We’ve highlighted some of the most thought-provoking points on postpartum care for women from our panel discussion with healthcare and advocacy experts. Watch the full webinar on Why the healthcare industry must rethink postpartum care to hear the full conversation.
According to the CDC, 80% of pregnancy-related deaths are preventable. To help change this, the ZS Women’s Health Expertise Hub and our longtime partner Working for Women (W4W) hosted a panel aimed at those in the healthcare industry as part of a longstanding series of panels that highlight disparities in women’s health and their impact in the workplace. ZS Associate Principal Camille Emma Schilkie led four cross-functional experts in a conversation about postpartum health challenges and care gaps in the U.S. The discussion highlighted the need for comprehensive support that addresses mental and physical healthcare, parental leave and the pressures of returning to work.
Leaders in women’s health who focus on postpartum healthcare joined us, including OB-GYN Dr. Amanda Williams from the California Maternal Quality Care Collaborative (CMQCC), former interim chief medical officer of the March of Dimes and adjunct clinical associate professor at Stanford University School of Medicine, who shared insights on the physical and mental challenges of the postpartum period. Dr. Venice Haynes, senior director of research and community engagement at United States of Care, brought a public health perspective, emphasizing the importance of community interventions and paid leave. Meghan Doyle, Chief Executive Officer at Partum Health, emphasized how multidisciplinary support for women and their growing families can help address postpartum health gaps. And Cos Trifonidis, U.S. market development lead at Organon, a women’s-health-focused biopharmaceutical and medtech company, shared opportunities to improve outcomes for those who experience postpartum hemorrhage (PPH) emergencies.
Camille Schilkie: According to the CDC, nearly half of pregnancy-related deaths occur during the postpartum period. The U.S. has a significantly higher maternal mortality rate than other high-income countries, and this rate is three to four times higher in the Black and Indigenous population. A full 80% of pregnancy-related deaths are considered preventable—these are big numbers that need to be addressed. Dr. Williams, can you start us off with the definitions of postpartum and the postpartum period?
Dr. Amanda Williams: Traditionally it’s considered six weeks after birth or 42 days after birth. This helps define the maternal mortality rate—pregnancy plus those six weeks—and international comparisons. When we discuss “pregnancy-related,” however, postpartum includes the entire first year. Many experts agree that addressing the whole first year after birth is essential to support patients and ensure smooth transitions to their family medicine or internal medicine doctors.
CS: What are some of the common challenges women face in the postpartum period?
AW: I want people to go into pregnancy and postpartum informed and prepared, not scared. While I wish these lives weren’t being lost, it’s motivating that 80% of pregnancy-related deaths are preventable. If we have the right systems in place, better outcomes are possible.
I group postpartum challenges into physical, mental and systems-based categories. Physically, blood pressure control and hemorrhage are top concerns, as both can happen after going home. High blood pressure is the number-one reason for early hospital readmissions in the early postpartum period. I’d argue that every pregnant and postpartum person should have a blood pressure cuff at home, because symptoms like headache, blurry vision and swelling often don’t appear until after blood pressure has been high for a while. Home monitoring can catch issues early.
Additional physical problems like lactation and sleep issues also affect mental health. In the postpartum period, overdose and suicide are the number-one cause of maternal death, highlighting the need for strong mental health screening, referrals and support. Structural factors also need to fall into place around coordination of care, parental leave and the access to different benefits, all of which make a difference in the postpartum journey.
Dr. Venice Haynes: Challenges in returning to work are common. Six weeks of leave isn’t enough. And women experience stress and anxiety about leaving their babies at such an early age, especially when they need to support their families. They face pressure at work while they’re still living in their healing postpartum bodies and lactating. Are they going to have breastfeeding support in the workplace to allow them to pump as necessary? Mental health support is critical to managing this stress and anxiety.
Employer support after pregnancy loss is rarely discussed. We’ve heard heartbreaking stories from women going back to work immediately after experiencing loss because they’re not afforded the same benefits in postpartum as if they had brought a baby home. Child care and paid leave are also essential in the early years.
Cos Trifonidis: For emergencies like PPH, there are opportunities for improvement in the U.S. health system. PPH, a life-threatening bleeding emergency that affects about 5% of women, can cause serious physical, mental and financial challenges. Mothers and their partners may experience symptoms of post-traumatic stress disorder and associated fears of the birthing experience for years after a PPH episode. It’s important to ensure consistent early intervention and appropriate follow-up by healthcare providers, the health system and the folks supporting these women.
Meghan Doyle: Our system of care isn’t designed to meet the full range of postpartum challenges. Patients consider their OB or midwife as the single provider encompassing all of their needs. Yet we just heard about blood pressure control, lactation challenges, mental health challenges and the physical recovery from labor and delivery. At Partum, we think about how the system needs to mirror the range of mental, emotional and physical challenges people commonly encounter in the postpartum period.
There are many obstacles to getting care. The OB and midwifery workforce is overburdened, and coordinating care is challenging. Finding care that’s covered, especially through Medicaid, is hard. Ultimately, we believe this model needs to flip on its head and default to a multispecialty approach to better address these challenges.
CS: Many of you have mentioned a gap in care during the postpartum period. My postpartum experience was that I saw the pediatrician with my baby, and he gave me a form asking about my mental health. Then, I didn’t see my OB until six weeks after delivery. What is the current standard of care for the postpartum period?
AW: The standard of care is evolving. The six-to-eight-week postpartum visit was an all-in-one appointment trying to cover everything from mental health, recovery, lactation, birth control and more. At the end of pregnancy, women are seen weekly, and then poof, that’s gone, leaving them feeling as though they no longer have support. The American College of Obstetricians and Gynecologists (ACOG) added a second postpartum appointment, an initial contact at two-three weeks—either virtually or in person—while keeping the second six-week appointment as a comprehensive visit. So, the standard of care is supposed to be a three-week initial contact, and then a six-to-eight-week appointment.
But the two-to-three-week appointment doesn’t always happen, either because the practice doesn’t offer it or the woman cannot attend. Many women without maternity leave prioritize their baby’s appointments over their own. Dyad care, where mother and baby are seen together, is ideal. It’s one of the many reasons the midwifery model is strong. Even appointments in the same building make a difference. High-risk patients, particularly with blood pressure issues, need follow-up within the first three to seven days. Or better yet, they need remote blood pressure monitoring at home, since readmission is most likely about five days after birth. That’s what should be standard, but it’s inconsistent.
CS: There is no federal paid family leave policy in the U.S. Although there’s an unpaid leave policy (FMLA), it has some restrictions and differs by state. Venice and Meghan, can you talk about the status of family leave in the U.S. today and what we hear from women?
MD: I think we can all agree we’re envisioning a world where the postpartum standard encompasses much more and will require more frequent touch points, beyond an OB. Paid leave is key to accessing care and having the space to recover. To prioritize their health, women need the opportunity to take time off work without sacrificing their income.
VH: The U.S. is the only high-income country without paid leave. It’s not realistic to birth a human and then return to work, picking up where you left off, all while your body is still recovering. Employers need to consider the implications for productivity in the workplace when women may be stopping every hour to pump. We can’t gloss over the pain after a C-section and the extended recovery time women need, especially if there was a near-miss event or a traumatic birth. Paid leave is critical, not just for workplace productivity, but for the health and well-being of women, their babies and families.
CS: We know many people who screen in for postpartum depression are not getting treated. Why is this and what can we do better?
AW: As an OB-GYN and postpartum depression survivor, this topic is near and dear to my heart. I couldn’t diagnose my own depression, because I was a machine trying to get my work done after going back at six weeks. The irony isn’t lost on me. Although depression screening is now a HEDIS standard, it happens for fewer than 50% of both commercially insured and Medicaid patients. And referral rates to a mental healthcare provider are poor also. We have a major gap to fill.
Having a therapist or counselor in the same office where you’re providing postpartum care can make a huge difference. Yet there’s a shortage of mental health professionals in the U.S., especially those with perinatal expertise. Determining which types of professionals to plug in at what point is important, but it’s gray. Is a support group enough? Does the mother need someone with a master’s in family therapy or a psychiatrist who can prescribe medications? It’s still being figured out, but in the meantime, we must do something to support these patients.
MD: Although the U.S. Preventive Services Task Force recommends behavioral health services for anyone at risk during the perinatal period, stigma and challenges persist. People worry about having a diagnosis in their medical history. Women and families need and deserve mental health support. Even without severe postpartum depression, everybody is navigating a major transition. Reframing the conversation to acknowledge that everyone could use a little extra support during this time could greatly change people’s willingness to get that support.
At Partum, all of our patients do proactive behavioral health screenings. A recent patient’s screening indicated she needed to connect with a behavioral health provider. This patient was also seeing a Partum lactation consultant in person the next day. Not only were we able to follow up with the patient directly, but also the lactation consultant provided additional support and reassurance. By reducing barriers, we can encourage proactive engagement and hopefully avoid the more severe mental health conditions we know are possible during this period.
“The integrated model of care is what I want to hammer home—bringing together different disciplines with expertise in perinatal support to compliment the primary care women receive.”
Meghan Doyle, Co-Founder and CEO, Partum Health
CS: We talked about challenges. Now, let’s talk about solutions. Meghan, how does the postpartum care model need to change to deliver better, complete and more comprehensive care to patients?
MD: The integrated model of care is what I want to hammer home—bringing together different disciplines with expertise in perinatal support to complement the primary care women receive. Also, continuous care: Dr. Williams mentioned remote patient monitoring, particularly blood pressure monitoring. We want to encourage people to stay connected to their provider team beyond individual appointments. The more we can shift to a multidisciplinary model with ongoing engagement, the better results we’ll see. Best practices in countries with leading maternal health outcomes include getting eyes on patients early, in their homes, to provide practical support. They have a community-based care model that I believe we can replicate with healthcare providers in the U.S., nonclinical support from postpartum doulas and enablement through technology. That’s where we see models like Partum and others doing exciting things to shift to continuous multidisciplinary solutions, while removing friction for people to get support.
CS: What else do we observe about the concept of continuous solutions and more comprehensive care? How do we see the model evolving?
VH: I’d like to talk about the many community-based organizations throughout the U.S. that are adopting models and operating more tangibly to provide services to women and families. Places like Oshun Family Center in Pennsylvania, Mamatoto Village in Washington, D.C. and Family Solutions in South Carolina. These organizations have been operating for 20+ years and providing wrap-around services to women up to two years postpartum. This includes home visits and social needs support, which is a huge barrier we haven’t talked much about, but factors into how women navigate postpartum. They have community health workers and doulas trained to provide home visits to literally meet women where they are. We have to think more holistically and dig deeper into the good work that’s happening on the ground and in communities to figure out how we can replicate these models, pay for them and scale them accordingly.
AW: People ask why we now need doulas and lactation specialists when families managed without them for generations. The reality is that we no longer have the organic village and family support that existed, and we need to recreate it. Venice mentioned social needs. If people’s basic social needs aren’t being met—for example, if they’re unhoused, don’t have adequate food or don’t have transportation to get to the appointment, they’re not going to go. We need an integrated model that includes social needs screening, mental health and obstetric care. We need both digital health and traditional community interventions. Sending patients home with a blood pressure cuff, ensuring doula follow-ups and having the home visiting nurse do a weight and latch check on the baby are all wrap-around interventions that we know work. For context, European countries provide far more leave than the U.S., plus home visits. Why is the maternal mortality rate five per 100,000 live births in the U.K., but 19 per 100,000 in the U.S.? Part of the reason is the support that’s provided in the postpartum period in the U.K.
CS: Earlier we mentioned PPH as a cause of maternal mortality. Cos, what does more comprehensive care look like for PPH?
CT: There are a lot of opportunities to improve outcomes in PPH situations. It’s important to ensure that labor and delivery units, or all places where children are being born, are implementing consistent protocols for managing these emergencies. This can be as simple as taking extra care during the intake process when a woman arrives in labor, or having the information transferred from her primary provider to the Labor and Delivery healthcare team so they can better assess her PPH risk and prepare for a potential emergency. Staff readiness and training are critically important to recognize and respond quickly to obstetric hemorrhage emergencies. As I mentioned earlier, PPH occurs in about 5% of cases, so folks aren’t dealing with these patients every day. Simulations for these stakeholders can help. It’s also crucial to have the right equipment and medications ready. Readiness isn’t consistent across the U.S. and represents an opportunity for improvement.
It’s important for mothers to be educated after an event transpires so they know what to look for when they go home. They should have earlier follow-up appointments than a mother who has delivered a baby without this emergency. They should be briefed on the importance of caring for themselves relative to their child. We’ve heard a lot about that in today’s discussion. Too often the child is the priority and the mother is forgotten. We can’t let that happen because women who have experienced an emergency need extra care.
“I would tell people who are pregnant to register for a postpartum doula and a blood pressure cuff instead of a dress or bouncy seat.”
Dr. Amanda Williams, OB-GYN, Adjunct Professor, CMQCC
CS: Let’s do a rapid-fire last question: What one action can people take to their work or their personal lives?
VH: My key takeaway is to rethink, as a country and as employers, the investment and return on investment in women, particularly around paid leave as it relates to postpartum care. Imagine how transformative it could be for women to show up to work as their whole selves.
CT: Putting the woman at the center, thinking about her journey end-to-end and how we can intervene along the way. That’s what we think about every day.
MD: We all have a responsibility to get more vocal about the challenges women face. It’s not about scaring people; instead, it’s about informing them and making sure they understand the potential outcomes they may face that are common in postpartum. Whether it’s in the workplace or with local politicians, we need to move forward on this issue as a country. Ask people about their postpartum experiences and share yours. Normalize the conversation so we can normalize the kind of care we believe everybody deserves.
AW: I would tell people who are pregnant to register for a postpartum doula and a blood pressure cuff instead of a dress or bouncy seat. Know that over 40% of births in this country are insured through Medicaid. Whether or not you’re pregnant, you will love someone who is, so write to your representatives in congress and to your senators to make sure the cuts to Medicaid aren’t too deep. Recent Medicaid expansions have provided longer postpartum coverage, more family leave and doula support, all of which are now at risk. Visit the marchofdimes.org to find your representatives and send a letter. Without this insurance infrastructure, hospitals and providers can’t deliver the care families need.
CS: I want to thank our panelists for this amazing conversation.
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Watch the full webinar on why the healthcare industry must rethink postpartum care.
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