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As Covid surges, health officials must remember that in-person postpartum care is essential

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As Covid surges, health officials must remember that in-person postpartum care is essential

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With the omicron variant once again forcing hospitals to make difficult decisions about what care to provide, Covid-19 no longer needs to delay postpartum care. Postpartum follow-up care is essential health care, and we should expand rather than restrict access. The experiences of women who gave birth at the start of the pandemic make this clear.

I gave birth to my youngest daughter in March 2020, just as our state shut down. Things quickly changed as I attended my final antenatal 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 one support person when it came time to give birth.

The onset of the pandemic disrupted any progress towards this new paradigm for postpartum care in the United States by undermining access to even a single postpartum check-up at six weeks.

We were discharged early, just 24 hours after Lily was born, to limit our risk of exposure to Covid in hospital. Despite the extraordinary adaptation that this unprecedented crisis has demanded from our healthcare system, I have always felt that my healthcare providers and the healthcare system as a whole were committed to taking care of my baby and me.

That changed when I left the hospital. I had never felt more alone. Even in normal times, weekly visits late in pregnancy give way to a profound lack of care for women in the United States after childbirth. Just one routine postpartum visit at six weeks leaves women largely on their own to deal with physical and emotional challenges that range in severity, from postpartum pain to depression to breastfeeding issues.

As a researcher who studies the transition to parenthood, I have always wished that mothers in the United States could have the same access to better support and aftercare that women routinely receive in other countries at high income. Instead, with the onset of the pandemic, access to a single postpartum visit has been reduced and pre-existing disparities in postpartum care along racial/ethnic, geographic and income lines have been exacerbated. Endemic racism, shortage of providers in rural areas and lack of insurance are just some of the factors contributing to reduced access to care that the pandemic has amplified.

My six week postpartum visit was done via telehealth. It only lasted a handful of minutes. Rather than being assessed and treated by a clinician, I was asked to self-diagnose. Questions such as “Do you think the tears you suffered during childbirth are healing well?” felt impossible to answer. “I think so?” I answered, unsure and desperate for professional advice.

I was also struggling emotionally, dealing with the combined effects of sleep deprivation, early parenthood, loss and uncertainty incurred by the pandemic. But the message I received was very clear: we really don’t want you to come, and you should only ask to be seen if your need is really 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 not healing properly with the risk of catching Covid during the visit and bringing it home to my family.

Over the past year, I’ve interviewed dozens of mothers like me who gave birth early in the pandemic about their experiences. From my interviews, I know that mothers across the United States faced similar barriers to accessing in-person postpartum care, and for some the costs were substantial.

A first-time mom who said she had suffered from postpartum depression told me, “It took me a long time to feel like I could hold my own for an in-person date. And then when I felt like the hoops kept being placed in front of me, it was incredibly disheartening and very hard on me emotionally and on my own mental health.

Another mother says she had a rare complication following an epidural injection. She said her healthcare providers downplayed her pain and discouraged her from seeking care in person, delaying the identification and treatment of nerve damage. She said, “It was very frustrating…in the meantime it went from numbness to extreme pain…and I’m still dealing with it. [a year later].”

Our experiences were collateral damage stemming from guidelines issued by the Centers for Medicare and Medicaid Services in mid-March 2020. The guidelines recommended postponing non-essential medical services to preserve resources for the Covid response, but did not define “ essential”. Many healthcare systems have chosen to delay postpartum follow-up or move postpartum appointments to telehealth.

The American College of Obstetrics and Gynecologists recognizes the weeks after birth as a critical time for maternal and infant health that sets the stage for long-term health and well-being. The organization recommends that postpartum care be an ongoing process and not just a one-to-one encounter. In 2018, her Committee on Obstetric Practice and her 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, ongoing follow-up care adapted to the needs of each woman. .

Unfortunately, the onset of the pandemic disrupted any progress towards this new paradigm for postpartum care in the United States by undermining access to even a single postpartum check-up at six weeks.

We are now at another tipping point as the omicron variant is contributing to a record number of cases. Again, health systems need to identify which services need to be delayed to get through the current wave of the pandemic. Admittedly, this is not an easy task. But the experiences of mothers who gave birth at the start of the pandemic and the recommendations of the leading national professional organization dedicated to women’s health care make it clear that postpartum follow-up care is essential health care and should no longer be deferred.

As Covid surges, health officials must remember that in-person postpartum care is essential

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