Q&A: Gap in postpartum care is driving the maternal mortality 'public health crisis'

Key takeaways:

• Many women suffer complications in the time between giving birth and the 6-week visit.

• A Women in Medicine Summit presenter discussed how her own journey informs her work and what she is doing to help new moms.

A multidisciplinary approach can help close gaps in postpartum care and improve outcomes for new mothers, according to an expert.

Phindile Erika Chowa, MD, a board-certified emergency medicine physician and founder of concierge medical practice EMCare2U, spoke about overlooked gaps in postpartum care at the recent Women in Medicine Summit.

Chowa’s “own harrowing postpartum journey exposed the dangerous gaps in care — gaps that nearly cost her life,” according to Chowa’s Women in Medicine Summit bio. This led her to create EMCare2U “to provide what every mother deserves: personalized, in-home, physician-led postpartum support.”

Healio spoke with Chowa to learn about her presentation and what women’s health providers need to know.

Healio: Your talk was titled “The postpartum gap: What medicine overlooks and how we fix it.” What exactly is the postpartum gap ? What is overlooked?

Chowa: I kind of break it up into two parts: it’s structural as well as relational.

Structural is during pregnancy. Moms get 9 months of care — multiple prenatal visits, multiple touch points, and then they deliver. After that, they’re sent home and they have to wait 6 weeks to see a provider. The gap is the fact that they are not monitored between the time when the baby comes and the 6-week visit, and then on. Also, a lot of women suffer complications in that timeframe, and really up to 2 years. We have to do a better job of treating postpartum care like prenatal care.

The other part of it is relational. We say a lot to our patients, but patients often don’t hear everything. Also, they don’t necessarily understand. Then, that disconnect leaves them vulnerable and confused; they don’t feel supported. We treat birth like the finish line, and then after that, mom just has to figure it out. It’s really a starting line for her. So that’s what I call the postpartum gap.

Healio: Why is this an important subject for health care providers to know about?

Chowa: In the United States, we have some of the worst maternal mortality rates among developed nations. I think what people don’t understand is most of the women who are dying are not dying during pregnancy, and they’re not necessarily dying in childbirth — they’re dying postpartum. And about two-thirds of women who die, who suffer from preventable deaths in the maternal period, are postpartum, within the first 42 days. So, something is happening. If most of these women are dying postpartum, why isn’t attention focused on this period? So, I think it’s a really important issue for all health care providers, because at some point, they’re all going to interface with mom. For example, a lot of moms will seek out care in the ED. There’s primary care doctors who may need to involve themselves, because, right now, they usually refer care of the mom to the OB. However, maybe primary care doctors need to be more involved after moms give birth. Pediatricians see mom multiple times when they give birth, so maybe they can be educated or do some of the screening and help protect our moms.

There are multiple disciplines that can be involved in this work, including other members of the community there — pelvic floor therapists, lactation consultants — who may come in contact with mom. So this is an “everybody problem.” I feel like multiple people can do the work of educating mom. They can build a community and the systems around mom to make sure that they’re checking on them. It can really be an interdisciplinary approach. I don’t think just OBs need to do this work; there are multiple people who can.

Healio: Your bio on the Women in Medicine and Summit website mentioned your own distressing postpartum journey. Could you tell me a little about what you went through and how that has informed your work?

Chowa: I had severe postpartum depression. I didn’t really recognize it as such. I had a miscarriage before I had my child, and I don’t think I really grieved that loss. I don’t think that I received mental health care for that loss, because before my postpartum, I didn’t even think I needed a therapist. I am a medical professional, but that was just how I was raised. You push through; you watch your parents push through. So, I went through a loss before I had my daughter, and then during my pregnancy with my daughter, I had significant bleeding. That was just a really anxiety-provoking pregnancy because I bled due to a chorionic hemorrhage, and then when I delivered, it was an emergency. People rushed in. My daughter inhaled amniotic fluid and went to the NICU. Then I could not breastfeed my daughter.

I was discharged with a baby who was breathing very fast, and I was scared. Consequently, I did not sleep. I watched my daughter constantly. I literally sat next to her crib, her little bassinet, and I just watched her breathing all night. When I was not doing that, I was trying to pump obsessively. My breast milk did not come, and so I had a pretty awful lactation journey. I did not sleep. I cried every day. It took the help of a neighbor who would just come and check on me [before things got better]. I think she noticed something in me because she just started checking on me more often. After a while, she talked about her own journey with therapy. She got a lactation consultant to come to my home, which I didn’t even know about at the time. The lactation consultant told me, “I want you to forgive yourself. You have something called glandular hypoplasia. Your glands did not grow during pregnancy. So, no matter how much you pump, you’re not going to produce enough milk. So this is not doing you a service. It’s causing you harm. I want you to put away the pump.”

My neighbor referred me Psychology Today to find a therapist. I remember actually going to my OB and saying “I think I’m depressed,” because I didn’t know that I had it at the time. And he said, “Oh, I think you’re fine. A lot of moms go through this.” I took the Edinburgh postnatal screening test to screen for depression. I failed it at my pediatrician’s office and my OB’s office, but nobody gave me resources.

Ultimately, I remember one day coming downstairs and I had the baby in hand. I gave the baby to my mother in law and my husband, and I walked out the door. I didn’t know where I was going. I started driving, and I just thought to myself, what would happen if I just drove off the road? And at that moment, I sort of caught myself, and I called my mom, and I talked to her. My mom is an African mom, and the answer was not what I wanted, really, but it was enough. I had to say to myself, “Okay, no one’s going to do this for me. I’ve got to fix this.” So I got a therapist for the first time, and I worked with my therapist, who helped me get back to normal.

There was a lot of behavioral therapy, a lot of things I had to change, and we got through it. I probably didn’t feel like myself until 1 to 2 years postpartum, but I didn’t talk about that experience until I started doing this work. I encountered moms who were postpartum, and in it, I just started remembering my own journey that I had suppressed. Often, women don’t talk about these things. And then I realized just how important this work is because I remember how isolating that period was and the people who got me out of it.

Healio: We talked about the postpartum gap and what medicine overlooks, but how do we fix it?

Chowa: I always use a three-method approach. No. 1 is education, No. 2 is a community-driven approach and No. 3 is pushing for systemic change.

Mothers have to feel informed. They have to feel educated enough to feel empowered to say something. I think the issue is sometimes there’s a disconnect between the people who take care of them, so I think sometimes they may not want to speak up. Or if there’s something that’s been bothering them for a while, they may not think this is an issue. Maybe they’ve been dismissed during pregnancy. There’s just that disconnect, so No. 1 is educating moms to the point that they feel empowered. However, they also need to be educated about postpartum. There’s a lot of education about pregnancy and childbirth, but more education around postpartum is needed.

And then there needs to be a community-driven approach. Since I started doing this work, I’ve met amazing people like doulas and lactation consultants, pelvic floor therapists, mental health workers who are specifically dedicated to perinatal mood disorders. There are community navigators, there are night nurses — I mean, there’s a whole community of people out there. Bringing those people together and providing a network that is accessible for mom is important. I think building systems around our clinics to be able to refer moms to these community resources is really important.

I can’t talk about fixing gaps without fixing the systems. Our health care system is not set up for moms to recover postpartum. I’m going to provide you with some history. Before women gave birth in the hospital, they gave birth at home. When they gave birth at home, it was a sacred experience. The community was involved. Mom gave birth, and the community came. They surrounded her. They really made sure that she was healing and recovering well. People brought her food. She rested. People helped her. And then that birthing process was medicalized and moved to the hospitals.

Initially, birth outcomes did not improve. They worsened because there was a lot more instrumentation. The community was less involved in that experience. There was less of an emphasis on postpartum. It was a very medical experience. Basically, experimentation got us to where we are today. Yes, now, outcomes are far better in the hospital, however, in that transition, guess what got lost? The emphasis on recovery postpartum. Community as well.

The focus also needs to shift to recovery again. Moms just can’t deliver, go home and that’s it. The first priority is changing the system to recognize postpartum care as equally important as prenatal care. Once we do that, the next challenge is convincing policymakers and insurance companies to actually support it. Right now, most women get a single postpartum visit at six weeks—and that’s it. We can do better. Imagine sending nurses into moms’ homes. Imagine integrating virtual check-ins, remote monitoring, or even apps that use unbiased AI to flag warning signs early. These are creative, realistic ways to provide postpartum care that saves lives. And none of it works without improving paid maternity leave, so moms can heal and access the care they need while at home.

We can educate moms and build community all day, but without changing the systems that fail to prioritize women’s wellness and recovery, we won’t get very far.

Healio: You built EMCare2U — can you tell me more about that venture and how it helps postpartum mothers?

Chowa: I originally built it thinking I was going to just see primary and urgent care patients in their homes. When I went in, I received a lot of calls from moms who just gave birth, moms with small kids — and so that’s when I realized, “Okay, aha, there’s a huge need here.” And so once I started recognizing that, moms started sharing my information in their groups. Then I had birth workers sending their moms to me, and then I just realized this is it for me. This is my purpose. This is what I’m supposed to be doing.

I go through and create a postpartum plan for them, depending on if it’s their first birth or if they’ve had children before. Then we prioritize the areas that I think we need to, but I always make sure that my moms have access to a lactation consultant, a pelvic floor therapist and mental health worker. Obviously, if moms’ needs differ, they get more than that. So, my model of care is very multidisciplinary: it uses members of the community who are doing this work, who I’ve worked with multiple times, who I refer my moms to in their homes. Honestly, sometimes they just want to talk. I sometimes just go to moms’ homes, and they just want to talk their problems through and make sure that somebody is available to talk with them. A lot of what I do is listening. A lot of what I do is actually what I do in the ER, which is triaging moms to get the care that they need. So, it’s been a really great experience.

Healio: Are there any concrete steps women’s health providers can take to close the postpartum gap? How can they best support postpartum mothers?

Chowa: If I had to have a word with clinics, I would say, maybe they can create these postpartum networks or hire someone to do this. That person should make sure that they have extra resources for moms who may be high risk. Maybe those moms need extra appointments in the book. Maybe they don’t need a 6-week checkup — let’s do a 1-week checkup, a 2-week checkup, a 3-week checkup. And it doesn’t have to be in person; it could be virtual. Let’s have a nurse calling her house. Let’s have a care navigator who is going into the homes and checking on mom. Let’s try to build these systems so mom is feeling safe and supported during that time. So, I think that’s No. 1, just maybe adding more appointments or more touch points with moms.

No. 2, we need to build community around moms, not just babies. That means shifting from baby showers to mom showers, where birth workers and resources come together to support her recovery. Postpartum should be about preparing moms for healing, returning to work in a healthy frame of mind, and knowing there are systems ready to catch them when complications arise.

No. 3, we need our creative brains. There are a lot of tech people. I’m not a technology person, but I can think of so much technology out there that can be used to save our moms, whether it’s apps, whether it’s AI-driven systems or detection tools. Let’s use technology.

Healio: What is the take-home message here? If nothing else, what should health care providers get out of this article?

Chowa: If nothing else, they need to know that the problem exists. They need to know that the challenges associated with pregnancy do not end when mom gives birth. The biggest takeaway is, we have a public health crisis. Women are dying, and they’re dying postpartum. If they’re not dying postpartum, they’re suffering significant morbidities. There’s pelvic floor dysfunction that they don’t find out until much later in their postpartum journey. There are mental health challenges that linger for some time. So, let’s focus our attention and also apply change to the postpartum period.

Healio: Is there anything else you’d like to add?

Chowa: I contact birth workers from around the community about three times a year. I ask them to sit on a panel, and they educate moms about all four trimesters. At that time, moms ask questions, and a lot of moms leave feeling ready for pregnancy, ready for childbirth and postpartum. And I just find [these showers] so useful. They continue to grow. This next shower in September has 120 people. I would love to do these showers around the U.S., or help people replicate them. This is a way to educate moms without putting all of the work on our providers.