Monday, August 19, 2013


Frances is just over twelve weeks old, and I am just over twelve weeks postpartum - long since ineligible for maternal mortality.

the best tummy time includes opportunities to drool on mom

We just had what I thought was going to be our last home visit with the midwife. It turns out we can have up to seven more covered by insurance on an as-needed basis, where "as-needed" means "if I want." We've had maybe a dozen visits so far, starting the day after the birth. (Actually later the same day, as Frances was born just after midnight.)

Having had this sort of postpartum care, I cannot imagine what it's like for parents in the US, who typically have one visit at six weeks with their maternity care provider - and typically not at home, of course.* (Postpartum home visits here are standard, not related to the fact that I gave birth at home.)

This interesting article compares postpartum expectations cross-culturally and finds the US lacking: both family/friends and the postpartum person expect to be up-and-at-'em immediately and often are. There is not a cultural understanding of the need for postpartum rest and recovery, either in terms of physical recuperation or the importance of time and space to make the psychological changes that come along with adding a baby to the family.

I can't really speak to the German cultural context, as most of the few parents I know here aren't German. I can say for me personally, though, the expectation of frequent midwife visits in those first days and weeks sent a clear cultural - not just medical - message that my body was still in a special state (that it should be cared for, that I should be gentle with it) and that our family was going through a unique period (that we should be nesting, that the transition we were making was important and might be difficult).

Our insurance is mandatory and public; we pay half and Aaron's employer pays half (his salary was calculated to ensure that it met certain take-home standards, meaning that if the cost of insurance were to go up, his take-home pay would remain the same). Frances and I are covered under his plan and adding her did not make it more expensive. In the eight months we've been here, I've paid a total of 1.09€ out of pocket, for some creme at the druggist's.

I wonder what would happen if real, thorough postpartum care was included in the ACA's essential health benefits?** With the passage of time, would such a medical change inspire a cultural change, helping us better value and protect the postpartum period? It's kind of chicken-and-egg -- makes me wonder about the history of postpartum care in countries where it's standard. Has it always been this way?

*Of course, most people are also seeing a pediatrician within this period. This is also standard in Germany, meaning your midwifery postpartum care overlaps with finding and getting to know a pediatrician. For us, having an established care provider we knew and trusted who could also answer baby-related questions and provide basic baby care (weighing, Vit K, etc) at the beginning was invaluable, especially since we really disliked the first pediatrician we saw.

**The specific inclusions of the essential health benefits are left to the states, so while every many insurance plans have to cover "maternity and newborn care," what exactly that means varies. Notably, however, most health plans are required to offer postpartum lactation support without cost-sharing. (Here's more about the implications of the ACA for maternity care.)

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