The fourth trimester: a critical transition period with unmet maternal health needs

Am J Obstet Gynecol. 2017 Jul;217(1):37-41. doi: 10.1016/j.ajog.2017.03.032. Epub 2017 Apr 5.


After childbirth, most American women are not scheduled for follow-up care for 6 weeks, and this visit is poorly attended. Many new mothers feel unprepared for the common health issues they encounter and are uncertain of whom to contact. To improve care, the 4th Trimester Project is bringing together mothers, health care providers, and other stakeholders to explore what families need most from birth to 12 weeks postpartum. Eighty-seven individuals convened in March 2016 in Chapel Hill, NC. Four major topic areas emerged: (1) the intense focus on women's health prenatally is unbalanced by infrequent and late postpartum care; (2) medical practice guidelines often do not align with women's experiences and constraints; (3) validation of women as experts of their infants and elevating their strengths as mothers is necessary to achieve health goals; and (4) mothers need comprehensive care, which is difficult to provide because of numerous system constraints. Considerations for improving postpartum services include enabling more convenient care for families that is holistic, culturally appropriate, conversation based, and equitable. Maternal health issues in the fourth trimester intersect and can compound one another. Enhanced collaboration among health care providers may improve the focus of clinical interactions to address the interrelated health issues most important to women.

Keywords: adult; child; continuity of patient care; contraception/ethics; contraception/psychology; delivery of health care; family practice; female; humans; infant; integrated/organization and administration; models, United States; newborn; nurse midwives; nurse's role; obstetrics; patient compliance/statistics and numerical data; patient satisfaction; physician’s role; postnatal care/psychology; postnatal care/standards; postnatal care/utilization; postpartum experiences; pregnancy; qualitative research; social justice; theoretical.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Female
  • Humans
  • Maternal Health Services
  • Maternal Health*
  • Postnatal Care / statistics & numerical data*
  • Postpartum Period / physiology*
  • Pregnancy
  • Prenatal Care
  • Puerperal Disorders / physiopathology
  • Puerperal Disorders / psychology
  • Puerperal Disorders / therapy
  • Quality of Health Care
  • Quality of Life