As a generalist, I see a broad sample of the population. I believe the highest impact that we can make on maternal chronic disease is through a focus on two interrelated illnesses: Depression and Obesity. They impact a huge proportion of mothers, but they are most deeply felt by mothers surviving the harms of trauma and poverty.
- Pregnancy and the mothering period are a special opportunity for women suffering from trauma, depression, and food insecurity because a lot of resources are suddenly put toward these women. Undocumented women will find themselves with health insurance. Many programs already target this population, and communities also tend to step up in support of women in a new way during pregnancy and the early mothering period. It’s also often an especially motivating time for the woman. With the transition of welcoming a new child into the world comes inspiration to make other transitions in life.
- When women become enrolled in WIC (Women, Infants, and Children) - a Federally funded nutrition support program - it’s a great opportunity to introduce additional programming. Almost every mother I’ve cared for during the peripartum period has signed up for WIC. New research* recently showed that if you add an exercise program to WIC, you can reach a really broad audience of postpartum women living in poverty and it helps them get back to their pre-pregnancy weight. There’s a lot of opportunity here for community-based exercise and prenatal care.
- Centering prenatal groups are really interesting: They keep moms from feeling isolated. Throughout their pregnancy, women are receiving care with a group of women who will then also have children of the same age. These groups could add resources that target depression and obesity. It would be great to have those groups continue in post-partum period. For any woman who has had depression, the chance of postpartum depression is really high. Same with weight - pregnancy can be really challenging for women struggling with obesity - there can be a lot of pressure to eat. These women often find themselves busy, exhausted, and depressed.
- My dream model for these moms: Empowering women who are pregnant to help other women in one of these Centering prenatal group models. They would be trained and compensated. A program like this would be both skill-building and an income source. A lot of women who are poor and pregnant are unemployed, or marginally employed (at a place where the working conditions are so bad that they need to quit when they become pregnant) and need another source of income. Like all of us, many of these women crave empowerment and an identity beyond their role as a mom. Some clinics have patient advisory committees who are doing work in this direction: developing and compensating leadership from within the patient community. To me, this is the most powerful and sustainable way to go. And, the women are coming directly from the community they are there to support.
JAMA. 2017 Jun 20;317(23):2381-2391. doi: 10.1001/jama.2017.7119.
Effect of an Internet-Based Program on Weight Loss for Low-Income Postpartum Women: A Randomized Clinical Trial.