Postpartum Visit in Iowa

Iowa

The days and weeks after childbirth are a critical time for both mothers and newborns. New mothers experience many physical, social and psychological changes during this period. It is important that women who recently gave birth attend postpartum checkups to ensure physical and mental wellness during recovery.

At a postpartum visit, health care providers and patients may discuss: 

• Pregnancy complications.
• Mental health, including postpartum depression.
• Concerns about infant care.
• Breastfeeding assistance.
• Care referrals for preexisting or developing medical conditions, such as diabetes, obesity or hypertension.
• The transition to well-woman care.
• Sexual health and relationship development.

Women who lack stable housing, continuous health coverage or social or financial support are less likely to attend postpartum follow-up care. These structural barriers cause many women to miss opportunities for counseling, screening and treatment for postpartum concerns and overall guidance and support needed after childbirth. 

Postpartum visits are more common among:

• Women ages 30-39 compared with women younger than 25. 
• Asian women compared with American Indian and white women.
• Women with health insurance compared with uninsured women.
• Women with higher educational attainment.
• Women who are married compared with those who are unmarried. 
• Women with adequate prenatal care compared with those who received intermediate or inadequate care.
• Women with higher socioeconomic status. 

The American College of Obstetricians and Gynecologists (ACOG) suggests an initial assessment within the first three weeks of birth, and concluding with a comprehensive well-woman visit no later than 12 weeks after birth, with ongoing individualized care in between as needed. Multiple visits may be recommended for women with complex medical problems. 

Strategies to increase postpartum visits include:

• Discussing postpartum visits during prenatal care appointments.
• Scheduling postpartum visits during prenatal visits or before hospital discharge.
• Using technology to schedule reminders.
• Continuing care with the same provider across prenatal, delivery and postpartum visits. 
• Addressing barriers related to transportation and child care by offering assistance, home visits or alternate locations for appointments and flexible scheduling. 

Providing postpartum depression screening guidelines to health care providers and connecting women with community resources can further improve postpartum care. The Centers for Medicare & Medicaid Services’ Maternal & Child Health Initiative has published a resource on state-level strategies to improve the rate and content of postpartum visits among those enrolled in Medicaid or the Children’s Health Insurance Program (CHIP). 

Medicaid pays for approximately 40% of all births in the U.S. and must cover women for the first 60 days postpartum, which is less than the ACOG recommendation of 12 weeks (or 84 days). Most states have expanded coverage beyond the first 60 days to 12 months postpartum, allowing women who have low incomes or live below the poverty level to receive the care recommended by ACOG. The expansion of Medicaid coverage from 60 days to 12 months postpartum is a White House Blueprint for Addressing the Maternal Health Crisis goal.

Healthy People 2030 has multiple pregnancy and childbirth objectives, including increasing the proportion of mothers screened for postpartum depression during a postpartum visit and increasing the proportion of pregnant women who get early and adequate prenatal care.

Attanasio, Laura B., Brittany L. Ranchoff, Michael I. Cooper, and Kimberley H. Geissler. “Postpartum Visit Attendance in the United States: A Systematic Review.” Women’s Health Issues 32, no. 4 (July 2022): 369–75. https://doi.org/10.1016/j.whi.2022.02.002.

Danilack, Valery A., E. Christine Brousseau, Briana A. Paulo, Kristen A. Matteson, and Melissa A. Clark. “Characteristics of Women without a Postpartum Checkup among PRAMS Participants, 2009–2011.” Maternal and Child Health Journal 23, no. 7 (July 2019): 903–9. https://doi.org/10.1007/s10995-018-02716-x.

Ranji, Usha, Ivette Gomez, and Alina Salganicoff. “Expanding Postpartum Medicaid Coverage.” Issue Brief. KFF, March 9, 2021. https://www.kff.org/womens-health-policy/issue-brief/expanding-postpartum-medicaid-coverage/.

Stuebe, Alison, Tamika Auguste, and Martha Gulati. “ACOG Committee Opinion No. 736: Optimizing Postpartum Care.” Obstetrics & Gynecology 131, no. 5 (May 2018): e140–50. https://doi.org/10.1097/AOG.0000000000002633.

“White House Blueprint for Addressing the Maternal Health Crisis.” Washington, D.C.: The White House, June 2022. https://www.whitehouse.gov/wp-content/uploads/2022/06/Maternal-Health-Blueprint.pdf.

Wilcox, Annemieke, Erika E. Levi, and Joanne M. Garrett. “Predictors of Non-Attendance to the Postpartum Follow-up Visit.” Maternal and Child Health Journal 20, no. Suppl 1 (November 2016): 22–27. https://doi.org/10.1007/s10995-016-2184-9.