UTSW
By Jamie Morgan, M.D. Obstetrics and Gynecology
The postpartum period, or what we refer to as the fourth trimester of pregnancy, can be challenging – physically and emotionally. Your body is healing from childbirth and trying to return to its pre-pregnancy state. Meanwhile, you’re adjusting to life with a newborn.
Traditionally, women who give birth have had only one postpartum care visit with their Ob/Gyn, and up to 40% of new moms do not even have that. However, the postpartum period carries potential health risks – one-third of pregnancy-related deaths in the U.S. occur between one week and one year after delivery.
My colleagues at UT Southwestern, along with Ob/Gyn teams across the country, are working to change the traditional approach to postpartum care by reimagining it as a bridge for patients to transition from pregnancy to well-woman care, setting them up for better long-term health.
As part of this effort, I was proud to co-author a recent article in the American Journal of Obstetrics & Gynecology (AJOG) that recommends a postpartum visit checklist for patients after normal and complex pregnancies.
While the AJOG article is geared toward providers, it’s equally important for women to know what to discuss with their providers during postpartum visits to make educated healthcare decisions. Here are three essential talking points.
1. Referrals for ongoing health care
A PCP can help you manage preexisting conditions, such as high blood pressure or diabetes, and improve your overall health. Ideally, patients will have a primary care provider (PCP) before pregnancy who they can keep seeing after the postpartum period. If you don’t have a PCP or want a new one, your Ob/Gyn can connect you.
Certain conditions that develop during pregnancy and may warrant additional testing or follow-up with your Ob/Gyn or other health care providers include:
- High blood pressure: New moms who had hypertension during pregnancy (preeclampsia) are at increased risk for postpartum complications, including stroke. You should have your blood pressure checked by your Ob/Gyn 7-10 days after delivery. If you had severe hypertension or preeclampsia, we’ll want to check your blood pressure within 72 hours of giving birth. If high blood pressure persists beyond the postpartum period or if you still require blood pressure medications more than 6 weeks after delivery, your Ob/Gyn may want to refer you to a PCP for further management.
- Mood disorders: Patients who had depression or anxiety during pregnancy are more likely to develop postpartum depression, which affects 10-15% of new moms. If you had mood symptoms, particularly if you were hospitalized during pregnancy, you may benefit from more frequent postpartum mental health assessments or a referral to a psychologist.
- Gestational diabetes: If you had gestational diabetes, you’ll need another glucose screening 4-12 weeks after delivery to see whether your blood sugar levels are returning to normal or if you need treatment. Having gestational diabetes increases your risk of developing Type 2 diabetes later in life. Given the increased risk of future diabetes, your Ob/Gyn may recommend that you follow up regularly with a primary care provider in the future, especially if you don’t already have one.
2.Counseling for future heart health
Some conditions that develop during pregnancy can act as a predictor of future cardiovascular health. Women who deliver before 37 weeks, experience fetal growth restriction, or develop gestational diabetes or preeclampsia, have a higher risk of developing heart disease later in life.
If you have one of these complications, we may refer you to a cardiologist to discuss your long-term heart health and reduce risks. The goal is to begin risk assessment and counseling immediately after giving birth and continue it throughout your life.
Patients with preexisting heart conditions such as pulmonary hypertension, congenital heart disease, valve disease, or peripartum cardiomyopathy need close monitoring of their heart in the days and weeks after giving birth. You should have an appointment 7-14 days after delivery and subsequent visits for at least three months to help identify potential complications early.
3. Future pre-pregnancy counseling
It may seem odd to discuss a potential future pregnancy when you’ve just given birth, but there actually is no better time. Women can begin ovulating as early as three weeks after giving birth, and it is possible to get pregnant while breastfeeding.
Prior to delivery, we recommend talking with your doctor about the type of birth control you’d like to use after delivery. And at your postpartum visits, discuss whether you feel comfortable and confident using it.
Pregnancies that begin shortly after delivery are at an increased risk of preterm birth, low birthweight, and postpartum depression. Kaiser Family Foundation estimates that proactive contraceptive use can prevent approximately one-third of maternal deaths worldwide.
We advise women who want another baby to talk with their doctor before becoming pregnant to address underlying health problems and discuss steps to increase the risk a successful outcome. Pre-pregnancy counseling is especially important if you have a chronic health condition or have experienced pregnancy-related complications in the past.
Depending on your health history, your doctor may suggest specific interventions. Patients at high risk of preeclampsia, for example, may benefit from taking low-dose aspirin during pregnancy. Or we may recommend diet changes, an exercise plan, or quitting smoking to reduce cardiovascular risk. We also can discuss any medications you are taking and whether we need to adjust the type or dose during pregnancy.
Signs to call the doctor right away
No matter when your postpartum appointment is scheduled, if certain symptoms arise or something just doesn’t feel right, call your OB/Gyn. Signs of an emergency can include:
- Dizziness
- Excessive fatigue
- Extreme sadness or mood swings
- Headaches
- Thoughts of harming yourself or your baby
- Sharp, persistent, or intense abdominal pain, particularly after a cesarean section delivery (C-section)
- Vaginal bleeding that lasts longer than two weeks or contains clots larger than a golf ball
Ask your doctor questions about any postpartum symptoms, even if they seem trivial. Issues such as urinary incontinence or an abdominal bulge known as diastasis recti are common, but they are not “normal” and they can be treated.
The days, weeks, and months after having a baby can be filled with joy and stress. Even if your pregnancy was ideal and you aren’t experiencing any unusual symptoms after giving birth, postpartum care is still vital for your health, and it shouldn’t be a one-size-fits-all appointment.
Instead, postpartum care should be viewed as ongoing process to help you reset your health and live your healthiest life.
To schedule a visit with a primary care doctor or Ob/Gyn, call 214-645-8300 or request an appointment online.
