ACOG Redefines Postpartum Care

At first, the statistic could seem shocking: Over 50% of pregnancy-related deaths occur AFTER the birth of an infant (1)However, when you consider the massive toll placed on women during the postpartum period (recovering from physical trauma of labor, dealing with the 24/7 demands of an infant, suffering from raging hormones and severe sleep deprivation, and adjusting to a major life transition) combined with the current lack of any established postpartum care, suddenly the statistic becomes clear. Women are in an extremely delicate state following delivery — physically, mentally, and emotionally — yet to date, the primary focus once a baby is born, is on the baby.

Perhaps though….just perhaps….we are headed toward a major turning point. In a landmark opinion piece, the American College of Obstetricians and Gynecologists (ACOG) is recommending completely redefining the way we approach postpartum care.  While it’s just a recommendation at this point, it’s a very important first step.  Read on for the highlights, as well as actions YOU can take now to help give your postpartum clients the care they deserve.

What Postpartum “Care” Looks Like Today

We use the term “care'” loosely because after 1-2 days in the hospital (perhaps 2-3 for a C-section), women are handed their babies, told “good luck,” and basically sent off on their own to figure out how to heal their bodies, as they navigate the many new challenges of motherhood. While infants have a regimented series of frequent checkups, women are given one “postpartum checkup” 6-8 weeks after delivery, which typically lasts no more than 5-10 minutes. This is also the appointment where many women get cleared to exercise, but typically doctors do not even check for core injuries like Diastasis Recti or Pelvic Floor Dysfunction.  So, many women end up jumping back into exercise without knowledge of any critical rehabilitation work they may need to do first, and therefore end up doing further damage.

 

How ACOG Wants to Redefine Postpartum Care

In it’s published opinion piece from May 2018, ACOG recognizes the importance of consistent and comprehensive care for women during the critical “fourth trimester” (the 12 weeks following delivery), emphasizing that “postpartum care should be an on-going process, rather than a single encounter.”  Some of the key recommendations made are:

  • Anticipatory guidance should begin during pregnancy with the development of a postpartum care plan that addresses the transition to parenthood and well-woman care.
  • Women should have contact with a maternal care provider within the first 3 weeks postpartum
  • This initial assessment should be followed up with on-going care as needed, concluding with a comprehensive postpartum visit no later than 12 weeks after birth
  • This comprehensive visit should include a full assessment of physical, social, and psychological well-being
  • Services and support should be tailored to each individual woman’s needs.
  • Women with chronic medical conditions, or those who experienced pregnancy or birth complications, miscarriages, or stillbirths should be given extensive care and appropriate support tailored to their specific needs

As mentioned, these are just recommendations, and implementing them will require policy changes.  However, there are things you can do in the interim to give your clients the care they deserve.

What YOU can do to help your clients

In the absence of standard policies, you can play an integral role in supporting your clients’ recovery. You may even find you become her key go-to person when it comes to caring for herself. The payoff is huge. She experiences a faster and more effective recovery, and you build a loyal client and strong advocate:

  • Establish a referral network. This should include women’s health physical therapists, postpartum doulas, lactation consultants, baby nurses, and psychologists. Constantly check in with your client, and facilitate connections when needed.  You’ll find these partners can become great referral sources for you as well.
  • Begin educating your clients during pregnancy. Conversations about postpartum care should begin during the third trimester of pregnancy, and should include gentle core recovery education like 360 Breathing, gentle pelvic floor activationspostural awareness, self-care (hydration, nutrition, daily walks, etc), and a general discussion about her post-birth support network.  It’s also good to make sure she is aware of postpartum depression and baby blues, and understands the symptoms of each.
  • Encourage your clients to ask their doctors for a 3 week postpartum visit: Many doctors are actually fine doing this!  This does not replace the later postpartum check-up, but gives an earlier check-point to make sure healing is happening as needed.  In some cases where a woman had an uncomplicated birth, she may actually be cleared to resume exercise at this early visit (just recognize this does NOT mean traditional exercise!).
  • Start back SLOWLY. Remember, her body has been through 9 months of massive stress, followed by the extreme physical trauma of labor, and she’s likely coming to you de-conditioned and exhausted.  Your top priorities in the beginning should be core rehabilitation and providing a psychological benefit (you want this to be something she truly enjoys and looks forward to).  Before beginning, you should always check (or ensure your client gets checked) for Diastasis Recti and Pelvic Floor Dysfunction, as these may require her to begin with physical therapy first.
  • Remember SHE is your priority, not her baby. After a baby is born, all the focus turns to the baby.  Women often feel like slaves to their little ones, and can easily forget to focus on themselves. Make it clear that SHE is your priority, and you are here to support her every step of the way.

By focusing on these tips, you can have a huge impact on her physical and mental recovery, and as a side effect, have a loyal client and strong advocate for you.  The postpartum period is exciting, but daunting — and often quite difficult.  It’s impossible to cover it in one post!  To learn more about proper care during the postpartum period, sign up for one of our upcoming live certification workshops.  Or contact us to inquire about hosting a workshop at your facility.