True confession time. During my pregnancy, I purchased and read just about every book available on how to be prepared for a newborn. From The Happiest Baby on the Block to The Baby Whisperer to the official publications of the American Academy of Pediatrics, I read them all. What I didn't find were books on how to what to expect or how to take care of myself after the baby was born. And even as an Ob/Gyn, I was shocked at how ill prepared I was for the "4th trimester".
As discussed in Part 1 of this SFOTD, the entire focus of society and the medical profession during pregnancy is on a healthy baby - with very little attention paid to the real health risks women face before, during and after birth. Women are sent home typically 1-2 days after birth with a lot of information about breastfeeding, car seats and bathing their babies but little or no information about what to expect or how to care for their own bodies. Even more concerning, women are not told of serious potential complications or warning signs such as blood clots or elevated blood pressure. There is then no follow-up for the woman's health until the one standard postpartum visit at 6 weeks after birth (which 20-40% of women do not attend). Even the timing of this one visit makes no sense given the number of issues, including ovulation and need for contraception, that need to be addressed prior to 6 weeks.
The concept of the 4th trimester (the three months after birth) as a time when increased attention is warranted for women is starting to gain traction in the medical community. Researchers with The 4th Trimester Project at University of North Carolina, Chapel Hill have been following postpartum women for two years. Their goal is to identify ways to improve care in the 4th trimester through a series of studies focused on themes of mood and emotional wellbeing, infant care and feeding, birth spacing, sleep and fatigue, physical recovery from childbirth and medications, substances, exposures.
I hope the results of these studies ensure that women in the US will soon receive the support from the healthcare system that they need following birth. There are still MANY other barriers to optimal maternal health including poverty, lack of paid maternity leave, sick leave and childcare, pay inequity and gender norms that reinforce mothers as the primary caregivers regardless of how much they work outside the home. But better medical support in the first three months is a great start!
For more information on the problems with postnatal care in the US, check out this great article from Vox: What no one tells new moms about what childbirth can do to their bodies.