Your Postpartum Care Plan: How to Stay Healthy During the 4th Trimester

You’re nearing your due date (yay!), and by now, you’ve probably got your birth plan ready to go, but… do you need a postpartum care plan, too?

Before you scoff at the idea. Consider this: Global studies show that the standard of postpartum care is declining, even in countries like the United States. In fact, the United States has the highest maternal morbidity rate in the developed world.

Why? Dangerous conditions, like postpartum preeclampsia, go undiagnosed and the CDC estimates that nearly 40 percent of American mothers with postpartum depression never get proper care.

Because of this, it’s so vital to have a proper postpartum care plan in place.

In this article, we’ll cover:

• What the current standard of postpartum care is and why it isn’t enough
• Common health concerns every postpartum mama should know about
• Plus, explore how the right postpartum care plan can help you stay healthy

The Problem with Postpartum Care

If you’ve ever watched Call the Midwives, you know that the majority of mid-twentieth century English mothers gave birth at home with midwives. After the delivery, midwives would continue to make house calls to check on both baby and mama.

Unfortunately, the model of care has shifted, and traditional healthcare professionals don’t make house calls. This is despite the fact that, according to the American College of Obstetricians and Gynecologists (ACOG) Committee Meeting in May 2018, postpartum women should:

• Be in touch with their OBGYN during the first three postpartum weeks
• Discuss infant care, sleep needs, and basic baby care with their OBGYN
• Schedule a comprehensive postpartum assessment between six to 12 weeks postpartum that focuses on all needs of mama: physical, social, and psychological well-being.
• Go over physical recovery needs with their OBGYN
• Review mental and emotional needs with their OBGYN
• Discuss current health needs (including nutrition and chronic condition management and sexual health needs)

But these standards aren’t often met. 

Here’s what really happens…

Many women leave the hospital quickly with limited information on how to care for their body and what warning signs require a call to the OBGYN or midwife.

Once mama returns home, she probably won’t even speak with her doctor until a six-week checkup, which may entail the following:

• Weight check
• Blood pressure screening
• Postpartum depression screening
• Pelvic exam
• Birth control discussion

But sadly, many of these appointments are rushed and focus on the latter part—birth control discussions. Too often mamas do not receive any guidance on postpartum nutrition, physical needs, or mental health needs.

Why is this a problem?

According to the World Health Organization, most maternal deaths are related to hemorrhaging and infections after childbirth.

And not just in the first 24 hours following delivery. Statistically, women are more likely to die a few days to a few weeks after birth. (source)

Women of Color and Post-Birth Complications

These stats are even more relevant for African American women, who are 243 percent (!) more likely to die from either pregnancy-related conditions or childbirth-related causes than women of other ethnicities. (source) Black women also have higher rates of morbidity associated with preeclampsia, placenta previa, placenta abruption, and postpartum hemorrhage. The worst part is that all of these conditions can be monitored and treated by an OBGYN or midwife.

This is prime evidence that most women aren’t getting the care they need during the crucial postpartum window.

Why is this? Mamas of color aren’t just at risk for complications because of potential genetic and lifestyle risk factors. Racism of hospital workers or even doctors can contribute to less-than-adequate healthcare. According to an article published by the American Heart Association, a bigger problem is this: African American women are often undervalued in medical settings.

This scary stat makes a postpartum care plan even more essential. If possible, look for fellow women of color to support you during your birth and afterward:

• National Black Doulas Association has a directory so you can find a doula near you
• Sista Midwife Productions has a directory for black midwives and doulas

Why You Need a Postpartum Care Plan

All mothers deserve so much more.

We are hyper-vigilant about checking baby’s well-being (and rightly so!), but we need to do the same for moms.

Any marathon runner knows that the race is important—but they also know just how important the recovery is, too. Childbirth is a marathon, and the postpartum period is when mamas heal. During this recovery time (ancient cultures called this a lying-in!), mamas need to know about the biggest health concerns:

• Postpartum pre-eclampsia: Pre-eclampsia and eclampsia are often thought of as prenatal conditions, but it is possible to develop postpartum pre-eclampsia. It is a rare condition characterized by high blood pressure and protein in your urine after childbirth. Headaches, severe swelling, and blurred vision can be warning signs of pre-eclampsia.
• Postpartum hemorrhaging: It’s normal to bleed after childbirth, but losing more than 1000 ml of blood during the first 24 hours can be a sign of postpartum hemorrhaging. Blood clots (larger than a golf ball) and severe bleeding (that fills a pad in an hour) can also be signs of hemorrhaging.

These two conditions are serious, but they aren’t the only healthcare concerns. Postpartum mamas should also know about other conditions, such as:

• Heart conditions and cardiovascular disease: Postpartum cardiomyopathy (which means your heart isn’t pumping strongly enough) can occur up to five months after childbirth. (source)
• Blood clots: The risk of serious blood clots (such as in the leg) extends three months after childbirth. (source)
• Pelvic pain caused by pelvic organ prolapse: A pelvic organ prolapse refers to one of your pelvic organs (e.g., the uterus, bladder, and/or bowel) slipping out of its normal positions and sliding down towards the vagina. This condition can affect your ability to use the restroom comfortably, but it can also contribute to back pain and incontinence.
• Diastasis recti: This condition refers to the separation of your abdominal muscles. This naturally happens during childbirth, but the gap doesn’t always return to normal. A gap bigger than 2.7 centimeters is considered to be diastasis recti. This can cause the “mom pooch,” but it can also contribute to incontinence.
• C-section recovery issues like infection (which can lead to sepsis), pain, and delayed healing.
• Postpartum depression: Postpartum depression is a mood disorder that develops in postpartum women due to shifting hormone levels. It’s characterized by feelings of sadness, anger, difficulty concentrating, and even a lack of interest in favorite hobbies.
• Postpartum anxiety: Like postpartum depression, postpartum anxiety affects mothers shortly after childbirth. Postpartum anxiety is characterized by intense worry that affects your daily life. Studies show more women have postpartum anxiety—a whopping 17 percent of postpartum women!

Creating Your Own Postpartum Plan

So what can you do with this knowledge? Besides use this information to empower yourself, you can create a postpartum care plan to make sure your body and mind stay as healthy as possible. Here’s how:

1. Stock up on essentials

Many hospitals and birthing centers will send you home with the basics, but this may not be enough. Before your due date, consider stocking your home with your own postpartum kit. Padsicles, Rescue Remedy, and easy-to-grab snacks are just a few things that will make your recovery easier. For a more comprehensive postpartum kit, check out this post.

2. Rest

We live in a go-go-go society, but after you have a baby, your body needs rest—and lots of it. Most mothers need 30 to 40 days of rest and TLC. Studies show that most mothers are not even prepared for this period, so it is important to plan for rest. Not only does this give your body and mind time to heal, it also allows you plenty of time to focus on  your baby and nurse in peace on demand.

To make sure that you get the rest you deserve, consider hiring a postpartum doula. Friends and family members can also be invaluable during this time, too.

3. Advocate for yourself

You don’t have to wait until the six-week postpartum check-up to see your healthcare provider. Talk to your doctor about checking in before the three-week mark as per the committee recommendations outlined above. This is especially important if you have other health conditions unrelated to pregnancy and childbirth.

If you suspect any issues during the postpartum period, don’t be afraid to mention them to your OBGYN or midwife. Speak up and demand to see your OBGYN or midwife—mention the ACOG guidelines if you need reinforcement. Don’t settle for dismissal. You know your body best and you can always seek a second opinion. Even if everything ends up okay, the peace of mind can be invaluable.

Even though you need care shortly after birth, you’ll continue to need care for a full year (yes, childbirth recovery can take a full year!), so don’t feel ashamed to check in with your doctor or midwife more frequently. This is especially good to remember if you feel like something is wrong.

4. Try Zuo Yuezi

In Asian cultures, most postpartum mothers adopt a practice called zuo yuezi, which translates to “confinement.” The zuo yuezi refers to the first 40 days after childbirth in which mama confines herself to the home.  This is a confinement period in which mama settles cozily into the home, resting and eating warming foods. The majority of the time is spent nursing, bonding, and resting. Interested? You can learn more about First 40 Days here.

5. Focus on a nourishing diet

Although you may be anxious to shed the baby weight, this isn’t the time to focus on weight loss. Let food be your medicine. Nourishing food can help your body heal, promote breastmilk production, and provide you with energy. Food plays a big role in supporting your mental health, too! One study found that supplements (including blueberry juice) helped reduce the risk of postpartum depression.

Not sure what to eat while nursing? Check out this post.

6. Get help

You know the phrase: it takes a village to raise a child. It takes a village just to recover from childbirth, and there is no shame in asking for help. Here a few ideas you can use when creating your postpartum plan:

• Hire a postpartum doula
• Ask friends or family members to make meals for you (or sign up for a meal delivery service)
• Ask friends for help with specific tasks (like chipping in for a doula or running to the store for more pads, diapers, so you don’t have to venture out while still recovering)
• Ask for a friend or family member to come hold your baby while you take care of yourself (like taking a sitz bath, a shower, or even just a nice nap)
• Have a friend sit with you and chat while you nurse your baby (sometimes just being present with another adult is comforting)
• Arrange for someone else to drive you to any follow-up appointments
• Hire a cleaning service to take care of the household chores (at least during your initial healing period)
• Ask for help from your midwife or OBGYN if you’re struggling with mental health issues after delivery

Asking for help is one of the bravest things you can do, and sometimes it’s the only way to find the time and energy to truly take care of yourself.

What About You?

Did you make a postpartum care plan? What did you include in your care plan?