The Fourth-Trimester and the Global COVID-19 Pandemic

The Fourth-Trimester and the Global COVID-19 Pandemic

Many women have felt unprepared for the physical and emotional difficulties brought on during the postpartum period. The “fourth trimester” (or the first three months after childbirth) has been made even more difficult for new mothers in the midst of the current COVID-19 pandemic. A recent Boston Globe article delved deeper into this topic. Here are the key takeaways:

The fourth trimester and the global pandemic 

  • For many decades, the United States has treated the health of new mothers as an afterthought to that of their babies. This is despite the fact that the first three months after a child is born bring on lots of physical and emotional changes for new mothers. 
  • Physical changes include pain from vaginal tearing or a C-section and urinary incontinence due to weakened pelvic muscles (experience by 1 in 3 women). Mental health challenges include postpartum depression (for which 1 in 7 women are diagnosed), and generalized feelings of sadness following childbirth (described by up to 4 women out of 5).  
  • Women are often left to navigate these new or exacerbated mental health problems on their own. In the context of the current pandemic, new mothers are especially isolated and overwhelmed, and feelings of anxiety are worsened. 
  • Not only has social distancing placed an economic strain on many new mothers, many have been cut off from support networks they would’ve typically relied on, such as relatives, friends, home health visitors, or new moms’ groups. 

Postpartum care in the United States

  • The uncertainty and medical complications brought on by the global pandemic have exacerbated the long standing problem of the US prioritizing babies’ well-being while disregarding that of the new mother. 
  • While many cultures around the world observe rituals to support new mothers, America is characterized by a deep disregard for the postpartum period, and women feel pressured to recuperate rapidly from pregnancy. 
  • This is highlighted by the fact that the United States is the only industrialized nation without paid parental leave. Qualified employees are offered just 12 weeks of unpaid leave under the Family Medical Leave Act. 
  • Nearly ¼ of employed women in the US return to work within 10 days after giving birth, often due to financial pressures. This impacts mental health, breastfeeding rates, as well as ability to attend postpartum appointments. 
  • Inadequate postpartum care results in the US having a higher maternal mortality rate than any other developed country, and more than half of these deaths take place in the year following the day of the birth. This emphasizes how we should be as concerned about women’s health after birth than during pregnancy. 

Towards a new model of postpartum care 

  • Currently, during a traditional six-week postpartum checkup, women receive just 25 minutes of care. Thankfully, a growing group of doctors, doulas, and health experts across the country are fighting to give postpartum mothers the care they deserve. 
  • New models of care are emerging to incorporate more care for the mother during the three months after birth, some integrating family-centered care into the child’s visit, in order to cover topics such as postpartum depression, stress management, family planning, and domestic violence.
  • With the current COVID-19 pandemic, many physicians are including virtual appointments into their practice, and some are launching virtual fourth-trimester support groups to help women manage the pandemic with a newborn. 
  • With rapidly changing hospital policies surrounding childbirth, many women are having to adapt very quickly to new, unexpected situations. Doulas are figuring out new ways of supporting laboring, with some offering virtual crash courses in labor and postpartum support. 
  • In 2018, the American College of Obstetricians and Gynecologists released a committee opinion in which they proposed a new paradigm for postpartum care. They recommended that providers work with pregnant women to create a postpartum care plan, and replace the lone visit at six-weeks with at least one appointment within the first three weeks, followed by more as needed until a final comprehensive visit at 12 weeks. 
  • The “fourth trimester” message has been increasingly normalized in recent years, with many women speaking out about postpartum recovery and their experiences following childbirth. 

Read the Boston Globe’s full article here.

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Disclaimer: This is general medical information and not specific medical advice.  It does not and should not replace diagnosis or treatment by your healthcare provider. If you are seeking personal recommendations, advice, and/or treatment, please consult your physician. If you have an emergency, you should contact 911 or go to the nearest Emergency Room.