By Sharon Muza, BS, CD(DONA), BDT(DONA), LCCE, FACCE, CLE
The American College of Obstetricians and Gynecologists (ACOG) released an updated committee opinion last month titled Optimizing Postpartum Care. This opinion was endorsed and supported by fellow maternal-infant health organizations that include the Academy of Breastfeeding Medicine, the American College of Nurse-Midwives, the National Association of Nurse Practitioners in Women’s Health, the Society for Academic Specialists in General Obstetrics and Gynecology, and the Society for Maternal–Fetal Medicine.
Before this new committee opinion had been released, current recommendations and community standards for postpartum medical visits for a birthing person under the care of an obstetrician were one visit at approximately six weeks post-birth. Birth and especially postpartum doulas working with families in the fragile days and weeks after birth have long recognized the need for quality support and care from a unified team of people, including family, doulas, friends, and health care providers. So much could and does happen in those first six weeks that lay the groundwork for future emotional and physical situations and challenges.
This newest statement acknowledges these challenges and the importance of ongoing support in this fragile time. The statement includes the following:
There is a lot to like in these recommendations. For many people, the time period in the immediate days and first weeks after giving birth can be dangerous and often life-threatening. This is especially true for people of color. Sixty-one percent of deaths related to childbirth occur in the postpartum period and most of those occur in the first 42 days after birth (MacDorman, Declercq, Cabral, & Morton, 2016). Currently, 41 percent of postpartum people do not attend any postpartum visit. For families of color, this number is even higher.
Discussion prenatally about planning for the postpartum period is critical so that expectant parents can prepare and have in place the support they will need after childbirth. These new recommendations support those prenatal discussions and ask that they occur at several points during prenatal care. (SM note: how that is possible with the limited amount of time designated for a typical prenatal visit is unclear to me.)
ACOG recognizes that emotional and physical complications are more likely to arise and remain when adequate support is not available postpartum. The Committee Opinion also identifies some of the barriers that currently exists for families who are not receiving appropriate postpartum care, including a quick return to work, lack of clarity on when and how to contact a provider for postpartum complications and even a lack of education provided before hospital discharge about circumstances that may arise that require contact with their provider.
One thing that is completely missing in this revised statement on Optimum Postpartum Care is the role of the postpartum doula. This trained professional can make an incredible difference in the lives of a new family, helping them to navigate the early days and weeks with confidence and unbiased support. ACOG needs to recognize that a postpartum doula can help ease the transition, encourage families to seek medical care when situations arise and be a valuable source of community resources of all sorts that families can access.
In the last two major committee opinions on birth, Safe Prevention of the Primary Cesarean and the newer Approaches to Limit Intervention during Labor and Birth, ACOG has recommended the presence of birth doulas as a method to improve maternal-infant health. This is to be applauded. Birth doulas are being recognized for their contributions to birth outcomes. The time has come for the same recognition to be made about postpartum doulas. This new committee opinion was the perfect document to include this statement, but unfortunately, the opportunity was missed. Postpartum doulas play a critical role in supporting families during the transition to parenthood.
The time is now to recognize the valuable role that postpartum doulas have in the childbearing year. DONA continues to train and certify qualified individuals to serve in this role, providing valuable and necessary skills applicable to all families. Postpartum doulas deserve a place at the table and to be recognized for their valuable contributions to families after the birth of a baby.
Approaches to limit intervention during labor and birth. Committee Opinion No. 687. American College of Obstetricians and Gynecologists. Obstet Gynecol 2017;129:e20–8.
MacDorman, M. F., Declercq, E., Cabral, H., & Morton, C. (2016). Recent Increases in the US Maternal Mortality Rate: Disentangling Trends From Measurement Issues. Obstetrics and gynecology, 128(3), 447-455.
Optimizing postpartum care. ACOG Committee Opinion No. 736. American College of Obstetricians and Gynecologists. Obstet Gynecol 2018;131:e140–50.
Safe prevention of the primary cesarean delivery. Obstetric Care Consensus No. 1. American College of Obstetricians and Gynecologists.