Oregon health director pens New York Times essay to decry nation’s care for new mothers like her

Oregon’s top public health official says that even as a physician with strong health insurance and deep knowledge of the medical system, she struggled to get the care she needed after giving birth.

In a guest essay published Monday in The New York Times, Dr. Sejal Hathi, director of the Oregon Health Authority, described a difficult postpartum recovery and her struggle to find a doctor willing to coordinate her care.

“I am a physician who runs her state’s health agency,” Hathi wrote. “I had good insurance, paid leave and a fluency with institutions most new mothers should never need. What I did not have was a single provider who could serve as a quarterback for my care.”

Hathi wrote that she suffered a third-degree tear during delivery, dealt with urinary incontinence for months and experienced abdominal muscle separation that made basic movements, including lifting her daughter from her crib, painful.

Yet, when she sought help, she said, she was bounced between providers. Her obstetric specialist discharged her six weeks after delivery. A general OB clinic, she wrote, had stopped accepting new postpartum patients because it was stretched too thin. Her primary care doctor told her postpartum recovery fell outside her scope.

With no clinician overseeing her recovery, Hathi said she pieced together her own care, researching symptoms, calling pelvic floor therapists and coordinating referrals herself.

Hathi’s essay highlights a longstanding problem of American maternal healthcare. The Commonwealth Fund and other health policy groups have found that while patients receive intensive monitoring during pregnancy, support often fades after childbirth, even though serious physical and mental health complications can emerge or persist for months.

A 2025 report from Oregon’s Maternal Mortality and Morbidity Review Committee echoes many of the concerns Hathi raised.

The state panel, which reviews pregnancy-related deaths and recommends ways to prevent them, found that 32 Oregonians died from pregnancy-related causes between 2018 and 2021, a rate of 19.4 deaths per 100,000 live births. By comparison, the national maternal mortality rate in 2021 was about 33 deaths per 100,000 live births, according to the Centers for Disease Control and Prevention.

Nearly three-quarters of those deaths may have been preventable, the committee found. About one-third occurred after the standard six-week postpartum checkup. Mental health conditions and substance use disorders accounted for the largest share of pregnancy-related deaths, at 41%, while suicide accounted for more than 20%.

The committee also found that discrimination — including bias related to race, language, poverty, substance use, mental illness or weight — contributed to nearly half the deaths it reviewed.

Oregon’s review panel called for stronger postpartum support, better coordination between doctors, expanded access to mental health and addiction treatment and dedicated care coordinators for high-risk patients during pregnancy and the postpartum year — the kind of “quarterback” Hathi said she lacked.

Hathi argues the U.S. health care system still treats postpartum recovery as a brief afterthought rather than a major phase of care. While newborns typically see doctors repeatedly in their first year, mothers often get a single follow-up visit a few weeks after delivery.

That gap has serious consequences, Hathi argued. In the United States, more than half of pregnancy-related deaths happen in the year after a pregnancy ends, and over 80% of these deaths are considered preventable, according to the CDC.

Hathi argues that expanding insurance coverage alone won’t solve the problem. Oregon, like nearly every state, now extends Medicaid postpartum coverage to a full year, rather than ending it after 60 days. But coverage, Hathi argues, does not guarantee coordinated care.

Instead, Hathi proposes rethinking postpartum care around the reality that mothers and newborns are deeply connected.

Federal maternal health initiatives, including the Centers for Medicare & Medicaid Services’s Maternal and Infant Health Initiative and Maternity Care Action Plan, have been nudging care in this direction, pushing for better postpartum coordination, integrated services and new payment models. But Hathi goes further, calling for a more fundamental redesign in which mothers and babies receive care through the same clinics and care teams during the first year after birth.

She proposes embedding maternal health services inside pediatric clinics, allowing mothers to access physical therapy for common childbirth complications, mental health counseling and midwifery care while bringing their babies to routine checkups.

She also suggests screening mothers for a broader range of postpartum complications during infant visits and changing payment systems so providers are rewarded for coordinating maternal and pediatric care rather than treating them as separate systems.

As one model, Hathi points to Finland, where public maternity clinics follow both mother and child through the early years, often with the same nurse.

Hathi also ties the issue to the national debate over family policy and declining birth rates, arguing that difficult postpartum recoveries can influence whether families decide to have more children.

“My husband and I always imagined we would have more than one child,” she wrote. “I understand more viscerally now why so many women stop at one — not because they don’t want another child, but because they know how swiftly the system lets go once the baby arrives.”

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