Improving Care in the ‘Fourth Trimester’

New guidelines aim to redesign and improve postpartum maternal care


In the United States, more than 700 women die each year from pregnancy- and childbirth-related complications, such as hemorrhage and postpartum depression. 50,000 more suffer from life-threatening complications, and the mortality rate for black mothers is three to four times that of white mothers.

In a recent report, the American College of Obstetrics and Gynecology attributes these numbers, in part, to the absence of “formal or informal maternal support” in the postpartum period. In contrast to the prenatal period, where pregnant women might see their provider 12 or more times, many insurers cover only one postpartum visit, which might not happen until a month or more after delivery.

New guidelines from ACOG seek to improve maternal health in the “fourth trimester,” recommending a more proactive approach to postpartum care, including:

  • Formal patient education about pregnancy-associated risks
  • Helping patients establish a social and community support network
  • Earlier, more frequent post-partum visits that address the range of physical, mental, and emotional issues new mothers might be facing

ACOG also hopes to work with insurers and health systems to help secure coverage for multiple postpartum visits and ensure that bundled pregnancy care models don’t create disincentives for providers.

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