Because of my career in public health, I come face to face with gaping holes in our health care system every day. Sometimes it’s outdated care protocols. Other times it’s health insurance plans dictating access to health care based on reimbursement. The U.S. health care ecosystem has systematically neglected many groups of people, including women, and we have all suffered as a result.

Women and minority populations have been excluded from medical research and clinical trials, leveraging mostly white male populations to draw conclusions and extrapolate to the general population. Modern-day women’s health care is based on outdated care practices, and when combined with implicit gender biases of women, especially women of color, the result is subpar care for 50% of the U.S. population.

Most health insurance plans do not proactively cover the basic needs of women, such as pelvic floor physical therapy, mental health services, and additional postpartum follow-up care. Women are left not knowing how to talk about their own health.

Absent systemic support, women have to wade through the incomplete and complicated world of women’s and maternal health on their own. It doesn’t need to be this way, but until there is a massive shift in the ecosystem, our only option is to look out for ourselves and one another.

No one should have to rely on fortunate circumstances when it comes to health.

Almost three years out from my own pregnancy, I look back and recognize just how fortunate I was to have needed so little from my postpartum health care. Yet, I’m angry about how little care I received. One week postpartum, I had one home nursing visit to remove my C-section bandages and check on my stitches. She spent maybe 20 minutes with me. Six weeks postpartum, I had one 10-minute phone call with a midwife. That’s it.
The rest of my health care was self-directed, sourced from online communities of women who had come before me — women who were forging their own paths of successes and failures. I proactively set up a lactation consulting appointment days after giving birth. I found an amazing local pelvic floor PT, who was the first one to tell me the emotions of my unplanned C-section would come in waves when I least expected it. I had a husband who carefully watched for signs of postpartum depression.
As I reflect on my own postpartum health care journey and watch national news outlets spotlight the devastating results of our broken health care system, I find myself giving pregnant friends different advice these days. Here’s what I tell them:

Ask your partner or trusted friend to check in on you.

I’m immensely grateful my husband proactively decided to use the Edinburgh Postnatal Depression Scale and didn’t make it optional for me. I also told a very close friend in the medical field that I needed her to check in on me during my first few weeks postpartum. I trusted that my friend would be able to find the right resources if she felt I needed them. Assign a friend or family member the task of helping you source resources, like Postpartum Support International or 4th Trimester Project, should you need them.

Decide what you need before the baby comes.

After witnessing a village of women crowdsourcing advice, I decided to proactively plan out some of the pieces of my health care ahead of my birth, rather than wait to find out if I needed it. I knew many women wished they had sought lactation support earlier in their feeding journey, so I found a local company and reached out ahead of time to request services. I even filled out most of the paperwork before my baby was born. I’m very grateful I was proactive about this, because those first few days at home with a newborn left me with very few brain cells to wade through deciding which companies had the best reviews and getting the paperwork filled out.

Outsource finding services you need, including the paperwork.

New moms can be proactive up to a point before giving birth, but some needs may only become apparent down the road. Don’t be afraid to ask friends to help out, whether it be finding the resources you need, completing paperwork, making appointments, or even submitting health insurance claim forms. The power of the internet means that even long-distance friends can search around to find local resources on your behalf. My mother-in-law is the queen of finding local companies and services even though she lives several states away.
Regardless of whether you are pregnant with your first or your fifth, we all need to care for ourselves in a new way.

So my best pregnancy advice? We must prioritize our health — physically and mentally — and ask the people around us to support us in doing that, even if our health care system is not there for us. 

Sarah Aspinwall
Sarah grew up in Connecticut, but Massachusetts has always felt like a second home with extended family across the state. With a master's in public health and a lifelong passion for healthcare, Sarah moved to Boston after graduation. She is a fierce advocate for better access and reducing the complexities of the healthcare system. Sarah met her husband covered in sweat and lifting weights at a local CrossFit gym (talk about first impressions!). They adopted a rescue pup from Mississippi and welcomed their daughter in 2021. After nearly a decade of city living, Sarah and her family headed to the Metro West area to start a new adventure in the suburbs. Sarah has volunteered for Community Consulting Teams of Boston (CCT), offering pro bono management consulting to Boston-area nonprofits, and she served a three-year term on the board. She is an alumna member of the Kappa Delta sorority and has served as an advisor to the Northeastern chapter since 2014.