Better Care After an Ankle Sprain than After Childbirth?

Want to see a grown person tremble with fear, laugh nervously, and smile widely all at the same time? 

Find yourself a West Point Cadet or Graduate and say, “High Zero.” Then watch. And listen. And laugh! 

If you don’t have easy access to a West Pointer, I’ll spoil the surprise for you. 

High Zero

Every freshman (aka plebe) at West Point has to take gymnastics (affectionally termed plebe falling - not to be confused with swimming - aka plebe drowning). It’s basically a rite of passage, but it also sets the foundation for mental toughness and the physical wellness and expectations for Cadets and graduates. We learn practical things like climbing a rope, climbing over a wall, and low crawling. Then we also learn technical things like climbing a shelf, ankles-to-the-bar, quickly walking across a balance beam, and bounding across a set of pull up bars suspended six feet in the air. The professors methodically teach these skills and, as part of the completion requirement, each Cadet tests on these skills. The grading criteria is a highly subjective 0 - 5 point scale, with 5 being Gold Medal Olympic Athlete performance (I’m not sure anyone ever earned a 5). Well, many of us, since it was our first time performing these skills, epically failed. And when you epically failed, you got a straight up zero. But, if you only slightly failed, you might earn yourself a high zero! Still a zero and still totally failing, but it served as a bit of encouragement and consistently made Cadets laugh.

You know “high zero” is a real thing when it’s on a vanity plate. Thanks so much for letting me use this picture Doug!! No idea who this person is but I love this!

You know “high zero” is a real thing when it’s on a vanity plate. Thanks so much for letting me use this picture Doug!! No idea who this person is but I love this!

My High Zero

I had never climbed a rope before plebe falling class. I probably swung on one or two but never attempted to climb one. In gymnastics class, they taught us three climbing methods, designed to use our legs more than our arms, and use our bones more than our muscles. I’d found a method that I liked best and did pretty well in practices. I’m sure I earned a few high zeros but I felt pretty confident on my skill. So I tested and passed. I was ready to move on to the higher rope that required dismounting on a ledge about 10 feet off the ground (instead of simply sliding down the rope to the ground). This 10’ climb was just one of the many parts of the horrible, very bad, no good Indoor Obstacle Course Test (IOCT) and needed to be practiced prior to completing the IOCT. I’d practiced the 10’ rope a few times, and did fine. Then came my day to practice the rope plus the preceding elements of the IOCT. Not sure if I was nervous or what, but I made it to the top of the rope, touched the ledge with one foot and then…my hands slipped. 

And down I went. 

Ten feet down, landing right smack on my left ankle. Oh good Lord it makes me cringe just thinking about that. It flippin’ hurt. The whole class knew immediately. Honestly, I blacked out and the next thing I remember, I woke up with my ankle braced in the hospital. Nothing broken, just a high sprain to go with my not-so-high zero. I left the hospital with some motrin, a brace, and an embarrassing yet welcomed set of crutches. My pride was pretty sprained too. 

There it is. The scene of the crime. A cadets’ version of a torture device. The rope climbing portion of the IOCT.

There it is. The scene of the crime. A cadets’ version of a torture device. The rope climbing portion of the IOCT.

It was April 2001. I was a freshman on the softball team and was super excited because I had just solidified my role as starting catcher. My parents were out since we were playing local and it was just about as beautiful as a New York spring could be. And there I was. Sitting on the bench, with my glove and gear still in my bag, doing my best to cheer on my team! I was injured and needed to rest and heal. That became my focus. 

I had a day off of school then I got right to recovery. I only had one class after lunch so I’d zip back to my room to change uniforms then head down to the training room. We’d ice it, shock it, heat it, massage it (my least favorite by far), stretch it, and then we’d strengthen it. I’d get a ride down to practice and I’d be able to walk at practice with the trainer there (and with crutches for a while) but that was about the max of physical strain I could put on my ankle. The cycle continued and eventually I was cleared to play again. 

That’s the story of my high sprain and my recovery from that injury. Let’s compare and contrast that recovery with the United States’ typical practice for postpartum recovery.

Child Birth

For the sake of this article, let's say childbirth is an injury (more injury than illness because of the physical aspect of it) and the actual birth of the child is the incident of injury. So, you get your injury. Bam. Right off the bat there’s a difference here. When I sprained my ankle, I was tended to right away. Think about birth though - who gets the immediate attention with this injury? I’m not questioning medical procedures and absolutely agree that baby should receive immediate attention, but shouldn’t the birthing person receive equal attention?

The standard hospital discharge present and rehabilitation plan for childbirth recovery. Postpartum care and recovery plan.

The standard hospital discharge present and rehabilitation plan for childbirth recovery. Postpartum care and recovery plan.

Fast forward to baby’s third day of life. If the birth occurred at a birthing facility/hospital, the family is likely being released on this day. Similar to leaving the hospital after the ankle sprain, after childbirth I left the hospital with motrin, stool softener, a bag full of expendable products like disposable underwear, Dermablast, a peribottle, witch hazel pads, and some latex gloves for icing. That was it. No crutches. No next appointment scheduled. No plan for rehabbing my uterus or any other body part. Oh, I guess I did receive several sheets of paper but really, on day 3 of life with a new baby, who has the time or mental capacity to read and comprehend anything? There’s a quick check-in before they give you your discharge papers, release you and you’re on your own. Depending on your circumstance, you will likely be on your own and the next time you see a medical professional will be two days from then when you see your pediatrician. If you’re lucky and have a good pediatrician, the doctor will ask how feeding is going and how the birth partner is feeling. That’ll likely be it though. Good for baby, yet horrible care for the injured/birthing person. 

But, in current practice, what’s next for you, the injured? A visit in 6 weeks for the provider to aggressively “massage” your uterus and ask what you want for birth control. Sure, when you leave the birth facility you’re told to call if you experience complications but many of us won’t call because we don’t know what complications really are, we call too late and require additional treatments, we’re afraid to call at all, we can’t make it in to the doctor if they want to see us, and a myriad of other reasons. 

Recovery from the Injury in Standard American Practice

Compare this to my ankle sprain. I was given the day off after the injury and required to only take care of myself. I attended physical therapy every day, starting immediately after the injury to help blood flow for healing and to reduce swelling. I sat on the sidelines and focused on healing and recovering. My coach and trainer took me out of the game. 

I liken this to Asian practices where the birthing person is also ‘taken out of the game’, except to breastfeed. A whole team of women - midwives, nurses, and family - take over the game and keep the injured out, allowing for healing and recovery. 

Not in the US though. We’re back in the lineup 36 hours after a major, life changing injury. 

Let me tell you something. I still feel the effects of that sprain 19 years later. My ankle has chronic pain and chronic instability. It gives out on me at random, unpredictable times. Sure other Army adventures probably haven’t helped reduce ankle pain, but my ankle pain started from that sprain. And I was very well tended to after the injury. I had a trainer looking out for me daily. I had friends, superiors, and teammates reminding me of my injury and to take it easy. And this is just for a high sprain.

Why the hell do mothers not receive this kind of care and treatment after childbirth? Why isn’t childbirth healing and recovery given as much attention as a measly ankle sprain? Why aren’t there friends, superiors, and teammates reminding postpartum people of their injury and to take it easy? I could write a whole separate article about all the injuries that could be avoided down the road if we tended to postpartum people as well as I was tended to after I sprained my ankle. 

I think it’s sad that our standard American medical system provides better care and understanding for the healing and recovery of a sprained ankle injury than the healing and recovery from childbirth.

Stay blessed, 

Kari Haravitch, owner, From The Start, Postpartum Doula

Kari Haravitch, owner, From The Start, Postpartum Doula

Kari Haravitch

P.S. You may have noticed I spent a good amount of this article on the events leading to my ankle sprain and only one paragraph on my recovery. That was intentional. Think about mainstream childbirth and how much time/effort/money/thought we give to the actual birth/preparing for the injury and how little time/effort/money/thought we give to the postpartum period. Birthing people are checked weekly before the injury, then not checked for 6 weeks after the injury.

P.P.S. I know those checks are for the safety of everyone involved. Not questioning that at all. Just simply wondering, on paper, what it would be like if that additional care continued AFTER the injury. Postpartum doulas (and several other postpartum professionals) are doing our best to serve as that missing trainer. 

P.P.P.S. I wrote this article from an extreme perspective. Not all births feel like an “injury.” I chose to use the term “injury” in an attempt to compare apples to apples. Trust me. I’ve (obviously) sprained my ankle and I have birthed 2 children. They are not the same. And, personally, I did not experience any injuries during or after the birth of my second child, so I’m really using the term injury loosely. Using it to try to make a point, not to insult anyone.