The Gap in Postpartum Care
By Sejal Hathi
Pregnant women in America receive comprehensive medical care during their pregnancy. Their health is closely monitored through regular blood tests, glucose checks, weight tracking, and frequent doctor visits. These appointments occur every four weeks, then every two weeks, and eventually weekly as the pregnancy progresses.
However, once the baby is born, this intensive care often abruptly declines. As a new mother, I have firsthand experience with this change. A year after having my daughter, I still face challenges with my body, which feels unfamiliar. The delivery resulted in a third-degree tear, leading to months of dealing with urinary incontinence. Additionally, my abdominal muscles separated during pregnancy and have not fully healed, making everyday movements, like lifting my daughter, demanding.
After my obstetric specialist discharged me six weeks post-delivery, I struggled to find adequate postpartum care. The general OB clinic was overwhelmed and stopped scheduling new postpartum appointments. My primary care doctor indicated that postpartum recovery was beyond her scope of care. Consequently, I had to navigate my recovery independently—researching symptoms, contacting pelvic floor therapists, and coordinating referrals.
Despite holding a position as the director of a state health agency, having good insurance, paid leave, and a strong understanding of healthcare systems, I lacked a central provider to oversee my care. The existing obstetric care model views postpartum recovery as a brief extension of pregnancy care, typically terminating after a short interval with a clinic visit three to six weeks following delivery.
This approach is reinforced by the reimbursement system, which combines prenatal care, delivery, and immediate postpartum care into one global fee. This practice persists even when recovery continues for several months afterwards.
Starting next year, the American Medical Association plans to separate this global fee into distinct billing codes, allowing providers to charge for each component of care individually. However, this change might exacerbate the core issue. After the initial postpartum weeks, no single clinician remains responsible for the mother’s ongoing recovery and wellness. While the baby receives ample attention from pediatricians, with seven or more appointments within the first year, a mother’s access to a doctor is mostly contingent on emerging complications.