Postpartum

The fourth trimester of pregnancy

The best way to deal with postpartum should be prepared even before birth through a path that addresses the transition to parenthood and the well-being of women.

Pregnancy consists of three trimesters , nowadays highly medicalized, but, once the baby is born, often the woman and the couple are left to their own devices at the mercy of problems that could be difficult to face and overcome.

Problems with breastfeeding, lack of sleep , difficulty understanding the needs of the newborn, postpartum depression, relationship problems,…

It is clear that women in particular need support immediately after childbirth , in those first three months after birth, which we can refer to as the fourth trimester of pregnancy. Support that over the years has no longer come from the family, but not even from those assistance systems such as consultants who are struggling to take their place in the national health system.

In the United States something is moving in this direction and the hope is that this model will also be imported by us, the benefits would certainly be many.

The fourth trimester of pregnancy

According to the American College of Obstetricians and Gynecologists (ACOG), pregnancy support and care should extend postpartum, to at least those first three months after the baby is born, and consist of ongoing, direct communication between new mothers and medical assistance figures such as that of the midwife.

Also according to the ACOG,  monitoring the physical and mental health of women after childbirth can help reduce maternal morbidity and mortality.

In addition to being a time of joy and excitement, this fourth trimester can bring significant challenges for women, including lack of sleep, fatigue, pain, difficulty breastfeeding, stress, new onset or exacerbation of pre-existing mental disorders, lack of sexual desire and  urinary incontinence .

According to Alison Stuebe, a physician and associate professor of maternal-fetal medicine at the University of North Carolina, new mothers need ongoing care . Therefore the ACOG wants to create a comprehensive care plan for every family.

If previously a complete visit was recommended within 6 weeks of giving birth, more or less as is done in Italy, now the focus is on continuous assistance that aims to give mothers confidence and support them in times of difficulty.

The main points of the guide to the fourth quarter

The best way to deal with postpartum should be prepared even before birth through a path that addresses the transition to parenthood and the well-being of women.

Women should have initial contact with health professionals within 3 weeks of giving birth for an initial assessment of their psycho-physical health. This first meeting so close to the birth allows to evaluate the risk for postpartum depression but also to respond to the difficulties related to breastfeeding , which, if not resolved, often lead new mothers to completely stop breastfeeding before 6 weeks from the birth of the child.

After this first meeting, others will follow, scheduled on the basis of the woman’s needs and for all of them, a complete post-natal check-up is scheduled within 12 weeks of giving birth.

Postpartum problems

Lack of sleep, fatigue, pain, urinary incontinence, breastfeeding problems, lack of sex drive, new or flaring psychological issues, stress, anxiety, and uncertainty can all contribute to new mothers’ increased vulnerability to physical and/or psychological issues.

The weeks following childbirth represent a critical period for women, therefore the complete visit should consist of an in-depth evaluation, which must consider:

  • Physical recovery from birth
  • Mood and emotional well-being
  • Infant care and feeding
  • Sleep and tiredness
  • Sexuality and contraception
  • The management of chronic diseases
  • Maintaining a state of general well-being

Complicated pregnancies, chronic conditions and adverse pregnancy outcomes

Fourth trimester management, according to the ACOG, must have a personalized approach to the woman and her problems. For this reason specific guidance should be offered for women with complicated pregnancies, chronic medical conditions or adverse birth outcomes.

For example, women with pregnancies complicated by premature delivery , gestational diabetes or hypertensive disorders in pregnancy should be informed about the risk of cardiovascular or metabolic diseases.

Specifically, ACOG recommends that pregnant women with hypertensive disorders have a postpartum visit within 7 to 10 days of birth to have their blood pressure assessed, and a follow-up visit within 72 hours for those with severe hypertension.

According to the authors, this evaluation is essential given that more than half of postpartum strokes occur within 10 days of discharge.

These scheduled evaluations are very useful for women at high risk of complications , such as postpartum depression, to prevent the risk of infections of the caesarean or perineal section wounds , to respond to breastfeeding difficulties or to chronic conditions that require the prescription of a drug suitable…

Women who have suffered a miscarriage , stillbirth or neonatal death should be followed up both from a physical point of view but also and above all from an emotional point of view, be subjected to control examinations and supported by counseling courses that evaluate the risks related to future pregnancies.

Women suffering from chronic medical conditions such as obesity, diabetes, kidney disease, thyroid problems, mood disorders, etc., others, should be followed up in a coordinated manner by physicians treating their condition in tandem with gynecologists and midwives .

Questa nuova proposta del Comitato ACOG è stata  approvata dell’Academy of Breastfeeding Medicine, dall’ American College of Nurse-Midwives,dal  National Association of Nurse Practitioners in Women’s Health, dal Society for Academic Specialists in General Obstetrics and Gynecology, e dalla Society for Maternal-Fetal Medicine.

Dr Kathryn Barlow

Kathryn Barlow is an OB/GYN doctor, which is the medical specialty that deals with the care of women's reproductive health, including pregnancy and childbirth.

Obstetricians provide care to women during pregnancy, labor, and delivery, while gynecologists focus on the health of the female reproductive system, including the ovaries, uterus, vagina, and breasts. OB/GYN doctors are trained to provide medical and surgical care for a wide range of conditions related to women's reproductive health.

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