Why Postpartum Care Is an Oxymoron

For all the hoopla about pregnant bodies, when it comes to postpartum ones, we literally couldn’t care less.

Women should expect better not only during pregnancy, but after. Pictured: A family participating in the Pan American Health Organization's #ZeroMaternalDeaths campaign to mobilize the Americas to reduce maternal deaths.
Women should expect better not only during pregnancy, but after. Pictured: A family participating in the Pan American Health Organization’s #ZeroMaternalDeaths campaign to mobilize the Americas to reduce maternal deaths. (Pan American Health Organization PAHO / Flickr)

Three months after giving birth, I sat in the chilly exam room of our pediatrician’s office, waiting for the doctor. On my lap, I held my daughter, naked except for a size one diaper, and tried to keep her little body wrapped in a swaddling blanket while she squirmed.

The nurse walked in and read some questions off a clipboard. “Are you currently nursing?” she asked and I nodded. “Exclusively breastfed,” she said, making a note in the chart. “That’s wonderful.”

Was it? The reason I’d made the appointment was because my baby seemed scrawny and fretful, one half of a mother-daughter dyad stymied, depending on which lactation consultant you believed: by thrush, a tongue tie, a lip tie, a tongue and lip tie, poor milk production, or that catch-all of all nursing-related diagnoses—the bad latch.

The doctor came in—not our regular pediatrician, a kind, nerdy soul who always took my questions seriously. Without examining us, he dismissed my concerns. He advised me to “just relax.”

I drove home in a daze. When I got back, I carried my daughter—still strapped in her car seat—into the bathroom and set her down while I showered and cried. Since giving birth, I often felt as though I had drifted off the map of medical care into some Bermuda Triangle, a literal no-man’s land populated only by postpartum women. My daughter had her pediatrician; I had a primary care physician, but barely—basically someone I’d seen once for a sinus infection. I had had my ob-gyn, but she was what my husband called a “war-time consigliere.” She provided sound prenatal care, but postnatal? Not so much.

I did have a six-week check-up. But the primary goal of that visit, as it is for most women who deliver vaginally, was to confirm my fitness for sexual intercourse. At six weeks out, I was exhausted and had only just stopped using frozen witch-hazel-soaked maxi pads to soothe my perineum. The last thing I needed was the green light for penetrative sex.

When I mentioned that I felt out of sorts, and asked for a referral to a therapist, my doctor seemed surprised. “I think we have a business card for someone,” she said, vaguely. “Just tell the nurse when you check out.”

I left that appointment convinced I had done something wrong—picked the wrong doctor, asked the wrong questions, not asked the right ones. But by the time I stepped out of the shower, and stood, dripping, looking down at my daughter, it felt clear. I hadn’t failed; I was being failed. For all the hoopla about pregnant bodies, when it comes to postpartum ones, we literally couldn’t care less.

This shouldn’t have come as a surprise. American obstetrics, after all, is full of frank misogyny, baked into concepts like “incompetent cervix,” “geriatric pregnancy” or “advanced maternal age”—the label assigned to decrepit women like me who dared to conceive after 34. When, in my second trimester, my doctor recommended “pelvic rest,” it sounded like something Victorian physicians proscribed to protect their convalescing patients from rape-y husbands.

Then, of course, there are the many, more material ways America devalues mothers and mothering. The U.S. has abysmal track record when it comes to maternal health. For Black women, they’re especially abysmal. We’re unique among industrialized nations in lacking paid parental leave, and offer the least affordable child care. But somehow, confronting the nonexistence of routine postpartum care in this country still came as a shock.


Then, of course, there are the many, more material ways America devalues mothers and mothering. But somehow, confronting the nonexistence of routine postpartum care in this country still came as a shock.


All that exclusive breast-feeding gives you lots of time to think, and to watch TV. As I sat on the couch binging seasons of Call the Midwife, I found myself fixated less on the plotlines than the prospect of free postnatal care. These British mothers may have had endured some harrowing deliveries, but at least they got home visits. At least they had a midwife they could call!

For those in the U.S., it is easy to be amazed by other countries’ postnatal caretaking rituals: rest periods for new mothers in Japan and Mexico; trained nurses dispatched to assist parents in the Netherlands; or boxes sent by the Finnish government that hold baby supplies and also double as infant beds.

Here, by contrast, most parents confront a postnatal care void, into which rush all manner of variously qualified individuals: doulas, lactation consultants, even craniosacral specialists, who—in the interest of improved nursing—will charge you to manipulate the bones in your baby’s head. Then, there are the local moms’ groups, like the one I joined when I was feeling especially unhinged, and whose members scared me in their quiet desperation.

“You know how it is!” one wrote in an email. “One minute you are carefree listening to the giggles of your children sledding and then the next minute you find yourself hiding in the closet with a bowl of Lucky Charms and a glass of wine!”


It is not enough for individuals to care for new mothers. We need policies, institutions and structures that care for us too. 


Months later, when my daughter turned one, I left town for a two-week workshop and made the hasty decision to wean. I tried to hide my gloom by commiserating with a Belgian colleague, the only other mother in the group—joking, in the American way, about the physical devastations of childbirth. “What do you mean?” she asked, genuinely confused when I expressed nostalgia for my pre-baby abs. “You get a prescription for the Pilates,” she said to me. No, I thought, you get a prescription for the Pilates. 

Since then, I’ve come to learn about things like diastasis recti and pelvic floor therapy, and the fact—shared with me by a scholar of Russian history—that what we’ve come to talk about as “natural” childbirth actually had its origins as Soviet propaganda.

But none of this was part of the extensive literature we received in birth class, which focused mostly on practicing laboring techniques I was never allowed to use. Instead, diagnosed with low amniotic fluid, I was induced, given an overdose of Pitocin, hooked up to multiple beeping machines, and provided an epidural that only worked on one side of my body. On the second try, they numbed me entirely below the waist. When I complained, the labor nurse seemed more annoyed than interested in helping. Having been coached to ask that my daughter be taken to the nursery the first night, so I could rest, I was given such a withering look, I almost relented.

Over the years, I’ve learned that my experience was utterly normal. But it shouldn’t be. To paraphrase economist Emily Oster: Women should expect better not only during pregnancy, but after. It is not enough for individuals to care for new mothers. We need policies, institutions and structures that care for us too. 

Last year, when my daughter turned five, I bought her a book called Who Needs Donuts? by Mark Alan Stamaty. In it, a young boy travels to the big city, an upside-down version of New York, in search of donuts. He acquires donuts beyond his wildest dreams, but then meets a “sad old woman” who challenges his fixation: “Who needs donuts, when you’ve got love?” In the end, the boy does indeed gain love, and can ditch the donuts.

One day, as I went to put the book back on my daughter’s shelf, it struck me: All mothers do get is donuts. Baby shower donuts and Mother’s Day breakfast donuts. Six-week check-up donuts. Goddamn mommy’s group donuts! Symbolic donuts. We don’t need any more donuts. What we do need, what we are still nowhere close to getting, is love.

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About

Elizabeth Alsop is an assistant professor at CUNY, where she teaches and writes about film, television, and 20th-century literature. She is the author of Making Conversation in Modernist Fiction, and her cultural criticism has appeared in The Atlantic, The New York Times Magazine, Salon, and The LA Review of Books. She is currently writing a book on the films of Elaine May.