New research underscores the need to make sure women receive the physical, emotional and psychological help they need beyond the typically recommended six-week postpartum checkup.
A recent study by the Journal of the American Medical Association showing an increase in maternal deaths, noted that one third of them occurred six weeks after childbirth. According to JAMA, causes included cardiovascular disease, mental and behavioral disorders and substance abuse.
“This article highlights the fact that a certain percentage of new moms face postpartum health issues that need to be taken seriously,” said Dr. Jeff Chamberlain, an obstetrician and gynecologist at UCHealth Women’s Care Clinics in Steamboat Springs and Craig. “It also points out that we may need to look at extending what we have traditionally considered ‘postpartum’ to beyond six weeks.”
Currently, a new mother with no apparent health problems is seen at two weeks and six weeks postpartum. It is the hope that she would then transfer care to her primary care physician for follow-up for any non-OB/GYN issues.
“We have close connections with other providers and work hard to ensure our patients are getting any care they need seamlessly and quickly,” said Chamberlain.
High blood pressure in new moms
A complication some new mothers experience after pregnancy is hypertension, or high blood pressure. This is a serious condition that can cause heart disease and stroke.
“In most cases, we will know if a patient has developed postpartum hypertension, since she has been screened for it during pregnancy, before leaving the hospital and at follow-up OB/GYN appointments,” said Chamberlain.
Still, a woman should call her doctor if she experiences headaches, vision changes, abdominal pain and swollen ankles or feet, he said.
In addition to physical problems, it’s important to stay on top of any emotional or psychological concerns a new mom might be experiencing such as depression or overwhelming feelings of sadness and anxiety.
Chamberlain said current protocol requires that women receive a mental health screening early on in their pregnancy, as well as before they leave the hospital after giving birth, and at their two postpartum OB/GYN visits.
“We try to identify anything early on,” he said. “If someone screens high in the hospital and we’re flagging them, then we want to get as many of our available resources laid out for them before they are discharged.”
Those resources could include engaging with a social work team, receiving outpatient mental health services and monitoring responses to new medications and/or anti-depressants that may have been prescribed.
Postpartum depression
When it comes to postpartum depression, new moms, their partners or family members should look for signs that may include severe mood changes, inability to complete daily tasks, threats of self-harm or harm to others, trouble sleeping, and withdrawal from family and friends, as well as major changes in eating and hygiene.
The past couple of decades have included major changes in the way anti-depressants are viewed, both during and after pregnancy, said Chamberlain.
“Now, we can find an individualized prescription plan for someone who wants to get pregnant but stay on medication,” he said. “You can also breastfeed with certain medications.”
Chamberlain stressed that the goal is for a new mom’s health care team to cater her care to her needs and not use a “one size fits all” approach.
“We want to make sure a mother’s mental health is paramount so she can take care of herself and her baby,” he said. “Treating each patient to their unique needs is a way we make sure they are not just going to be cut off at six weeks, and that they continue to flourish and enjoy their time with their baby.”
Chamberlain said studies like the JAMA one remind hospitals and health care staff to be open to whether certain standards of practice should be updated.
“We are sensitive and always willing to take a fresh look at new recommendations that come from JAMA and the American College of Obstetricians and Gynecologists, as well as those from the maternal fetal medicine team on the Anschutz Medical Campus,” said Chamberlain. “We always strive to offer the best care for our patients.”
Mary Gay Broderick writes for UCHealth. She can be reached at [email protected].
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