After my baby was born, I was shocked that I wasn’t going to see my doctor, the person I had seen (and emailed!) so often during pregnancy, for six weeks. I’m certain I knew that before I went into labor, but when the doctor reminded me two days postpartum, it was as though I was hearing it for the first time. I could have cried when she broke the news. I probably did.
I had read many recent articles on postpartum health complications and found it so strange that after a day or two in the hospital (where I learned that asking to be examined when my OB checked in on me was apparently unusual), women are left to tend their own wounds and monitor their own recovery -- all while caring for a newborn. Even though my recovery was relatively easy -- and for that, I’m deeply grateful -- breastfeeding was an immense challenge. But I thought if other women didn’t see their doctors before six weeks, then I too could handle the wait. I accepted the protocol, even as my best friend, who was living in London at the time, told me all about her enviable postpartum home visits from a midwife.
Then, during the long-awaited six-week appointment, my doctor told me that I wouldn’t see her again for six months. I could have cried when she broke the news. I probably did.
When I read the new recommendations released by the American College of Obstetricians and Gynecologists (ACOG), I was excited by the proactive effort to reduce some of the challenges women experience postpartum, especially in the early weeks, which “are a critical period for a woman and her infant, setting the stage for long-term health and well-being.” I was also encouraged by ACOG’s recognition of the challenges of the fourth trimester.
Below are some key points from the opinion, which proposes “a new paradigm for postpartum care.”
Prenatal care should include creating a postpartum plan for how to transition into parenthood and receive ongoing well-woman care.
When I was pregnant, I read a ton of books to prepare. I didn’t remember a single word of those books after having my baby -- but I did read them! Receiving “anticipatory guidance” during prenatal appointments will help women better prepare for those early months and ensure they have a plan for taking care of themselves, which can be easy to overlook when taking care of a newborn.
Prenatal care should also address plans for any future pregnancies, which will impact postpartum contraceptive options.
Having more children is a big financial and emotional decision. There are many different contraceptive options; with the help of your healthcare provider, you can find what works best for you. It’s important to have a plan in place before delivering, not least because figuring out contraception is generally not top of mind during the newborn period.
Postpartum care should be ongoing and individualized.
Every postpartum experience is different. Some women will need more postpartum care than others, and getting that care shouldn’t be a challenge. We all deserve care that is specific to us and addresses our individual needs.
The first postpartum appointment should occur no later than three weeks after delivery.
When you have a newborn, the difference between three weeks and six weeks may feel quite a bit longer. If I had had my first appointment at three weeks, I would have perhaps realized sooner that I needed more professional help -- that my friends, amazing though they are, were not going to be able to help me with my baby’s latch.
No later than twelve weeks postpartum, there should be a comprehensive visit to address physical and emotional well-being.
This visit should address "mood and emotional well-being; infant care and feeding; sexuality, contraception, and birth spacing; sleep and fatigue; physical recovery from birth; chronic disease management; and health maintenance."
Twelve weeks was when the fatigue was really toppling me. I also found that, at that point, the stream of helpful visitors had mostly waned. The emotional reality of it all was starting to sink in then, too. To have a doctor’s appointment at that time would have been amazing. A comprehensive appointment at three months will help countless women give voice to their concerns and get the help they need.
Complications and other health concerns should be proactively addressed in postpartum care and beyond.
According to the report, women should be advised that pregnancy complications are associated with a higher risk of cardiometabolic diseases. Follow-ups are essential for women who have chronic medical conditions and those who have experienced pregnancy or neonatal losses. These women and their obstetric care providers should determine which health care provider will take primary responsibility for their health.
Pregnancy-related conditions, such as preeclampsia and gestational diabetes, have been linked to increased incidence of high blood pressure and type 2 diabetes later in life. It is important to discuss with your healthcare provider what you can do to stay healthy.
Providing optimal postpartum care will require policy changes. Obstetric care providers should be on the frontlines.
Our doctors should be among our greatest allies, but it’s also important that we stand up for ourselves and the care we deserve. If we don't require certain things of our health care providers, then postpartum care won’t change.
Giving birth is an incredible feat. Jumping into caring for a tiny human immediately after that is another incredible feat. Now that I have a baby, I am so much more aware of how remarkable mothers are. I’m also so much more attuned to women’s health issues -- and how we have to do more to not fail new mothers. I’m grateful that obstetrics providers have reevaluated their postpartum protocols to help women make healthy transitions to motherhood.
For a recap of ACOG’s 2017 recommendations for limiting intervention during birth, check out our blog.
What was your experience with the six-week wait? Do you think you received optimal postpartum care? Comment below.