The United States lacks postpartum support for mothers

Last month, vegan couple Jade Sanders and Lamont Thomas’ appeal of their life in prison sentence was overturned.  The couple reportedly starved their 6 week old to death by feeding him only soymilk and apple juice.  When reading this, so many questions arise. How could they not know their child was starving? Where was their support? Were they truly negligent?  And what happened to all the systems in place to protect children?

In an ideal world if a child is failing to thrive, someone should notice.  Having done deliveries for the first 6 years of my family practice, I had one memorable case of failure to thrive.   I ultimately admitted the infant who gained weight in the hospital.  She was not being fed properly.  In this case, a little education on not watering down formula went a long way.

But what if an infant is thriving at the 1-week and the 2-week visit?  The next visit might not happen until 2 months of age.  Where are our checks and balances?

Having lived as an expatriate 5 1/2 of the past 6 1/2 years, I can’t help but notice the many postpartum services available in other parts of the world are not universally available in the USA.  If they were available, they may have prevented this unnecessary death.  The operative word is “may.”

Let’s look at these postpartum services.  In the UK, there are “health visitors” that visit all mothers at home postpartum. Every family with children under five has a named health visitor. They offer support and encouragement to families and work closely with the family’s GP (UK’s equivalent to the Family Medicine Doctor) Recently with additional mental health training, these health visitors are helping prevent post partum depression.

In the New Zealand, they have Plunket, an organization that provides free support services for the development, health and well-being of children under five.  They make home visits, have a call line, provide parenting education and have a drop in center.  Any woman who simply needs a break can drop in and take a nap while her infant is watched.  I don’t know of a single mother who could not benefit from this service.

While in Australia they have Early Childhood Australia that provides support to children from birth to 8.  Community child health nurses do the first visit at home and then see the infant every 2 weeks until seen by their pediatrician.

It is true that the above-mentioned countries have socialized medicine.  But we must ask ourselves why should this matter?  Can’t we strive to be better in the USA and provide services universally to all mothers not just when a problem arises? Imagine how we all as mothers could have benefited… maybe not have struggled as much.

As a new mother of any socioeconomic status, there are challenges.  These challenges exist no matter how “textbook baby” your infant is, how well read on parenting you are or even if you are trained as a physician.

Our first-born was severely irritable from GER for the first 13 months of his life.  It was a vicious cycle of eat vomit cry.  We were helpless to help him.  Our GI specialist warned us of how draining it would be and to get help. Imagine if seeking help was readily available through an organization like Plunket.  Imagine how a mother would feel if she wasn’t made to feel like a failure from the start.

Rajka Milanovic Galbraith is a family physician who blogs at Expat Doctor Mom

Submit a guest post and be heard on social media’s leading physician voice.

Comments are moderated before they are published. Please read the comment policy.

  • Maryann Long

    One has to wonder what the postpartum nursing staff observed with this vegan couple, and why the infant was not being fed human milk – his mother’s? shouldn’t breastfeeding be encouraged for ALL babies?  It’s true that in general postpartum followup in the US is poor.  However, midwives often see their moms/babies at 1-2 weeks postpartum in the belief that 6 weeks is much too long to wait, especially if breastfeeding/first baby.  IMO this should be standard of care.  If baby is truly thriving at 1-2 weeks it seems unlikely that the situation would reverse itself without there being an acute problem, which should trigger a call to the baby’s care provider without waiting for the 6 week appointment.

    • http://expatdoctormom.com/ Expat Doctor Mom

      Thanks for taking the time to comment Maryann.  It does make me wonder about what was observed postpartum.

      I was fortunate to be the one delivering and following the baby. So I would see mom with baby at 1-2 weeks and could watch for signs of postpartum depression, distress, as well as failure to thrive in the infant.
      Best,
      Rajka

      • Anonymous

        Hi Rajka,

        I could really have used the guidance at home following the c-section delivery of my first child.  Healing from the incision was incredibly hard when up and down throughout the day and night to breastfeed. Breastfeeding itself was uncomfortable and entirely new to me. I agree with one of the other commenter’s – - I was no doubt post partum depressed and wasn’t going to call the doctor’s office with every question. But I do clearly remember the desire for help – - something that my husband or mother couldn’t even do. I often thought of single mothers and new mothers that didn’t have a family unit to step in. My heart really goes to them.

        • http://expatdoctormom.com/ Expat Doctor Mom

          Thanks for your comment.  Your response is why I wrote the article, it is tough no doubt and my desire would be to see more support of all mothers.  I have  often about all the mothers who don’t have any support.

    • Anonymous

      As a postpartum nurse, I can tell you we spend as much time as possible encouraging breast feeding, and have dedicated lactation nurses who do fabulous work in promoting and teaching breast feeding. But for the most part, new moms quit breast feeding once they get home. Why??? For some unknown reason, showing off your breasts in public is perfectly acceptable, as long as you are not breast feeding a baby- then it’s tabu! I can’t understand it!

      I have noticed that many new moms who are married tend to continue to breast feed, while the single ones do not. My personal belief is that the single moms simply don’t have the support system that the married ones do, and her significant other may not be the dad, who obviousy would not share in the well-being of the infant in the same way a dad would. And, many grandmothers did not breast feed, so they are not supportive either.
        
      What a sad comment on our culture concerning breast feeding!! As the saying goes, you can lead a horse to water, but you can’t make him drink holds true for teaching new moms to breast feed.  As far as the vegan couple goes, they were probably given misleading information by animal activist groups.  My daughter was a vegan until health issues changed her mind.  She was told all kinds of lies concerning nutrition while starving herself in order to “save the animals”.  

      • http://expatdoctormom.com/ Expat Doctor Mom

        Dear Lunell

        Thanks for commenting.  I have always had great rapport and seen great things out of my nursing staff while doing obstetrics. So I have seen the great work that the nurses do. 

        Sadly when it came time for me to deliver (in a new city where I no longer did deliveries), the nurses were great but the lactation consultant came into the room 10 minutes before her shift ended (after waiting on her for more than 24 hours). I needed help as tmy son wouldn’t latch.  At the exact moment she walked in, I sat up in severe pain as I had developed urinary obstruction after a forceps delivery.  It was shocking to have to try and listen to her bark orders at me as to what I should do while I was in such pain and being catheterized.  And then 10 minutes later she announced my shift is over, I am leaving.  So unfortunately, the support for moms is not always great!  In this case, it was clear that the consultant was overworked.

        • Anonymous

           I am so sorry to hear your story!!   Sounds like you did not have a good experience at all!  I hope it was unusual, but in this day of overworked, underpaid nurses, I am afraid it is more common than we would like.  
           
           

          • http://expatdoctormom.com/ Expat Doctor Mom

            Thanks Lunell.  Fortunately, the delivery of my daughter was uneventful and I fed her immediately after birth without difficulty!

  • http://www.facebook.com/people/Molly-Cooke/567191747 Molly Cooke

    I would have loved some post-partum support, especially after the birth of my first.  I had a ton of questions that seemed too trivial to bother the pediatrician with (the baby has occasional little twitches – what does that mean?), I needed some advice about pumping in preparation for going back to work without making my body convinced that I had had triplets, and I was a bit lonely at home, possibly even a bit post-partum depressed, with my husband at work all day and me with a very intense, irritable infant.  Having moved to a new part of the country for residency, I didn’t have a network of women relatives, and I felt as a physician that i was supposed to know what to do, not that internal medicine training prepares anyone for caring for a newborn.

    Now that my three are all grown and out of the hose, I have tried to take an interest in how things are going with my younger colleagues and their new babies, not that this is the equivalent of a real standard support program.

    • http://expatdoctormom.com/ Expat Doctor Mom

      Thanks for sharing Molly. I had that same infant.  And even though I was supposed to have all the answers after training in Family Medicine… I did not.

      That is lovely that you take an interest in your younger colleagues!  I think every bit helps in those early days as well as until the children are more self sufficient! 0-5 is busy times!

  • https://openid.aol.com/opaque/7197ff1a-f5a0-11e0-ac74-000f20980440 Carla

    I am not a physician, however I am a first time mom of a now six month old baby girl.  I do breast feed, but it has been a battle.  Even those who think they are supporting you seem to sabotage at times.  Everybody loves a new baby and wants to be with them or help with them and there are times that NO ONE can help. There have been numerous occassions (and it still happens) where I have been home and make the comment that the baby is hungry and somebody rushes off to make her a bottle. This of course infuriates me!  Yes, I pump and there is a storage of milk in the fridge, however that does not mean you can feed it to her at any given time.  I am her source of food!  My husbands mother did not breast feed and she is the worst at this!  No matter how many times I try to explain that I cannot simply pump and feed her they don’t get it.  Without her stimulation my body doesn’t just produce milk and it has gotten to be a battle to produce enough for her since I have gone back to work. I know the only reason I am still breast feeding is because I have an awesome lactation nurse at the children’s hospital I work at.  Anytime I have a question I can go find her and ask. Of course all lactation nurses are going to push for you to breast feed, however Mrs. Martha has never been overbearing and that has made all the difference for me.  The lactation nurse I had in the hospital I delivered in was terrible and it is unfortunate, but I believe this happens to a lot of first time mothers.  They of course then go home and have no resources except friends (who are sometimes very uneducated about the subject as well) and I believe they get frustrated, overwhelmed, a bit of depression sets in and they give up. So I do believe having a few in home check ups (from the right people) would be very beneficial!  It’s also nice to hear from your provider/physician that you are doing a good job, I believe that those words can boost one’s confidence and definetly helps curb the depression.  All mothers know that the hormones after giving birth are crazy and I think they may get the best of us at times.    

    • http://expatdoctormom.com/ Expat Doctor Mom

      Dear Carla

      Congrats on your little girl! I am pleased to hear that you have the support of “Mrs. Martha”.  Everyone deserves to have this sort of support!

  • Erin Hoagland

    While this tragedy is horrible to contemplate both for the family of the child and the community and while postpartum support is not as robust here in the US as in other places, I have to say that the parents shoulder the majority of the responsibility for this outcome.  So much is not known from your post.  Did the parents seek prenatal care at all?  If they did and they saw a physician or midwife even once, I’m almost positive healthy feeding, particularly breastfeeding, came up.  Did they read any of the myriad books on parenting published in the US, including those published for non-mainstream parents like vegans and vegetarians?  Did they seek to take any birth education classes such as Lamaze?  Did they seek advice from their own parents or relatives?  Did they do even one Google search on how to feed a vegan child?  This couple did not conceive and deliver in a vacuum, devoid of any other human contact.  At least one person they interacted with during the entire prenatal and delivery experience had to have discussed appropriate nutrition for the neonate. 

    In my opinion, the parents had the responsibility to avail themselves of the support available to them prenatally and in the postpartum period.  If they refused the assistance or ignored the medical or nutritional advice, then they are responsible for the terrible tragedy that befell them.

    And to answer the question about “How could they know they were starving their child?”, their child lived for six weeks.  Surely during that time that baby cried piteously, wanting to be fed.  Surely there were physical signs of illness or distress during that six weeks that even the most naive new parent would have recognized.  Did they not seek help?  Did no one visit them, even friends or family?  Most clinics and hospitals in the US recommend a 2-day postpartum weight check for baby plus a first week of life return visit to assess exactly the things supposedly missed here.  But if the parents don’t show up to these appointments, even after telephone reminders and letters in the mail and even, possibly, outreach by perinatal coordinators, the responsibility for a negative outcome isn’t in the hands of the clinic or its personnel or can it be blamed on a lack of support. 

    As the saying goes, you can lead a horse to water, but you can’t make him drink.   

    • http://expatdoctormom.com/ Expat Doctor Mom

      Dear Erin

      Thank you for taking the time to comment and share.  The infant’s death is a tragedy and it makes me saddened as that child probably suffered dearly as it was starving.

  • http://www.facebook.com/people/Natalie-A-Sera/743004321 Natalie A. Sera

    Seems to me there was some willful ignorance and neglect on the part of the parents. A baby who starves becomes emaciated, and even in the popular media, there are enough pictures of chubby, thriving babies that they should have known that something was wrong, and gotten help.

    On the subject of breastfeeding, when I had my son 38 years ago, I joined La Leche League. They were very supportive. I don’t know if they are still in existence, though. On the other hand, nursing was very painful to me, apparently because I have inverted nipples, and my son had a very high-arched palate, and at 8 weeks, I developed mastitis. At that time, the obgyn simply told me to stop nursing. I would really have appreciated help from a lactation consultant because I really wanted to breastfeed longer, but the pain and the mastitis and the doc’s instructions put an end to it. My sister-in-law didn’t breastfeed her son because she couldn’t get him to latch on. When breastfeeding is so demonstrably healthy for the child, we needed support that we just didn’t get.

    • http://expatdoctormom.com/ Expat Doctor Mom

      Dear Natalie

      Thanks for sharing.  La Leche still exists! 

      I am very sorry about the experience you had with breast feeding.  That is what I wanted to highlight by this article that we as moms no matter the walk of life need more support.