Thoughts on the 12-week Postpartum Appointment and the Lack of Mental Healthcare Support in New Moms
You're 12 weeks postpartum and the day finally arrives... your postpartum OB appointment. While I have many thoughts on the absurdity of our country's single 15-minute postpartum appointment at 12 weeks and the content most providers primarily focus on during that time, this post will focus on the mental health aspect of the visit.
If you're lucky, you will receive a general depression questionnaire upon checking into your postpartum appointment for you to fill out in the waiting room and give to your nurse when she brings you to your room. This questionnaire, mind you, isn't specific to postpartum depression, isn't considered the best assessment for postpartum depression, nor does it examine any other perinatal or postpartum mental health issues such as postpartum anxiety, OCD, pyschosis or birth trauma, to name a few. It is quite literally the bare minimum and in my professional opinion, a slap in the face to new moms. I truly believe most providers only include this as a way to avoid liability if something were to happen to the new mom.
And for most women, that's it. No follow up on your responses, no discussion on what you should look out for, names of therapists or other community resources that might be helpful as you navigate this huge life transition of caring for a tiny human.
Yet, perinatal mental health issues are extremely common. And it's well documented that mothers carry a huge role in a child's life yet are very often undersupported in many ways in our country from our policies to the lack of preventative care we give new moms. There are huge systemic issues in our country around maternal mental health care, not to mention the disproportionate amount of women of color who shoulder the cost of maternal mental illness.
Many OBs treat the physical component of a new mom's healing progress in what feels like a push to get back on birth control and get clearance to have sex again. There is little to no mention of "how are you really doing?" or "do you have enough emotional support?" from providers in these sessions. This absence in care can send the message to a new mom that struggling with mental health is something to hide, be ashamed of, not to mention, or something uncommon. None of which are true.
For many moms, this can feel reminiscent of her personal life. Our society doesn't help new moms and for the most part, focuses on baby. Good pediatric care is not individualistic care, though. Good pediatric care includes care of the mom and that includes her mental health, too. When new moms are supported, set up for success, and really asked about how their mental health is doing postpartum, both mom and baby are more likely to do well long-term.
If you are struggling postpartum and feel unheard or confused about what is or isn't considered worthy of being a postpartum mental health concern, you aren't alone. It is confusing because providers (and, yes, insurance companies who have the power over providers) have made it confusing. The truth is, there's nothing wrong with you for struggling postpartum or being confused. It's common and you deserve care. For some, that's medication and for others, that's something like individual, couples or group therapy.
If you think you're fine and don't have any "real issues" postpartum, you still qualify for postpartum mental health care, no matter how postpartum you are. As a perinatal mental health provider, I can help you understand your unique postpartum experience and if necessary, can even look at (much better) assessments to see how you're doing. Only this time, there will be follow up which is something all new moms really need from their providers, whether they think they're struggling, doing better than ever or somewhere in between.
"I see that you specialize in trauma & emotionally unavailable/immature parents but my childhood wasn't all that bad. I have a good enough relationship with my parents as an adult, too. Is therapy right for me?"
This is a common question I get asked by many potential new clients or clients who are new to therapy beyond the 8-12 weeks of solution focused therapy. I'll go into my longer, more therapist-y response below but to answer this question succinctly, the answer is yes, therapy can still be for you even if all of the above is true.
I practice trauma-informed therapy which means that I understand that the environment we grew up in and the things that happen to us, even as adults, can have a direct impact on how we respond to and see the world around us. There's nothing wrong with solution focused therapy that solely focuses on developing coping skills to help us through difficult times. However, I don't think that learning more coping skills will ever solve our problems as complex humans.
Have you ever worked up the courage to tell someone about something you're struggling with only to be met with a question like, "at least it's not (enter some hypothetical situation they deem as worse than what you're going through)"? Maybe you've received unsolicited advice from others when you really just want to emotionally connect with them. Or maybe that person misinterprets what you've said and now you're comforting them and never end up circling back around to the topic you brought up. For a lot of us in these situations, this doesn't feel good. It feels dismissive.
To go even deeper, I believe that the response we receive from others when going through difficult experiences can have the power to make or break how we view ourselves and the situation. If we are receiving dismissive and invalidating responses from others while dealing with postpartum anxiety or a breakup, we might look back at the experience with disgust or frustration with ourselves. If we were to receive compassion, nurturance and care while going through that same experience, we might be more likely to think on the experience with tenderness that someone was able to show us love/care when we needed it the most.
This is what trauma-informed therapy is like. It doesn't mean that you need to have experienced trauma, to have a bad childhood or terrible parents. It means that I understand that life is complex and sometimes we can have difficult emotions about people and situations we love. It means there is no judgment for what you're feeling. It means offering a space for you to be curious about what happened to you and why that might be difficult to feel.
Trauma-informed therapy also means I understand everyone has a different experience of the world. I understand that I am not all powerful as a therapist. Instead of saying something like "You need to exercise more to feel better", I might say something such as, "I'm curious about how relate to your physical body in the world. If it feels safe to do so, I'm wondering what shows up for you when I bring up the concept of movement. For some people, movement might be a place of safety or refuge, for others, this might elicit anger, and for others, there might be shame or maybe even no response at all or one that's hard to identify. Tell me about your experience". See how much more curiosity and compassion a trauma-informed response sounds?
Lastly, trauma informed care is slow. It has to be. In order to be truly trauma-informed and inclusive, we must ask more questions out of curiosity out of the expense of efficiency. It means we get a chance to rewrite our narratives when we've received negative or harmful responses from others or ourselves in the past. And that takes time... and a whole lot more that simply learning how to meditate.