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EQUAL VALUE

New US guidelines aim to change the sorry state of medical care for new moms

Annabelle Timsit
By Annabelle Timsit

Geopolitics reporter

Babies are most vulnerable during their first month of life—and so it makes sense that newborns are carefully monitored by doctors and other health-care providers. But in the US, too often, that comes at the expense of the health of new moms, who are also at risk during the weeks after giving birth.

That’s why the American College of Obstetricians and Gynecologists is recommending sweeping new guidelines that aim to ensure that the medical system in the US cares for new mothers to the same extent it does for their newborns. In a committee opinion released by the organization this week, and endorsed by a slew of medical associations, the organization advocates for a wide range of changes. “Postpartum care should become an ongoing process, rather than a single encounter, with services and support tailored to each woman’s individual needs,” the committee writes.

The committee’s recommendations include:

  • Developing a plan for postpartum care before a woman gives birth, which addresses the transition to parenthood as well as whether the woman has any plans for future pregnancies
  • Ensuring that all women visit a maternal care provider within three weeks after giving birth, followed by ongoing care as needed
  • A comprehensive, individualized postpartum visit no later than 12 weeks after giving birth that addresses the mother’s psychological and social well-being as well as her physical health
  • Giving more specific post-natal care and guidance to new moms whose pregnancies were complicated by preterm birth, gestational diabetes, or hypertensive disorders
  • Guaranteeing medical follow-up with women who have experienced a miscarriage, stillbirth, or neonatal death
  • Providing the financial backing for these new guidelines with insurance reimbursement policies that support postpartum care as an ongoing process, rather than an isolated visit

These guidelines are informed by the current deficiencies in US post-natal care. There’s a major disparity between the medical care pregnant women receive and the care given to new moms. As NPR notes, a pregnant woman sees her doctor a dozen or more times during the pre-natal period, and the visits get more frequent as her due date approaches. But after giving birth, she typically waits another four to six weeks to have a follow-up appointment with her doctor. In many cases, her insurance will only cover that one visit.

A lot can happen during those four to six weeks. Typical symptoms of what is known as “the fourth trimester“—which spans the 12 weeks following delivery—include heavy bleeding, night sweats, headaches, decreased libido, depression, and anxiety. A new mom also has to recover from childbirth, learn to feed and care for her newborn, and adapt to a completely different lifestyle than the one she had before. While the support of family and friends certainly helps, she needs professional guidance and care from her medical practitioner during this time—and the average American mom just doesn’t have access to it.

These recommendations could be an important step toward addressing the tragic ways in which the medical system has failed America’s new mothers. The US has the highest maternal mortality rate of all industrialized countries and, unlike the rest of the world, that trend has worsened over the years. In October 2017, Quartz reporter Annalisa Merelli wrote about the disproportionate number of American women who die during childbirth—the result of a deeply embedded tradition of sexism in medicine, exacerbated by issues of race and class.

In an interview for NPR, Alison Stuebe, who heads the task force that drafted the committee opinion, summarized the problem succinctly: “The baby is the candy; the mom is the wrapper. … [a]nd once the candy is out of the wrapper, the wrapper is cast aside.” There’s no reason for doctors to prioritize the health of the child to the detriment of the health of the mother. It’s time to start treating babies and those who give birth to them as equally valuable.

This reporting is part of a series supported by a grant from the Bernard van Leer Foundation. The author’s views are not necessarily those of the Bernard van Leer Foundation.