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Ob-Gyns are invited to see new mothers earlier and more often: NPR



Under the new recommendations of the American College of Obstetricians and Gynecologists, doctors would see new mothers earlier and more frequently, and insurers would cover the increased visits.

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Under the new recommendations of the American College of Obstetricians and Gynecologists, doctors would see new mothers earlier and more frequently, and insurers would cover the increased visits.

FatCamera / Getty Images

This story was published together with ProPublica.

Doctors would see new mothers earlier and more frequently, and insurers would cover the increased visits among the comprehensive new recommendations from the organization, which set standards of care for obstetrician gynecologists in the US

The 11-page "Committee Opinion" "Optimizing Postpartum Care," published today by the American College of Obstetricians and Gynecologists (ACOG), provides a fundamental redefinition of how providers, insurers, and patients can work together to improve care for postpartum women.

"In order to optimize the health of women and young children, postpartum care should become an ongoing process, not just a single meeting, with services and support tailored to the individual needs of every woman," the Committee said.

While an ACOG Task Force began rethinking its approach several years ago, the Guidelines came at a time of growing concern over rising rates of pregnancy-related deaths and near-deaths in the US. As ProPublica and NPR have reported, more than 700 women die each year in this country from causes related to pregnancy and childbirth and more than 50,000 suffer life-threatening complications, leading to the worst records for maternal health in the industrialized world. The mortality rate for black mothers is three to four times higher than for white women.

The days and weeks after birth can be a period of particular susceptibility for young mothers, with physical and emotional risks such as pain and infection, high blood pressure and stroke, heart problems, blood clots, anxiety and depression. More than half of maternal deaths occur after the birth of a child, according to a new report by the CDC Foundation.

Nonetheless, the ACOG committee believes that many women in the US lack "formal or informal support from the mother." This reflects a worrying tendency in the medical system – and throughout American society – to become more open to focus on the health and safety of the fetus or baby as that of the mother. "The baby is the candy, the mother is the packaging," said Alison Stuebe, who teaches in the Department of Obstetrics and Gynecology at the University of North Carolina's Faculty of Medicine and directs the task force that drafted the guidelines. "And once the candy is out of the wrapper, put the wrapper aside."

The way providers are currently providing for pregnant women and infants compared to new mothers illustrates this difference. During the prenatal phase, a woman may see her ob-gyn a dozen or more, including at least two examinations during her ninth month. The first pediatric examination of her baby usually takes place a few days after birth. However, the mother is only allowed to make an appointment with her family doctor four to six weeks after delivery – in many cases, the insurance covers only one visit. "Once this baby comes out, [the mom] is a kind of afterthought," said Tamika Auguste, Associate Medical Director of the MedStar Health Simulation Training & Education Lab in Washington, DC, and co-author of the ACOG Statement. [19659017] The baby is the candy, the mother is the packaging. And once the candy is out of the package, the package is thrown aside.

For working mothers, have to wait four to six weeks to make it harder to arrange a check-up.

Approximately 23 percent of mothers who are employed outside the home are back at work within 10 days, a 2014 report found for the US Department of Labor; another 22 percent return to work within 40 days. A lack of childcare and transportation can also pose significant barriers to access to care. According to ACOG, up to 40 percent of women skip their visit after birth; For low-income, colored women the odds are even higher.

"Maybe you have a woman who has asthma, has breastfeeding problems and is overweight, and if they visit you after six weeks, we missed the boat here," Auguste said.

There is not a single visit that has enough time to address the questions and concerns of a new mother, especially if she has had a complicated pregnancy or is suffering from chronic illnesses such as high blood pressure, diabetes or an affective disorder. "We're trying to address all the issues women face after having a baby in a 20-minute encounter," Stuebe said. "And that's really hard to do."

Under the new ACOG guidelines, women would see their providers much earlier – within three Postnatal days, when they had severe hypertension after three weeks, when their pregnancies and births were normal – and would return as often as needed. Depending on the symptoms and history of a woman, the final postpartum visit may take place only 12 weeks after birth, ideally including "a full assessment of physical, social and psychological well-being" from pain through weight loss to sexuality management of chronic diseases, ACOG says.

In another significant change, ACOG is urging providers to emphasize in conversations with patients the long-term health risks associated with pregnancy complications, such as premature birth, preeclampsia and gestational diabetes. "These risk factors are an important predictor of the future [cardiovascular disease]," reads the recommendations. "… [B] ut, because these conditions often subside after birth, the increased cardiovascular disease risk is not consistently passed on to women."

Earlier, more frequent and individualized care could be a step towards overcoming racial disparities Mother and child health, said outgoing president of ACOG, Haywood Brown, who has made the reform of postpartum care one of the key initiatives of his term. Black mothers are at greater risk for many birth complications, including pre-eclampsia, heart failure, and blood clots, and are more likely to have long-term health consequences. They also have higher rates of postpartum depression, but are less likely to receive treatment. Regardless of race, for women whose pregnancies are covered by Medicaid, the postpartum period may be their best option for getting help with chronic illnesses before they lose coverage.

The new guidelines encourage physicians to act proactively and help patients develop a postpartum care plan during pregnancy. to provide social and other support. According to ACOG, one in four new mothers surveyed recently said they did not even have a healthcare provider's phone number to deal with concerns about themselves or their babies.

ACOG is not the only organization that calls for a reinvention of postpartum care; Patient safety groups, researchers, nurses and midwives have also addressed this issue, rephrasing the three months postpartum into a "fourth trimester".

"The postpartum period has become a priority," said Debra Bingham, a professor of nursing at the University of Maryland and managing director of the Institute for Perinatal Quality Improvement, which has participated in many of these initiatives.

Some vendors, including Brown, who is affiliated with Duke University, already include some of the ACOG ideas. However, putting the reforms into practice can take years. One of the biggest obstacles is the reimbursement of insurance. Currently, the payment for prenatal care, childbirth and a single postpartum visit is bundled in a global fee, discouraging physicians from seeing patients more than once, Auguste said.

The barriers to Medicaid women are greater. which accounts for about half of US births. In addition, Medicaid coverage ends in many states two months after birth. The ACOG opinion did not estimate the costs of implementing its recommendations.

Brown agreed that it was crucial to reform the way the postpartum care is reimbursed, and insurance representatives – along with other medical specialties – were in the ACOG working group that drafted the new guidelines. "I want to make sure I get some health plans for workers and some health care systems to do it nationally," Brown said.

Although the guidelines are aimed at lenses, they would require changes in the entire maternal care system. That's what ACOG hopes for. "It's a social call to action," Stuebe said.


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