by Anne Eglash MD, IBCLC, FABM
When is the optimal time for a mother to follow up with her maternity care provider postpartum? The American College of Obstetrics and Gynecology recently published ACOG Committee Opinion Number 736 in May 2018 entitled Optimizing Postpartum Care
Women who give birth often seek care from their maternity providers before the traditional 6-week postpartum visit. Some women develop life threatening complications such as pre-eclampsia, deep vein blood clots, postpartum hemorrhage, and postpartum psychosis. Other women experience postpartum health issues that are less urgent but yet quite significant such as breastfeeding problems, body rashes, postpartum anxiety, depression, persistently elevated blood sugars, thyroid dysfunction, joint pain, tendonitis, etc. In addition to addressing health problems, women would benefit from counseling regarding birth control, intimate partner violence, substance use, or stillbirth. For these reasons, ACOG recommends that we consider the postpartum period as the ‘4th trimester’, by providing earlier medical care postpartum based on a mother’s individualized needs.
The World Health Organization recommends routine postpartum evaluation for all women and infant dyads at 3 days, 1-2 weeks, and 6 weeks postpartum. The USA National Institutes of Health and Care Excellence guidelines recommend screening all women for resolution of ‘Baby Blues’ at 10-14 days after birth, to identify and begin early treatment for postpartum depression.
According to the ACOG Opinion, which statements do you think are accurate (choose one or more):
- More than ½ of pregnancy-related deaths occur postpartum.
- ACOG recommends that the first maternal postpartum visit occur within the first 3 weeks after birth.
- A comprehensive postpartum visit should be done after 3 weeks but no later than 12 weeks postpartum.
- Pregnancy-induced hypertension increases the future risk of maternal cardiovascular disease, and women should be counseled about this.
- Increasing attendance at postpartum visits is a developmental goal for Healthy People 2020.
- Phone support or text messaging within 3 weeks postpartum is an option for early postpartum support instead of an office visit.
See the Answer
All are true
ACOG Committee Opinion Number 736 May 2018
Presidential Task Force on Redefining the Postpartum Visit
The Committee on Obstetric Practice
The Academy of Breastfeeding Medicine, the American College of Nurse-Midwives, the National Association of Nurse Practitioners in Women’s Health, the Society for Academic Specialists in General Obstetrics and Gynecology, and the Society for Maternal–Fetal Medicine endorse this document. This Committee Opinion was developed by the American College of Obstetricians and Gynecologists’ Presidential Task Force on Redefining the Postpartum Visit and the Committee on Obstetric Practice in collaboration with task force members Alison Stuebe, MD, MSc; Tamika Auguste, MD; and Martha Gulati, MD, MS.
Optimizing Postpartum Care
ABSTRACT:
The weeks following birth are a critical period for a woman and her infant, setting the stage for long-term health and well-being. 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. It is recommended that all women have contact with their obstetrician–gynecologists or other obstetric care providers within the first 3 weeks postpartum. This initial assessment should be followed up with ongoing care as needed, concluding with a comprehensive postpartum visit no later than 12 weeks after birth. The comprehensive postpartum visit 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. Women 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 obstetrician–gynecologists or primary care providers for ongoing coordination of care. During the postpartum period, the woman and her obstetrician–gynecologist or other obstetric care provider should identify the health care provider who will assume primary responsibility for her ongoing care in her primary medical home. Optimizing care and support for postpartum families will require policy changes. 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.
Obstetrician–gynecologists and other obstetric care providers should be in the forefront of policy efforts to enable all women to recover from birth and nurture their infants. This Committee Opinion has been revised to reinforce the importance of the “fourth trimester” and to propose a new paradigm for postpartum care.
Milk Mob Comment by Anne Eglash MD, IBCLC, FABM
This is an important recommendation for the health of all women who have recently given birth. In my lactation clinic, many mothers inquire about health concerns unrelated to breastfeeding because they don’t have an appointment with their maternity provider until 6 weeks postpartum. They generally don’t want to ‘bother the doctor’ for issues that they hope are normal such as lower leg swelling, joint pains, baby blues, prolonged vaginal spotting, etc. We often identify postpartum hypertension because we routinely check mom’s blood pressure during lactation visits. Many mothers are on their own regarding their postpartum mental health, at a time when they are at their highest risk of emotional vulnerability, so having routine mental health screening at 3 weeks postpartum by the maternity provider is optimal.
An early postpartum visit with the maternity provider will be another opportunity to support breastfeeding, particularly for women who have not sought help elsewhere.
Let’s hope that insurance companies in the United States embrace these recommendations and cover the cost of this routine postpartum visit without cost sharing.
Sally Hammerman
All are things that those who are perinatal or assisting perinatal women/families should be familiar with. Thank You Milk Mib
Preneta Richmond
I think this change to postpartum follow-up care will prove beneficial to both mom and baby and address many important issues that may otherwise be overlooked.
Frieda Fox
I think the early approach to the issues, will be of great help for the dyad with early assessments we can avoid problems that later may be difficult to find, thank you for your comments
Kira
Nice to see that ACOG is realizing what midwives have been doing since the beginning of time is beneficial. It saddens me that this isn’t common practice.