What is the postpartum period so important?
The postpartum period is an extremely important and challenging phase, and often not widely addressed in U.S. culture. Many people think that once delivery occurs, a pregnancy is over, but that is simply not true. It takes several weeks for a pregnant person to get back to the pre-pregnancy state. In fact, a person actually remains physiologically pregnant for the first several weeks following birth. There are multiple physical, social, and psychological changes a person goes through in the weeks following birth-now referred to as the fourth trimester.
The P.U.S.H. Revolution
I recently talked with Dr. Courtney Amerin, an ObGyn, and Katie Danielson, a Certified Nurse Midwife. They are a perfect team to help us understand the postpartum phase, including postpartum care and planning. Dr. Courtney and Katie teamed up to create The P.U.S.H. Revolution, where they provide expert advice and evidence-based information to empower parents in achieving understanding, support, and health in the postpartum period.
The “Fourth Trimester”
During the first few weeks of postpartum, called the “fourth trimester,” a person is recovering from childbirth, adjusting to changing hormones, and learning to feed and care for one’s newborn. This period can present considerable challenges, including lack of sleep, fatigue, pain, breastfeeding difficulties, stress, new onset or exacerbation of mental health disorders, lack of sexual desire, and urinary incontinence. Some may also need to navigate preexisting health and social issues, such as substance dependence, intimate partner violence, and other concerns.
What are some of the fourth trimester physical changes?
After one gives birth, they might be under the impression that they will immediately look like they are no longer pregnant and expect to see their waistline shrink back to what it was before pregnancy. However, the uterus, just like all the other parts of the body that changed to accommodate growing a baby, takes time to return back to its pre-pregnancy state.
The uterus is about the size of a fist before pregnancy and stretches to about the size of a watermelon at the end of pregnancy. It shrinks about 1 centimeter a day, and as this happens, no matter if one had a cesarean or vaginal delivery, it must release the additional blood and liquid that is inside. This process takes several weeks, and is often physically felt as contractions or cramps along the way.
Why is there a 6-week postpartum doctor appointment?
A comprehensive postpartum visit has typically been scheduled between 4 weeks and 6 weeks after delivery; a time that likely reflects cultural traditions of 40 days of convalescence for postpartum persons and their infants. Today, however, 23% of employed postpartum persons return to work within 10 days postpartum and an additional 22% return to work between 10 days and 40 days.
One should ideally have contact with an obstetrical care provider either in person or by phone within the first 3 weeks postpartum to address acute postpartum issues. This initial assessment should be followed up with ongoing care as needed, concluding with a comprehensive postpartum visit no later than 12 weeks after birth.
What is a comprehensive postpartum visit?
A comprehensive postpartum visit should include the following:
--a full assessment of physical, social, and psychological well-being: mood and emotional well-being
--infant care and feeding
--sexuality, contraception, and birth spacing
--sleep and fatigue
--physical recovery from birth
--chronic disease management
--health maintenance
The timing of the comprehensive postpartum visit should be individualized and patient-centered. A person giving birth can and should discuss with their obstetrical care provider before giving birth details of their “Postpartum Care Plan.” The postpartum care plan should be reviewed and updated after giving birth.
Who should you see for your postpartum care or concerns?
Before one leaves the hospital after delivery, it is suggested to have a care plan that includes the contact information and written instructions regarding the timing of follow-up postpartum care.
Just as a healthcare provider or health care practice leads care during pregnancy, a primary obstetrician–gynecologist or other health care provider should assume responsibility for postpartum care. This individual or practice is the primary point of contact for the postpartum patient, for other members of the postpartum care team, and for any health concerns noted by the infant’s health care provider.
When one is discharged from inpatient care, but prolonged infant hospitalization remote from the woman’s home is anticipated, a local obstetrician–gynecologist or other health care provider should be identified as a point of contact and an appropriate hand off should occur.
What is a postpartum care team?
The postpartum care team is Inclusive of family and friends who will provide social and support in the months following birth, as well as the medical provider(s), who will be primarily responsible for care of the person who has given birth and one’s infant after birth.
What are the special considerations for those who experienced pregnancy loss, stillbirth, or neonatal death?
For someone who has experienced a miscarriage, stillbirth, or neonatal death, it is essential to ensure follow-up with an obstetrician–gynecologist or other obstetrical care provider. Key elements of this visit include emotional support and bereavement counseling; referral, if appropriate, to counselors and support groups; review of any laboratory and pathology studies related to the loss; and counseling regarding recurrent risk and future pregnancy planning.
What are the special considerations for those who experienced pregnancy loss, stillbirth, or neonatal death?
For someone who has experienced a miscarriage, stillbirth, or neonatal death, it is essential to ensure follow-up with an obstetrician–gynecologist or other obstetrical care provider. Key elements of this visit include emotional support and bereavement counseling; referral, if appropriate, to counselors and support groups; review of any laboratory and pathology studies related to the loss; and counseling regarding recurrent risk and future pregnancy planning.
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Summary:
The postpartum period is essential to know about, understand, and prepare for. As an obstetrical care provider, I must educate my patients on this phase, and as patients, we must be proactive in preparing as best we can for it. Talk with your healthcare provider at some point during pregnancy about the expectations of the postpartum period. Also, write down any questions you have and bring them to your appointments. In addition, you can use the support and resources Dr. Courtney and Katie have available on their website!