Volume Four: The State of Postpartum Care in the United States and Opportunities for Growth in Supporting Maternal Mental Wellness
Bridging the Gap in Maternal Mental Wellness in Postpartum Care
In many cultures, postpartum care is seen as a critical component of a mother’s journey, where physical recovery, emotional well-being, and nurturing care are prioritized. Yet, in the United States, postpartum care—especially in terms of mental health—has long been overlooked. While there have been advances in maternal health care, the nation's postpartum support system, particularly regarding mental wellness, still has significant gaps.
This disparity is not just a healthcare issue but one that intersects with societal, historical, and racial contexts, demanding a comprehensive shift in how we support new mothers.
A Global Comparison: Postpartum Care Across Borders
Countries in the Eastern world, such as China, South Korea, and Taiwan, have a comprehensive postpartum care systems, including services offered by postpartum wellness hotels (PWHs), month centers, and zuoyuezi centers. These services combine medical care with rest, education, and emotional support, recognizing the “Fourth Trimester” as a time when women are most vulnerable to both physical and mental health challenges. In these countries, postpartum care is viewed as essential, often lasting several weeks in a nurturing environment.
These centers are not merely about providing physical care but also about integrating wellness from a holistic perspective, including mental health, physical recovery, emotional well-being, and educational opportunities.
In contrast, the U.S. postpartum system is fragmented and often focuses primarily on physical recovery. The emotional and mental health of mothers is often neglected, with mental health concerns like postpartum depression (PPD) and anxiety being under-recognized and under-treated. Additionally, mothers are only allocated one postpartum visit from her doctor at six weeks. The U.S. healthcare system is built around a model of short-term acute care, and for many women, the postpartum period is seen as a phase that requires little follow-up care once the mother is discharged from the hospital.
The Lack of Mental Health Focus in U.S. Postpartum Care
In the U.S., mental health care for mothers is significantly lacking despite rising awareness of conditions such as postpartum depression and anxiety. Research shows that 1 in 8 women will experience postpartum depression, and 1 in 5 will experience some form of maternal mental health disorder. However, studies have shown that as many as half of these women will not receive treatment. Despite recommendations from the American College of Obstetricians and Gynecologists (ACOG) for postpartum mental health screening, the reality is that mental health screenings are inconsistently administered and are often not followed up with adequate care.
The culture of “rugged individualism” prevalent in the U.S. may contribute to this neglect of mental wellness, where the expectation is often that new mothers will simply “bounce back” without assistance.
This cultural framework emphasizes self-reliance and can stigmatize mental health struggles, especially those that are perceived as a sign of personal weakness or failure. Additionally, healthcare professionals, often overwhelmed with medical duties, may lack the time or training to address the emotional and mental well-being of mothers, viewing it as secondary to physical recovery.
Moreover, there is insufficient integration of mental health professionals in the postpartum care process. Mental health support for mothers is often relegated to specialists or therapists who are not always accessible or affordable. The mental health care system is also fragmented, with few programs dedicated exclusively to supporting new mothers, especially in the critical first year following childbirth.
Historical and Racial Context of Postpartum Care in the U.S.
The historical and racial context surrounding postpartum care in the U.S. adds layers of complexity to this issue. The country’s healthcare system has long been shaped by disparities based on race and socioeconomic status, which profoundly impacts maternal care. Black, Indigenous, and women of color (BIPOC) face disproportionately high rates of maternal and infant mortality, and they are also less likely to receive adequate postpartum mental health care.
The history of medical abuse and neglect of Black women, particularly in the context of reproductive health, has created a deep mistrust of the healthcare system. The infamous history of gynecological experimentation on enslaved Black women, as well as ongoing maternal health disparities, contributes to the reluctance of many Black mothers to seek postpartum care.
This mistrust, combined with inadequate support systems, further isolates these mothers during a vulnerable time in their lives.
In addition, social and economic disparities, such as access to quality healthcare, insurance coverage, and living conditions, exacerbate the mental health challenges that many mothers face. For BIPOC women, economic barriers prevent many from accessing quality postpartum care, including mental health services. For example, while postpartum care is often covered by Medicaid in many states, mental health services, including counseling, may not be included under the same plans or may require long waits or high out-of-pocket costs.
Opportunities for Growth and Improvement
Given the gaps in postpartum mental wellness care in the U.S., there are several opportunities for growth. This includes expanding access to comprehensive, integrated postpartum care that includes mental health screenings, education, and support for mothers, especially in their emotional and mental wellness.
1. Holistic Postpartum Care: A Need for a Shift
The U.S. can learn from countries like China, South Korea, and Taiwan by integrating mental wellness into the broader postpartum care framework. Wellness hotels or similar facilities that combine medical care with mental and emotional support could provide a model for care that addresses the “Fourth Trimester.” These centers would not only focus on physical recovery but also offer mothers the chance to rest, learn about baby care, receive counseling, and participate in therapeutic activities aimed at mental wellness.
This could also include community-based support programs, where new mothers have access to peer support, mental health professionals, and educational resources that are tailored to their unique needs. The provision of postpartum care could go beyond the standard 6-week checkup to a more continuous model, with regular check-ins, emotional support, and resources available throughout the first year.
2. Addressing Mental Health Stigma
A significant cultural shift is needed to address the stigma surrounding postpartum mental health. Public health campaigns aimed at normalizing mental health struggles during the postpartum period—emphasizing that struggling is not a failure—can help reduce stigma and encourage mothers to seek the help they need. Increased education for both healthcare providers and new mothers about postpartum mental health issues is essential. Training for obstetricians, midwives, and pediatricians should include a deeper focus on identifying and addressing mental health concerns, and mothers should be informed that emotional wellness is just as important as physical recovery.
3. Expanding Mental Health Access
Access to mental health care must be improved for postpartum mothers. Insurance coverage for mental health services, including counseling and therapy, should be expanded. Increased funding for community-based services and support groups could ensure that mothers, particularly those from marginalized communities, have access to mental health support without the burden of high costs or long wait times.
4. Tailoring Care to Racial and Cultural Needs
To effectively address the needs of all mothers, postpartum care must be culturally competent. This means taking into account the unique challenges faced by BIPOC mothers, such as experiences with systemic racism, economic barriers, and cultural differences in health care expectations. Developing community-centered models that are sensitive to these needs and that incorporate culturally relevant care could help to build trust and improve maternal mental wellness outcomes.
5. Incorporating Peer Support
Peer support is crucial in addressing the mental wellness of new mothers. Programs that connect new mothers with others who have experienced similar challenges could provide invaluable emotional support. The establishment of more doula programs, postpartum care circles, and community-based maternal wellness groups would help create a network of support that goes beyond the medical establishment, allowing mothers to share experiences, learn from one another, and support each other.
The Path Forward
The mental wellness of mothers is not just a healthcare issue—it is a societal one. By redesigning the postpartum care in the United States to include more holistic, culturally competent, and comprehensive support systems, we can ensure that all mothers, regardless of their background, have the opportunity to thrive emotionally, mentally, socially, and physically after childbirth. This shift will require collaboration across healthcare systems, public health advocacy, community leaders, and policymakers to create a care model that truly values the mental wellness of mothers.
The time for change is now, and the benefits of investing in maternal mental health will reverberate through families and communities for generations to come.