In a helpful move in the right direction for women, mothers, parents, and birthing people's health, the American College of Obstetricians and Gynecologists (ACOG), which is the guiding organization for OBs, has released a new "Committee Opinion" paper providing updated recommendations for improved postpartum care in the weeks after giving birth. This change comes as the United States is experiencing the worst and highest rates of maternal deaths in all industrialized counties.
Currently, after giving birth, a person is a told to make one six-week follow up appointment with their OB or midwife. For someone who has a c-section or other complications during birth, the appointment may be sooner. The problem with this current standard is both in the timing -- 6 weeks after birth -- and the frequency: once.
Postpartum health begins the moment after you give birth and continues until the end of the first year after birth. In the first few weeks after having a baby, people are susceptible to complications, many of which can be life-threatening. Complications also can occur well beyond the six-week mark. With only one appointment, and not until six weeks after birth, and not again until needed, there are a lot of symptoms, signs, and issues that could be appropriately treated that are missed. Considering that as many as 40% of people do not attend any postpartum care appointment, we have room to do much better with the care of people in the first year after having a baby.
Think about it this way: In a baby's first year, routine check-up guidelines include being seen in the first 3-5 days after birth, then again at 1, 2, 4, 6, 9, and 12 months. For the person who gave birth, the first year routine check-up is one appointment, six weeks after birth. Considering that a parent's health also impacts baby's health, this is problematic.
ACOG's new recommendations are developed for obstetricians in order to guide new practices that will improve health. They include:
- Postpartum care should become an ongoing process, rather than a single appointment; it should include services and support tailored to each person's individual needs
- Contact should be made with your obstetrician within the first three weeks after giving birth -- by phone, in person, or both
- The initial assessment should be followed up with ongoing care as needed in addition to a comprehensive postpartum visit no later than 12 weeks after birth
- Your comprehensive postpartum visit should include a full assessment of physical, social, and psychological well-being, including: 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. Those with chronic medical conditions such as hypertensive disorders, obesity, diabetes, thyroid disorders, renal disease, and mood disorders should be counseled regarding the importance of timely follow-up with their providers for ongoing coordination of care.
Of course, these new recommendations require that they be implemented, which means getting both care providers (OBs and other maternal health providers) and insurance companies on board with new practices and financial coverage. This will take time. In the meantime, you can be proactive in requesting earlier contact and more comprehensive care with your care provider after giving birth.
It's important for you to know that your health after having a baby is just as important as your baby's health in the first year, and should be attended to appropriately. It helps for you to know as much about what happens in the postpartum period as you do about what happens in pregnancy, giving birth, and your baby's development. You can do this with the help of a good childbirth class, and/or through the support of a postpartum doula.
The health of mothers and parents in this country is in critical condition. We must do better -- we must change practices, policies, and we must become educated on what better care looks like and what it takes to have better outcomes.
Published: April 25, 2018
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BirthPregnancyPostpartum