Postpartum Visit in Maryland

Maryland

The days and weeks after childbirth are a critical time for the care of 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 receive postpartum checkups. 

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

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

Women who lack stable housing, continuous health coverage and social or financial support are less likely to attend postpartum follow-up care. These individuals are missing opportunities for screening and treatment of postpartum concerns, contraception counseling and overall guidance and support needed after childbirth.

Postpartum visits are more common among:

• Women older than 30 compared with women younger than 20. 
• Women who identified as Asian.
• Women with private insurance compared with women who are uninsured and with public insurance.

The American College of Obstetricians and Gynecologists (ACOG) suggests an initial assessment within the first three weeks of birth, followed by individualized, ongoing care, and concluding with a comprehensive well-woman visit no later than 12 weeks after birth. 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.
• Providing incentives. 

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 provides states with resources to improve the rate and content of postpartum visits among Medicaid and Children’s Health Insurance Program (CHIP) populations. 

Medicaid pays for almost half of all births in the United States and must cover women for the first 60 days postpartum. Many states have expanded coverage beyond the first 60 days, but some have not. Expanding Medicaid coverage during the postpartum period would allow for the most vulnerable women to receive the recommended ACOG postpartum care. Encouraging states to expand Medicaid coverage from 60 days to 12 months postpartum is also a goal within the White House’s blueprint to address the maternal health crisis in the U.S.

Healthy People 2030 has multiple pregnancy and childbirth objectives, including:

• Increasing the proportion of mothers screened for postpartum depression during a postpartum visit
• Increasing the proportion of pregnant women who get early and adequate prenatal care.

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

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

Stumbras, Katrina, Kristin Rankin, Rachel Caskey, Sadia Haider, and Arden Handler. 2016. “Guidelines and Interventions Related to the Postpartum Visit for Low-Risk Postpartum Women in High and Upper Middle Income Countries.” Maternal and Child Health Journal 20 (Suppl 1): 103–16. https://doi.org/10.1007/s10995-016-2053-6.

Wilcox, Annemieke, Erika E. Levi, and Joanne M. Garrett. 2016. “Predictors of Non-Attendance to the Postpartum Follow-up Visit.” Maternal and Child Health Journal 20 (Suppl 1): 22–27. https://doi.org/10.1007/s10995-016-2184-9.