Giving new parents the best postpartum recovery, physically and mentally

After giving birth three times, I thought I knew what to expect with my fourth pregnancy. I was ready for night sweats, limited mobility, mental exhaustion, and breastfeeding difficulties. I had a support system in place. I was prepared.

Still, my fourth pregnancy hit me differently. I had never needed physical therapy during pregnancy, but during my third trimester, I regularly sought help managing my changing body. Members of my support system were eager to help, but I knew I needed to try a slightly modified approach this time around. I realized that with all of this, in addition to a lack of sleep—which contributed to my moods—I wasn’t going to bounce back as quickly as I had from earlier postpartum periods. That’s why I sought out a doula.

This doula helped me find and evaluate lactation consultants, and guided my baby into a better sleeping pattern. She reassured me that I was doing everything I could and needed to prioritize my own rest. She gave me the time to recharge and heal.

Postpartum mental health by the numbers

Postpartum mental health is complicated and varied: some people experience mild emotional disruptions because of hormonal shifts, while others face postpartum blues, postpartum depression (PPD), anxiety, and, in severe cases, psychosis or even suicide. About 1 in 8 women experience PPD symptoms after a recent live birth, and among those reporting symptoms, 75% go untreated. These numbers are elevated for minority populations: 81% of Black women and 76% of Hispanic women said they would have liked to learn more about postpartum mental health before having children, compared with 70% of women overall.

While there is no one easy solution that fits each person’s postpartum challenges, culturally competent care, education, and—where necessary—medication (such as Zuranolone, recently approved by the FDA) can have an enormous impact.

We can’t stop at postpartum screenings

Following birth, a baby sees a doctor within a few days and multiple times after that during the following weeks. In contrast, birthing parents are advised to get an initial evaluation within three to six weeks, with a comprehensive checkup by 12 weeks. Think about it—at 12 weeks, the baby has had multiple visits with the pediatrician, but the birthing parent doesn’t always receive the same level of support. 

Due to maternity healthcare deserts, postpartum checkups often aren’t happening within six weeks (if at all), and even if they are, obstetricians in many states aren’t required to screen for PPD or they struggle to give further support because of limited resources. Patients may assume that what they’re feeling is caused by the lack of sleep that comes with having a newborn or they don’t feel comfortable sharing depressive symptoms with their physicians because of embarrassment around seeking therapy or medication, or a lack of cultural understanding.

States that have attempted to mandate PPD screenings, including Illinois, Massachusetts, New Jersey, and West Virginia, have seen the best results when those screenings are paired with active follow-up connecting patients with necessary mental health resources, and where appropriate, medication.

Doulas fill in the gaps

Earlier screenings are critical in identifying people at risk of developing serious postpartum mental health issues, but they are just the start.

In one survey, the number of birthing parents in the U.S. seeking mental health therapy increased from 43% to 46% between 2022 and 2023, and the National Maternal Mental Health Hotline received 12,000 calls and texts in its first year alone (2022). A study of new birthing parents in Australia showed that social support might be one of the most important factors in improving postpartum mental health outcomes, which is where the work of doulas becomes critical.

A study with 330 women in the U.S. who received doula care (before, during, and after birth) via Medicaid showed they had lower rates of PPD and anxiety (57.5%) than women who did not. Another study demonstrated how doulas can even counteract the powerful influence that economic stability, education, neighborhood and environment, and social relationships have on health outcomes for at-risk populations.

Preparing a culturally appropriate care plan with the help of an accessible care team, including doulas, is a critical first step in improving postpartum mental health. 

Personalized support makes the difference

No two postpartum journeys are alike — each of mine has been different. My doula helped because I knew that she had experience handling both postpartum parents and newborns and could recognize signs or symptoms of concern. With her, I felt the psychological safety to say, “I’m actually not doing okay today and this is why,” and work through the best ways to care for myself and my baby.