A - ACOG's New Postpartum Guidelines
It is not new news that the United States has one of the highest maternal mortality rates in the world. Between 2000 and 2014, the number of maternal deaths per 100,000 live births more than doubled.
Any death is a tragedy but the death of a mother, especially immediately postpartum, is one of the greatest. The children, spouse, and other family members are effected drastically (MacDorman).
In May of 2018, the American College of Obstetricians and Gynecologists made new recommendations and conclusions regarding postpartum care. However, the use of this care change is listed as voluntary (Optimizing, e140). That statement boils my blood with the common stories of obstetrical violence and unnecessary medical procedures on pregnant women. I believe the ACOG should hold all members responsible and make these new postpartum guidelines mandatory but that’s just my opinion.
To quote the ACOG’s paper, the new guidelines are as follows.
“The American College of Obstetricians and Gynecologists makes the following recommendations and conclusions:
Currently, prenatal care, delivery, and a single postpartum visit are bundled into one global fee covered by insurance (Martin). To implement these new guidelines, the insurance industry would need to be on board and cover the additional visits so even if the ACOG did make these changes mandatory, it could take years to be implemented.
It is estimated that as many as 40% of women do not go to their postpartum visit (Optimizing, e141) and less than half of the women who do attend state that the information given is inadequate at best (Optimizing, e142). At the very least, care should cover postpartum depression, birth spacing, nutrition, exercise guidelines, what to expect hormonally, and sexual response (Optimizing, e142). From my first birth experience, I remember not being counseled on any of that. It was an incision check, a quick “how ya feeling?” and on my way I was sent.
Ideally, postpartum care would include “an initial assessment, either in person or by phone, within the first 3 weeks postpartum to address acute postpartum issues” and follow up care would be as needed. A well-woman visit would conclude the postpartum care at 12 weeks (Optimizing, e140). More so, the World Health Organization suggests an exam at 3 days postpartum, another at 1-2 weeks, and a final at 6 weeks (Optimizing, e144). During the initial assessment and the follow up care, topics such as infant feeding, emotional health, chronic diseases, and continuation of care planning should all be discussed (Optimizing, e142). Maybe then many women would not go through late onset postpartum depression as often or at least be able to recognize the signs and symptoms better. They also would not question which care provider to contact. After the current 6-week postpartum checkup, any questions a new mom has are often left unanswered based solely on the fact that she doesn’t know whom to call.
Even more ideally, postpartum planning should begin during prenatal visits as well. This should include familial and social support plans as well as medical care plans where both parties – the patient and provider – have discussed and come to conclusions (Optimizing, e143).
Furthermore, society – new parents as well as employers – need to understand that, even with the current schedule, the final postpartum visit is just a medical appointment and “not an ‘all-clear’ signal”. This does not give the woman the green light to resume life as normal. She should still continue recovery and have support (Optimizing, e145).
This brings me to another point of having a better parental leave policy, which I’ll cover in another blog post. However, it is quite reassuring to read that “the American College of Obstetricians and Gynecologists endorses paid parental leave as essential, including maintenance of full benefits and 100% of pay for at least 6 weeks” (Optimizing, e148). Six weeks is not long enough but it is a start!
Imagine these new guidelines implemented in every OB’s office in America. I think that the maternal mortality and the postpartum depression rates would both decline significantly. What do you think?
“Optimizing postpartum care”. American College of Obstetricians and Gynecologists Committee Opinion No. 736. American College of Obstetricians and Gynecologists. Obstet Gynecol 2018; 101: e140-150. https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Optimizing-Postpartum-Care. Web. 17 Sept 2018.
Martin, Nina. “Redesigning Maternal Care: OB-GYNs Are Urged to See New Mothers Sooner And More Often”. NPR. 23 April, 2018. https://www.npr.org/2018/04/23/605006555/redesigning-maternal-care-ob-gyns-are-urged-to-see-new-mothers-sooner-and-more-o. Web. 17 Sept, 2018.
MacDorman, Marian F. et al. “Is the United States Maternal Mortality Rate Increasing? Disentangling Trends from Measurement Issues Short Title: U.S. Maternal Mortality Trends.” Obstetrics and gynecology 128.3 (2016): 447–455. PMC. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5001799/. Web. 17 Sept. 2018.
Allesanda received her Bachelors in Behavioral Science from the University of Louisiana at Lafayette in December 2013. She now lives in North Texas with her husband and children. As a doula and educator of infant sleep and eco-friendly living, she blogs about pregnancy, birth, postpartum, and parenting.