Almost 30 years ago, as an OB/GYN intern at a large urban medical center, I was privileged to learn from exemplary doctors and midwives. After 4:30 a.m. postpartum rounds one day, a midwife said, “I saw your note. You listened for bowel sounds and examined her abdomen.” I replied, “I did.” She asked, “Did you also check her bottom?” I responded, “No. Why?” She explained, “She delivered the baby through her vagina. You have to check her bottom, assess the amount of bleeding she’s experiencing, examine the laceration repair, and ensure there’s no hematoma.” That marked my introduction to postpartum care.

The postpartum service was extensive and felt overwhelming. Women needed immediate attention: blood had to be drawn, IVs started, and charting completed before 7 a.m. rounds. Afterward, I would be on the Labor Floor, learning to manage labor, deliver babies, assist with cesarean sections, and engage in any hands-on opportunities available.

As I progressed in my residency, postpartum rounding was delegated to the interns. I was relieved, as I often felt guilty about waking women up at 4:30 a.m. to inquire about their well-being when all they truly needed was rest. I didn’t fully comprehend the critical nature of the postpartum period and the extensive care it demanded.

Upon entering private practice, I dedicated more time to postpartum care for my mothers. There was no longer a need to disturb them at 4:30 a.m. I checked their bottoms, evaluated their bleeding, and discussed the baby blues. My admittedly minimal postpartum counseling advised pelvic rest for six weeks, prioritizing sleep during the baby’s sleep schedule, and scheduling a postpartum visit at six weeks.

One afternoon, I received a call from one of my new mothers. As I greeted her, she exclaimed, “Dr. Mahon, babies are incredibly expensive. I don’t know how we’ll afford all of this.” This outburst, uncharacteristic of her, raised a red flag signaling an underlying issue.

She was the primary breadwinner, concerned about her return to work. I inquired about her sleep, and she had only slept six hours over the past two days. She was utterly exhausted. Despite having a supportive family willing to help, she felt compelled to manage everything on her own. She was overwhelmed by the demands of caring for her baby, breastfeeding, recovering from labor, and finding a way to juggle it all while resuming work.

Addressing her work concerns wasn’t feasible at the moment. Instead, I suggested she pump breast milk into bottles and ask her mother to cover afternoon feeds, allowing her to shower and nap. Her family contributed by preparing meals and assisting with night feeds, giving her opportunities to rest.

I never forgot her. That call marked the beginning of my education in the fourth trimester.

Over the years, I’ve witnessed new parents leaving the hospital with smiles, expressing gratitude, and their baby peacefully asleep in the car seat. This image radiates happiness. However, while incomparable and exhilarating, the fourth trimester – the weeks and months following delivery – can also be overwhelming. Many struggle with physical, mental, and emotional challenges as they recuperate from labor and childbirth. At the most extreme end, some individuals tragically take their own life or that of their newborn.

Perinatal mood disorders, including postpartum depression, rank among the highest pregnancy-related complications, affecting one in five mothers. Unfortunately, many suffer in silence, fearing judgment as weak or inadequate mothers. Pediatricians often become the first to identify postpartum depression due to their interactions during newborn checkups.

My understanding of the postpartum experience accelerated when I ventured into social media to promote a postpartum ice panty I had invented. On platforms like Instagram, the struggles of the postpartum period are laid bare. Numerous posts describe physical and mental exhaustion from sleep deprivation, the embarrassment of engorged and leaking breasts, the management of urinary incontinence with diapers, torn and bleeding perineal areas, as well as anxiety and depression. These revelations shocked me by revealing the pain and indignity that women endure after childbirth. The mothers on Instagram formed communities to support others going through similar postpartum struggles.

As I read their posts, I gained a deeper insight into their challenges and the assistance they wished they had received from medical professionals like us. I felt a sense of shame when I realized that we had failed to adequately educate mothers about the postpartum period and the available support services. Mothers whose needs during the fourth trimester were unaddressed by the medical community turned to unverified social media figures for guidance – some offered well-meaning advice, while others propagated misinformation that was potentially dangerous. This phenomenon cannot be reversed.

Can the medical community change now that it’s glaringly evident we’re falling short in meeting our patients’ needs during the fourth trimester? The answer is a resounding YES.

To begin, in 2018, the American College of Obstetricians and Gynecologists (ACOG) issued a revised Committee Opinion recommending discussions about emotional well-being, contraception, infant feeding, fatigue, and physical recovery from birth during a three-week postpartum visit, instead of the conventional six weeks.

In my opinion, pregnancy care should incorporate a multidisciplinary approach to postpartum care starting one week after delivery. This approach should involve obstetricians, behavioral health experts, pelvic floor physical therapists, and lactation support. Overcoming the primary challenge will involve shifting our perception of the postpartum period. It’s not a time when our responsibilities as obstetricians end as we hand over our tiny patients to pediatricians and exit the spotlight.

Today, I engage with mothers in discussions about postpartum demands, the baby blues, postpartum depression, and contraception. I examine their perineal areas, check their breasts for colostrum, and provide advice on managing cracked nipples and allowing their bodies time to heal. I read the nurses’ notes and the intern’s postpartum report from the 4:30 a.m. rounds.

The intern’s report mentioned a nontender abdomen with bowel sounds after a vaginal delivery that included a third-degree laceration. However, there was no mention of assessing her perineal area. When I later spoke with the intern, I inquired if she had checked the mother’s perineal area. She stared back at me with wide eyes and asked, “No. Why?”

Disregarding the fourth trimester with a casual wave of a gloved hand has come to an abrupt halt. I told the intern that I wanted her to truly understand the postpartum experience. I introduced her to my esteemed educators – the mothers on Instagram.

Theresa Mahon is a board-certified obstetrician-gynecologist who has been practicing for over two decades. Dr. Mahon realized that there were no effective solutions to help with postpartum healing, so she invented and patented the PIPs® Panty—a unique postpartum ice panty that provides cooling relief for the pain, swelling, and discomfort following vaginal birth. She can be reached on Instagram @pips4moms and on Facebook at PipsComfortCare. You can also visit PIPs Postpartum Ice Panty on Amazon.