The Postpartum Cliff Doesn’t Need to Be So Steep

For many people, giving birth is a time full of hope and possibilities. But the list of potential complications that follow pregnancy and childbirth can derail the conditions that parents and babies need to thrive. These include depression, exhaustion, difficulty with breastfeeding, infant sleep challenges, reproductive health complications, pelvic pain, infections, fistulas, and incontinence. Insurance interruptions and lack of coordination among healthcare providers can further compound health issues during the postpartum transition.

These problems don’t always show up right away. Some can take weeks or months to emerge and become dangerous. But postpartum care generally ends at 6 weeks, far too soon to give many parents with new babies the best opportunity to thrive. Furthermore, there is no recommended standard of care for a mother or birthing person that goes beyond 12 weeks after birth.

Seamless postpartum care for at least 1 year after birth could save lives and allow families to thrive. Appointments should mirror the customary schedule of child vaccinations, at 2 months, 4 months, 6 months, 9 months, and 12 months.

That simple commitment could have a profound effect. Every year, at least 40 million people around the world experience medium- and long-term complications from labor and childbirth. Millions of new mothers die, and many of those deaths are entirely preventable. We could save many lives if our healthcare systems provided care to prevent people from falling off the “postpartum cliff” — the 6- or 12-week cutoff when routine clinical care ends and new mothers and babies are on their own.

The WHO acknowledges that there is a growing body of evidence that considers the postpartum period to extend beyond 6 weeks — and up to 1 or 2 years. In the U.S., Medicaid has extended the insurance coverage option for up to 12 months after birth, acknowledging the need for care beyond the traditional 6-to-12-week period.

Clinical guidelines must now follow to guide the delivery of holistic high-quality care to assure early identification and treatment of postpartum health issues. This care would be delivered by interdisciplinary teams of midwives, nurses, obstetricians, social workers, lactation consultants, doulas, pediatricians, community health workers, and peer support.

By aligning postpartum wellness visits with the CDC’s vaccination schedule, new parents would receive reliable, routine, holistic care that would address the vast array of challenges they may be facing. Besides the physical recovery from childbirth, these visits could include assessment and guidance on depression and anxiety, drug and tobacco use, nutrition, sleep, contraception, parenting, and social support.

Everyone who gives birth deserves this kind of care, but too often they don’t get it. These visits don’t have to be too complicated or expensive — not all of them need to be one-on-one appointments in a clinical setting of a doctor’s office or hospital. Care could be provided in a group setting or through in-home visits, in mobile clinics, or through telemedicine. Care could and should involve family members and others who provide women and birthing people with postpartum support.

This model has shown early, but encouraging, results in Malawi, a country that has one of the highest maternal mortality rates globally. Through the intervention, 41 mothers and their infants met at group visits in clinics with midwives and community health workers. The care they received included family planning and vaccinations, as well as treatment for the women’s high blood pressure and the babies’ flu.

In the U.S., a nationwide nonprofit called the Nurse-Family Partnership provides postpartum home visits. An article published in June in JAMA makes clear the value of delivering care to both mother and infant during a routine postpartum well-child visit. Simple screenings led to some women being readmitted to the hospital with previously undiagnosed preeclampsia.

A full year of postpartum care would bring us closer to fulfilling the pro-parent, pro-child values that society so often preaches. It would better reflect people’s lived experience of the postpartum period and how long the need for more intensive support lasts.

No single clinician can address everyone’s health and health-related social needs after birth. But as a nurse and midwife, I think I speak for many in our profession when I say that well-coordinated work among interdisciplinary teams (also including physicians, community health workers, doulas, lactation consultants, pediatricians, and social workers) can make a real difference.

We can provide better care that centers women’s and birthing people’s needs and well-being. We can integrate this care within existing services and extend it for 12 months after birth. Furthermore, a universal set of care guidelines would help prevent and manage postpartum issues and chronic conditions that can arise many months after giving birth. This would help eliminate longstanding health inequities, improve the quality of life for millions around the world, and build stronger societies.

What is good for moms and babies is good for all of us.

Ashley Gresh, PhD, MSN, is an assistant professor at the Johns Hopkins School of Nursing in Baltimore as well as a certified nurse-midwife and public health nurse.

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