stressors of lack of maternal leave and pay, can feel too much to handle.
Where Do We Go From Here?
No sane person would argue against the fact that our children are the future of our country, of our planet, and yet our investment in the health and wellbeing of the primary caregivers in our society after they give birth, is almost nonexistent. What’s more is support staff who help nurture our future – childcare workers and early childhood educators – typically earn at or minimum wage. Meanwhile the plumber who shows up to fix your toilet can charge in upwards of $250 per visit.
Mother’s wages lag even farther behind women’s wages. To add insult to injury, if you are a mother working from home to raise up the future of our country, you get nothing. Not even a social security credit. You must depend entirely on your partner’s wages and retirement. You in effect become a financial dependent, unable to qualify for credit or loans, and with your long-term income potential severely stunted. This injustice affects not just mothers, but families. It hurts not just women, but men also.
Don’t be fooled, those who say “at least your baby is healthy” are also dead wrong, because in addition to not caring for postpartum mothers, we are neglecting our country’s children. Amnesty International’s executive director Larry Cox in 2010 states “this (USA) country’s extraordinary record of medical advancement makes its haphazard approach to maternal care all the more scandalous and disgraceful.” The annual State of the World’s Mothers report reports, “the United States has more neonatologists and neonatal intensive care beds per person than Australia, Canada and the United Kingdom, but its infant mortality rate is higher than any of those countries.
Mothers are in urgent, critical need for mother-centered, holistic, compassionate care. A mother’s recovery after birth has been neglected for long enough. Postpartum healthcare is a public health failure that is nothing short of a global health crisis. For all the love and care that mothers provide, it is time for society to respond to the long-neglected needs of its mothers. Wake up world, it’s time to serve mothers for a change.
About the Author
Ginger is a doctor of physical therapy, author, mother of three, and trauma survivor. She is passionate about advocating for women’s health and access to therapy services.
- Obstet and Gynecol. 2016; 128(3):447-455.
- Save the Children, State of the World’s Mothers Report, 2015.
- USA Today, July 26, 2005.
- Sources also in text