I remember running to the lactation room on Parkland’s third floor. I had just seen 8 patients in our busy gynecology clinic, and my breasts were aching like crazy. I’d unpack all of my supplies – the pump and its parts and turned the machine on while I began trying to type up my notes as to not get behind in clinic. After the 10-15 minutes, it was a race to get everything cleaned and stored properly before heading back to the clinic where my attendings and fellow residents were working diligently away.

I missed my son so much. I felt grateful for being back at work. I had so many mixed emotions and anxiety all around with no time to process my feelings. But really, I had it good.

My son’s birth went great. Breastfeeding was fairly easy for us to pick up. I can’t imagine the hundreds of other things that could have gone wrong or contributed to my own feelings of inadequacy. I had 5 weeks off from work.

Did you know 1 in 4 moms in the U.S. return to work after just 10 days after delivery? Postpartum care is getting more attention recently, and for good reason!

So much is happening in the adjustment time- self-care completely changes, baby-care becomes all-encompassing (figuring out bathing, feeding, all the things), self-identity changes, family-care changes (including your relationships with your spouse, other kiddos, and other family members). All these things are complicated, and they all overlap.

More and more we are defining postpartum recovery as process that sometimes cannot be fully encapsulated in a single visit. And most importantly, it needs to be individualized. For some women, the single postpartum visit may be all they need. Others may develop significant health issues that can persist weeks or months after childbirth or struggle mentally.

This time period after birth has been termed the ‘4th trimester’ and has been a focus of the women’s health community including here at FĒNOM.

The number of women who experience problems after birth is alarming. Nearly 70% of women describe at least one physical problem in the first year. For 20% of these women, these problems are serious.

This leads to corresponding functional limitations that may affect their ability to work, care for children, or simply perform daily tasks. Postpartum depression and other mental health issues are also incredibly common.

The American College of Obstetrics and Gynecologists (ACOG) formed a task force with the goal to redefine the postpartum visit to reflect the importance of the 4th trimester. ACOG’s task force determined that postpartum care provides a critical opportunity to support women and their well-being.

Their findings are summarized as follows:

• It should be an ongoing process, not a single encounter, with care and support tailored to a women’s individual situation.
• A postpartum care plan should be developed before or during pregnancy that addresses the transition to parenthood.
• Ideally, all women should have contact with a care provider within the first 3 weeks after childbirth, with follow-up care as needed, concluding with a comprehensive postpartum visit no later than 12 weeks after birth.
• Women with complicated pregnancies or prior chronic medical conditions should be heavily counseled regarding the importance of timely follow-up, and postpartum care should continue to focus on these issues.

A renewed focus on motherhood and the 4th trimester will take effort from all parties involved. Currently, physicians are not incentivized to implement these changes as insurance companies are not reimbursing for expanded postpartum visits.

Changing the paradigm will not be easy, but it is necessary to do so for the betterment of all women. It is incumbent on health care providers to start the conversation and emphasize the importance of the weeks and months following birth.

From a provider perspective, these changes have already begun, but insurance companies must get on board with the new recommendations regarding the timing and frequency of postpartum visits.

Mothers can help by empowering themselves with the information that postpartum issues are common, and they should express their concerns to their providers. Together, we can continue to make progress in this area and ensure that the 4th trimester is cemented as a critical time period in a woman’s, baby’s, and family’s life.