I gave birth. The most dangerous part came later.

Like many American women, I didn’t plan to take the first postnatal exam until six weeks after giving birth. Until then, I had little idea of ​​how bad it was.

Breastfeeding for a week burned an extra 500 calories a day, and I lived primarily on broth and popsicles. When I finally measured my body temperature, I had a slight fever. When I called the midwife, she encountered a possible symptomatology and apparently found no mistakes. The obstetrician she spoke to said she was likely to have mastitis, a common infection during breastfeeding.

Good news, she told me, I didn’t have to go to the hospital, it was fighting COVID-19 Pandemic.. She said we’re going to keep you safe at home.

A week later, I returned to the hospital and was fighting a life-threatening infection. Two weeks after giving birth, I developed a racing heartbeat, lost 20 pounds and became too weak to change diapers before doctors discovered any serious problems.

My experience shows the gap in postnatal care in the United States. The doctor interviewed for this article later told me. According to the US Centers for Disease Control and Prevention, 40% of maternal deaths from early pregnancy to the end of the first year of childbirth occur in the first 42 days after childbirth.

Doctors said there was a lack of patient education on potential complications such as pre-eclampsia, bleeding and infections. They also emphasized a typical 6-week medical break from vaginal delivery to the appointment of the first postnatal doctor, which can prevent early detection of problems. Others cited the lack of research, training and experience of doctors who met women during this period.

Alison Stube, a professor of obstetrics and gynecology at the University of North Carolina School of Medicine, said: “Not much attention has been paid to it.”

Mara Murray Horwitz, an attending physician and assistant professor at Boston University School of Medicine, said she was unaware of the “big gap” in the postnatal patient’s healthcare system until she struggled to treat post-pregnancy complications. “It opened my eyes to the dangers of the postpartum period and the way it is much more dangerous and difficult to access care,” she said.

It was carefully monitored during pregnancy due to genetic conditions that increase the risk of complications such as preterm birth and postpartum bleeding.When in spring Covid-19 19 cases in New York City Having reached its peak, I rarely left Brooklyn’s home except for a 30-minute Lyft ride to the hospital for additional ultrasound scans and tests. When I gave birth at maturity, I arrived at the hospital early just in case.

I didn’t do anything. After routine delivery, I gave birth to a healthy 7.5-pound boy. We named him Jonah.

However, four hours after giving birth, I felt the room rotate when I tried to help the nurse get out of bed. My blood pressure dropped to 74/35. This indicates that I was bleeding too much.

My medical record states that I improved quickly from the first night and by the afternoon of the next day I had no dizziness or blood loss. Two days after giving birth, I left the hospital with my husband and son. In the last few decades, hospitals have begun to discharge most women within a few days of giving birth. Traveling reduces costs and families often become more comfortable at home.

Christopher Grants, a professor of obstetrics and gynecology at the University of Rochester Medical Center and co-director of the Maternal Death Review Board in New York, was one of two independent physicians who examined my medical records in this article. did. He estimates that about 1 liter of blood leaked into the abdomen after delivery, leading to the severe dizziness I experienced. Dr. Grants said the blood pool was likely infected shortly after we got home with the newborn.

During my pregnancy, I had an experienced and highly trained medical team in New York City’s top hospital system, including high-risk obstetricians.

When I interviewed my health care provider, they said it was difficult to distinguish my symptoms from normal postpartum complaints. For example, low-grade fever is very common among lactating women, my midwife told me for this article. When I asked my obstetrician about blood loss the first night, he said his role as a high-risk specialist was to provide prenatal counseling about potential complications, He did not have a formal role in my postnatal care. He said the blood could be hidden deep inside my abdominal cavity, where it’s difficult to identify. He said this rare complication was most likely partially caused by my genetic condition, which increased the risk of infection.

Blood pools are usually reabsorbed harmlessly. So the standard treatment policy is to wait, other doctors told me.

The pandemic also complicated my medical care and gave the doctor a reason to stay at home rather than send me to the emergency room. My hospital system introduced all the questions to my doctor.

According to the Commonwealth Fund, which is based in New York City, the Healthcare Research Foundation, maternal mortality in the United States is twice that of most other high-income countries, including the United Kingdom, Canada and Australia. The CDC states that about two-thirds of pregnancy-related deaths are preventable. Factors include lack of access to care, delayed diagnosis, and missed warning signs.Black women and Medicaid women Affected by disproportionate..

To address this, the American College of Obstetrics and Gynecology announced in 2018 that women would be much earlier than 6 weeks, low-risk women within 3 weeks of birth, and women at high risk of complications. Recommended to contact the healthcare provider sooner. (Approximately 30% of women who have a Caesarean section may already have follow-up plans after 2 weeks.)

The doctor who prepared the 2018 Recommendation said such major changes would be difficult. “It’s an old habit. It’s a big cultural change,” said Tamika Auguste, chairman of Women’s and Infants Services at the MedStar Washington Hospital Center, who co-authored the recommendation. My midwife said that in 20 years of practice, she met most women about six weeks later and found it to be effective.

The American College of Obstetricians and Gynecologists also support home visits by nurses during the first few days of life. This is standard practice in other high-income countries, but it is not always covered by insurance in the United States. “Health insurance providers support evidence-based, high-quality, cost-effective care,” said the American health insurance plan, an industry group.

Adding more care increases the cost and demand for the doctor’s time. Scientists say there are relatively few studies on postpartum health, and doctors asking women for unnecessary appointments can confuse women while caring for their newborns. It states that there is.

Even doctors who help add more care say it’s difficult to find the right balance. Mark Clap, a maternal-fetal medicine expert at Massachusetts General Hospital, said:

Almost a week after I first noticed that I had a fever, my obstetrician sent me to a walk-in clinic, where the doctor was surprised. She promoted my blood test and showed that my white blood cell count was high and could indicate a serious infection.

My husband and I cleaned up the two-week-old baby and went to the emergency room. The obstetrician there told me that my symptoms did not seem to be abnormal. Postpartum women may have high white blood cell counts. She urged me to go home and take a sitz bath. I really wanted to go back to bed with my newborn baby, but I told her it wouldn’t get better at home.

The doctor ordered an additional blood test. The obstetrician told me to make an appointment with another doctor a few days later and discharged me.

When I emailed the obstetrician from the ER for comment on this article, she said my symptoms were unusual for a serious infection and I didn’t have higher fever and pain So she wrote that she was abandoned. “As an OB / GYN, listening to women is very important to me,” she added, “women’s symptoms may not be taken as seriously as they should be.”

The next afternoon, the hospital told me to come back. An ER test found bacteria in my blood. This is a sign of sepsis, the leading cause of maternal death. I hung up and checked my body temperature. It soared to 103.

I spent the next 8 days in the hospital. The blood pool turned into a small watermelon-sized abscess, requiring blood transfusions, surgery, and 6 weeks of antibiotics.

Due to Covid-related visitor restrictions, I wasn’t allowed to see Jonah all the time.

The night I was hospitalized, when I learned that I was leaving him, I pressed the phone button again to find a nurse who would remove the IV and monitor so I could see him again. Finally, ignoring the alarm, I stripped off my monitor and moved to the waiting room.

I sat on a stretcher in the hallway, breastfeeding my baby and looking for a way to say goodbye. In this world he just entered, his voice and heartbeat are uniquely familiar, and I was worried about who would comfort him without me. Does he need a mother and always cry?

Will he forget me? “He’s part of you and it’s impossible to forget it,” my sister sent me a text message.

When I got home, the caregiver I hired while in the hospital held my son in his arms. He earned pounds and learned how to make eye contact with me. I was injured and felt grateful that he prospered without me.

I had an IV line on my left arm and two drains on my abdomen, and I was discharged because it was difficult to hold him. Breastfeeding did not go smoothly. After moving away so quickly, I had a hard time deepening my bond with my child, so I talked to the therapist.

I finally recovered completely, and the only permanent traces are two small round scars where the tube for the drain was once. As I change Jonah’s diapers and rock them to sleep in the afternoon light, I find that my motherhood finally feels as I had imagined. Possible.

Write to With Laura Kushisuto [email protected]