Systemic conditions hinder access to maternity care

This piece was originally published in Madre Tierra Producciones. Find the first part in the series here.

*This is a pseudonym used to protect this person's identity

Kate is over 12 weeks postpartum, but she’s at work. She walks through the hallways looking stable, intact, while inside, every cell is changing. Her body, in transition, tries to recover what it was ten months ago while retaining maternal capacities—a silent internal revolution.

According to gynecologist Dr. Ariel A. Morfa Machado, during postpartum a woman has a lower heart rate, increased basal temperature, and may experience edema due to vascular decompression, hypoglycemia, and increased urination—justifying the first days of leave.

Janela Rodríguez, maternal-child nursing specialist and master in
comprehensive women’s care, explains that postpartum is divided into:
immediate (first 24 hours), early (days 2–10), and late (up to 45 days).
“The cervix should be closed by day 10, with lochia (postpartum bleeding)
lasting up to four weeks. Involution of the placental site takes around six
weeks,” adds Dr. Morfa Machado.

There is also a remote postpartum period from day 41 up to two years,
during which female reproductive organs return to their pre-pregnancy
state.

Regarding newborns, Rodríguez says that at 12 weeks they have only basic
psychomotor skills: recognizing sounds and light, eye contact, babbling, and
smiling. They communicate through crying. This stage—called the
breastfeeding crisis—can overwhelm mothers who struggle to interpret their
baby’s needs. They must be attentive to respond and increase feedings if
necessary.

Ferni—a Mexican migrant father—remembers this as a special time for his
wife Erin and their daughter Camila. They had skin-to-skin contact and
bonded until Camila started recognizing voices. Breastfeeding was key.
“Babies eat a lot. I don’t know how many times a day—maybe 8 to 10 times,” Ferni says, still amazed.

He has been able to follow every detail of Camila’s development and Erin’s
recovery thanks to the paternity leave he arranged at the bar where he
works, and support from colleagues who helped cover his shifts.

Description: Postpartum and breastfeeding are essential moments for
mother and baby to build stronger emotional bonds.

Meanwhile, Kate’s husband has struggled with bottle feeding while she’s at
work. He’s even had to bring the baby to her school to calm him down.
He is the main caregiver while she works. His full-time job at a university
provides paternity leave through FMLA. Kate, as an independent contractor,
does not receive these benefits.

Newborns are used to the mother’s heartbeat, scent, temperature, and voice
—an essential attachment period reinforced through breastfeeding.
Distances—what consequences can be expected?

“Babies separated from their mothers for different reasons can experience
short- and long-term consequences: excessive crying, sleep disorders, and as
teenagers, insecurity, violence, or dependency,” explains Rodríguez.

After 12 weeks, babies should begin fine motor skills, crawling, first words,
walking—requiring parental attention for emotional connection and
psychomotor development. Returning to work doesn’t recover those
moments, Dr. Morfa states.

“I’m the higher earner, so it made more sense for me to return to work,”
Kate says. But she recalls how tense the first weeks were.

After work, she’d return home and argue with her husband, throw things,
calm down, sleep, and repeat the next day.

After childbirth, a new being and a new woman arrive—now a mother, undergoing bodily and identity upheaval. Yet postpartum care focuses only
on the baby, ignoring the mother’s process.

Dr. Morfa warns that early separation can affect maternal quality of life.
Limited engagement with the baby can lead to postpartum psychosis.
The baby blues is a temporary sadness that can last weeks. It’s vital to
support the mother’s needs and create calm to prevent it from turning into
depression.

Kate experienced this in her first pregnancy and was medicated with
Lexapro. She resisted medication the second time, but after giving birth, she
relapsed:

“I didn’t enjoy being a mother, going to work, or anything I used to love like
movies or music. Everything felt gray.”

She went back on medication. She wanted to flee work, feeling like a failure
as a mother, wife, and professional.

The Public Good News reports: “Approximately one in eight people who give
birth in the U.S. experience debilitating symptoms of postpartum depression
(PPD).”

The FDA approved the first oral medication for PPD in 2023: zuranolone,
under the brand Zurzuvae. It promises faster relief with shorter treatment,
but it's not widely accessible—nor a solution to postpartum complexities in
the U.S.

Kate says the best help would be consistent support for at least a year—but
culturally, that’s not a norm.

Doulas could help. Ndidiamaka Amutah-Onukagha of Tufts University says:

“People with doulas are more likely to breastfeed, four times less likely to
have low-birthweight babies, and twice as likely to avoid delivery
complications.”

Still, doulas remain a privilege for those with financial means. Most
postpartum services aren’t covered.

Kate recalls that her husband’s previous insurance covered a nurse visit—
which also supported her mental health. The new plan does not.

Dr. Morfa reminds us that what matters isn’t only recovery time, but also the
risks during extended postpartum, which may require reconsultation or
hospitalization.

Ferni, Kate, and Adriana*—though from different backgrounds—highlight
cracks in FMLA. Yet they’ve overcome some challenges through shared
responsibility during pregnancy and postpartum.

Ferni cares for Camila four days a week while Erin works from home. The
rest of the week, he returns to the bar. They both know every milestone in
Camila’s life. The attachment process has helped Camila express her needs
and grow confidently with her parents’ support.

A year later, Adriana* reapplied to her school. Her job was available, and
she returned. Now she’s expecting her third child—with more awareness to
plan her next postpartum experience.

Kate seems better now. Summer arrived, and she spends more time at home
with her two kids. Though she still struggles, she gives her best and urges
other mothers to ask for support:

“I don’t know how women are supposed to feel when the only option is to go
back to work and earn money for both parents. We live in a society where
both must work, and I feel like we’re working harder than our parents ever
did.”

Meanwhile, the U.S. Department of Labor insists:

“We’ve worked to support the principle that no worker should have to
choose between the job they need and the family they love. With FMLA, our
nation made it a priority to give workers the opportunity to balance work
and family—promoting healthy babies, healthy families, and healthy
workplaces.”

Maternity leave must be a public policy priority. While current law is
insufficient, it’s even more inaccessible for women in vulnerable
communities—Black, Indigenous, Latina, immigrant, single mothers in low-
income neighborhoods, non-English speakers, undocumented, or uninsured.
Their postpartum period is filled with more barriers.

Many work in small private companies not covered by FMLA. They receive
no health benefits or legal protections to retain their job during recovery.
This increases the risk of stress and depression.

The broader political context is also relevant: the U.S. government seeks to
cut public health and essential care funding. Although it proposed a $5,000
birth allowance, it likely won’t reach all women. And the amount pales in
comparison to real childbirth and childcare costs.

Such measures avoid responding to public demands for revising maternity
leave conditions and expanding the federal child tax credit.

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