The United States has the highest maternal death rate of all developed countries in the world. That is last place, according to a National Public Radio series that explored this issue.
Our health system is failing to support, let alone nurture, new mothers after childbirth.
My own experience after childbirth illustrates the challenges a postpartum woman can face and the positive impact a successful partnership between physicians and physical therapists can play in maternal health.
I was lucky. I had the best obstetric doctors. My husband and I relied on them throughout our miscarriages and subsequent successful pregnancy. We had our sweet little Lucy Lorraine in August 2017.
I was also unlucky. Five days after Lucy’s birth, I developed mastitis in both breasts, causing pain, brain fog and flu-like symptoms. In the weeks following delivery, I also suffered from back and pelvic pain, leg numbness and low heart rate.
In every instance, my doctors did their best to support me: prescribing antibiotics for the mastitis, thoroughly investigating the cause of my other symptoms and even calling at 8 p.m. to review the gamut of test results. When the tests came back normal, however, I was still unsure, scared and suffering.
As a physical therapist, I decided to consult friends who are women’s health physical therapists. Although my specialty is acute and critical care in the hospital, I was familiar enough with the postpartum PT program at Heart of the Rockies Regional Medical Center to realize something wasn’t right.
Ann Croghan and Sarah Hudelson specialize in women’s health PT, also known as pelvic-floor PT, at HRRMC and have developed a postpartum PT program at the Salida hospital.
Every woman who gives birth in HRRMC’s Family Birthing Center is offered a physical-therapy evaluation before discharge from the hospital. The therapists screen for any abnormal pain, incontinence and other medical issues related to labor and delivery.
The program is tailored for each mom and includes exercises to help them recover and education about normal and abnormal recovery, healing time and proactive measures to stay healthy.
A six-week follow-up visit with a pelvic health PT is recommended, and at any point during the mother’s recovery, if questions or concerns arise, the pelvic health PT can be consulted as a resource.
Since 2016, the majority (90 percent in 2017) of women giving birth at HRRMC have received a PT evaluation prior to discharge.
That’s why I called my friends and pelvic health PTs when I was suffering from mastitis and the antibiotics had not yet kicked in. Ann used a gentle massage technique known as lymphatic drainage, ultrasound and taping to help remove the swelling. She also taught me techniques to continue at home to prevent future mastitis.
Three weeks after giving birth, I once again reached out to Ann and Sarah. They discovered the pain I experienced while sitting was related to scar tissue around my pudendal nerve, and after four visits it was gone.
But something still felt wrong. I was exhausted and struggling to balance working full time with being a new mom.
On Jan. 1, I woke up with my left hand numb, tingling and weak. I wrote it off as carpal tunnel syndrome, which is common during and after pregnancy. Two days later, I had to prop up my left arm to do my hair, and the numbness was in my face and tongue.
I called my primary care doctor. She acted quickly and called the local neurologist and radiologist and sent me to the Emergency Department. I spent seven days in the hospital as the numbness and weakness spread and my heart rate went haywire. The diagnosis was Guillain-Barré syndrome, a rare neurological disease.
To compound my problems, I got aseptic meningitis from the treatment for Guillain-Barré, which is rare (less than 1 percent) and really bad luck. My neurologist said I was “extra special.”
I am on the mend now and feeling incredibly grateful. But my story illustrates the vulnerability of postpartum women and the life-altering difference those women can experience when physicians and physical therapists create successful partnerships, each serving a different role, throughout postpartum maternal care.
The American College of Obstetricians and Gynecologists recently acknowledged a gap in postpartum maternal care and proposed guidelines for earlier and more frequent follow-up. This is a step in the right direction.
Physicians need to initiate the shift but should not be alone in this effort. Physical therapists, with knowledge in pelvic health and obstetric care, have the expertise and skill to help.
Physicians and physical therapists each possess specialized knowledge and skills that serve a valuable purpose. Together they can improve the maternal death rate in this country.
Sarah Nazzaro is a physical therapist at Heart of the Rockies Regional Medical Center.