For years, the standard in postpartum care has been postpartum checkups with moms six weeks after baby was born. That's a long time for a new mom to go without a chance to share her questions or concerns with a healthcare practitioner. It is also a significant amount of time for physical, emotional and mental struggles to fester—and with new studies illuminating the reasons behind the rising rates of maternal mortality in the United States (with half of the maternal deaths occurring in the postpartum period), it's time we make changes to better serve American mothers.
That starts with expanding maternal healthcare beyond the "arbitrary" six-week appointment, according to a a formal opinion on postpartum care from the American College of Obstetricians and Gynecologists (ACOG) published in 2018. "To optimize the health of women and infants, postpartum care should become an ongoing process, rather than a single encounter, with services and support tailored to each woman's individual needs," said the committee behind these new guidelines.
In the wide-spanning set of recommendations from ACOG, the committee calls for a first meeting between a new mother and her obstetric care provider three weeks postpartum rather than six. From that point, they recommend ongoing care as needed with a comprehensive visit no later than 12 weeks.
Beyond a simple pelvic exam, ACOG recommends the comprehensive appointment should "include a full assessment of physical, social, and psychological well-being, including the following domains: mood and emotional well-being; infant care and feeding; sexuality, contraception, and birth spacing; sleep and fatigue; physical recovery from birth; chronic disease management; and health maintenance."
These new recommendations address not only the physical needs of mothers, but also the common barriers that many women face when scheduling their one and only postpartum visit: By the time baby is six weeks, many new mothers have gone back to work—resulting in as many of 40% of women skipping their postpartum visit entirely. However, trials have shown that outcomes improve when women get help and reminders in scheduling their appointments and are able to check in with their healthcare provider earlier.
"Rather than an arbitrary '6-week check,' the American College of Obstetricians and Gynecologists recommends that the timing of the comprehensive postpartum visit be individualized and woman centered," the committee writes. "To better meet the needs of women in the postpartum period, care would ideally include an initial assessment, either in person or by phone, within the first 3 weeks postpartum to address acute postpartum issues."
In line with more frequent and available appointments, ACOG calls for expanded insurance coverage for postpartum care. "Changes in the scope of postpartum care should be facilitated by reimbursement policies that support postpartum care as an ongoing process, rather than an isolated visit," ACOG notes, adding they advocate for 100% paid parental leave for "at least" the first six weeks postpartum.
If enforced as recommended, this is a significant step in the right direction. Currently, more than 700 American women die annually from causes related to pregnancy and childbirth; 50,000 more suffer life-threatening complications. The outcomes are worst among black mothers, who die at a rate of three to four times that of white mothers. This makes the United States the most dangerous country in the industrialized world to give birth.
Says the ACOG committee, "Given the urgent need to reduce severe maternal morbidity and mortality, this Committee Opinion has been revised to reinforce the importance of the 'fourth trimester' and to propose a new paradigm for postpartum care."
We applaud ACOG for these new recommendations. Now let's see them in action.
[A version of this post was first published April 25, 2018. It has been updated].