Preparing New Parents for the Postpartum Period
by Anne Eglash MD, IBCLC, FABM
New parents often find that the postpartum period brings significant changes across various dimensions. Due to the complexity of emotional, physiologic, socioeconomic, and infant feeding/care issues that arise during this time, the first 3 months postpartum are commonly referred to as the 4th trimester.
A recent Integrative Review examined 22 studies involving 7736 participants to identify knowledge gaps new parents face regarding postpartum events.
This review identified 4 major domains of postpartum issues: Mental Health Concerns, Physical Concerns, Infant Feeding Concerns, and General Concerns and Recommendations.
Mental Health Concerns were reported in 20 studies, revealing that new parents sought more anticipatory guidance on postpartum depression and anxiety. One study found that 62% of new parents experienced anxiety about caring for their baby, with fewer than half feeling prepared for these anxious feelings.
Postpartum physical concerns were evaluated in 19 studies, including issues such as fatigue, breastfeeding problems, vaginal bleeding, hair loss, back pain, and weight concerns. Up to 32% of participants expressed concern about urinary changes or incontinence, with many women surprised by the severity of their symptoms.
In the domain of Infant Feeding and Care Concerns, the primary concern was breastfeeding. Evidence showed that women found breastfeeding more challenging than expected, with most not receiving sufficient anticipatory guidance on breastfeeding difficulties.
Eight studies reported on participants’ concerns regarding postpartum education received in the hospital. Some found the information excessive and overwhelming, while others felt it was inadequate and did not prepare them for their postpartum challenges. Many felt abandoned by the healthcare system after hospital discharge. In one study, 45.6% of new mothers reported receiving no education on postpartum warning signs for serious postpartum complications including cardiac problems, preeclampsia, postpartum hemorrhage, deep vein thromboses or postpartum depression.
- 28%
- 42%
- More than 50%
- 73%
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Abstract
Background
In the United States, 35% of all pregnancy-related deaths occur between 24h and 6weeks after delivery, yet the first outpatient visit is not typically scheduled until 6weeks postpartum. Thus, the ability to independently navigate this period is critical to maternal well-being and safety. However, previous research suggests that many women feel unprepared to manage the challenges they encounter during this time, and there is a current need to synthesize the existing evidence. Therefore, the purpose of this integrative review is to describe parent-identified gaps in preparation for the postpartum period in the United States.
Methods
Using the Integrative Review framework by Whittemore and Knafl, a systematic search of Medline, CINAHL, PsychInfo, Web of Science, and a handsearch was conducted for peer-reviewed articles published in English between 1995 and 2023. Results were reported according to PRISMA 2020 guidelines. Studies that met eligibility criteria were synthesized in a literature matrix.
Results
Twenty-two studies met inclusion criteria. Four themes were identified: Mental Health Concerns, Physical Concerns, Infant Feeding and Care Concerns, and General Concerns and Recommendations. Many women, regardless of parity, reported feeling unprepared for numerous postpartum experiences, including depression, anxiety, physical recovery, breastfeeding, and infant care. Parents reported difficulty differentiating normal postpartum symptoms from complications. Hospital discharge teaching was viewed as simultaneously overwhelming and inadequate. Parent recommendations included the need for earlier and more comprehensive postpartum preparation during pregnancy, delivered in multiple formats and settings. Parents also reported the need for earlier postpartum visits and improved outpatient support.
Conclusion
Our findings indicate that many parents in the United States feel unprepared to navigate a wide variety of emotional, physical, breastfeeding, and infant-care experiences. Future research should explore innovative educational approaches to postpartum preparation during pregnancy as well as outpatient programs to bridge the current gaps in postpartum care.
In summary, 21/22 studies reviewed for this report identified a significant lack of postpartum preparation and knowledge gaps among 25-100% of participants.
What are best prenatal strategies to provide anticipatory guidance regarding the multitude of postpartum challenges and experiences that lie ahead? While prenatal didactic education, audiovisual resources, and support groups could certainly help, no amount of prenatal education will prepare families to navigate the postpartum period on their own.
In 2016, United States Preventive Services Task Force recommended providing interventions during pregnancy and after birth to support breastfeeding. Emphasis should be on ‘after birth’. It is time for health systems to diligently improve their postpartum support for mental health, postpartum physical concerns and infant feeding by recognizing the need for 4th trimester support, changing policies and practices to provide such care and integrating their efforts with community organizations and peer support.
I would love to hear about the interventions being implemented in different health systems and communities to elevate 4th trimester care.