ACOG's Committee Opinion: Mothers Need Postpartum Care

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The American College of Obstetricians and Gynecologists (ACOG), the body of OBGYNs that sets the standards for US maternity care, issued a new committee opinion statement earlier this month on "Optimizing Postpartum Care" for mothers. This is what they decided:

"To optimize the health of women and infants, postpartum care should become an ongoing process, rather than a single encounter, with services and support tailored to each woman’s individual needs."

Currently, women who work only with an obstetrician during their pregnancy have one single postpartum visit after they are discharged from the hospital - at 6 weeks. It appears that ACOG has finally figured out that mothers need to be cared for after the birth too - that one visit at 6 weeks postpartum isn't enough.  It's simultaneously depressing and infuriating that ACOG has released this statement like it's actually news. 

In the 5 week and approximately 5 day interim after a new mother leaves the hospital and before she is seen again at the doctor's office, an abundance of physical changes occur:

  • Vaginal bleeding slows and eventually ceases
  • The uterus returns to its non-pregnant size
  • Breastmilk production begins
  • Breastfeeding is established 
  • Pregnancy hormones drop rapidly and return to non-pregnant levels
  • The muscles and mucosa of the vagina and pelvic floor heal, including any tears or damage caused by the birth
  • The abdominal muscles, which may have separated during the pregnancy, begin to come back together
  • Sexual intercourse may resume

These physical changes are coupled with enormous psychological and emotional shifts. A new baby means the complete disruption of the family's previous way of life. Sleep is greatly reduced. Daily tasks that were simple become difficult and time-consuming. And a mother's (and father's) sense of identity shifts dramatically and irrevocably. All of these changes come with associated risks, where the normal course of things can get off track. The consequences can be devastating if these deviations from normal are not noticed and handled in a timely way:

  • Late postpartum hemorrhage 
  • Uterine or other infection leading to sepsis, causing grave illness or death
  • Anemia
  • Low milk supply
  • Painful breasts and nipples
  • Cessation of breastfeeding due to lack of support
  • Postpartum depression and psychosis
  • Suicide or infanticide
  • Preeclampsia
  • Pelvic floor dysfunction causing urinary incontinence, fecal incontinence, and pain
  • Incomplete or improper healing of the vaginal tissues, causing pain and dysfunction
  • Painful sexual intercourse
  • Diastasis of the abdominal muscles

How many of you have friends who are mothers, or have yourselves, suffered from one of these complications after giving birth? I know many.

And this list is not exhaustive. Giving birth is a complex process, for both the mother and the baby. Why would anyone who knows anything about childbirth believe that a mother doesn't need support from her care provider in the 6 weeks after giving birth to her baby?

That ACOG is only now coming to the conclusion that mothers need ongoing postpartum care, despite decades (centuries, millennia) of evidence, can only lead us to one conclusion: the US maternity care system is yet another way in which our society undermines and silences women. And even more so for women of color.

If you need more evidence that this is true, allow me to point you to a tweet that sent ripples of disbelief across social media a few weeks ago:

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This proud tweet is from a presentation given at the ACOG 2018 Annual Clinical and Scientific Meeting, and suggests that "using condoms to prevent pregnancy [is] ACOG's best advice for reducing the maternal mortality rate that is on the rise in the USA."

Sarita Bennett, Vice President of the Midwives Alliance of North America, summed it up well: "As the only industrialized country to hold the dubious honor of having the most expensive system of maternity care while its outcomes are worsening, the profession who presides over the vast majority of those births [ACOG] seems to think that a cartoon condom holds the answers. Given that these statistics are three times worse for women of color, the sentiment takes on a racist tone to add to the misogynist attitude that is at the heart of the power dynamic identified as a leading contributor to obstetric violence." 

Postpartum care is one of the (many) areas where the midwifery model of care excels beyond the obstetric model. We see our clients five times postpartum, three of those being in the first week after the birth. At every visit, we evaluate and support the wellbeing of both the baby AND the mother. We look at physical recovery and healing, as well as signs that the mother is or isn't coping well emotionally. We support breastfeeding, help with achieving a good latch, evaluate the mother's milk supply, diet and nutrition, and make sure she is getting adequate rest so that her body can heal. That is midwifery care. That is GOOD care for mothers.

It is hard to express how difficult it is to see ACOG and its member physicians slam licensed midwives and home birth on a regular basis and then come out with some asinine statement like this one. It makes me sad for families in the United States because so many do not know, and do not understand, how political and capitalist our maternity care system is. The knowledge gap between consumer and provider is cavernous. Families are caught in the web, thinking they are receiving the best care, and making the best choices for themselves and their babies, when so much of current practice is deeply influenced by money, politics, powerful trade organizations, smear campaigns, and outdated clinical practice.

So yes, ACOG, we should check on the mother more than once after she and her body undergo a deeply transformative physical and psychological process. Thanks for letting us know.

Read the full ACOG Committee Opinion here.