New Fourth Trimester Guidelines Highlight the Need for Follow-up Care

Last year the American College of Obstetricians and Gynecologists (ACOG) released new recommendations for obstetricians during the immediate postpartum period—what is referred to as the fourth trimester. The new guidelines suggest that post-natal appointments are set as early as three weeks or sooner after birth for those with certain risk factors. This is a change from the previous trend of continuation of care at six weeks postpartum. They also recommended more comprehensive screenings for new moms after delivery, to guarantee they are getting the emotional and physical care they truly require and deserve.

The following statistics cited in the American College of Obstetricians and Gynecologists’ Presidential Task Force on Redefining the Postpartum Visit support the need to evaluate patients earlier rather than later. It helped define the revised recommendations for increased and earlier engagement for moms after birth.

• More than half of pregnancy related maternal deaths occur after the birth of the infant
• More than half of postpartum strokes occur within 10 days of discharge from the hospital
• 20% of new moms discontinued breastfeeding by six weeks postpartum
• 55% of new moms return to work within 40 days postpartum

The task force also reported that more than 40 percent of new moms do not attend a postpartum visit at all. This is concerning for both mom and newborn, as many health concerns like mood changes, birth recovery and feeding issues can be addressed and resolved during this initial appointment. Caring for herself early (physically and mentally) can allow mom more time to focus on baby.

With a new baby at home it’s hard to get out the door for an appointment, but knowing what to expect can help the appointment feel uncomplicated. A comprehensive follow-up appointment is often individualized and is based on the patient’s needs, risk, lifestyle factors and birth experience, but the following social, psychological and physical needs should be covered.

• Physical recovery from birth: Whether mom has had a vaginal or C-section delivery we do appropriate checks of the breast, abdomen and pelvis to ensure recovery is going well. We also talk about resolving any concerns like incontinence, unexpected pain or any discomforts she is having.
• Emotional well-being: All new moms will feel tired and overwhelmed at some point, but we always check to ensure mom is feeling safe at home, is not exhibiting symptoms of depression or anxiety and is receiving support from family and friends. We also check on any previous mental conditions and ensure she is being attended to by a mental care team, if appropriate.
• Infant care and feeding: We cover baby’s health and pediatric visit, as well as feeding methods and future feeding plans. We can refer the patient to lactation counseling, if appropriate.
• Sexuality and contraception: We cover family planning, birth spacing and contraceptive options. We can even schedule the patient for Intra-Uterine Contraception, Nexplanon or provide the partner with a vasectomy referral.
• Health management: From chronic diseases to new post-partum concerns, we discuss and assess her continuing health and offer options for follow-up care. We also ensure both mom and caregivers are fully immunized and have ongoing well visits. Smoking cessation is also always encouraged.

Picking the right provider can go a long way in keeping mom healthy and guaranteeing the fourth trimester goes smoothly. Many obstetric offices, like ours, have always had their own processes in place to prepare new moms for the postpartum period and to confirm all patients receive comprehensive aftercare; after all, preparation for this period is as important as the follow-up appointment. However, it is important that this information is widely distributed so that all moms (first time and repeat moms) receive and seek timely and first-rate pregnancy and post-natal care.

Khadijah Jordan, M.D., F.A.C.O.G., F.A.C.S. is a board-certified obstetrician/gynecologist. Dr. Jordan obtained her medical degree from Morehouse School of Medicine with clinical rotations at Emory University School of Medicine, both in Atlanta, GA. She completed a medical internship followed by a residency in Obstetrics and Gynecology at Harbor Hospital Center in Baltimore, MD., with training at Johns Hopkins Hospital and the University of Maryland Medical Center. In addition to becoming a Fellow of the American Congress of Obstetricians & Gynecologists, she has also met all requirements to become a Fellow of the American College of Surgeons. She was the first woman Department Chairman of OBGYN @ CRMC and served as President of the Chesapeake Medical Society.