Postpartum Care Is Getting A Makeover – and its about time!

If you don’t already know, a complete overhaul of what postpartum care looks like is long overdue.

In May, the American College of Gynecologist, will officially release its new stance on what postpartum care should look like. And thankfully, YOU are the focus of this new plan.

The current standard, referred to as the 6 Week Visit,  includes one comprehensive postpartum visit at 6 to 8 weeks postpartum that is tailored to the individual woman’s needs.

And that’s it. Yes the 6 Week Visit model is as basic as it’s name.

And that is one of the main reasons that I became a postpartum doula.

I always noticed the imbalance between pregnancy and postpartum. Or baby and postpartum. Or birth and postpartum. How many times have you heard the phrase, “at least the baby is healthy” in response to a mother sharing her birth trauma?

This is a direct manifestation of that imbalance.

The imbalance that tells you that you are not as important at her baby, that she comes second.

The imbalance that tells you that you are only worthy of protection when you are carrying a baby in your womb.

That imbalance, that forces you to suffer and/or survive in silence during one of the most vulnerable times in your life.

Fortunately there is a shift happening. In how we define postpartum and how we care for postpartum women.

The postpartum woman is incredible vulnerable in many ways. Physically, emotionally, socially.

The 6 Week Visit model allows far to many mothers, like you, to slip through the cracks into low self esteem, poor physical health, broken relationships, postpartum mood disorders and even death.

 

So Why The Change?

With recent awareness being brought to the state of the postpartum black woman in America, many are looking to the medical community to make the changes needed to stop women from developing serious complications or dying from birth related causes.

When we support and uplift the most vulnerable of us, in this case black women, we support and lift us all.

Both research and anecdotal evidence shows us that postpartum complications do not discriminate. Regardless of race, economic status, religion or family support, maternal health can be compromised. Take Serena Williams’ story or Shalon Irving’s story or this article about preventable maternal deaths in New York  for just a few examples.

A Thriving Postpartum Starts Prenatally

The ACOG, is taking steps by introducing its Postpartum Process model of care.And this new idea about what postpartum care should look like starts during pregnancy.

Maternal care providers, like your OB/GYN, midwife or family practitioner, should help you create a postpartum care plan that addresses the transition to parenthood and well-woman care.

Important discussions about infant feeding, baby blues, postpartum emotional health, the challenges of parenting and postpartum recovery from childbirth should also take place prenatally.

This postpartum care plan should also list contact information for members of your maternal care team and instructions on when your postpartum follow up care should take place.

by 3 Weeks

After you give birth and take your baby home, your first postpartum check-up or “initial assessment” should take place no later than 3 weeks postpartum. This assessment can be done in person or by phone and addresses immediate postpartum issues. This is the time to ask unanswered or new questions you may have about your labor, delivery and immediate postpartum.

If you had any pregnancy complications or have an ongoing chronic condition, the first visit should take place between 1 and 3 weeks postpartum and your maternal care provide should be in contact with your primary care provider.

between 3  and 12 Weeks

Ongoing follow- ups are encouraged as needed based on issues brought up in the first assessment. Complications from pregnancy and chronic conditions are managed by your primary maternal care provider during this time.

by 12 Weeks

By 12 weeks you should have a comprehensive postpartum visit. This visit should include a full assessment of your physical  emotional and psychological well-being. This visits also signals your transition from postpartum care to well woman care. In some cases the primary maternal care provider will change and in this case your initial provider will make sure that there is continued care.

The timing of this visit should be individualized to each woman’s needs.

Pregnancy and Heart Health

If you dealt with preterm birth, gestational diabetes or pregnancy related blood pressure issues then you will counseled about being at a higher lifetime risk of maternal cardiometabolic disease. Pregnancy acts a “natural stress test” by identifying at -risk women.

Ongoing Health Conditions

If you have a chronic medical condition like diabetes, renal disease, thyroid disorder, mood disorder or substance abuse disorders, you will be counseled on how it is crucial for your to go to your follow up visits so that there is continued care of your condition and so that any prescriptions you are taking can be re- evaluated to account for the postpartum changes your body is going through and breastfeeding.

Pregnancy Loss

If you have experienced a miscarriage, stillbirth or infant loss, it is very important that you receive follow up care too. Follow up care will be focused on providing emotional and bereavement support as well as reviewing lab results or studies related to your loss, future pregnancy planning and any risks moving forward

Policy and Insurance

To accommodate the ACOG’s new recommendations for postpartum care, insurance groups will need to broaden the scope of postpartum care from one postpartum visit at 6 weeks to an ongoing process lasting the first 12 weeks after birth and adjust their reimbursement policies accordingly.

Paid parental leave including full benefits and 100% of pay for at least 6 weeks are essential to improving maternal and infant health and well-being. And anything else, is a grave injustice leaving the most vulnerable of us to bear the burden.

OB/GYNs should be on the front lines of all policy efforts that allow you to recover from birth and nurture your baby.

Its About Time

I mean this in many ways. This change and new focus on the postpartum woman as an individual has been long overdue. Women need A LOT more face time with their care providers after birth and the Postpartum Process encourages that.

The 6 Week Visit model communicated that in the medical community, the postpartum woman has no or little value. That the health and safety of her baby is far more important than her own health and well being.

When the reality is that you need just as much support as your baby does after birth.

You need nurturing and support so that you can focus on recovering from birth, get a good start to breastfeeding and build a strong bond with your baby.

As your postpartum doula, my services already include many of the changes proposed by the ACOG. I work with you to create a postpartum plan that addresses much more than just your physical recovery and how to care for your baby. I am constantly adding premier providers to my referral network so that when you need a little more support, you don’t have to go searching far, and so much more

I am hopeful that care providers will eagerly adopt the Postpartum Process so that you can get the REAL support and care you need after giving birth.

References:
Optimizing postpartum care. ACOG Committee Opinion No. 736. American College of Obstetricians and Gynecologists. Obstet Gynecol 2018;131:e140–50.

 

 

 

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