Earlier this year, Molly Hahn intentionally stayed in bed for two weeks.

She wasn’t ill. In fact, she had recently delivered a healthy third child at home and had been lifting weights throughout her pregnancy.

Hahn’s goal was to make sure she was nourished with healthy, warm food and plenty of rest for 45 days of personal healing. She was borrowing from a traditional Chinese belief that holds that nurturing the mother determines her future vitality, makes for a healthier baby, and strengthens the mother-child bond.

“In Chinese culture, they really don’t let postpartum moms do anything,” Hahn said. “My sister sort of drilled into my head how important this was.

“I am a hardcore researcher at heart, so you can believe if I’ve decided something, I’ve researched the heck out of it.”

Shifting Postpartum Values

More recently, there’s been a push to reform medical care so that women can more readily access resources and support to thrive in their transition from pregnancy to motherhood. It’s a departure from a bare-bones postpartum system emphasizing expedient recovery.

Postpartum care is becoming an issue of growing importance in the United States. In this country, two-thirds of maternal deaths occur during the postpartum period, according to the Commonwealth Fund, a nonprofit organization that calls for a better health care system.

Maternal death rates are rising in the United States, particularly among black and indigenous women, and are far higher than in other high-income countries. About 80 percent of these deaths are preventable. The Commonwealth Fund’s June 2024 report on the maternal mortality crisis found that compared to women in other countries it studied, American women were the least likely to have postpartum support, including home visits in the critical weeks following birth.

Valuing the ‘4th Trimester’

In other cultures, new moms and newborn babies are often unseen during the postpartum period—sometimes called the “fourth trimester”—because they stay in the house, Vivian Keeler, a chiropractor and certified doula with Amazing Births and Beyond, told The Epoch Times.

“Aunties,” a term of endearment for any close family member or even close friend, often stay with new moms to take over responsibilities like cooking, caring for other children, and cleaning the house. According to Keeler, this enables new moms to rest so they can heal and focus on breastfeeding and bonding while being well-nourished. Keeler is president of HypnoBirthing International, an organization helping women achieve more peaceful birthing experiences.

Such traditions are maintained by some cultural groups in the United States. But for most women here, the postpartum period is “devoid of formal or informal maternal support,” a group of health care workers wrote in an American Journal of Obstetrics and Gynecology editorial.

The authors called for changes in federal policy to improve fourth-trimester care, such as paid family leave. Postpartum mothers, they wrote, should have more opportunities to see health care professionals in the six weeks after delivery, and federal funding should support this.

Standard Care Lacking

In the days following birth, the average mother in the United States can expect little more from her health care provider than being told, “Congratulations. We'll see you in six weeks,” Keeler said. Those six-week checkups with obstetrician-gynecologist (OB-GYN) doctors then symbolize the end of pregnancy care. However, not all women will attend that appointment. Reported rates vary, but only 54 percent to 80 percent of new mothers have a postpartum visit.

Meanwhile, underlying medical problems—often first discovered during a woman’s prenatal appointments—can rapidly become acute emergencies or chronic medical issues, according to a 2024 review in Archives of Gynecology and Obstetrics.

Hypertension, or high blood pressure, is the most common medical issue in pregnancy. It is a risk factor for heart attack, stroke, and blood clots and complicates between 10 percent and 15 percent of pregnancies.

Urgent warning signs in the postpartum period include:

• A headache that persists or worsens
• Fainting and dizziness
• Changes in vision
• Trouble breathing
• Fever
• Chest pain or heart palpitations
• Pain, redness, and swelling in the legs
• Excessive vaginal bleeding or passing large clots
• Extreme swelling of the face or hands
• Overwhelming fatigue

The review noted that educating women about the value of postpartum appointments could help prevent the most common causes of death among new moms: stroke, heart disease, and cardiomyopathy.

Earlier Doctor Visits

The six-week examination could be too late. A study published in The American Journal of Obstetrics & Gynecology examined postpartum needs, particularly for low-income women. It noted they require the most physical and mental recovery in the weeks immediately following delivery. The Commonwealth Fund reports that 35 percent of maternal deaths occur within 42 days of delivery.

The American College of Obstetricians and Gynecologists now recommends that women are seen within three weeks of delivery for ongoing care that concludes with a comprehensive appointment assessing physical, social, and psychological well-being at 12 weeks postpartum.

Women who had medical issues or complications during pregnancy should receive additional counseling, the organization suggests, and insurance reimbursement policies should be updated to include care as “an ongoing process, rather than an isolated visit.”

However, research published in Women’s Health Issues shows that moms with a chronic condition and those on Medicaid are less likely to show up at postpartum appointments. Some of the reasons might be lack of transportation or child care, as well as poor communication about the importance of follow-up care.

Because moms might prioritize their baby’s well-child appointment over their own postpartum visit, a 2024 JAMA Network Open study found that using pediatrician offices as a screening opportunity for maternal health could be a viable alternative. Babies typically see their doctors three times within the first two months, at two days, two weeks, and two months of life.

Specifically, researchers found the following:

• More than 95 percent of mothers accompanied their babies to appointments.
• Screening women at pediatric visits improved diagnostic rates.
• Screening women at pediatric visits caught cases of hypertension related to pregnancy that would have otherwise been missed in postnatal clinics.
• The women who were treated as a result of these earlier screenings had better outcomes than those who were not screened.

Home Visits

Another option for preventing maternal death is to deliver care to women in their homes—a common practice in the 13 other countries examined in the Commonwealth Fund report.

These visits, made by a midwife or nurse, lead to better mental health and breastfeeding outcomes while reducing health care costs. “Midwifery-led care models have been shown to provide care that is comparable to, or sometimes even better than, that provided by obstetrician-gynecologists,” the report states.

It cited a 2021 study proposing that midwives, who can offer similar care as OB-GYNs, could provide 80 percent of maternal care worldwide and avert 41 percent of maternal deaths. In most countries, midwives actually outnumber OB-GYNs. In the United States, however, both are lacking; it’s estimated that half of all counties lack a single OB-GYN, and that it would take another 8,000 such specialists to meet demand.

But even when midwifery care is an option, American families face the added barrier of insurance coverage, which in many states does not cover midwifery services.

Hahn, who was able to hire a midwife and give birth at home, was visited two days after birth, as well as after one week, three weeks, and six weeks. She didn’t think she would need the appointments, but ended up appreciating that she could ask questions as they arose about back pain, bleeding, milk supply, healing, and her newborn.

“That was amazing, to be able to touch base that many times and be checked on that many times,” Hahn said. “You don’t get that care in the other model, which is really too bad, because moms need just as many checkups as the newborns do.”

Home visits are a component of New York City’s new pilot program, the maternal home collaborative, that aims to reduce pregnancy-related deaths among black women by 10 percent in six years.

Keeler said supporting moms at home is a missing piece of the solution—especially for those who might not have a family member or friend who will advocate for them, connect them with resources, and offer emotional support.

Self-Advocacy

According to Keeler, regardless of whether a woman has access to extended medical support, moms can take steps to set themselves up for success in the postpartum period. Her suggestions include:

• Eating warm foods, which are nourishing. Traditional Chinese medicine considers warm or hot foods vital to restoring balance to the body after blood loss, decreasing blood clots, and increasing breast milk production.
• Practicing “nesting,” or creating a comfortable space and setting up boundaries to tune out the rest of the world during the first several weeks.
• Seeking out bodywork, such as massage, acupuncture treatment, or chiropractic care that facilitates relaxation.
• Joining a support group, such as mom and baby classes or other community groups.
• Taking classes during pregnancy to learn about the postpartum period and breastfeeding.
• Making a postpartum plan that includes cooking and freezing meals, and telling your family and friends how they can best serve you during baby’s first few weeks.

“A lot of times, friends and families want to help, but they’ve forgotten what it’s like to have a newborn,” Keeler said. “Their idea of helping is coming over and hanging out, and it’s really not so helpful.

“Maybe make a list of things you need help with, and then say, ‘Pick two, and then you can hold the baby.’”