The Overlooked Fourth Trimester: Why Postpartum Care Shouldn’t Stop at Six Weeks

For most new parents, the six-week postpartum checkup feels like a milestone, the supposed moment you’re “cleared” for normal life again. But the truth is, recovery and adjustment don’t end there. The postpartum time, the fourth trimester, is probably one of the most transformative and vulnerable times in a person's life. It's a time for healing, to get acquainted with this new identity, and to experience the ups and downs that come with this new chapter. But our health care system treats it as if it were the end of the race instead of the beginning of a new cycle of care.

What the Research Says

A process, not a visit six weeks after delivery, would be the most effective way to define postpartum care, the American College of Obstetricians and Gynecologists (ACOG) says. In their 2018 report, Optimizing Postpartum Care, ACOG recommends a general postpartum plan beginning prenatally and continuing well into the first year after delivery; focusing on the physical, emotional, and social support (ACOG, 2018).

So asserts the World Health Organization. Their Guidelines on Postnatal Care are adamant that postpartum is a period of greatest significance to infant and parent's health, when as many as two-thirds of maternal deaths occur in the post-delivery period; many in the initial six weeks but some in later months (WHO, 2022). The WHO enacts today a minimum of four postnatal contacts for infants and their mothers, along with the follow-ups early in life.

The science proves it: one visit won't cut it.

The Long-Term Physical and Emotional Healing

Recovery from postpartum takes months, or longer, based on birth experience, complications, and general health. Weakened pelvic floor, perineal discomfort and hormonal shifts don't just get better overnight.

A JAMA Pediatrics study highlight that 1 in 3 mothers develop health conditions months after giving birth, including sleep disturbances, fatigue, and pain that interfere with daily functioning (Cowan et al., 2022) and mental health, of course.

There's also the impacts on mental health. A CDC study found that 1 in 8 women experience postpartum depression and the majority of them are after the six-week follow-up, the traditional model missing them entirely, since they're not being seen past this point (CDC, 2023).

A review in Women's Health Reports, emphasizes that postpartum mental health illnesses could occur even at a year or more postpartum, this can widely affect not only the caregiver's wellbeing but it can also impact infant attachment and family dynamics (Silverman et al., 2022).

Reimagining Postpartum Care

What if postpartum care would actually live up to the evidence?

Picture having check-ins scheduled; not only at six weeks, but at two weeks, three months, six months, and one year after giving birth. Picture lactation consultation, pelvic floor physical therapy, and mental health screening as the norm, not something to be cut back on.

In other countries, for instance, in the UK and in the Netherlands, such postpartum care for days or weeks is routine. The WHO advocates a continuity of care model in the health system, viewing postpartum as being a crucial part of maternal health, not as an add-on (WHO, 2022).

The Importance of Community Support

Healing after giving birth takes a giant village, and that's where community comes in. Peers' connection and support can be incredibly effective in reducing isolation and promoting mental health.

We at The Life Workshop know that the fourth trimester requires compassion, gentleness, and support. That is why we offer a free online postpartum support group; a warm, secure environment where new parents can gather to share, navigate, and heal with one another. You don't have to go through this alone, and support shouldn't be confined to one doctor's visit.

Healing after childbirth isn't linear. There will be days where you'll be feeling strong; there will be days where you'll be wondering how long before you are you again. This is all part of the process.The six weeks doesn't determine your value or your healing. It is merely one point on a far larger, more profound journey.

You are worth postpartum care that breaks the checklist, care that sees you as the complete person. Let's redefine postpartum care to address the reality of what parents truly need: time, kindness, and continued contact.

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References:

American College of Obstetricians and Gynecologists (2018). Optimizing Postpartum Care.

World Health Organization (2022). WHO Recommendations on Maternal and Newborn Care for a Positive Postnatal Experience.

Silverman, M.E. et al. (2022). “Persistent Postpartum Health Problems and Associated Factors,” Women’s Health Reports.

Centers for Disease Control and Prevention (CDC, 2023). Postpartum Mental Health Surveillance and Support Strategies.

Cowan, R. et al. (2022). “Maternal Morbidity Beyond Six Weeks Postpartum,” JAMA Pediatrics.

Declercq, E.R. et al. (2018). “Maternal Experiences and Health Outcomes After Childbirth,” PubMed Central.