ACOG Redesigns Postpartum Care
Given the urgent need to reduce severe maternal morbidity and mortality, the American College of Obstetricians and Gynecologists (ACOG) released today a revised Committee Opinion to reinforce the importance of the “fourth trimester,” and to propose a new paradigm for postpartum care. Redefining postpartum care is an initiative set forth by ACOG President Haywood L. Brown, M.D.
Previously, ACOG recommended a comprehensive postpartum visit take place within the first six weeks after birth. ACOG now recommends that postpartum care should be an ongoing process, rather than a single encounter and that all women have contact with their ob-gyns or other obstetric care providers within the first three weeks postpartum.
Timely follow-up is particularly important for women with chronic medical conditions. The initial assessment should be followed up with ongoing care as needed, concluding with a comprehensive postpartum visit no later than 12 weeks after birth. This visit should serve as a transition to ongoing well-woman care and the timing of the visit should be individualized, woman-centered and the follow-up should 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
• health maintenance
The weeks following birth are a critical period for a woman and her infant, setting the stage for long-term health and well-being. During this time, a woman is adapting to multiple physical, social and psychological changes. She is recovering from childbirth, adjusting to changing hormones and learning to feed and care for her newborn. Postpartum care visits with ob-gyns or other obstetric care providers can help women navigate the new challenges of motherhood. 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.
“New mothers need ongoing care during the ‘fourth trimester.’ We want to replace the one-off checkup at six weeks with a period of sustained, holistic support for growing families,” said Alison Stuebe, M.D., lead author of the Committee Opinion. “Our goal is for every new family to have a comprehensive care plan and a care team that supports the mother’s strengths and addresses her multiple, intersecting needs following birth.”
Currently, as many as 40 percent of women who have given birth do not attend a postpartum visit. Underutilization of postpartum care impedes management of chronic health conditions and access to effective contraception, which increases the risk of short interval pregnancy and preterm birth. Attendance rates are lower among populations with limited resources, which contributes to health disparities.
“This revised guidance is important because the new recommended structure is intended to consider and cater to the postpartum needs of all women, including those most at risk of falling out of care,” stated Dr. Brown. “As the nation’s leading group of physicians providing health care for women, we must use the postpartum period as gateway opportunity to counsel women on long-term health implications.”
While postpartum care visits occur after delivery, obstetric providers should begin counseling their patients during pregnancy. Prenatal discussions should include the woman’s reproductive life plans, including the desire for and timing of any future pregnancies.
Committee Opinion #736, “Optimizing Postpartum Care” is published in the May issue of Obstetrics & Gynecology.
The Committee Opinion includes the following link to resources: https://www.acog.org/More-Info/OptimizingPostpartumCare.