Why Doctors Are Now Recommending 'Fourth Trimester' Checkups at 3 Weeks Postpartum as Opposed to 6
Dr. Alison Stuebe says that problems with breastfeeding and PPD "are more likely to get better if mothers get support in the first few weeks after birth"
New moms may want to think about scheduling their post-delivery checkups a bit earlier than they have in the past.
In a recently resurfaced set of guidelines published in May 2018, the American College of Obstetricians and Gynecologists is recommending “that all women” who give birth “have contact with their obstetrician–gynecologists or other obstetric care providers within the first 3 weeks postpartum.”
“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,” the ACOG says.
“The comprehensive postpartum visit should include a full assessment of physical, social and psychological well-being, including the following domains: mood and emotional well-being; infant care and feeding; sexuality, contraception and birth spacing; sleep and fatigue; physical recovery from birth; chronic disease management and health maintenance.”
In addition, the ACOG advises of this crucial “fourth trimester” period, “The timing of the comprehensive postpartum visit should be individualized and woman centered.”
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Parents.com spoke to one of the authors of the guidelines, Dr. Tamika Auguste, who said one of the goals of the advice was to “give providers a new structure for postpartum care, and will help them make the changes necessary to better serve women in the postpartum period and as they transition to well-woman care.”
As far as the reason behind them, a co-author, Dr. Alison Stuebe, said the new advice was “in response to the fact that maternal mortality is rising in the U.S., and women are more likely to die of pregnancy-related causes after the day of delivery than during pregnancy or birth.”
“We also know that problems like postpartum depression and breastfeeding difficulties are more likely to get better if mothers get support in the first few weeks after birth, rather than muddling through until six weeks postpartum,” Dr. Stuebe told Parents.com.
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Dr. Stuebe went on the highlight the longer “rest period” mothers used to have but is now often shortened as they return to work sooner, saying that the six-week postpartum appointment makes sense in that respect but doesn’t necessarily fit a new mom’s biological need.
“To survive, a human mom needs other helpers, what anthropologists call ‘allo-mothers,’ to assist her,” she told Parents.com. “When we had a 40-day period to nurture our babies surrounded by allo-mothers, it made sense to go out into the world at six weeks and see a healthcare provider. In modern life, we’ve jettisoned the 40 days of rest, and all that’s left is the six-week visit.”
“The U.S. has no national maternity leave like many other developed nations. This trickles down to the type of care one visit — women receive postpartum,” noted Dr. Auguste. “We must change the culture and that will take time, but these guidelines are a start.”