To the Editor:
Re “It’s Not Just Babies Who Need Checkups,” by Sejal Hathi (Opinion guest essay, May 28):
The most medically intense periods of my life were during both of my pregnancies; my first hospital admission was for the birth of my now 5-year-old. However, my experience was very different from Dr. Hathi’s.
I am a family medicine physician, and my family doctor provides my care. “We care for patients from womb to tomb,” the adage goes. This includes postpartum mothers and their babies, frequently in the same visit. After I had my first baby, my family doctor placed my IUD, right after she saw my 2-month-old for his checkup.
I’m saddened to hear that Dr. Hathi felt she had nowhere to turn, because we would have welcomed her, and her baby, in our family medicine clinic. There are 193 million visits made to family physicians annually, 67 million more than the next largest medical specialty. I have helped patients navigate postpartum mood disorders, lactation difficulties, common aches and pains and beyond.
Family medicine already does much of what Dr. Hathi calls for. We have maternal and pediatric services in the same location. In fact, they are in the same doctor.
Glenna Martin
Seattle
To the Editor:
This essay highlighted a failure in American health care: Women receive intense medical attention during pregnancy, but it ends suddenly at six weeks after delivery. As a maternal-fetal medicine specialist, I have seen this gap in care and its adverse effects on maternal health.
For many women, the months after delivery are marked by both physical and emotional changes, including pelvic floor dysfunction, sleep deprivation, anxiety, depression, nutritional challenges, relationship stress and managing their own health while caring for a newborn. Yet postpartum care in the United States is fragmented and episodic.
At the Carolyn Rowan Center at Mount Sinai, we are working to address this gap.
Women have access to coordinated care between eight and 20 weeks after delivery and continue through six months of integrated follow-up, which may include mental health services, pelvic floor therapy, nutrition counseling, sleep medicine and other services.
There is a pathway of coordinated care for women who experienced complications that raise the risk of cardiometabolic disease, such as gestational diabetes, hypertensive disorders, spontaneous preterm birth or stillbirth.
Pregnancy is a window into a woman’s future health. The postpartum year should be the beginning of a more preventive, longitudinal approach to it.
We hope models like ours establish a new standard for mothers in the year after delivery and become the norm, not the exception.
Joanne Stone
New York
The writer is the chair of the department of obstetrics, gynecology and reproductive science at the Icahn School of Medicine at Mount Sinai.
To the Editor:
Dr. Sejal Hathi’s account of her postpartum care is wrenching, and her diagnosis of the system that failed her is largely right. But the model she proposes, dyadic care paid for as a mother-baby unit, is not new. Researchers and state Medicaid agencies have piloted versions of it for years. Clinics like Cleveland’s Village of Healing have already built it.
The reason it has not scaled up is not a failure of imagination. It is a failure of payment. A mother recovering from birth produces relatively little billable medical activity once the baby becomes the patient, so she makes little claim on the system’s resources.
That is patriarchy in one of its durable forms: the inheritance of an economy that does not count the labor of feeding and raising children, joined to a clinical system organized around what procedures it can bill for. Individual clinicians need not be misogynists for the outcome to harm women. The machinery does that work on its own.
Women will not fall off the postpartum cliff because we failed to imagine a bridge. They will fall because we refused to fund one.
Brynn Rubinstein
Berkeley, Calif.
Hungary as a Role Model
To the Editor:
Re “Hungary Shows the World How to Defeat an Autocrat,” by M. Gessen (column, May 31):
I left Hungary almost 70 years ago, and we were fortunate enough to be granted asylum in the United States. I’ve loved this country and never looked back at the country that allowed much of my family to be slaughtered in the Holocaust and then turned to Communism.
It is astonishing to me that Hungary is a role model for how to change the corrupt regime in this country. We, too, must fight the autocratic system in power now and stop the attacks on our democracy. We must do it at the ballot box starting this November.
It is imperative that we have a huge turnout. We can do this.
Kathy Siegel
Port Washington, N.Y.
