The President’s
Program at the opening of ACOG annual conference in Austin, Texas stressed the
importance of comprehensive pregnancy care that should extend well beyond the
third trimester and labor into period 3 months post-delivery, rightly called as
“the fourth trimester”.
Keeping with
this year theme of “Medical and Surgical Innovations in Health Care,” the
President’s program was not three separate lectures but a ‘President Panel’ that
included 3-star speakers discussing “The New Postpartum Visit: Beginning of
Lifelong Health.”
Dr. Brown
opined that ob-gyns are the primary doctors that most women see for the bulk of
care throughout their lives and we must make it sure that we also meet her
additional healthcare needs beside pregnancy and gynecology care.
Postpartum
care was always in focus throughout Dr. Brown’s tenure as ACOG President. The
task force on “Redefining the Postpartum Visit” and ACOG Committee on Obstetric
Practice have released a revised “Optimizing Postpartum Care” Committee Opinion
published in the May issue of Obstetrics & Gynecology.
ACOG
previously recommended that all women should have a comprehensive health check-up
visit within the first 6 weeks after birth, now ACOG recommends that post-partum
care is an ongoing process and women should stay in contact with their obstetrician
or other obstetric care provider for the first three weeks after birth.
This close
contact with the obstetrician is especially important for elderly mothers and
women with chronic diseases. The initial visits should culminate into a comprehensive
individualized post-partum visit at 12 weeks that includes a full assessment
of:
- Mood and emotional well-being
- Infant care and feeding
- Physical recovery from birth
- Physical intimacy, spacing and contraception
- Sleep and fatigue
- Chronic disease management
- General health maintenance
Early
follow-up is also important for women who had cesarean section, perineal
lacerations, lactational difficulties or postpartum depression.
Mothers who
had any superimposed medical problems gestational diabetes mellitus or hypertensive
disorders or had a preterm labor should undergo special counselling about the
increased risk of these disease later in life.
Those women
who have had a pregnancy mishap also benefit from early visit in terms of
emotional support and counselling and referrals as needed for future risk of
such mishap.
It is known
that one half of postpartum strokes occur within 10 days of discharge, hence
women with hypertensive disorder of pregnancy should have the first follow-up
within 7-10 days and those with severe hypertension should be in within 72
hours to evaluate the status of blood pressure.
The
postpartum visit at 12 weeks serves as a transition towards the ongoing well-women
care. The obstetric care provider should initiate communication with the patients’
primary care provider regarding the medical problems faced by her in pregnancy and
the future implications of such problems on the woman’s long-term health.
Currently, about
40% of women do not come for a follow-up visit and important opportunities for contraception
counselling and spacing and treatment of chronic health condition is lost.
“New mothers
need ongoing care during the ‘fourth trimester.’ We want to replace the one-off
checkup at six weeks with a period of sustained, holistic support for growing
families,” said Alison Stuebe, M.D., lead author of the Committee Opinion. “Our
goal is for every new family to have a comprehensive care plan and a care team
that supports the mother’s strengths and addresses her multiple, intersecting
needs following birth.”
Dr Brown
added “This revised guidance is important because the new recommended structure
is intended to consider and cater to the postpartum needs of all women,
including those most at risk of falling out of care.”
