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We sit down with Phindile Chowa, an emergency medicine physician, to discuss her personal and professional journey through postpartum care. Phindile shares her harrowing experience of childbirth and postpartum depression, shedding light on the gaps in the health care system that leave many new mothers without adequate support. We delve into her transition from full-time emergency medicine to starting her own concierge practice, where she advocates for comprehensive care for postpartum women.
Phindile Chowa is an emergency medicine physician.
She discusses the KevinMD article, “Postpartum crisis: a physician’s call for comprehensive maternal support.”
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Transcript
Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today, we welcome Phindile Chowa. She’s an emergency medicine physician. Today’s KevinMD article is titled, Postpartum Crisis: A Physician’s Call for Comprehensive Maternal Support. Phindile, welcome to the show.
Phindile Chowa: Thank you. I am so excited to be here.
Kevin Pho: Alright, so you’re an emergency medicine physician in Atlanta. Tell us a little about your story and journey to where you are today.
Phindile Chowa: For sure. I’m originally from a small country in Africa of about one million people called Eswatini. From the very young age of nine years old, I decided to choose a career in medicine, and that decision was really fueled by the inequities I witnessed as a small child.
My grandmother was pretty sick while I was growing up, and I had to go back and forth to the hospitals with her. So, I got to witness the health care system in my country. I saw patients during the HIV/AIDS pandemic. I saw stroke care and end-of-life care. From the age of nine, I decided that medicine was what I wanted to do.
I came to America in 1995 and ended up going to undergraduate at the University of Pittsburgh. I did my medical school at the University of Pittsburgh. I originally thought that I was going to go into OBGYN, but at the very last minute, I decided that I wanted to do emergency medicine because I wanted to do it all.
I loved the excitement and the change in the day-to-day. So, I went to Boston where I did my residency at the Harvard-affiliated Massachusetts General Hospital and Brigham and Women’s Hospital. Then I moved to Atlanta, where I originally came to work for a large academic institution. I currently am a concierge physician with a particular focus on helping postpartum moms in the fourth trimester.
Kevin Pho: Alright, so your story leads into this KevinMD article, Postpartum Crisis: A Physician’s Call for Comprehensive Maternal Support. Now, tell us about the events that led you to write this article in the first place. And for those who didn’t get a chance to read it, of course, tell us about the article itself.
Phindile Chowa: Yeah, so, after COVID, we all went through sort of this existential crisis, reevaluating our lives—what do we want to do, and are we living a purposeful life? I love medicine, I went into medicine. I’m a physician, and I’ve been in medicine for the interactions I have with people. But after COVID, I really wanted more.
I went through a transformative time within myself and started to reevaluate my day-to-day life and tried to find purpose in that. I decided, after going through COVID doing administrative work, that I wanted to do something that was less reactive in terms of medicine. I wanted to focus a lot more on preventative care and on building those interactions with my patients. So, I left my full-time job and went into concierge medicine.
Those initial few months of seeing patients within their homes, I started getting a lot of calls from moms. It might start as a call for something like mastitis or issues with a C-section, but when I would go in there, I would speak with these moms and see that they were struggling with so much more. They were struggling with things in that first six weeks that went beyond what they had called for. I may have been called to evaluate their wound, but they were struggling with depression, anxiety, physical ailments like bilateral carpal tunnel, back pain, and SI joint dysfunction. There was so much more going on.
Going into their homes took me back to my own journey as a mother. I started reflecting on my own experience postpartum, and I had a really difficult time during my postpartum period. I felt like I was alone on an island, per se, and nobody really understood what I was going through. It was like this crazy initiation into motherhood that everybody has to go through.
I struggled with back pain. I struggled with deep postpartum depression, and I had no one. At my six-week appointment, I was cleared for physical activity, cleared for sex, and then… that was it. But the journey of healing was almost a year-long process of trying to find myself again. So, looking at the patients in front of me and remembering my own journey, I felt empowered to speak more about my experiences and to find solutions in a way that I could help other mothers through this.
So, as I was sitting at my desk and thinking, I realized we really need to get the word out—moms need more support. There’s a lot of attention that goes to pregnancy, a lot of attention that goes to delivery and childbirth. But once a woman delivers, she’s left alone to figure it out until that six-week appointment. At that six-week appointment, it’s short, and there’s just so much to cover.
I wanted to write this article because I wanted people to understand that there’s more that we can do for moms. There’s more that we should be doing for moms. It’s not just the work of the OBGYN or the midwife. OBs are busy. They are on the forefront of research, policymaking, and trying to keep up the standard in obstetrics. Midwives are delivering babies and may not have the same expertise as an obstetrician, but it’s not just on them.
It’s on our policymakers, our government, our community workers, our birth workers, and other physicians. We really need to join hands and come together to be able to fight for maternal health and to get moms the help that they need. Because remember, a lot of the deaths that happen under maternal mortality occur after a woman gives birth. We need to be doing more because 60 percent of these deaths happen after a woman gives birth.
Kevin Pho: So what are the major issues and lack of support that moms typically face in that immediate postpartum period?
Phindile Chowa: In my practice, the things that I’ve really encountered are postpartum preeclampsia, postpartum high blood pressure, abnormal vaginal bleeding, and postpartum mental health disorders. You know, when a woman delivers, she’s sent home, and she’s told, “If you have a headache, if you have blurry vision, abdominal pain, any of these things, give us a call because we could be worried about X, Y, and Z.” But here’s the reality:
A woman goes home, and she’s taking care of her child. She may be taking care of her home, trying to maintain a relationship with her spouse. She’s not thinking, “Oh, this headache could be life-threatening.” She’s not thinking, “Oh, these aches and pains, this swelling could be life-threatening.” She’s thinking it’s just a normal part of postpartum, and she’s just going about her day.
When I’ve gone into moms’ homes for one issue, I always check their blood pressure. I’ve caught at least two or three moms with life-threatening blood pressures who had to go into the emergency department or back to labor and delivery, where they were admitted for postpartum preeclampsia. If I wasn’t there for that one particular issue, they could have gone to bed and never woken up. So, these are the issues that are really taking away the lives of our moms—postpartum preeclampsia, hypertensive disorders of pregnancy, strokes, and heart disease. These all require additional screening because patients are not always going to look within and say, “Let me call my doctor because I have X, Y, and Z.”
Kevin Pho: So, from a policy standpoint, what are some things that we can do to help? Should we just move the follow-up to a shorter time period? Add more resources? Obviously, what you’re doing, you know, you can’t necessarily see as many patients as you would like to see. So, what are some solutions that we can implement to solve this?
Phindile Chowa: I think we have to look to other places that are already doing the work. In the article, I focus on other countries that have implemented similar solutions. For example, France is sending people to moms’ homes—nurses, pelvic floor therapists, lactation workers. If you train these workers to go beyond their specialties and to also ask questions like, “How are you feeling? Any thoughts about hurting yourself? Tell me what you’re experiencing,” or even having these people be able to check blood pressures…
I know one thing that Kaiser hospitals have implemented, at least the Kaiser system in Atlanta, is sending every woman home with a blood pressure monitor. They’re doing a lot of remote tracking where moms have to check their blood pressure within a couple of days and send it into the clinic. But that’s not standard for everybody. Some clinics are also moving the follow-up from six weeks to three weeks. Some of my colleagues want to see some of their high-risk patients earlier on instead of waiting for the six-week mark.
So, I would say trying to get our moms seen earlier, and if they can’t get into the clinic, let’s utilize our community resources. We have doulas who can go into the homes. We have nurses who can go into the homes. All these people need to be integrated within the system. It shouldn’t just be, “Here’s a doula, here’s a lactation consultant, here’s a pelvic floor therapist.” We need to create alliances and networks that are going to surround the mom and be able to screen for life-threatening medical conditions and meet her where she is.
Let’s face it—leaving your house to go to a clinic when you have a child, when you have other children, when you don’t have the support needed to get the help you need—it’s really a setup for disaster. Our policymakers need to find ways to integrate other models of care and other birth workers within this system to sort of shield the mom and protect her from these conditions.
Kevin Pho: Just to be clear, other than a few patchwork solutions like you mentioned with Kaiser, new moms are typically sent home without really any of this support. They’re not sent home with visiting nurses. Traditionally, they’re sent home and told to come back in six weeks. Is that right?
Phindile Chowa: You are correct. At six weeks, they’re told to come back for their checkup. You can imagine going home for six weeks. By that time, you have probably accumulated a hundred questions. You’ve probably struggled with breastfeeding. You’ve probably had a clogged duct and mastitis by then. You may barely be able to walk because of back discomfort, SI joint issues, or bilateral carpal tunnel. You’re dealing with anxiety, depression, worry over your child—you have a hundred problems that you’ve accumulated.
Now, you go to your six-week checkup and try to bring all that to your physician. In a general clinic visit, there is no time. Imagine how many patients an OB-GYN is seeing for these types of visits. They don’t have time to go through individualized and personalized questions because everyone is different, right? Everybody’s not going to follow the textbook.
So, it’s just not enough time given for an obstetrician to be able to screen women for all the problems, and it’s just not enough time to discuss and go through everything to connect moms to resources. One of the things I talk about is, when I was dealing with my postpartum depression, I went to my OB-GYN for my six-week appointment. I went to pediatricians for my child’s checkup. I took all the tests that are required to screen for mental health disorders, and I scored poorly. And I was told, “You need to get the help that you need. You need to find some resources.”
But no resources were provided. I wasn’t given a sheet with a list of therapists or psychiatrists. I wasn’t given a list of support groups. I wasn’t sent to a community to help me heal. I was literally sent back home, feeling the same way, until a neighbor came and said, “Listen, this is what you need to do.” If she hadn’t been there, I honestly don’t know where I would be without that help.
Kevin Pho: Now, as you know, with policy changes, sometimes they go through, and sometimes they don’t. And even if they do go through, we’re talking about a matter of years. What are some shorter-term solutions that the health care system can implement to address this issue more immediately or feasibly?
Phindile Chowa: Policies take a while. I think there’s a “Momnibus” Act that has really been in the hands of Congress for a very long time. So, you’re correct—our policymakers may not push this forward as quickly as we would like. I think it’s going to be up to individual clinics and insurance companies to take the lead.
Many people don’t know that you can have lactation consultants come to your home, and insurance companies are not going to tell you this. As soon as you get pregnant and give birth, these resources should be pushed to you. But insurance companies aren’t going to tell you, “Hey, you have covered lactation services. You have covered pelvic floor therapists, and these people can come to your house.” They’re not going to tell you that.
So, it’s going to have to be OB-GYNs getting on board and using the resources they have. Before, there was this kind of fighting match between doulas and OB-GYNs, but I think now they’ve embraced doulas because they understand they can’t do all this work. There’s more of a collective society when it comes to helping moms. But I think we need to do better.
OB-GYNs need to utilize their doulas, have a birth network, and, when a mom is pregnant, say, “This is your team. This is what you need.” Also, I think what the community is doing really well right now is birth workers are getting together. Here in Atlanta, we have meetups where lactation specialists, pelvic floor therapists, mental health workers, and midwives get together.
I will say that my OB-GYN colleagues often are not in those meetings. But, you know, like I said in my article, they are busy. They still have to pour into themselves while doing clinic work, performing surgeries, leading policy efforts, and maintaining the standard of care. So, we just need to find a way for OB-GYNs to get involved in this work, for midwives to get involved, and to have the community back them. It needs to be a joint effort.
Kevin Pho: Now, for those new moms who may be listening to you now, are there any resources that they can request so they have someone to turn to? You mentioned the example of lactation consultants that are available to them. Are there any other resources they should specifically ask for before going home?
Phindile Chowa: A blood pressure cuff. If it’s not a blood pressure cuff, then at least something else to monitor their symptoms. One thing I give all my new moms is a book I wrote called What to Expect Next. The reason I wrote that book, and I’ve tried to distribute it to different OB-GYN clinics, is because I think moms often don’t know what to expect or what to ask.
Having resources and guides—checklists that go through and say, “Today is week two. How should my bleeding be?”—helps. In the book, I outline what is considered normal bleeding at different time points, and if a mom is experiencing more bleeding than that, she should talk to her doctor. Or I include information like, “What does your blood pressure say?” If a mom’s blood pressure is above a certain number, she should contact her doctor.
Having guides like this is really helpful for understanding what symptoms to look out for. OB-GYNs can definitely come up with that information to give their patients pamphlets. There are podcasts out there. I am a huge believer in self-advocacy. If our policymakers are not doing it and your provider may not have the time to do it, you have to take that into your own hands.
There are several podcasts you could listen to that will teach you about the fourth trimester, like Fourth Trimester Voices and The Birth Squad. I could name a whole bunch of different podcasts that can help you know what to look for. Then there are support groups everywhere. Join a Facebook support group where you can connect with other moms and hear from them and know that, “Oh my goodness, maybe this thing I’m experiencing is not normal.”
There are in-person support groups all over. Here in Atlanta, there’s MESH Moms, the Atlanta Mom Group meetups—there’s so much you could utilize. But don’t be in a corner by yourself. This journey is not meant to be walked alone. We’ve seen it in many communities around the world where the communities literally surround moms and are vigilant, looking out for symptoms. This is not the time to be out on an island by yourself because you’re dealing with so much. Your body and your mind are changing, and you need somebody there with you to be able to point out when something is going wrong because you may not realize it on your own.
Kevin Pho: We’re talking about the KevinMD article, Postpartum Crisis: A Physician’s Call for Comprehensive Maternal Support. Dr. Chowa, we’ll end with some of your take-home messages that you want to leave with the KevinMD audience.
Phindile Chowa: I want to emphasize for our audience that personalized, patient-centered care is so important. Oftentimes, in our medical schools and residencies, we’re really taught to look for certain signs and symptoms, but everybody may not present in that way. People are not just physical. There’s the environment they’re in, there are the social environments they’re in, there’s the mental, the spiritual—there’s so much more.
When you’re looking at a patient, treat them as an individual. They may not come to you with the textbook signs and symptoms. You’ve got to ask the right questions. You’ve got to ask about their environment. Do they have the support they need? It’s extremely important because people come with their own stories, their own unique needs. We just need to take a step back and go beyond what we see, ask more, and we’ll find out more. We’ll see that it goes deeper than the surface.
Kevin Pho: Well, thank you so much for sharing your perspective and insight, and thanks again for coming on the show.
Phindile Chowa: Thank you so much for having me.
