The Fourth Trimester
By Nancy Charlebois PT, LMT, co-owner of Jade Integrated Health
In the US, there continues to be positive growth in Women’s Healthcare, from fertility to menopause. An area that is coming to light is care for women in the immediate weeks postpartum. As we look around the globe, many cultures offer support and care that improves recovery and quality of life for new mothers. For example, in some European countries, women receive regular home visits from nurse-midwives while China and Mexico support a 30-40 day “lying in period” for recovery. France provides perineal re-education therapy to aid in recovery and to prevent pelvic problems that can arise as a result of childbirth. Any and all of these options could greatly improve the quality of care that exists here in our country.
Where to start? Why not start with regular, early postpartum medical care? Women being seen earlier and more frequently was recently highlighted in recommendations by The American College of Obstetrics and Gynecology. You can read about it in this NPR article or go straight to the ACOG source.
There are 2 immediate challenges to these recommendations. First, OB/GYN’s and nurse midwives are already in short supply, so there will be great difficulty logistically to schedule more postpartum appointments or phone calls. Secondly, reimbursement for pregnancy and postpartum care is bundled and not paid “per visit”. As a result, providers would have to absorb the cost of additional visits in the flat bundled rate.
So, how do we increase care in this system? In our culture, women rely heavily on their partners and, not uncommonly, do not have immediate or extended family close by that can fill the role that many other cultures provide to their new mothers. One solution is to fill the gap with additional medical providers that have specialty training and education in postpartum care. In-home visits by nurses, physical therapists, occupational therapists or clinical counselors could provide support. In-home providers can communicate potential concerns to the patients’ OB/GYN or midwife so they can recommend increased medical support as needed. With proper communication, patient follow up visits will be more productive, allowing more meaningful discussion of topics most relevant to the patient. New moms can leave feeling confident that their concerns are addressed, adding value to their visits.