Postpartum: The Most Dangerous Period in Pregnancy

Last Sunday, Babyscripts was featured on the front page of the New York Times in the article “Maternity’s Most Dangerous Time: After New Mothers Come Home.”

The article highlights one of the most problematic issues with the current state of maternity care -- an overemphasis on prenatal and infant care to the detriment of the mother's health after childbirth. It puts a much-needed focus on the needs of postpartum mothers, and validates the need for solutions like Babyscripts.Though there is still work to be done to equalize the care experience during pregnancy and childbirth, the U.S. healthcare system understands the need to emphasize and guarantee necessary prenatal care. Postpartum care is a different story. 

The New York Times piece highlighted some key data around the postpartum period:

• New research shows that the deadliest time for mothers is after the baby is born
• American women enter pregnancy heavier and older than historically, and hypertension and diabetes are more common than ever
• A third of maternal deaths occur in the first 6 weeks following delivery, and another 30% (including those from mental health complications) occur in the time between 6 weeks and one year postpartum
• Elevation in blood pressure during pregnancy can leave women at greater risk for cardiovascular disease during pregnancy or even decades later
• Life-threatening complications like preeclampsia can emerge in the postpartum period, even in women who have risk-free pregnancies. 

Although newborn appointments with pediatric caregivers begin after childbirth, a mother's interaction with her obstetric provider typically ends just as questions begin to develop about breastfeeding, monitoring well-woman health, and better adjusting to a new reality. While women in a comparably developed country like the U.K. are aided by local midwives, doulas, and nurses in the days and weeks following delivery, new mothers in the U.S. will often not see an obstetric health professional until the six-week follow-up appointment. Tellingly, the maternal mortality rates in the U.S. are 3.5X higher than those in the U.K. 

According to the CDC, eighty percent of those maternal deaths are preventable, and more than half occur in the postpartum period. And those numbers don't include deaths or long term health problems that may have their origins in pregnancy-related issues like gestational or postpartum hypertension.

To address the issues, ACOG changed its recommendation from a six-week comprehensive checkup to a more ongoing process, with first contact between patient and provider taking place no later than three weeks after birth. After the initial three-week visit, patients and providers can discuss the need for future check-ins or appointments. ACOG also recommends a comprehensive visit that occurs no later than 12 weeks to follow up on the mental and physical health of the new mom, to help facilitate the emotional and physical transition women experience after giving birth. 

Changing the structure of care delivery is a critical step, but for some new mothers struggling with a newborn, making it into the doctor's office provides its own challenges. The piece from the NYT exposes the variety of barriers that mothers face in receiving appropriate care, emphasizing the need for non-traditional solutions that can respond to the diverse needs of mothers across risk categories.