I ring the doorbell, waiting patiently outside. I hear a weak “coming” and some shuffling. Who greets me is a mother in her robe, hunched over at the waist, supporting her protruding postpartum belly. Her hair is disheveled. Her mask is revealing exhausted eyes with attempted mascara to look a “little freshened up,” she confesses a little later.

“My husband is just getting the baby; please come in.”

I proceed inside. I search my surroundings, looking for a table to replicate a pediatric clinic room. “Would you like anything, coffee, water?” They always offer. Already innately mothers. I always decline graciously.

The newborn arrives dressed in adorable onesies, bows on baby girls. Newborn fashion has come a long way, I remark. I make sure the mom is comfortable, surrounded by water and food. Then, like clockwork, I begin the appointment.

Appointments cover complete newborn medical care, including any necessary labs, breastfeeding sessions, safe sleep, and a focus on maternal healing. Adjustment of older siblings, pets, COVID related questions, and the role of partners are other questions usually addressed. Lastly, we always discuss postpartum depression. This is the real reason I am here. This is the mission of my company: normalizing postpartum depression by improving postpartum care through medical home visits.

My name is Sonal Patel. I am a physician specializing in neonatology and pediatrics with additional background in breastfeeding. I have four amazing children (all boys, and yes, it’s a wonderful, busy, messy life).

Three years ago, I opened my home health company specializing in improving and changing the narrative around postpartum care. What inspired me was my own four experiences blended with my professional career. I endured four different types of deliveries, from C-sections to vaginal deliveries with grade 3 to 4 tears, to all-natural births, dealing with pre-eclampsia, and suffering from postpartum depression and anxiety. And the crux of it all, I had an amazing family support system from my husband, mother, and father and mother-in-law. I was also fortunate to have economic stability allowing me to adjust my work as I chose fit. However, an amazing support system and economic freedom did not shelter me from enduring my physical and mental postpartum recovery. Some of the residual aftermath I am still working through.

Pregnancy is jubilated for ten months when the baby is growing; after delivery, it is expected that within days, a mother would be able to breastfeed, take care of older children, and just “bounce back.” This overview might sound harsh; however, it is a reality for many mothers.

Research is growing in postpartum care, now termed the fourth trimester. We understand that mothers probably need a minimum of three months, and at times up to one year, to recover successfully. Hormones that play a role in pregnancy and can contribute to postpartum depression are being better evaluated. For example, the progesterone hormone that supports pregnancy appears to be eight times higher from baseline and then drops dramatically after birth. Pregnancy is also shown to be comparable in endurance to extreme sports.

In these COVID times, my business has become in demand. Parents are hesitant about taking their newborns into the clinic. The above encounter is repeated multiple times. A knock, healing mother, newborn, partner, and myself showing how postpartum recovery starts by validating that a mom just ran a ten-month marathon. After each home visit, a similar reply echoes in all moms: “I cannot believe this was an option.”

Sonal Patel is a pediatrician, neonatologist, and breastfeeding specialist whose work centers on infant nutrition, early development, and maternal well-being in the fourth trimester. In 2018, she founded NayaCare, a home health clinic dedicated to improving postpartum care.

She has written widely on maternal and infant health, with articles published in Scary Mommy, KevinMD, and The Colorado Sun. She is also the author of The Doctor & Her Black Bag, which explores maternal mortality through historical and personal perspectives while offering solutions to reduce it. A TEDx speaker, she presented The Economics of the 4th Trimester.

She cofounded and serves as co-executive director of the Center for 4th Trimester Care, a physician-led national nonprofit working to transform maternal health care. She also recently cofounded Pulse Med AI to bring physician voices into the AI digital space.

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