Beyond the six-week postpartum checkup: How health care after pregnancy is evolving

For many years, the six-week postpartum exam has been considered little more than a clearance for women to resume their pre-pregnancy lifestyles. Even after cesarean section (C-section), which is a major surgery, the six-week checkup carried a “see ya later” tone – you’ve recovered, so enjoy your baby and come back next year for your well-woman exam. 

However, the American Congress of Obstetricians and Gynecologists (ACOG) suggests that doctors and patients start thinking about postpartum care as an integral piece of medical care. ACOG’s Committee Opinion No. 736 from May 2018 emphasizes a topic I’ve addressed many times on this blog: Postpartum care is very important for women’s long-term health, and it is evolving.

The weeks after pregnancy should be viewed as a critical stage in a woman’s long-term health and an opportunity to promote and support overall healthy living. Rather than having women wait until the six-week checkup for postpartum care, the new guidelines suggest a cascade approach, with incremental visits based on a woman’s health. 

Whole-patient care after pregnancy

ACOG suggests that most patients begin postpartum care with a visit to an Ob/Gyn two to three weeks after delivery to follow up on physical recovery, emotional health, and any special needs that arose during pregnancy. Women who had preeclampsia (high blood pressure during pregnancy) might need a visit 72 hours to a week after leaving the hospital to reduce the risk of serious health complications. 

Then, around 12 weeks postpartum, ACOG suggests that patients have a comprehensive visit with an Ob/Gyn, including a physical exam and a discussion that extends deeper to include emotional wellness and future health considerations. Some of these discussion topics include:

● Care plans for ongoing conditions, such as hypertension or diabetes

● Connection with a primary care doctor

● Family planning, such as birth control and how long to wait between pregnancies

● Infant care, including feeding and how the patient is adjusting to motherhood

● Mental health in the weeks and months after delivery

● Self-care after pregnancy loss

● Sexuality and relationships at home

● Substance abuse, including tobacco, alcohol, and other drugs

● Immunization status

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

Barriers to postpartum care

It’s important to note that as many as 40 percent of women do not have a postpartum visit. Some might think they don’t need care because they feel fine, while others are not connected to a health system or Ob/Gyn – for example, if a patient’s insurance healthcare coverage ended soon after they had their baby or they never had a relationship with a provider before delivery. Furthermore, some patients are compelled to put their baby’s health needs before their own. 

Many women also face geographic barriers to health care access. Getting to the Ob/Gyn can be inconvenient for women who live in rural areas or rely on public transportation. The ACOG opinion presents an opportunity for doctors and health systems to help patients overcome barriers. Postpartum care has growing potential for:

● Home visits

● Telemedicine, such as video calls

● Phone calls or text messages for follow-up questions and depression screening

Additionally, not every patient has insurance coverage for a 12-week visit. As such, patients and doctors might consider advocating for changes at an insurance carrier level, such as Medicaid coverage; perhaps including the 12-week visit in the “package cost” of delivery; or considering it a standalone visit with a copay, which could be conducted by a primary care doctor who is well-versed in women’s health.

The notion that the postpartum visit signals the end of a patient/doctor relationship has become antiquated. Instead, postpartum care should be treated as an opportunity to optimize a woman’s health for years to come. The earlier we can have these discussions, the more we can empower women to seek care after their babies are born.

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