The Fourth Trimester of Pregnancy: Committing to Maternal Health and Well-Being Postpartum

Abstract

The postpartum period is a time of significant challenge and need as women adapt to hormonal and physical changes, recover from delivery, experience shifting family responsibilities, and endure sleep deprivation, all while caring for and nourishing their newborn. It is also a period of significant maternal health risk. Recent data on U.S. maternal mortality indicate a shift in the timing of maternal deaths over the past 10 years, with the majority of maternal deaths now occurring postpartum, from one day to one year after delivery. Postpartum care also marks a period of transition, as women shift from pregnancy-centered care to interpregnancy and primary care, yet current systems of care are marked by poor coordination of care between providers and patient care settings. Suboptimal postpartum follow-up is particularly worrisome for women with chronic health conditions or pregnancy complications who face both short- and long-term health risks. Given known challenges and medical risks, the single, 6-week postpartum visit women receive is woefully inadequate in addressing maternal health needs. Postpartum visits often fail to address the unique postpartum needs identified by mothers, inadequately connect women with primary care services, and have low attendance. Recognition of these unmet needs of "the Fourth Trimester" have led national organizations, including the American College of Obstetricians and Gynecologists (ACOG), to call for a restructuring of postpartum care to reduce postpartum and long-term morbidity and improve postpartum well-being. Rhode Island has several recent initiatives with the potential to improve outcomes for mother-baby dyads including the Baby Friendly Hospital Initiative (BFHI), the provision of long-acting reversible contraception (LARC) immediately postpartum, and the addition of HPV immunization postpartum. These initiatives remove barriers of access to care and provide vital women's health services prior to discharge. The Fourth Trimester provides a rich opportunity for maternal risk reduction and health promotion at a time when women are motivated and engaged with health care.