Every year, at least 40 million women and birthing people around the world experience long-term complications following labor and childbirth. These complications range from sexual health issues to mental health to cardiovascular disease and are often rooted in systemic inequities.
Currently, there are no global clinical care guidelines to identify and manage these issues beyond the six-week postpartum period. This leaves so many women and birthing people to navigate their postpartum journey without adequate support or guidance in a time that should be full of support and focused on well-being.
In response to these gaps in care I took the lead to host a convening, “Strengthening Maternal and Child Health: Redefining and Reimagining Postpartum Care,” at the Institute for Policy Solutions at Johns Hopkins School of Nursing last week. The convening brought together global thought leaders to begin to conceptualize a plan for addressing women and birthing people’s ongoing care needs beyond the traditional six-week period. The consensus is clear: there are significant gaps in addressing the ongoing care needs of women and birthing people worldwide in the first year after birth.
There are significant gaps in addressing the ongoing care needs of women and birthing people worldwide in the first year after birth.
Nurses and midwives provide the majority of care to women, birthing people and infants before, during and after birth. This equips us with extensive expertise to advise on the best approaches to improve care during this crucial period. It is with this knowledge and perspective that I partnered with other nurses and midwives to bring together representatives from international organizations, professional organizations, NGOs, and researchers including WHO, UNFPA, UNICEF, and ICM with representation from 15 countries. We began by identifying the types of health and social needs that arise within the first 12 months after birth, focusing on addressing persistent health inequities and enhancing maternal well-being.
We identified three main areas of focus for moving forward:
1) Develop a plan that centers holistic care.
There is an urgent need for a paradigm shift in how we approach postpartum care. While there are many physical health concerns that arise both after pregnancy (i.e. miscarriage and abortion) and birth, these are often inextricably linked with mental health and social and structural determinants of health that need to be addressed simultaneously. Some of the health issues we discussed included cardiovascular disease, mental health, wound healing complications, urinary/fecal incontinence, nutrition, lactation support, chronic pain, and exposures to violence. We have evidence that the traditional six-week postpartum period is inadequate to address ongoing care needs and puts women and birthing people at increased risk of current and future health complications. Six weeks of postpartum care does not reflect people’s lived experience of the postpartum period and how long it continues. We need to center women and birthing people’s well-being at the core of comprehensive health services for at least 12 months of care and acknowledge that this is a period that requires intense holistic support.
2) Explore approaches that integrate health care services.
We need to center women and birthing people’s needs in the care we provide and integrate this within existing health care services. No single clinician can address all women and birthing people’s health and health-related social needs. The more we facilitate good care coordination and work with interdisciplinary teams (e.g., nurses, midwives, physicians, community health workers, doulas, lactation consultants, pediatricians, social workers, etc.), the more we can provide holistic health care services that can improve outcomes and the postpartum experience.
Several ideas were presented to integrate health care services. For example, we know that most people worldwide bring their infants to health facilities or community-based health care services for vaccinations. This can be a crucial touchpoint to address the care needs of women and birthing people particularly in the first 12 months after birth. We could also explore group care models, where people with similarly aged infants receive care together in a group setting; scale up home visiting programs; and increase the use of telehealth and mHealth. Ideally, this is all leading to transitioning women and birthing people to primary care so that should long-term health and related social needs arise, they continue to receive the care and support they need and desire. Much of the path forward will be about eliminating silos in care for women and birthing people and building on work that is already happening to improve health care in the 12 months after birth and strengthen clinical and non-clinical support mechanisms.
3) Prioritize policymakers as key partners in postpartum care transformation.
We need to continue to raise awareness and garner support from governments. That way, as we envision and create holistic models of care that can be implemented across high and low-resource settings beyond six-weeks through at least 12 months after birth, we are better positioned to have the infrastructure to help people in this pivotal transition period that sets the stage for long-term health. This includes elevating the voices of those with lived experiences so that policy is informed by what matters most to women and birthing people increasing the likelihood of success.
Improving health for women and birthing people and their infants
“Strengthening Maternal and Child Health: Redefining and Reimagining Postpartum Care” is just one step in our journey to improve health and well-being of women and birthing people after pregnancy and birth. The convening had great representation from international organizations, clinicians, and researchers from around the world. We recognize, however, that not all voices were present, and we intend to expand the pool of thought partners and collaborators as we move this work forward.
Through the convening, we affirmed our collective dedication to transforming postpartum care and ensuring it is equitable.
Care in the postpartum period beyond six weeks is too often neglected. Improving and extending care would improve health outcomes, not just for the woman or birthing person and infant, but for families and our communities worldwide. This convening is a call to action, and we invite you to join us to continue this work.
A special thank you to those who helped to prepare for this convening and who were able to take the time and space to attend. Thought partners that helped in the work leading up to the convening: Amy MacDonald, CNM from Pomelo Care who also facilitated the convening, Sharon Rising, CNM from Group Care Global, Laura Fitzgerald, CNM, Jessica Tsipe Angelson, CNM, PhD(c), Keisha Lockhart, DNP, APRN, CPNP-PC, CNM, Joy Wessman, CNM, Christina Marea, PhD, CNM, Noelene Jeffers, PhD, CNM, Nicole Warren, PhD, CNM, Kelly Bower, PhD, RN, Mothusi Mncedisi Ncube, Lecturer (RN,NM-Specialist), the Group Care After Birth Technical Working Group, MAMI Global Network and Emergency Nutrition Network, Kelley Robinson, PhD, CNM, Tiffany Alblinger, LM CPM, Anne Batchelder, MSN, MPH, RN, Teresa Pfaff, MSN, MPH, RN, PHNA-BC, CPH, Stacie Geller, PhD, and Annie Portela and Tina Lavin from WHO. The organizations and institutions that were represented at the convening: WHO, UNFPA, UNICEF, ICM, ACNM, USAID, PAHO, ICN, Jhpiego, Group Care Global, Postpartum Support International, COINN, AAP, JICA, Wajamama, Pomelo Care, UIC, IWK Health, LSHTM, Africa Health Governance Institute, University of Botswana, University of Rwanda, Malawi University of Science and Technology, UNC, Johns Hopkins Bloomberg School of Public Health and Johns Hopkins School of Nursing.
To get involved please reach out to Ashley Gresh [email protected] and sign up for the Institute for Policy Solutions newsletter.