How the health system is trying to improve postpartum care

Catch up quick: Postpartum care has traditionally been limited to a physical and mental health checkup at an OB-GYN six weeks after giving birth.

• That milestone was meant to encourage rest for new moms and infants but isn't scientifically supported, experts said. And this one appointment — which up to 40% of patients miss — may not be enough to flag potential long-term risks and complications, they said.
• "Our system isn't set up for ease of people to get the postpartum care that they need or desire," said Ashley Gresh, an assistant professor at Johns Hopkins University who studies the postpartum period.

State of play: Medical societies and governments have been revising postpartum care guidelines.

• The American College of Obstetricians and Gynecologists updated its recommendations in 2018, calling for an initial checkup within three weeks of giving birth and a comprehensive visit covering emotional well-being, sleep, sexual health and infant care within 12 weeks.
• The World Health Organization released guidelines for postnatal care up to six weeks in 2022.
• That same year, the Biden administration called for more consistent health insurance coverage for postpartum women and better care for high-risk patients as part of a blueprint for tackling the country's maternal health crisis.

Zoom out: More money has flowed to postpartum care in recent years.

• Medicaid, which pays for about 4 in 10 U.S. births, in nearly every state now provides one year of postpartum coverage, up from 60 days.
• Startups are offering services ranging from meal subscriptions to digital mental health care for postpartum women. Dedicated postpartum centers that mimic other cultures' focus on holistic post-pregnancy care are cropping up across the United States.
• A first-of-its-kind pill treating postpartum depression launched last year.

Yes, but: There's a long way to go, experts say.

• There's still no official clinical standard for how to care for a new mother in the first year after giving birth. ACOG doesn't know how widely providers adopted its updated framework, a spokesperson said.

Between the lines: Changing insurance coverage can improve postpartum care, said Tamika Auguste, an OB-GYN who helped draft ACOG's guidelines.

• Insurers often reimburse for obstetric care in one payment that covers prenatal to postpartum care. For routine births that aren't C-sections, providers get paid the same amount if they see a patient once postpartum or 10 times, Auguste said.

• Centene, the nation's largest Medicaid insurer, has already rolled back bundled payments in one of its markets and is exploring alternative payment systems, said its OB-GYN medical director, Dawn Steiner.
• The Centers for Medicare and Medicaid Services next year will start a 10-year pilot testing new ways Medicaid can pay for maternity care, including the postpartum period.

Improving postpartum care also requires better coordination among medical specialties and educating patients on when to come to the doctor, Auguste said.

• Maternal care needs "a change in culture," she said. "Other disciplines outside of obstetrics are just now realizing that they, too, have a role in maternal mortality."
• Aligning doctor's visits for new mothers with their infants' appointments would also make postpartum care more accessible, said Mara Horwitz, a doctor and assistant professor at Boston University studying primary care after pregnancy.

The bottom line: "This is systemic change that we're talking about. It's going to take much more than a couple of years for us to really see the effects of this," said Jennifer Law, who leads maternal health at technology giant Philips.

• "We cannot let up the urgency on this issue."

Editor's note: This story has been corrected to show Centene has rolled back bundled payments for obstetric care for one of its markets (not some of its markets).