“I’m scared,” my patient told me. “I’m scared of hurting the baby. It’s been almost a year, but I’m still scared of hurting her.”
She was 23 years old with her first child. She still felt guilty about these feelings a year after giving birth. She was unsure who to discuss these fears with, including her family and partner. She told me she was desperate when she made the appointment online at 3:00 a.m. Her visit started in tears but as she opened up about her debilitating anxiety around her child, she calmed down. She was overwhelmed with the frequent pediatric visits for her child and no one told her where she could seek help for this aƒnxiety. She did not know she could make an appointment with a primary care doctor to address her postpartum depression
Postpartum care refers to the medical, emotional, and social support a woman receives after giving birth. The American College of Obstetricians and Gynecologists recommends women schedule a comprehensive postpartum visit with their ob/gyn no later than 12 weeks after birth. After this visit, ACOG recommends the patient and the ob/gyn identify the clinician who will help manage and treat any chronic medical conditions after giving birth. ACOG recognizes the primary care physician as a possible clinician to assume this responsibility. Pregnancy has long-lasting impacts on a woman’s health including, but not limited to, chronic pelvic pain, pelvic floor dysfunction, cardiovascular health, metabolic health, and mental health. Life-long postpartum care can help mitigate these health issues. A collaborative approach between ob/gyns and primary care physicians can help ensure that a woman is well cared for after giving birth.
Countless physical changes come from childbirth. Women need to heal from the physical trauma of giving birth vaginally or the major surgery that is a C-section. Breasts are engorged and painful, hemorrhoids appear after days of constipation, and underwear becomes soaked after laughing or coughing. Too often, this history is overlooked when patients transition between clinicians. Multiple EHRs used across different clinicians contribute to this poor transition between doctors. Women switching from their ob/gyn to a primary care doctor can create gaps in care. Obstetric history is often overlooked during the initial visit to primary care. To prevent these gaps that leave women's health vulnerable, primary care doctors can and should ask new patients directly about any previous complications of giving birth, such as gestational diabetes, or preeclampsia. This history is important to the care needed by the patient going forward.
Limited research and data on postpartum care can exacerbate the challenges of providing women with continuous care. In the U.S., we lack national statistics on postpartum health care utilization or postpartum health problems. This dearth of research creates inconsistent findings and confusion for doctors and patients during the postpartum period.
For example, during the transition between ob/gyn and primary care, breastfeeding support often becomes scattered and inconsistent. My friends confess to seeking advice and information on online message boards, Facebook groups, and TikTok rather than the doctor’s office. The American Academy of Pediatrics supports continued breastfeeding, along with appropriate complementary foods introduced at about six months, as long as mutually desired by mother and child for two years or beyond. Since breastfeeding can be an ongoing conversation for two years based on these guidelines, primary care doctors can create a welcoming space for new mothers to bring up any concerns or frustrations about the process. By initiating conversations about breastfeeding, prioritizing nutrition for both mother and baby, and accommodating doctor’s offices with lactation rooms, primary care physicians can provide crucial support to the health of new mothers and their children.
Another issue that is frequently overlooked when new mothers transfer from their ob/gyn to primary care is urinary incontinence. My female patients often mention their urinary incontinence as an afterthought rather than a significant health concern. Up to 62% of women are living with bowel and bladder leaks after pregnancy. Pelvic floor therapy is a non-invasive, evidence-based intervention that can effectively treat incontinence. Primary care doctors should screen for urinary incontinence in women after giving birth and send in a referral for pelvic floor therapy with a physical therapist.
A woman’s mental and physical health are crucial for the health of the baby. Postpartum depression can be diagnosed at any time within the first year after childbirth. There are treatment options available that are also safe for breastfeeding. Since this diagnosis can occur within a year after childbirth, a woman should be established with a primary care physician she trusts and can open up about these vulnerable feelings.
Since we lack national research and clear guidelines for postpartum maternal health, primary care doctors need to work together with ob/gyn to fill this void for women. Specialized care for women and children led to advances in treatment options but created fragmentation of care. Everyone sees three doctors rather than the one family doctor of the town. Sometimes proximity to offices can close this gap. My residency clinic was a floor below the ob/gyn residency’s clinic. Before Epic Chat we would run upstairs and downstairs to coordinate the care of our patients. My current primary care clinic just moved downstairs from an ob/gyn’s office. I would love for a pediatrician to move into the empty office space on the block to make a one-stop shop for women and children. After exchanging cards and numbers with my new office neighbors, I look forward to working together to better serve women during this postpartum period.
What are some ways you support patients in the postpartum period? Share below!
Dr. Kathleen Grant is a primary care physician in Athens, Georgia. She enjoys hiking, yoga, and playing ukulele with her husband. Interests in general internal medicine include rural populations, medical education, and cancer prevention. Dr. Grant is a 2024–2025 Doximity Op-Med Fellow.
Image by Amr Bo Shanab / Getty
