The Economics Of The 4th Trimester | Dr. Sonal Patel | Tedxocala

In any language, the most dangerous phrase is "but that's how we've always done it." It's a phrase that stifles progress, innovation, and growth. On the other hand, the most powerful words are "there has to be a better way." These words hold the potential to ignite change and transform the world.

And that is precisely how my journey started. Hi, I'm Sonal Patel, a traveling fourth trimester doctor. I directly influence our country's economic GDP (ghost domestic product) by impacting families in the fourth trimester. But what exactly is the fourth trimester?

Even if you're not familiar with the terminology, you've likely witnessed or gone through it yourself. The fourth trimester refers to the three months after a baby is born, commonly known as postpartum. As a traveling doctor, I travel from home to home, easing the burdens of families and mothers entering this period by changing the way postpartum medical care is delivered. And in doing so, I am directly influencing our country's GDP.

Connecting the Dots

Let me paint a picture of how it all started. For ten years, I experienced pregnancy, breastfeeding, and my own fourth trimesters, courtesy of my four sons. I played the role of the perfect pregnant woman with glowing skin, luscious flowing hair, and an Instagram-worthy image. Thanks to Hollywood, we all have an idea of what labor looks and sounds like - a loud screaming mother, attempting Lamaze, and desperately squeezing her partner's hand. And yes, that was me too.

But what happens after the birth? The focus shifts to the newborn, and the mother is often left feeling overlooked and forgotten. This notion is perpetuated in Hollywood, our society, and even our medical field. As a physician, a pediatrician to be specific, I knew all too well the struggles of postpartum. I had the privilege of financial security, family support, and insider knowledge of the medical system. And yet, I found myself suffering. If I, with all my resources, was struggling, what about other mothers?

Seeking a Better Way

The tipping point for me came with the arrival of my fourth son and the six-hour ordeal it took me to get to his first pediatric appointment. With little to no help, three older boys returning to school, a surgeon husband with a packed schedule, a home renovation project, and a snowstorm, I was exhausted. In that moment, the words "there has to be a better way" kept nagging at me.

Why couldn't we deliver medical care to women during one of the most life-changing events in their lives? Why couldn't we ease the burdens of families and mothers entering the first trimester? Why couldn't we value postpartum moms and put them on a Hollywood pedestal?

And so, I transitioned out of my neonatal ICU job and began a new career as a traveling fourth trimester doctor. But why did I change the terminology from postpartum to fourth trimester? The answer lies in understanding the massive changes that mothers go through while newborns are adapting to the world outside the womb.

In 2002, Dr. Harvey Karp coined the term "fourth trimester," recognizing that full-term babies are actually born about three months early. Human evolution caused a disparity, leading to an upright posture, smaller pelvic sizes, smaller skulls, and smaller brains. This resulted in early births, needing additional care and support during the so-called fourth trimester.

The Science and Social Impact

Taking a scientific and social perspective, researchers have connected the role of progesterone, a hormone found in pregnancy, to postpartum depression, which often occurs during the fourth trimester. Progesterone is crucial in maintaining pregnancy, increasing uterus size, and preventing contractions. During pregnancy, progesterone levels steadily rise, peaking at around 40 weeks. However, following birth, progesterone plummets back to baseline, giving rise to postpartum depression.

This connection between progesterone and postpartum depression led the FDA to approve a synthetic version of progesterone for treating this mental health condition. But postpartum depression is only one aspect of the challenges women face during the fourth trimester.

Another startling revelation is the high maternal mortality rate during the fourth trimester. The death of a woman during this time, encompassing pregnancy, birth, and postpartum, is referred to as maternal mortality. As a barometer of a country's social and economic health, America has a maternal mortality rate of 23.8 deaths per hundred thousand live births, ranking last among industrialized nations.

What's even more alarming is that 78% of these maternal deaths occur after birth, with a quarter of them happening within the first week of delivery. Four to five of these deaths are preventable. The variations in these numbers across different states and racial disparities highlight the need for a better approach to maternal care.

Bridging the Gap

The stories of maternal mortality disparities are more common than we think. Celebrities like Drew Barrymore and Reese Witherspoon have openly talked about their struggles with postpartum depression. Cynthia Wickman, a Manhattan Caucasian lawyer, tragically succumbed to her struggles, leaving behind a grieving family and a 10-month-old son. Even Serena Williams, the greatest women's tennis player, experienced life-threatening complications after giving birth.

These disparities also extend to racial differences, with African-American and Indigenous mothers facing a much higher risk of maternal mortality. Even higher socioeconomic status and education do not protect black mothers from these risks. The leading causes of death also differ between races, with white mothers dying from suicide and black mothers dying from cardiovascular risks.

The statistics and stories paint a grim picture of the realities many mothers face during the fourth trimester. This pervasive tragedy affecting our country calls for a better way, a better approach to maternal care that considers the socioeconomic impacts on families, communities, and nations.

Investing in Maternal Care

Maternal mortality has become a barometer of a country's socioeconomic status, as recognized by the World Bank. The World Bank, created in 1944 to help rebuild post-war Europe, understood early on that investing in safe motherhood improved the health of women, children, families, and communities. It also yielded an increase in labor supplies and the economic well-being of the community.

A mother's unexpected death leaves behind a newborn and sometimes older children, creating a generational effect and shaking the household's economic foundation. In fact, the Council of Foreign Relations estimated that if women were part of the same rate of labor force as men, America's economy would grow by 4.3 trillion dollars in the next five years.

At this point, I could inundate you with more economic data, but instead, let's focus on real-life scenarios, starting with my own experience. During my first pregnancy, labor did not go as planned, resulting in an emergency C-section. The outcome was life-saving, both for my baby and myself. But it also highlighted the higher risk of death associated with unplanned C-sections.

In that moment, I envisioned the impact my demise would have on my newborn, my husband juggling a surgical career and a brand new baby, my residency program scrambling to fill my void, and the loss to the community. Over my 15 years of practice, I have not only contributed economically but also invested in the well-being of my community.

A Journey Towards Change

There had to be a better way to invest in maternal care, reducing healthcare costs, and increasing our economy. And that answer came to me in the form of medical fourth trimester home visits. These visits acknowledge that moms and newborns are intricately connected in health, despite the physical separation during birth.

In industrialized nations with low maternal mortality rates, universal postpartum visitations during the fourth trimester are the norm. With 78% of maternal deaths occurring after birth, and four to five of them preventable, the question arises: shouldn't we have a universal solution to a problem that affects us all?

I started my journey as a traveling fourth trimester doctor five years ago. The concept may seem old-fashioned, yet novel at the same time. And during the pandemic, more families began to recognize the value of in-home care. Our home visits have reduced the re-hospitalization rate of newborns, addressed mental health issues in a timely manner, and even saved two women's lives.

When I knock on the doors of these families, I am greeted by fathers trying to navigate their new roles, older siblings eager to help, and mothers who started their journey with exhaustion and a plea for a better way. This movement, propelled by the recognition of the centrality of motherhood to the socioeconomic aspects of our families, communities, and nations, is beginning to change the conversation and put mothers on the pedestal they deserve.

Conclusion

In a world where conventional wisdom can often hinder progress, it's vital to challenge the status quo and seek a better way. The journey towards a better approach to maternal care begins by recognizing the importance of the fourth trimester. By connecting the dots between science, social impact, and economic growth, we can ensure that mothers receive the care and support they need during this critical period.

Investing in maternal care is not just a moral imperative, but also an economic opportunity. By prioritizing the well-being of mothers, we can create a stronger foundation for future generations and foster a society that values and celebrates the importance of motherhood.

So let's leave behind the dangerous phrase of "but that's how we've always done it" and embrace the empowering words of "there has to be a better way." Together, we can revolutionize maternal care and build a brighter, more equitable future for all.

[Applause]