ACOG: Optimizing Postpartum Care

Well, it’s about time!

I always have this reaction when ACOG (American College of Obstetricians and Gynecologists) publishes a new Committee Opinion that, even though it’s a step in the right direction, should have been the standard decades ago…

This move has been prompted, I’m sure, by the recent stories appearing in the media drawing attention to the alarmingly high rates of maternal morbidity and mortality that happen AFTER a baby’s birth — not just around the globe, but here in the United States as well.

“This lack of attention to maternal health needs is of particular concern given that more than one half of pregnancy-related deaths occur after the birth of the infant (6). Given the urgent need to reduce severe maternal morbidity and mortality, this Committee Opinion has been revised to reinforce the importance of the “fourth trimester” and to propose a new paradigm for postpartum care.”

ACOG might be looking at this issue as one that can no longer be ignored. Women are dying (and women of color at even higher rates than their white counter-parts) in this country and they need to act, and act soon.

Maternal morbidity and mortality as a result of complications following the birth of a baby is a terrible situation that cannot be overstated. But surely, this can be lessened and potentially prevented if we do the right thing and change policies around how the majority of women are being cared for during pregnancy, birth and the postpartum period.

For far too long, obstetric care in this country has been modeled on a one-size-fits-all program whereby every woman who gives birth receives her post-birth follow-up visit at the six week mark. Kudos to ACOG for stating that this should no longer be the norm! In fact, they take this on as their first recommendation:

“To optimize the health of women and infants, postpartum care should become an ongoing process, rather than a single encounter, with services and support tailored to each woman’s individual needs.”


Not every woman gets the luxury of a full 4th Trimester (12 weeks of paid or unpaid Maternity Leave). In fact, according to this position paper, “23% of employed women return to work within 10 days postpartum and an additional 22% return to work between 10 days and 40 days.” With 45% of employed women returning to work before six weeks the traditional one-size-fits-all postpartum check-up is long overdue for an overhaul.

AGOC guidelines are now asking for individualized care plans to address the needs of each woman when it comes to creating the post birth care plan that will fit her particular circumstances.

They go on to state that if this comprehensive visit happens before the six-week mark, it should not be seen as an “all-clear” message and the provider, the woman, her family, and employer should recognize the need for continued support for the first six weeks postpartum — and beyond.

I’m happy to read ACOG’s position paper on the importance of postpartum care and I applaud many of its suggestions, but there are some missing pieces that need to be addressed.

It’s incredibly challenging for a woman who has a supportive partner and/or extended family to get in to be seen in the critical, early days and weeks after the birth of her baby. What about the woman who doesn’t have this level of support? I think ACOG could go farther in coming up with a postpartum care plan that takes this into consideration. But instead of re-creating the wheel, they should take a look at an already well-established, very effective model of postpartum care…

I spoke with my colleague, Laurie Perron Mednick, who is an out-of-hospital Midwife here in the Portland area to ask her about the model of care that clients can expect in the postpartum period if they’re working with an out-of-hospital Midwife, and this is what she had to offer:

“Oh, what a great question! It irritates me that we (culturally) are beginning to think about reducing maternal mortality and optimize mom and baby outcomes, but out-of- hospital Midwifery care seems to have been left off the table, and yet it’s perhaps the strongest component of our care for childbearing women and babies! Our community standard offers home visits at 24 hours post birth, 3 days and one week. We then have clients come in for 2, 4 and 6 week visits. Each visit lasts about an hour, and focuses on maternal health (physical, emotional, mental and  general coping), infant health and feeding. We also address the family’s support network, expectations around breastfeeding norms, and newborn development and behavior, and then family planning, returning to work, etc.

This isn’t a blogpost to discuss the difference between hospital and out-of-hospital birth.

What I want to highlight is that there’s already in place a model for excellent postpartum care, and ACOG might do well to look at this as a way to insure optimal contact and support for new Mommas, babies and families. Having six touchpoint visits in the immediate postpartum time, all occurring before six weeks, with enough time and attention to be able to discuss all of the factors that help to make the postpartum period go as smoothly as possible, is what I would consider “Optimizing Postpartum Care.”

But I’d also add that there are classes, support groups, and parenthood preparation programs — like the one I teach, Becoming Us — which are designed to prepare Mommas and partners for this life-changing transition. It’s important that we continue to prepare families adequately for what to expect during pregnancy and birth. And we should certainly continue to encourage learning about the skills of parent-ING, as there are so many they’ll need to master to feel confident about caring for their babies in those early days, weeks and months postpartum.

But we need to be doing a better job of preparing people for parent-HOOD — the complete and total shift in identity that happens when you take on the responsibility of becoming a parent, the normal changes that inevitably occur when you move from couple to family, the ability to navigate these changes and grow stronger by learning how to manage conflict well.

This is something that I find completely lacking in the ACOG Committee Opinion.

They list out the various members of the Postpartum Care Team. But childbirth educators, birth and postpartum doulas, new parent support group facilitators and parenthood preparation facilitators — these really important members of the Postpartum Care Team — are not even mentioned!

The people in these roles are often frontline and can “fill in the gaps” for expectant or newly parenting families on what to expect, what’s “normal” in the postpartum period, and when and where to seek help. Much of the work of these particular members of the care team is preventative and should be considered an integral piece to “Optimizing Postpartum Care,” in my opinion.

I applaud ACOG for releasing this committee opinion — for recognizing the deep need to do better by our families as they begin their parenting journeys. But my hope is that this would be just the beginning.

I’d like to see ACOG investigate, recognize and acknowledge all of the options already in place to help women and families make it through this life-changing transition. And further, that they might examine the power they continue to have in their role as the primary provider for a woman at this critical time in her life. If they encourage the families they work with that education and support during pregnancy and postpartum is absolutely worth seeking out and participating in, and they continue to push for policy changes that will allow all women to seek out affordable options for this care, then I’ll do more than just applaud — I’ll give ACOG a standing ovation!

Because, even though I read this statement and say, “It’s about (damn) time!” many expecting and new parenting families still rely heavily on what their doctor has to say about all things pregnancy, birth and parenting.

So, members of ACOG, don’t stop with this written statement…

Educate yourselves on what already exists as built-in supports for your patients and families and encourage them to take advantage of ALL the members of their postpartum care team. We’ve been working tirelessly for decades to ensure that our families get the education and support they need in this critical period.

Help us help them.


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