Nkechi Charles knows more than most about the unwelcome surprises that can happen during and after pregnancy.

She’s a doctoral student who has researched cases of women who have complicated births.

However, even the 39-year-old North Carolina mother was thrown for a loop during her two pregnancies.

Her first daughter was delivered by an emergency cesarean delivery weighing 2 pounds, 5 ounces after Charles’ blood pressure spiked.


During her second pregnancy, Charles’ abdominal muscles separated while she was still carrying the baby.

“It’s just a wild ride,” Charles told Healthline. “It still throws me. It’s a wild experience.”

Charles didn’t wait the usual six weeks after delivery to see a doctor about her concerns.

However, she wishes more new mothers were talking to their health care providers sooner rather than later about what’s on their mind, so they’re better prepared to handle life after childbirth.

The results of a national survey that a market research firm conducted last month on behalf of a Florida network of hospitals indicate that many women are ill-prepared for the physical and emotional changes they often experience in the wake of giving birth.

The online poll found that although nearly two-thirds of the 873 mothers were as concerned for their own well-being as their baby’s, 26 percent didn’t have a plan for managing their health over the period known as the “fourth trimester.”

Those in the 18 to 34 age bracket were even more vulnerable, with 37 percent reporting they hadn’t taken steps to ensure they’d get whatever help they needed after delivering.

In addition, 41 percent of those respondents indicated that they felt anxious, overwhelmed, or depressed after giving birth. That figure climbed to 57 percent among those under 45.

Megan Gray, an obstetrician and gynecologist with Orlando Health who served as a consultant to the study, attributes the results in part to doctors and midwives not emphasizing the importance of self-care to their patients.

“All the attention becomes focused on the baby. We totally forget about mom,” she told Healthline.

Fourth trimester care

The American College of Obstetricians and Gynecologists announced last year it was advising every woman to talk to her doctor within the first three weeks after giving birth, but most women still adhere to the conventional six-week checkup, Gray said.


By contrast, expectant mothers typically see their doctor once a month during the first trimester, every two weeks or so in the second, and once a week toward the end of the third, she said.

Because medical school training focuses on pregnancy and pays little attention to postpartum needs, doctors typically congratulate new mothers with a figurative pat on the back and send them on their way without scheduling a follow-up visit in short order, Gray said.

“Somehow, magically, women figure out how to be moms and take care of their newborns and themselves,” she said.

Gray isn’t talking in the abstract.

She recalls her disappointment in the lack of hands-on care she received after undergoing a C-section three years ago with her first child.

“I was surprised by how hard (that period) was compared with the other three trimesters,” she said.

Gray’s experience inspired her to spend part of her maternity leave writing a book to guide her own patients through that time.

“My goal is to make the fourth trimester just as important as the first three,” she said. “Happy, healthy mom equals happy, healthy baby.”

Topics include aspects of recovery such as how to care for vaginal tears and recognize common complications associated with C-sections. This information, Gray says, is something new mothers are often too exhausted and distracted to absorb when their doctors tell them.

The emotional side

Apart from needing help understanding the physical toll that childbirth can take on their bodies, many women suffer an emotional backlash, Gray said.

A postpartum drop in certain hormones can trigger depression and the sleep deprivation from getting up every two or three hours during the night to breastfeed doesn’t do wonders for their sense of well-being.

Some women also are trying to juggle cooking, cleaning the house, and caring for older children, Gray added.

And there are other anxiety-provoking changes.

First-time mothers who had derived a sense of identity from their professional careers may have a difficult time adjusting to maternity leave or leaving the workforce indefinitely.

Friends they used to socialize with might stop coming by, too.

On top of all that, some women have little or no support from a partner during this time of adjustment, Gray said.

Help from health professionals

One key to getting mothers of newborns the help they need is for healthcare providers to listen carefully to what those patients have to say about parenting, said Kristin Tully, a research associate with the Carolina Global Breastfeeding Institute at the University of North Carolina at Chapel Hill.


Without that two-way, nonjudgmental conversation, a clinician who’s focused on the merits of breastfeeding but whose patient wants to bottle feed her baby at night might miss the chance to find a mutually agreeable solution, Tully told Healthline.

“When you say, ‘Just do this and don’t ever do that,’ there’s no room for (recognizing) the realities of people’s lives,” she said.

Tully added that directives that don’t take into consideration how difficult it is to be a new mother can make a woman feel ashamed.

Tully is involved in the 4th Trimester Project, a university-sponsored team of healthcare providers, mothers, and others trying to educate the public about postpartum health concerns.

Gray would like to see healthcare providers offer classes on the postpartum experience and spend more time during patients’ pregnancies encouraging them to think beyond getting the nursery ready and taking classes to prep for labor.

They might, for example, ask whether a woman has lined up a lactation consultant or found someone to watch the baby while she sleeps.

Ideally, doctors should be checking in with women once every other week for the first couple of months after they’ve had their baby, Gray added.

She noted a phone interview might be more convenient for both than an in-person visit.

Gray believes the medical community is open to changing the way it delivers postpartum care, especially given that many OB-GYNs these days are women who understand firsthand the challenges their patients face.

In the meantime, first-time mothers need to be their own advocates, said Sarah Verbiest, director of University of North Carolina’s Jordan Institute for Families.

“She matters and she needs to ask for what she needs — no one’s going to give it to her,” Verbiest told Healthline. “If she’s hurting, she needs to call her doctor. It’s OK to ask for help.”

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