ACOG: Optimizing postpartum care begins in pregnancy

The American College of Obstetricians and Gynecologists has released a committee opinion on how physicians can provide comprehensive postpartum, or fourth trimester, care.

The organization, noting that as many as 40% of women do not receive postpartum care, urged providers to begin anticipatory guidance during pregnancy.

“We encourage providers to partner with women during pregnancy to begin planning for the fourth trimester,” Alison M. Stuebe, MD, lead author of the opinion, said in a press release. “Each woman has different postpartum needs, and we recommend that she and her provider identify members of her postpartum care team and develop an individualized care plan.”

Postpartum care teams can consist of a woman’s family, friends, primary maternal care provider, primary care provider, lactation support, care coordinator, home visitor and specialty consultants and the infant’s provider, the American College of Obstetricians and Gynecologists (ACOG) opinion noted. The individualized care plan should address the care team, postpartum visits, complications, mental health, chronic health conditions, postpartum problems and plans for reproductive life, contraceptives and infant feeding.

“As ob-gyns, we should leverage our community’s resources to provide patient-centered care for new mothers,” Stuebe said in the release.

“In the weeks after birth, a woman must adapt to multiple physical, social and psychological changes,” the opinion noted. “She must recover from childbirth, adjust to changing hormones, and learn to feed and care for her newborn. In addition to being a time of joy and excitement, this ‘fourth trimester’ can present considerable challenges for women, including lack of sleep, fatigue, pain, breastfeeding difficulties, stress, depression, lack of sexual desire and urinary incontinence. Women also may need to navigate pre-existing health issues, such as substance dependence, intimate partner violence and other concerns. During this time, postpartum care often is fragmented among maternal and pediatric health care providers, and communication between inpatient and outpatient settings is inconsistent.”

The opinion added, postpartum visits with obstetrician-gynecologists or other care providers can “help women navigate the challenges of motherhood.”

In providing these visits, the ACOG also recommended that:

a single practice assume responsibility for coordinating care immediately after childbirth;
the mother receive written instructions regarding the timing of postpartum care, as well as the contact information for her care team;
women with hypertensive pregnancy disorders or a high risk for complications receive early follow-up;
women receive a comprehensive postpartum visit within 6 weeks of giving birth that includes physical, psychological and social assessment;
the visit should also address whether a woman would like long-active reversible contraception or other form of contraception and anticipatory guidance, such as “infant feeding, expressing breast milk if returning to work or school, postpartum weight retention, sexuality, physical activity and nutrition;”
physicians discuss any complications with patients in regard to future pregnancies; and
the obstetrician-gynecologist or obstetric care provider discuss with the patient who will continue care at the end of the visit and if care should be transferred to another primary care provider, provide any information to the new provider with respect to maintain continuity of care. – by Chelsea Frajerman Pardes