Maternal health matters after birth. We need ‘fourth trimester’ care | Perspective

Pregnancy should be a joyous occasion. Yet the experience of pregnancy for a woman can be wrought with great concern for herself, and for her growing fetus. Since childbirth is when the frequent maternity care and appointments end, health-care professionals and women alike have rising concern about what happens to women during the postpartum period.

This is a story of my first pregnancy. It is also a call to action for additional increased assessments of women during the postpartum period.

As a first-generation college student, I’d earned a Ph.D. in nursing science, married a wonderful man, and was on the cusp of a budding career. I’d done it: I’d accomplished the American Dream.

Then I learned I was pregnant. What lay ahead was the wonderfully transformative and empowering journey of motherhood – as well as the alarming disappointment of navigating U.S. health care.

Traversing the health-care system should have been a cinch. I am a Ph.D.-prepared nurse, with knowledge about disparities in care. I was also diagnosed with multiple sclerosis 15 years ago, so I have years of experience in navigating the system. My expectations of care and the reality of the care I received were grossly incongruent, because of the current policies that shape how and when women receive postpartum care.

After my child was conceived, I received nine months of meticulous prenatal care. During this time, I felt special and appreciated as a woman. After my son was born, we received round-the-clock care in the hospital.

Then we were discharged. Discharge marked the end of meticulous care for me.

Swollen legs, extreme abdominal cramps, high blood pressure, limited access to care, and unanswered questions colored my postpartum experience. I did not feel special anymore. I felt confused, abandoned, and scared. All the meticulous care once lavished on me had disappeared. Now, I was fearful of a deep vein thrombosis and possible postpartum onset of preeclampsia.

Anxious for help, I called my obstetrician’s office several times to schedule an appointment, but was denied, because I did not have signs and symptoms of a uterine hemorrhage. Instead, I was told to go to the emergency room. I live with multiple sclerosis, had given birth less than a week prior, and wanted to be seen by someone who knew me. But I was also desperate. So I went to the emergency room, where I finally received the care I so badly needed.

After several diagnostic tests, I was diagnosed with a urinary tract infection and received antibiotics. I went home relieved but frustrated. I’d received the attention that I needed and deserved, but I had been essentially ignored by my obstetrician’s office.

My experience is not rare, particularly among black women. Today, 18 in 1,000 who give birth in the United States die due to a pregnancy-related issue. Pregnancy-related death among black women is 3.2 and 2.2 times higher than among white women and women of other races, respectively. As a black woman with a chronic illness who was experiencing abnormally high blood pressure and an undiagnosed urinary tract infection resulting in extreme pain, I had plenty of cause for concern.

The assessment of pregnant women is a regular occurrence. Postpartum care is less frequent than prenatal care. Women with uncomplicated pregnancies are assessed approximately six weeks after birth. That single assessment marks the beginning and end of their outpatient postpartum care.

Perhaps, as nursing professor Tiffany M. Montgomery (then at Widener University) and I argue in this month’s Nursing for Women’s Health journal, it is time to view the first six weeks of the postpartum period in the same manner as the prenatal period. To decrease complications in the early postpartum period, the American College of Obstetricians and Gynecologists recommends that care in the fourth trimester include:

1. Regular ongoing care, instead of the traditional single postpartum visit.

2. Care that is individually tailored for each woman.

3. First postpartum visit within three, not six, weeks of birth.

4. A final comprehensive postpartum visit no more than 12 weeks after birth.

Women should know they are not alone in their postpartum recovery. They should know that maternity health-care providers are just as committed to women’s healthy postpartum recoveries as they are to women’s healthy pregnancies and healthy deliveries. For the sake of social justice, and decreasing the significant racial disparities in maternal mortality and morbidity, health providers must realize the importance of fourth-trimester care.

Esther Laury, Ph.D., R.N., is an assistant professor at Villanova University.