The ‘fourth trimester’: Why women need health care after delivery

Prenatal care appointments can make it feel like you live at your Ob/Gyn’s office, especially in the third trimester as your due date approaches. Starting from the moment you find out you’re pregnant, you’re encouraged to see the Ob/Gyn regularly – and then some. Women typically are seen every four weeks for most of the first and second trimesters, then every two weeks for a period, and then every week in the later third trimester.

But for many women, after baby comes, the doctor-patient relationship becomes a vacuum. If you have a normal vaginal delivery, the standard post-delivery checkup is six weeks after your discharge from the hospital. After a C-section, which is a major medical procedure, it’s typically two weeks before women see the doctor again.

My colleagues and I call the postpartum period “the fourth trimester.” In this time, your body is healing from childbirth and trying to return to its pre-pregnancy state. Though a break from doctor appointments might sound like a good thing, it’s actually quite the opposite: The absence of health care after childbirth can lead to serious health implications, even death, for new moms.

Recent data has raised concerns regarding the maternal mortality rate in Texas. Fourth-trimester maternal care, also known as interconception care, can help reduce the risk of tragic medical issues after delivery and can be the first step towards optimizing your health, including for future pregnancies.

Health concerns we address in fourth-trimester health care

So many body transformations occur in new moms in the weeks and months after childbirth. The body’s adjustment from pregnancy to healing can cause uncomfortable side effects, including:

• General discomfort
  
• Hormone fluctuations
  
• Swelling for two to three weeks
  
• Postpartum bleeding for two to three weeks
  

Often, women either are unprepared for these side effects or perhaps expect that managing them will be easier than it turns out to be. Complicating recovery further, many women are diagnosed during pregnancy with health problems, such as diabetes or high blood pressure, that can last long after delivery. Depending on weight gain during and after pregnancy, women might face obesity-associated health risks. Some women are diagnosed with depression either during or after pregnancy. Depression that occurs after pregnancy is called postpartum depression.

These ongoing issues can be compounded by the sleep deprivation and stress that can accompany bringing home a newborn. In this sometimes-stressful time, it’s easy for women to overlook subtle emotional and physical signals that something more serious is wrong. This is especially true if the doctor sends you home with your newborn and says, “See you in six weeks!” without a thorough discussion of what to expect during recovery and what symptoms should alert you that something is wrong.

Gaps in fourth-trimester care

Unfortunately, even when a conversation about fourth-trimester health occurs, some women still don’t get that vital care. A study published in 2016 by the American College of Obstetricians and Gynecologists indicates that as many as 40 percent of women don’t go to their six-week postpartum exam. In Childbirth Connection’s Report of the Third National U.S. Survey of Women’s Childbearing Experiences, 44 percent of women surveyed who experienced depression symptoms had not met with their provider since giving birth.

Statistics like these indicate a disconnect in doctor-patient relationships and communication. Doctors can’t expect overwhelmed new moms to know what should be expected and what could be a problem. That’s unreasonable.

We must explain that even if a woman experiences no unusual symptoms postpartum, attending the six-week appointment still is vital for her health. And a woman shouldn’t wait until her six-week checkup if symptoms or questions arise, or if something just doesn’t feel right. She should call an Ob/Gyn or primary care doctor and be seen, even if her six-week checkup is weeks away. This is a partnership.

Red flags during the fourth trimester

Seeking care from a doctor prior to the six-week checkup can help reduce the risk of complications. These symptoms might indicate that something is wrong, and you should seek the care of your Ob/Gyn immediately:

• Excessive fatigue
  
• Headaches
  
• Dizziness
  
• Extreme sadness or mood swings
  
• Thoughts of harming yourself or your baby
  
• Swelling or postpartum vaginal bleeding that lasts longer than two weeks
  
• Any sharp, persistent, or intense pain in the abdomen, particularly if you’ve had a C-section
  

During the fourth trimester, enlist the help of your partner, loved ones, and friends to not only help with the baby but also keep an eye on you. Pay attention to their thoughts regarding your health and behavior, and let them check in on you from time to time and ask how you’re feeling.

I recommend that every woman see a doctor annually to continually optimize her health and monitor health concerns. This is especially important to manage or resolve chronic health conditions diagnosed during pregnancy. If a woman chooses to get pregnant again in the future, going into the pregnancy healthy can decrease the risk of complications for both her and the baby.

How primary care helps you in future pregnancies

A primary care doctor can help you achieve and maintain an ongoing healthier lifestyle, which can improve the chance for healthier pregnancies in the future. Ongoing primary care and healthy lifestyle choices can decrease the risk of complications such as birth defects, growth restriction, hypertension, diabetes, and other health concerns with your next pregnancy.

UT Southwestern maternal fetal medicine specialists (MFMs) like me are available on an outpatient basis to consult with women who have had or anticipate having complicated pregnancies. We will meet with you to create a plan to help optimize your health and potentially reduce preventable health risks to you and your baby. We also offer preconception counseling if you have a pre-existing condition that might make getting pregnant or having a healthy pregnancy difficult. 

In addition to seeing an Ob/Gyn, it’s important to see a primary care or family medicine doctor on a regular basis. These doctors often have training in a variety of areas, including pediatrics and women’s health concerns. These doctors can help you with questions about birth control, breastfeeding, and managing chronic concerns such as diabetes and high blood pressure.

Just as we encourage women in the third trimester to think about getting diapers and a car seat prepared, we encourage adding “find a primary care doctor” to the pre-baby to-do list. You can look on your own or request references from friends and family members, or we can recommend providers we know and trust who can take care of you going forward.

If you have medical conditions that made your pregnancy difficult, such as a heart problem, diabetes, obesity, or high blood pressure, your primary care doctor can help you optimize your health and straighten out your medications after pregnancy and as your health improves over time. Think about bringing your new child into the world as a chance to reset your own health as well.

The better your chronic conditions are controlled, the healthier you will be and the more energy you will have to care for your newborn – and the healthier you will be if you choose to get pregnant again.

Looking for a primary care doctor? Find a UT Southwestern doctor online or call 214-645-8300.