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POSTPARTUM CARE IN UNITED STATES, ARE WE THERE YET?
The arrival of a new baby is a beginning of all things, it holds the dream of so many possibilities. It signals the end of the long and grueling phase of pregnancy and the ushers in the fourth trimester commonly referred to as the postpartum period. This period of postpartum serves as the foundation for long term health and wellbeing of both mother and infant. It is period of joy, anxiety, excitement and it can be very challenging and tiresome on both. During the postpartum period, the new mother is adapting to so many physical and hormonal changes which include but not limited to lack of sleep, fatigue, breastfeeding struggles as well as lack of sexual desire and at the same time she is learning understand her new bundle of joy. Unfortunately, women in the United States are not getting the needed attention when it comes to these maternal health needs as more than half pregnancy related death occurs after childbirth (Kassebaum et al). In other for united states to meet the standards of other developed countries in terms of postpartum care, changes must be made to the existing policies related to maternal health.
The process of child birth transforms a woman’s life forever. Yet, the healthcare system does not adequately prepare women for the immediate maternal consequences of post-delivery (Kline et al). New mothers for the most part can describe the significant physical and emotional challenges including stress, and poor body image, but still they feel overwhelmed and not equipped to manage these changes. They sometimes struggle with common side effect of childbirth because they are scared and really don’t know how these changes will affect their daily activities and whether they can take care of their newborn. They believe that their doctors didn’t educate them well about these common symptoms but doctors on the other hand thinks they try their best to educate expecting mothers about all the consequences of childbirth, but they lack the time and training to cover the psychological issues. This shouldn’t be so as study has shown that when patient receive a message of empathy, kindness and support that lasted 4: seconds their anxiety was measurable reduced (Ritchie). Also, studies have shown that a short training in a neuroscience of empathy makes doctor interact with patients in ways patients rated as more empathetic (Ritchie). Doctors need to understand that each woman is unique in her needs and expectations. Therefore, they should be emphatic to every woman concern about any issues she feels is not right regardless of its normalcy because differing priorities between doctors and new mothers often leads to inadequacy in postpartum care.
During pregnancy, the expecting mother is seen very often by her health practitioner, paying close attention to the wellbeing of the growing fetus but after childbirth the focus of care is shifted to the baby as the new mother don’t get to see a doctor until 6weeks postpartum. This practice of a single postpartum makes women feel abandoned by the absence of maternal care during the early postpartum period, they feel that waiting that long might lead to complication and doctors also feel they might miss important aspect of the mother’s health (Anika et al). Also, for many women the six-week postpartum visit punctuates a period devoid of formal or informal maternal support (Stuebe et al). In contrast other developed countries like Netherlands, have a continuous one-week home care program covered by insurance for normal birth provided by kraamerverzorgsters, this postpartum home care includes care for children and mothers and housework services (De Vries et al). This process of treating a postpartum visit as a single visit and as an all clear signal is detrimental to both the new mother and child, therefore, more focus should be place on the new mother during those early periods following delivery, as substantial morbidity occurs after delivery (Stuebe et al).
Currently, as many as 40% of women do not attend a postpartum visit (Stuebe et al). And for many women, particularly low income and minority women, discharge from the hospital signals an immediate disengagement with health services (Decelercq et al), compared to France where postpartum nurses are mandated to do regular in – home visits. These lack of engagement by postpartum mothers are due to the maternity leave policies in the United states. Currently there is no paid maternity leave, as of today 23% of employed women return to work within ten days postpartum and an additional 22% return to work between 10days and 40 days (Klerman et el). Therefore, most women miss their postpartum visit because it collides with their work schedule and they can’t afford to miss work because of their financial situation. Inadequate parental leave might also be a burden on families with fewer resources as studies have shown that women with high education and high paying jobs have more access to flexible maternity leave than low income women. Access to paid leave should be available to all women regardless of their type of job and level of education. In Sweden, new parents can take at most 1 year leave at 80% of their salary (De Vries et al), whereas United States only have a six to twelve weeks leave program. Parental leave helps improve the health of both mother and infant and help the new mother bond with her baby at the same time recover from the physical toil of carrying and birthing a baby.
Insurance Reimbursement policies in the United State also contribute to the level of postpartum care been given to women. It can either facilitate or hinder the quality of care also. Currently insurance companies only allow for only one postpartum visit, it also restrict the placement of contraceptive immediately after delivery. This inability of accessing birth control immediately after birth or at the point of discharge can also lead to cases of repeated pregnancy which can have an adverse effect on the woman’s health as it is advised to avoid interpregnancy intervals shorter than 6months.
Optimal postpartum care provides an opportunity to promote the overall health and wellbeing of women and its importance can’t be overemphasized. Policies regarding maternal health needs to be realigned in other to support the transition from prenatal to postpartum and eventually to well-woman care, increase engagement among postpartum women by making available a good paid maternal leave and insurance policies should be redesigned so as to cover postpartum visit for at-least a year and also make contraceptives readily available to postpartum women.
- Declercq ER, Sakala C, Corry MP, Applebaum S, Herrlich A. Major Survey Findings of Listening to Mothers III: New Mothers Speak Out: Report of National Surveys of Women’s Childbearing Experiences Conducted October-December 2012 and January-April 2013. J Perinat Educ. 2014;23(1):17-24. doi:10.1891/1058-1243.23.1.17.
- Kassebaum NJ, Barber RM, Dandona L, et al. Global, regional, and national levels of maternal mortality, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016;388(10053):1775-1812. doi:10.1016/S0140- 6736(16)31470-2.
- American College of Obstetricians and Gynecologists. Committee Opinion No. 666. Optimizing Postpartum Care. Obstet Gynecol. 2016;127(666):e187-e192. doi:10.1097/ AOG.0000000000001481.
- Kassebaum NJ, Bertozzi-Villa A, Coggeshall MS, Shackelford KA, Steiner C, Heuton KR, et al. Global, regional, and national levels and causes of maternal mortality during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013 [published erratum appears in Lancet 2014;384:956]. Lancet 2014;384:980–1004. ⇦
- L. Carol Ritchie . Does Taking Time For Compassion Make Doctors Better At Their Jobs?
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- Anika Martin, Carol Horowitz, Amy Balbierz, and Elizabeth A. Howell Matern Child Health J. Author manuscript; available in PMC 2015 Jan 23 .Published in final edited form as: Matern Child Health J. 2014 Apr; 18(3): 707–713.
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