Will New Postpartum Care Standards Help Moms?

Clara Schriemer

Master’s Student in Epidemiology

December 19, 2018

 Maternal health in the US is a sorry state of affairs. While maternal mortality rates are declining in all developed countries around the world, maternal deaths continue to increase in the US. However, in April 2018, the American College of Obstetricians and Gynecologists (ACOG) took an essential step toward improving maternal health in the US by announcing new guidelines for postpartum care.

Under the previous ACOG recommendations, new mothers were not advised to see their health providers until six weeks after they were discharged from the hospital after having a baby. In this six-week period, the physical and emotional stress of pregnancy and delivery can cause existing chronic conditions to worsen or new health conditions to develop, which can lead to pregnancy-related complications or death from postpartum eclampsia (seizures that occur shortly after delivery), thrombotic pulmonary embolism (in which a blood clot blocks one or more arteries in the lungs), stroke, hemorrhage, or infection, to name just a few.¹

In order to recognize and address postpartum maternal health concerns quickly and prevent grave consequences, mothers must see their health providers consistently and frequently. ACOG’s new guidelines are founded on the belief that postpartum care is an ongoing process and should not take place in a single visit. The guidelines specify that the first check-in with a new mom should happen within the first three weeks after birth and that a comprehensive postpartum visit no later than 12 weeks after birth should include discussions ranging from the mother’s mood and emotional wellbeing to chronic disease management to contraception.²

The postpartum period is one of enormous hormonal change, identity shift, and sleeplessness. Supporting the regular and frequent contact between new moms and their health providers is one important factor in the healthy navigation of this critical period.

High Maternal Death Rates Across Populations in the US

In 2015, 26.4 mothers died for every 100,000 live births in the US.3 Compare this to Finland, where 3.8 mothers die per 100,000 live births or Denmark, where this rate is 4.2 deaths per 100,000 live births, and you will see that maternal mortality is a serious problem in our country.³

As with most health issues, disparities in maternal and pregnancy-related deaths are enormous. For example, rates of pregnancy-related death are 3.2 times higher for black women than for white women. Maternal death rates are also higher for women living in rural areas and those with low incomes.

Still, all mothers in the US, regardless of race, ethnicity, socioeconomic status, and geographic location, are at unconscionably high risk for pregnancy-related death and complication. And, for every maternal death, several more women nearly die.⁴ According to ProPublica, 700 to 900 women die from pregnancy or childbirth-related causes every year in the US and some 65,000 nearly die.⁵

The reasons for the increase in maternal deaths in the US are legion. New mothers are often older than they used to be, and as such, they may have more chronic conditions, making them more vulnerable to complication. Almost half (45 percent in 2011) of the pregnancies in the US are unintended, which means that women may not be in good health when they get pregnant.⁶ Difficulty navigating the US health care system labyrinth can also contribute to lack of proper care throughout a woman’s pregnancy, especially for those who lack comprehensive insurance coverage.⁵

How Will New Guidelines Impact Maternal Health?

Improvement of postpartum care in the US alone will not adequately reduce maternal mortality rates and pregnancy-related deaths, but it will help. For the ACOG’s new guidelines to truly contribute to widespread maternal health, the infrastructure of postpartum care will need to adapt.

Specifically, we know that low-income women suffer a higher risk of maternal and pregnancy-related deaths, and their access to care depends largely on insurance coverage. As such, insurance companies will need to offer new mothers financial coverage for more frequent and regular postpartum visits with their providers. The ACOG’s new guidelines for postpartum care are encouraging, but it is contingent upon the health care industry to adopt and facilitate these best practices to keep new mothers healthy, happy, and, at the most basic level, alive.

Works Cited:

1. Maternal Death and Pregnancy-Related Death.” The March of Dimes, August, 2018. https://www.marchofdimes.org/complications/pregnancy-related-death-maternal-death-and-maternal-mortality.aspx
2. “ACOG Redesigns Postpartum Care.” American College of Obstetrics and Gynecology. News Release, April 23, 2018. https://www.acog.org/About-ACOG/News-Room/News-Releases/2018/ACOG-Redesigns-Postpartum-Care?IsMobileSet=false
3. “U.S. Has The Worst Rate of Maternal Deaths in the Developed World.” NPR, May 12, 2017. https://www.npr.org/2017/05/12/528098789/u-s-has-the-worst-rate-of-maternal-deaths-in-the-developed-world
4. “Pregnancy Mortality Surveillance System.” Centers for Disease Control and Prevention, August 7, 2018. https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pregnancy-mortality-surveillance-system.htm
5. “The Last Person You’d Expect to Die in Childbirth.” ProPublica, May 12, 2017. https://www.propublica.org/article/die-in-childbirth-maternal-death-rate-health-care-system
6. “Unintended Pregnancy in the United States.” Guttmacher Institute, September, 2016. https://www.guttmacher.org/fact-sheet/unintended-pregnancy-united-states

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About the Author 

Clara Schriemer is a graduate student in Global Health Epidemiology at the University of Michigan School of Public Health, and a Gelman Global, and Fedor and Mechthild Medzihradsky Global Internship Scholar. She completed her undergraduate education at Hope College in Holland, Michigan, where she studied biology and chemistry. After graduation, she worked for Aqua Clara International, a nonprofit that develops water filters for use in low- and middle-income countries. Her research interests include maternal morbidities and neonatal health. As part of her master’s-level studies, she spent last summer in Kumasi, Ghana, studying birth asphyxia at a government hospital. She also serves as the assistant editor of the Pre-Publication Support Service, a nonprofit working to build research capacity in low- and middle-income countries. Learn more about here story here.