Amber Price, DNP, CNM, RN, Associate Administrator and Vice President of Women’s and Children’s services at The Women’s Hospital at Henrico Doctors' Hospital

American College of Obstetricians and Gynecologists Releases New Postpartum Guidelines

Unless you are part of the royal family, you likely will not leave the hospital hours after giving birth, with perfect hair, wearing your high heels and pearls. In fact, even if you are a princess, you should receive ongoing care within the first few weeks after having your baby. Recently, the American College of Obstetricians and Gynecologists (ACOG)1 released new recommendations for the so-called 4th trimester, the 12 weeks after the birth of your baby. The new guidelines highlight the need for ongoing follow up visits, with the goal of modernizing postpartum care.

Why does a woman need postpartum care?

For decades, women were told to visit their obstetrician (Ob-Gyn), certified nurse midwife (CNM), or other healthcare provider, within the first 6 weeks after giving birth. This timing was practical because it is when involution, the process where the uterus returns to its non-pregnant state, typically occurs. Unfortunately, the first 6 weeks also is the most risky for the mother, when a number of complications can arise. In addition to the normal physical recovery of childbirth, whether via natural delivery or a C-section, many women also deal with other medical conditions like: 

  • Diabetes
  • Depression and/or anxiety
  • Obesity
  • Thyroid disorders
  • Breastfeeding difficulties
  • Urinary incontinence
  • Issues related to a difficult birth

Seeing a healthcare provider sooner than 6 weeks helps address these issues before they become a bigger concern.

What are ACOG’s new postpartum care guidelines?

The new ACOG guidelines for postpartum care take all areas of a woman’s health into consideration. The 4th trimester focuses on creating “an ongoing process, rather than a single encounter, with services and support tailored to each woman’s individual needs.” The new recommendation is that women see their Ob-Gyn, CNM, or other obstetric provider, no more than 3 weeks after giving birth and again around 12 weeks.

Even before you give birth, your healthcare provider will talk with you about what to expect after childbirth and how to plan for, or how to prevent, future pregnancies. While you and your newborn are still in the hospital, you will be given information about the importance of having your first follow up appointment no more than 3 weeks after you go home. This visit helps ensure that your recovery is going well, both mentally and physically. It is especially important for: 

  • First-time mothers, who may not understand what is considered a normal recovery after childbirth, and may not realize if something is not right.
  • Mothers who are part of high-risk populations who traditionally do not take advantage of postpartum care. These include those living with:
    • Poverty
    • Differing cultural or ethnic beliefs
    • Geographic isolation

Old and New ACOG Recommendations

Source: www.acog.org

What to Expect at Your Follow Up Visits

Your First Postpartum Visit

Within the first 3 weeks after having your baby, you will have a follow up appointment with your Ob-Gyn, CNM, or other healthcare provider. This appointment includes an overall health assessment and an evaluation of your progress as you transition to parenthood. It also includes a continuation of the conversation around planning or preventing future pregnancies. This visit is especially crucial if you are at higher risk of complications like: 

  • Hypertension (high blood pressure)
  • Postpartum depression
  • Perineal or Cesarean section wound infection
  • Lactation difficulties
  • Pre-eclampsia 

Additional Follow up Visits

Extra follow up visits may be needed for women who are diagnosed with any medical condition that needs further care.

Your Last Postpartum Visit

The final visit, no more than 12 weeks after you have your baby, is a comprehensive exam that focuses on how you feel physically, mentally, and socially. 1This “transition to ongoing well-woman care and the timing of the visit should be individualized, woman-centered, and include a full assessment of the following”: 

  • Mood and emotional well-being
  • Infant care and feeding
  • Sexuality, contraception, and birth spacing
  • Sleep and fatigue
  • Physical recovery from birth
  • Chronic disease management
  • Maintaining health in general 

At this visit, you and your Ob-Gyn, CNM, or other provider, also will discuss which healthcare provider will resume your regular medical care going forward. You should leave this visit with the name and phone number of a physician or other type of provider that you can call with any health-related concerns. 

Can insurance companies and employers benefit from better postpartum care?

In addition to improving postpartum health for you and your baby, the hope is that ACOG’s new guidelines will transform the nation’s thinking about the postpartum needs of American women. These changes include: 

  • Expanding Maternity Leave

When compared with other leading countries in the world, the United States has a relatively short maternity leave. 1“23% of employed women return to work within 10 days postpartum and an additional 22% return to work between 10 days and 40 days.1 By granting employees longer paid maternity leave, with better postpartum care, companies will see more productive, healthier employees in the long run.” 

  • Expanding Insurance Coverage

Insurance reimbursement policies should “support postpartum care as an ongoing process, rather than an isolated visit”. Allowing more follow up visits after childbirth is beneficial for you and your baby. In the long run, it also financially benefits insurance companies that can avoid paying for illnesses that are preventable with more postpartum care visits. 

What is the most important takeaway from the new guidelines? The 4th trimester is just as important as the 1st, 2nd, and 3rd. Additional postpartum visits not only provide more support for you as you recover from childbirth, but also give you and your baby the best possible chance for a healthy future. 

Sources:

1American College of Obstetricians and Gynecologists (ACOG): www.acog.org