Reforming Maternal Care Could Avoid Postpartum Crisis

Earlier this year, Molly Hahn remained purposefully in her bed for two weeks.

She wasn’t ill. In fact, she was lifting weights one day—a week and a half past her due date—and delivering her third child at home the next. A personal trainer and active mom with a 4-year-old and 2-year-old, she ceased all activity immediately when the new baby was born.

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 a Chinese philosophy that a well-nurtured mother makes for a healthier mom and baby. Specifically, she was aiming for 15 days in bed, 15 days on the bed, and 15 days near the bed.

“We figured it out with my husband’s schedule, and I could literally live in my bedroom in the bed with the baby,” she told The Epoch Times. “I put so much effort into resting those two weeks that it really paid off long-term. It was the best postpartum I had.”

After 15 days, she did as much sitting as she could for 15 more days and then spent 15 additional days at home before transitioning into a more “normal” life. The idea, Hahn said, came from her sister who is an acupuncturist trained in traditional Chinese medicine.

“In Chinese culture, they really don’t let postpartum moms do anything. My sister sort of drilled in my head how important this was,” Hahn said. “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 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 barebones postpartum system emphasizing expedient birthing recovery.

Postpartum care is becoming an issue of growing importance in the United States, where two-thirds of maternal deaths occur during the postpartum period, according to the Commonwealth Fund, a nonprofit organization that calls for a more high-quality 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 with other countries it studied, American women are the least likely to have postpartum support, including home visits in the critical weeks following birth.

Valuing the ‘Fourth Trimester’

New moms and newborn babies are often unseen during the postpartum period—sometimes called the “fourth trimester”—in other cultures 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. The purpose is for new moms to rest so they can heal and focus on breastfeeding and bonding while being well-nourished, according to Keeler, who 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 calling for profound federal improvements to fourth-trimester care.

Changes should prioritize those most at risk and provide more opportunities to see health care professionals starting sooner after delivery, they said.

Standard Care Lacking

Standard postpartum care in the United States is little more than a health care provider saying to a new mom after a baby’s birth, “Congratulations. We’ll see you in six weeks,” Keeler said.

Six-week checkups with obstetrician-gynecologist (ob-gyn) doctors symbolize the end of pregnancy care. However, not all women attend this appointment. Reported rates vary, but anywhere from 54 percent to 80 percent 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 the 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 are:

• 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 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 examining postpartum needs, particularly for low-income women, noted they require the most physical and mental recovery in the immediate weeks following delivery. The Commonwealth 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 suggested, 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 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 that:

• More than 95 percent of mothers accompanied their babies to appointments, making it feasible.
• 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 in the Commonwealth report.

These visits, 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, or ob-gyns,” the report said.

Midwives, who are medical professionals who can offer similar care as obstetricians, could provide 80 percent of maternal care worldwide and avert 41 percent of maternal deaths, the report went on to say. In most countries, midwives outnumber ob-gyns, but in the United States, health care coverage doesn’t always extend to midwives. There’s a lack of ob-gyns—about 8,000 more are needed—as well as midwives.

Hahn, who hired a midwife and gave birth at home, was visited two days after birth, as well as 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’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

Regardless of whether a woman has access to extended medical support, Keeler said moms can take steps to set themselves up for success in the postpartum period. Among her suggestions:

• Eat warm foods, which are nourishing. Traditional Chinese medicine considers warm or hot foods to be capable of restoring balance after blood loss, decreasing blood clots, and increasing breast milk production.
• Practice nesting—Create a comfortable space and set up boundaries to tune out the rest of the world during the first several weeks.
• Consider bodywork—Arrange for massage, acupuncture, or chiropractic care that facilitates relaxation.
• Join a support group—Find mom and baby classes or community groups.
• Make a postpartum plan—Take classes during pregnancy to learn about the postpartum period and breastfeeding, cook and freeze meals, and tell 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. Their idea of helping is coming over and hanging out and it’s really not so helpful,” Keeler said. “Maybe make a list of things you need help with, and then say, ‘Pick two, and then you can hold the baby.’”