September 04, 2019 9:44 am

From the Duchess of Cambridge leaving the hospital in heels seven hours after giving birth, to Charlize Theron’s portrayal of a harried, exhausted new mom in the movie Tully, questions of what’s normal in the “fourth trimester” postpartum period are finally getting some attention. For too long, women have been sent home from the hospital with no idea of—and no support for—the physical, social, and psychological issues they are about to face. To remedy that, the American College of Obstetricians and Gynecologists (ACOG) has just issued guidelines for a radical shift in the postpartum care women should receive.

Postpartum women need more care

First off, ACOG says the six-week checkup is too late—the first visit with your doctor should happen no later than three weeks after birth. Postpartum care should be an “ongoing process” rather than a single visit, and more frequent contact should occur as needed through additional visits, phone calls, even texts (they know it’s tough to get out with a newborn). Finally, women should have a comprehensive assessment no later than 12 weeks to talk about mood and emotional well-being, infant care and feeding, sexuality and birth spacing, sleep and fatigue, physical recovery, and chronic disease management.

What prompted the switch in recommendations?

In addition, she says that moms who’ve had complications like preeclampsia or gestational diabetes are more likely to have other health problems like heart disease down the line. “Sharing this information with moms and providing holistic care after birth provides an opportunity to talk about preventive strategies to reduce these risks,” Dr. Stuebe says.

Challenges ahead

The new strategies will require better coordination within the mother-baby care team. “The team is critical because of the different aspects of the postpartum period that can be affected—issues that arise with the baby, obstetrical concerns with the mother, non-obstetrical concerns with the mother, and mental health issues,” Dr. Auguste says. “Those issues can be addressed by pediatricians, obstetricians, internists [primary care doctors], and mental health providers collectively as a team.” Lactation consultants and even home nurses may also be part of these conversations.

Working together may be an adjustment, though.

The other question is who’s going to pay for this additional care. “Reimbursement is going to be a key issue,” Dr. Stuebe says. “In the current system of care, obstetric care providers receive a bundled payment for prenatal care, birth, and routine postpartum care. It’s a tough sell for providers to add additional visits if there is no additional reimbursement.” Hopefully, insurance companies will see that more care early on will prevent more serious (and expensive) issues later.

Societal change on the horizon

Although it may take a while for the new program to be put into place, it does shine a light on how lacking the current support for new moms is.

Our modern society has lost the traditional 30 to 40-day post-birth rest period during which new moms would get a ton of support from others, Dr. Stuebe says. Today, a mom’s “village” is likely to be out working, and the new mother herself may have to return to work—but postpartum women aren’t biologically meant to go it alone.

Instead, women can start thinking about their plan for “fourth trimester” support even before the baby is born.

Identifying support services ahead of time—mom groups, baby-and-me classes, La Leche League meetings—is crucial. “Ob-Gyns can help a pregnant woman to build her village during pregnancy, and be a resource for problems that arise in the weeks after birth, rather than just waiting to see what’s left after moms spend 42 days in the wilderness,” Dr. Steube says.

As a society, we have to do better at caring for new moms. “We must change the culture and that will take time, but these guidelines are a start,” Dr. Auguste says.