Optimizing Postpartum Care in the Fourth Trimester

For years, standard maternal care guidelines recommended women check in with their doctor six weeks after giving birth. While most new moms follow up at the six-week mark, some women experience complications soon after they leave the hospital. Without timely care, preventable complications can be deadly.

According to multiple studies, the United States has the worst maternal mortality rate in the developed world — especially among African American women. The Centers for Disease Control and Prevention reported nearly a 27% increase in maternal deaths between 2000 and 2014.

“About half of these deaths occur after delivery,” said Dr. Laura Bishop, an OB-GYN at Ruch Clinic, chair of the physician evaluation committee and member of the perinatal quality committee at Baptist Memorial Hospital for Women in Memphis, Tennessee.

Now, experts agree that six weeks is too long for new moms to go without continued health support. To combat the rising maternal mortality rate, the American College of Obstetricians and Gynecologists has released updated guidelines for postpartum care.

Woman-centered, Follow-up Care

The report, published last year, recommends women have contact with their OB-GYN or obstetric care provider within the first three weeks of giving birth.

“Our goal in the first days and weeks of the fourth trimester is to catch complications that might be missed before women come in for a six-week visit,” said Bishop. “It’s important to maintain clear, individualized communication about how new moms are doing.”

At Baptist, postpartum care is woman-centered with a focus on monitoring childbirth-related injuries, high blood pressure and chronic medical problems, such as diabetes.

“Many preventable maternal deaths and postpartum complications are related to high blood pressure,” said Bishop. “At Baptist, we consistently target high blood pressure throughout pregnancy, during delivery and postpartum.”

In addition to addressing chronic and physical challenges, ACOG recommends health care professionals screen new moms for struggles with mental and emotional well-being. Postpartum depression rates vary by state and can be as high as 1 in 5 women.

“A baby can be challenging,” said Bishop. “Women are learning to care for a newborn while they recover from a major health event and struggle with changing hormones. We screen for postpartum depression and provide mental health resources.”

The Universal Parenting Place at Baptist Memorial Hospital for Women offers continued support for new moms. At the Rattled Postpartum Depression Support Group, women can talk with others suffering from postpartum depression. All moms and children are welcome.

“Rattled is a great, free resource,” said Bishop. “It’s a relief to meet others like you. Most importantly, women should talk with their doctor if they have mental health concerns.”

Making a Postpartum Plan

Many parents make a detailed birth plan, but delivery doesn’t always go as expected. Similarly, life after delivery is often filled with unanticipated challenges.

“When it comes to your postpartum health, it’s good to put a support system in place beyond just the first few days at home,” said Bishop. “Make a plan that prioritizes rest, recovery and successful breastfeeding if you choose to breastfeed.”

Even with a plan that includes supportive family and friends, new moms may find it difficult to manage infant care, fatigue, sexuality and health maintenance. Visiting the doctor’s office three weeks postpartum might seem impossible.

“We don’t always need to have a face-to-face visit,” said Bishop. “ACOG guidelines don’t mandate an office visit during those first three weeks. We understand it’s sometimes hard to get yourself and the baby to the doctor’s office, so we do health screens over the phone when possible.”

New moms experiencing pain, increased bleeding, trouble breastfeeding or other symptoms should not wait to contact their doctor.

“Don’t hesitate to call the doctor’s office if you’re having symptoms you’re concerned about,” said Bishop. “You should feel better every day, not worse. If you start feeling worse, we need to know. You should experience an improvement every day.”

Learn more about maternity and childbirth care at Baptist. Find a doctor by visiting our Find a Doctor page.