Soon after Megan Gearhart gave birth to her son in 2016, acquaintances congratulated her on how she looked.

“I looked really good postpartum, my baby weight did not stick around,” she said.

After having a baby, mothers are barraged with pressure to return to their pre-pregnancy lives and bodies during one of the most vulnerable periods of their lives — in comments from family or coworkers, or in the veneration of slim physiques on social media.

And Gearhart may have looked like she'd 'snapped back.’ But physically and emotionally, she was hurting from a complicated delivery.

During the birth, Gearhart experienced a level three tear. Stitched up and back at home with her newborn a few days later, she noticed symptoms of an obstetric fistula — an internal hole torn open between her anus and vagina.

“I noticed that the discharge would take on a really fetid smell. And that was the first inkling that I had that something was wrong…” said Gearhart. “I had only heard about it from an Oprah special from when I was in college.”

She contacted her doctor, who referred her to a gynecological surgeon, who confirmed her suspicions. But the diagnosis still shocked her.

“I thought, how can I have a fistula? That's something that happens in developing nations. That's not something that happens in Pomona, California in 2016. Well it absolutely does. It's just absolutely a part of life all over the world,” she said.

An exam revealed another injury to her rectal sphincter. For insurance reasons, Gearhart had to wait for the corrective surgery. She spent months raising a newborn while also struggling with incontinence.

Megan Gearhart, at her home in Pomona, California. She suffered from an obstetric fistula after the birth of her son.

(Jackie Fortiér/LAist)

“I cried a lot during those seven months. I was really happy to have this baby. But it was really hard to not feel normal,” she said.

None of the doctors or other health professionals who knew what she was going through asked about Gearhart’s mental health or offered counseling services.

“I had this schism, where I was outwardly, everything looks fine. And I've had this baby that I've wanted for years. But inwardly, I feel gross and I smell all the time, and I don’t want to leave the house, and I’m fairly ashamed,” she said.

She didn’t want to tell strangers about her condition, but felt the expectation to spend time with other new mothers.

“The new moms are supposed to hang out together and they push the strollers together, and they go to exercise classes together. And I really just wanted to stay at home with my baby. I didn't want to talk to people. I didn't want to meet new people,” she said.

She feels her postpartum period was gauged by others based on how she looked, rather than how she felt.

What Is #Snapback Culture?

Scroll through Instagram and TikTok and you’ll see the immense pressure on postpartum women to look and act like pregnancy and birth never happened. Picture after picture of women with rock hard abs weeks, sometimes just days after giving birth are liked and venerated by thousands. It’s known on social media as #snapback.

“The wellness being projected postpartum, in this snapback framework, is really about appearance. It's very much geared toward what you can post,” said Dr. Priya Batra. She’s an OBGYN in Los Angeles and medical director of the Health Promotion Bureau at the Los Angeles County Department of Public Health.

The normalization that “snapping back” quickly into a pre-pregnancy body is both achievable and desirable can lead to physical health consequences as people try to emulate or post their own snapback selfie.

“Both the strenuous exercise, and the diet questions I get [from patients] really are focused on quick weight loss, and changes in the physical appearance,” Batra said. “And they really don't align with the kind of nutrition you're looking for to support things like breastfeeding, to support things like healing after potentially a surgery.”

Strategies that worked before pregnancy such as cutting calories can have unintended consequences after having a child.

“Breastfeeding specifically calls for an extra 300 to 400 calories a day to support milk production. And restrictive diets really aren't compatible with that,” Batra said. “If you cut your calories down to less than 1,500 kilocalories per day, which is what a lot of these restrictive diets promote, you can decrease your milk volume by 15%. That's pretty dramatic.”

From a public health perspective, Batra says support for services such as home visiting programs and doulas should be more widely adopted.

“All these great things that exist to support that role transition postpartum. Because I think as a society, we asked you to snap back into every other piece of your life,” she said.

Snapping Back To Work

The pressure on postpartum women to look and act like pregnancy, birth, and motherhood never happened extends to the workplace.

When Hollie Overton learned she was pregnant with triplets, the television writer’s first thoughts were about how she would be perceived by potential employers.

“I thought, oh my God, who's gonna hire the triplet mom? It's hard enough to get a job when you say you have a baby, but three babies?”

Overton’s triplets were born 10 weeks early. They each weighed just 2 pounds, and were immediately whisked to neonatal intensive care.

The growing medical bills were in the back of her mind a week after the birth when she got a call from her agent, telling her about a meeting for a writing job. She and her husband were in the hospital elevator, on their way to visit their daughters in the NICU when she remembered their health insurance is through her writer’s guild membership.

“I remember telling my husband ‘absolutely not, I don't want to discuss this, I'm not taking a job right now.’ And it was almost like a scene in a movie, we got in the elevator, and he said ‘what about our insurance?’ The elevator doors closed, and I was like, oh my God, now I have to take this meeting. I have to go back to work.”

Overton’s daughters stayed in the hospital for months.

“The day my last baby was getting out of the hospital, I was running to a friend's house close by to do Zoom meetings, and then running back to Children's Hospital to bring my baby home,” she said. “I just didn’t want to be seen [by employers] as ‘the preemie mom.’”

The burden of returning to work, coupled with comments from family or friends about a new mother’s appearance can be a toxic mix.

“A lot of it comes down to this idea of shame, that if you're struggling, then it means that you're not doing it well enough,” said Angela Incollingo Rodriguez, assistant professor of psychological and cognitive sciences at Worcester Polytechnic Institute. Her studies on weight stigma both during and after pregnancy have found it can have concerning consequences.

“Things like increased risk for postpartum depression, less comfort [and] less intention to seek help with breastfeeding behavior. It was ironically related to more weight gain over the pregnancy, and then more weight retention after having the baby,” she said.

Cutting out social media is almost impossible in our digital age, but dialing it back could help, Incollingo Rodriguez said.

“We don't yet know what type of content is actually empowering, actually uplifting, actually supportive, versus which types of content just perpetuate this cycle of creating unrealistic expectations and making you feel comparatively less.”

Hearing Shared Experiences

Turning away from social media helped Megan Gearhart. Instead of Instagram she read Korean comics during late night feedings. She also limited her Google searches related to her fistula and her upcoming surgery.

“That calmed me down a little bit and put me in more of a soothing state of mind rather than a hyper state of mind,” she said.

Six years after her corrective surgery, her condition has improved. She still has occasional leaks and carries a spare pair of underwear with her wherever she goes.

“I had a baby, I had a fistula and I healed and at the end of it I was just a different person,” she said, laughing.

Gearhart looking at pictures from her postpartum days. Few people knew of her post birth complications.

(Jackie Fortiér/LAist)

Gearhart holds one of the few pictures of her out of the house while she had an obstetric fistula.

(Jackie Fortiér/LAist)

Gearhart says speaking about the depression she experienced related to her fistula and hearing from other women with the same complication at the time would have helped. And recognition of the permanent change that her body would go through.

“It would have been helpful for [doctors] to say ‘you’re going to be this new thing after you have a baby. You’re going to be new, it’s going to be different,’” Gearhart said.

That shift should also take place in the media, including news organizations, said Incollingo Rodriguez, who wants to see a different approach to postpartum stories and women’s bodies.

“When we look at the way it's portrayed, it's very much in this loss framework. What you lost through your pregnancy and how you get it back, how you bounce back. I think that's dangerous,” she said. “If we can just sort of shift the narrative and think about the gains. What do you get out of it? What does your body get out of it?”

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