Subscribe to The Podcast by KevinMD. Catch up on old episodes!

Join Theresa Mahon, an obstetrician-gynecologist, as she discusses her transformative journey in prioritizing postpartum care and the critical importance of the often-overlooked fourth trimester. Theresa shares her experiences and insights into improving the postpartum experience for new mothers and how the medical community can adapt to better meet their needs.

Theresa Mahon is a board-certified obstetrician-gynecologist who has been practicing for over two decades. Dr. Mahon realized that there were no effective solutions to help with postpartum healing, so she invented and patented the PIPs® Panty—a unique postpartum ice panty that provides cooling relief for the pain, swelling, and discomfort following vaginal birth. She can be reached on Instagram @pips4moms and on Facebook at PipsComfortCare. You can also visit PIPs Postpartum Ice Panty on Amazon.

She discusses the KevinMD article, “Essential postpartum care: lessons from 30 years in OB/GYN.”

Careers by KevinMD is your gateway to health care success. We connect you with real-time, exclusive resources like job boards, news updates, and salary insights, all tailored for health care professionals. With expertise in uniting top talent and leading employers across the nation’s largest health care hiring network, we’re your partner in shaping health care’s future. Fulfill your health care journey at KevinMD.com/careers.

VISIT SPONSOR → https://kevinmd.com/careers

Discovering disability insurance? Pattern understands your concerns. Over 20,000 doctors trust us for straightforward, affordable coverage. We handle everything from quotes to paperwork. Say goodbye to insurance stress – visit Pattern today at KevinMD.com/pattern.

VISIT SPONSOR → https://kevinmd.com/pattern

SUBSCRIBE TO THE PODCAST → https://kevinmd.com/podcast

RECOMMENDED BY KEVINMD → https://kevinmd.com/recommended

GET CME FOR THIS EPISODE → https://earnc.me/TBLzOw

Powered by CMEfy.

Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast and get CME for this episode by clicking on the CME link in the show notes. Today we welcome Theresa Mahon. She’s an obstetrician-gynecologist, and today’s KevinMD article is titled “Essential postpartum care: lessons from 30 years in OB/GYN.” Theresa, welcome to the show.

Theresa Mahon: Thank you so much, Kevin. I am so excited to be here, and I appreciate the opportunity to share my story with your audience.

Kevin Pho: So let’s start right there. Tell us your story and journey to where you are today.

Theresa Mahon: Well, as you mentioned, I’m a board-certified OB/GYN, and I’ve been in the field for almost 30 years. I actually did not come from a family of doctors. In college, I thought I wanted to do something in the helping professions, and I really was not focused on medicine at all. I guess, like most young people, I wasn’t laser-focused on one area. So when I came out of college, I worked for several years in the social service arena, and I realized that wasn’t really going to be for me. Then I had a wonderful opportunity to work as a research assistant in the Veterans Administration, at a VA hospital, on a project on depression in veterans. It was an amazing experience, seeing many of the vets getting better with pharmacotherapy, and honestly, I think that experience is what really led me to think about med school.

So by the time I went to med school, I had worked for several years; I was not a traditional student at all. I really, really enjoyed a lot of my clinical rotations in medical school, but OB/GYN grabbed my heart, because it was the chance to practice medicine and surgery, and the truth is that it was mostly very joyful. So that’s the short version of how I got here.

Kevin Pho: So you’ve been practicing obstetrics and gynecology for 30-plus years now. In general, tell me how the field has evolved to what it is today.

Theresa Mahon: Well, it has evolved a lot, particularly around postpartum, which is what I wrote my article on. There were three things that really came together for me in writing the article. One of the things about the field, and I think any obstetrician would say it, is that we’re constantly learning from our patients. When I was thinking about the article, I had an aha moment. I was a few years out of residency, working in private practice, and I got a call from a woman I had recently delivered. When I picked up the phone, I was not prepared for what I heard. She was panicked. She was screaming, basically telling me that babies were so expensive and she didn’t know how she was going to do all this. I was listening intently, and the more I listened and asked questions, the more abundantly clear it became that she was completely overwhelmed with the duties of motherhood and healing postpartum, and worrying about getting back to work and her responsibilities at home.

And you know what? I never forgot her. I think so many physicians would say there are patients you never forget, and she was one of them for me. That call really jolted me and crystallized things for me, and it helped me connect the dots with dozens of my own patients: This time after birth is immensely demanding, mentally, emotionally and physically, and as joyful as it is, it’s equally stressful and overwhelming. As people practice, especially in our field, you start to gain a better appreciation for that. Some women, when they have their baby in the hospital, have beautiful 24-hour care. Meals are brought in, and there’s help with the baby. Then they go home, and there’s nothing. One of my moms was in that situation just the other day, and there’s not much we can do about that, even at this point. Others may have a family member or friend who can help, or are lucky enough to hire help, and they have that for days or weeks, and then it stops, and they’re all on their own. So I think that appreciation has really helped develop some of the things we now have to offer mothers. That was one thing that factored into my thinking about the article.

The second thing was social media, which, honestly, Kevin, I had avoided for years, mostly because I didn’t have a lot of time. But I had invented something for postpartum healing, and that caused me to have to get onto social media. I started reading what mothers were posting in moms’ groups about their postpartum experiences, how unprepared they were and how they wished the medical community had helped them more.

And the third thing was this: I know what my experience was almost 30 years ago, and I see what it is today, and I realized we have to be teaching more about the fourth trimester. Unfortunately, in my opinion, that piece hasn’t changed a lot, not only regarding the physical aspects of postpartum, but regarding perinatal mood disorders and postpartum depression, so that young residents can recognize it when they see it, know what they’re dealing with, and offer women the help they need. So I think those are some areas where the specialty has changed, and some where it hasn’t, and those are the things that factored into why I wrote the article.

Kevin Pho: So you talk more about each of those points in your KevinMD article, “Essential postpartum care: lessons from 30 years in OB/GYN.” One of the things you mentioned was that proverbial fourth trimester, and you touched on this earlier, but go into a little more detail. What are some of the major issues women face in the postpartum period?

Theresa Mahon: Number one, postpartum healing. Women who’ve had a baby know, but women who have not had a baby don’t know and are not prepared for the fact that, postpartum, their bodies are physically extremely different, and they are sometimes not equipped to deal with all the pain, swelling and discomfort, which is pretty typical after vaginal birth. It’s not uncommon to have lacerations that are repaired and are very uncomfortable. Women sometimes experience urinary incontinence postpartum.

Just the other day I saw a young woman, 22 years old, who had had a baby, and as I was leaving the room, she asked me if she could tell me about something. She was so timid about it, and I said, “Yeah, sure. Tell me what’s happening.” She told me, “I can’t get to the bathroom. Urine is just coming out.” And you know what? I was thankful I was with a resident, because it was a real teaching moment. I was able to talk to her and say, “You know what? Sometimes this happens after you have a baby. The good news is that it usually resolves in a few weeks. But guess what? If it doesn’t, we have help. We have pelvic floor physical therapy. We can have you seen and get you help for that.”

So there’s that aspect of it. Then there’s the physical toll it takes on mothers. Sleep deprivation is ruinous. We as physicians know that, right? These are mothers caring for young babies, learning about their babies and learning their babies’ cues, while they’re juggling perhaps other children, household chores and work demands. Most women are working mothers, working outside the home. So this is a lot that women are coping with.

Kevin Pho: You mentioned earlier that a lot of what you see on social media is patients wishing the medical establishment would do more to ease the transition into the postpartum period: more support, more education. What would you like to see?

Theresa Mahon: Well, I’ll tell you, reading these firsthand accounts on social media from real moms with real struggles, who are really vocal and super disappointed about the lack of support they got, was shocking. I would love to see all women being offered pelvic floor physical therapy, and letting mothers know that mental health help is available if they need it. Lactation support has always been around in some form or another, more so now. But, you know what, also bringing mothers back sooner. Typically we’d see them at six weeks for a postpartum visit, which I think is probably still the norm. The American College of Obstetricians and Gynecologists, in 2018, issued a committee opinion about postpartum care, and, really recognizing this, they recommended that women be brought back sooner, maybe even at three weeks, for postpartum care.

The thing that really impressed itself upon me, not only with the young lady with incontinence I just mentioned, but also in what I read all over social media, is that women were afraid or ashamed to talk about the things happening to them postpartum. If we can address that early on, even during prenatal care, to prepare them, not to frighten them, but to prepare them, and also to let them know, “You know what? There’s help available. We’re here to help you,” I think that would be amazing.

Kevin Pho: Now, what is the current standard of care in terms of what is typically offered to most women postpartum? You mentioned a menu of resources. Are these resources available to most women?

Theresa Mahon: You know what, I don’t know that they are in all areas of the country. I’m very grateful that where I am, they’re available. I don’t know that they’re widely available everywhere.

Kevin Pho: And when you go on these social media boards and hear these firsthand accounts from postpartum women, one of the things we worry about on social media is misinformation, because a lot of times, when the medical establishment isn’t there, other practitioners fill that space, and the information they give isn’t always the most medically accurate. What are you seeing in that respect?

Theresa Mahon: A hundred percent. You know what? It wasn’t just disappointment from these mothers that I was reading in these posts. Sometimes it was outright anger, and even mistrust of the medical community. What it seemed to me, from what I read, is that those are the things that led them to these social media personalities who were ready to give advice. I was reading that women were turning to them for help with postpartum and being sold all kinds of services and products by people who seemingly had no medical background. It was really shocking, quite honestly. It was very tough to read.

Kevin Pho: What kinds of services did you see being sold to these women?

Theresa Mahon: Things like postpartum, I won’t say counseling, but support, I’ll say: support groups, or support therapy, talking therapy, that kind of thing. Sometimes herbal treatments and that kind of thing were being offered, too.

Kevin Pho: So what are some of the things women can do? Because, like you said, the medical establishment isn’t doing enough to ease the transition into the postpartum period. For women who are looking for more and are going to social media, what kind of advice can you offer them?

Theresa Mahon: I would ask them to talk to their health care provider, and I would ask health care providers to start talking to their patients. It’s interesting: When women come in to labor, and any OBs listening can relate to this story, some women come with beautifully written-out birth plans, sometimes 10 pages long, of the things they want in labor. In 27 years, I have never seen one mother come with a postpartum plan. So that’s an area where I think we can really start working to help women. It’s so simple to do. Especially at the end of pregnancy, you’re seeing them every week, and sometimes more often if other things are going on. It’s so simple to take five minutes to start bringing up some of these topics, talking to them about it and raising their awareness.

Kevin Pho: So tell us a success story. You’ve clearly spent a lot of time and effort on this postpartum period, bringing awareness and letting mothers know about some of the resources available. Tell us a success story where you really helped a mother transition as comfortably as possible into the postpartum period.

Theresa Mahon: Well, I think the mother I mentioned in my article will forever be in my mind and in my heart, and I was very happy to be able to be supportive of her, so that was a success story. I’ve also had women come back before the classic six-week postpartum visit to tell me that they were really feeling depressed and having trouble coping. And you know what’s funny? Early in my career, it wasn’t so easy to find mental health services to help them, but I have that ability now, and I am just so pleased and so grateful about that. The department I’m working in now actually has psychiatrists on staff to see these women if they want it, and pelvic floor physical therapy. So I am really lucky to be working in a space where I have the ability to refer women for these services right away and get them help right away.

Kevin Pho: So let’s talk a little bit more about the behavioral health component of postpartum care. We hear a lot about postpartum depression and how devastating it can be. Where are we today when it comes to addressing postpartum depression, and how can we improve?

Theresa Mahon: Interestingly, in June of 2023, this year, the journal Obstetrics & Gynecology, our Green Journal, devoted a significant piece of an issue to perinatal mood disorders, and they gave a statistic I was just shocked by: One in five women suffer from perinatal mood disorders, and that includes during pregnancy and up to a year after. And it’s not only postpartum depression; it’s bipolar disorder and anxiety disorders. I don’t know if it’s just me, and I think not, but I see a lot of patients who report anxiety, and not just feeling anxious, but being treated for anxiety, and that is a major predictor of perinatal depression. So it means there are people in all of our practices, not only obstetrics but probably internal medicine and other practices that see pregnant women, who are having this issue. So it is really huge.

It was so fantastic that they devoted a portion of that recent issue to this topic, because it raises awareness. It seems to take a tragedy in the news, when something happens to a mother or her newborn or both, and then the news cycle passes, and postpartum depression goes out of the public consciousness until the next tragedy happens. So I was really happy to see this devoted to it. It raises awareness, and that’s the thing: You have to be thinking about it and be aware of it. That’s the number one thing, and then, of course, getting someone the mental health support they need.

Kevin Pho: We’re talking to Theresa Mahon. She’s an obstetrician-gynecologist, and today’s KevinMD article is titled “Essential postpartum care: lessons from 30 years in OB/GYN.” Theresa, tell us some of the take-home messages that you want to leave with the KevinMD audience.

Theresa Mahon: Well, I would say this. In almost 30 years in this field, I’ve seen that pregnant women are a feared entity across medical specialties, and they’re treated with kid gloves, as they should be. Postpartum mothers aren’t given a second thought. So be aware, because emergency room physicians, family medicine doctors, internal medicine doctors and certainly pediatricians are going to see these women, probably before their obstetrician sees them for a postpartum visit. They may be challenging, so appreciate that they have been through a physically grueling experience, they’re probably immensely sleep-deprived, and they may be anxious over all the things they’re juggling. For whatever reason you’re encountering them, listen to them, because you may be the one who identifies the mother with postpartum depression or some other issue, and the first person she sees who can guide her to the help she needs. You can be the person who makes an immense difference in that mother’s life, and I think that’s the lesson.

Kevin Pho: Theresa, thank you so much for sharing your perspective and insight, and thanks again for coming on the show.

Theresa Mahon: Thank you so much, Kevin.