The American College of Obstetricians and Gynecologists (ACOG) issued a revised Committee Opinion proposing a new design for postpartum care to highlight the importance of the “fourth trimester.”
Previously, ACOG had recommended a comprehensive postpartum visit occur within the first 6 weeks after birth. Now the Committee on Obstetric Practice recommends postpartum care be an ongoing process, rather than a single encounter. The Committee Opinion states that women should have contact with their obstetrician–gynecologists or obstetric care providers within the first 3 weeks postpartum, and this initial visit should be followed up with ongoing care as needed, concluding with a comprehensive postpartum visit no later than 12 weeks postpartum.
The comprehensive postpartum visit 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
In addition to changes in postpartum follow-up, ACOG has issued the following recommendations:
- Women with pregnancies complicated by preterm birth, gestational diabetes, or hypertensive disorders of pregnancy should be counseled that these disorders are associated with a higher lifetime risk of maternal cardiometabolic disease.
- Women with chronic medical conditions, such as hypertensive disorders, obesity, diabetes, thyroid disorders, renal disease, mood disorders, and substance use disorders, should be counseled regarding the importance of timely follow-up with their obstetrician–gynecologists or primary care providers for ongoing coordination of care.
- For a woman who has experienced a miscarriage, stillbirth, or neonatal death, it is essential to ensure follow-up with an obstetrician–gynecologist or other obstetric care provider.
- 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.
Experts emphasized that discussions about postpartum care should begin during pregnancy to address issues such as infant feeding, “baby blues,” postpartum emotional health, recovery from birth, and the challenges of parenting.
“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, MD, lead author of the Committee Opinion.
ACOG President, Hayward L. Brown, MD, added, “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.”
The full ACOG Committee Opinion can be found here.
For more information visit acog.org.