To address the maternal health crisis, we must focus on the fourth trimester

The importance of the 4th trimester: ©Anatta Tan - stock.adobe.com

As a family physician, I’ve had the privilege of accompanying many patients on their journey through pregnancy, childbirth, and into parenthood. I am also painfully aware that for so many people, the journey is not a smooth one- and for some, it ends in tragedy. Our country has the highest maternal mortality rate of any developed nation, and Black patients are disproportionately impacted, being three times more likely to die from a pregnancy-related cause than white patients, according to the CDC. A glaring lack of access to quality health care contributes to these troubling statistics. Even more troubling is the number of complications that happen in the critical weeks and months after delivery.While maternal mortality is a devastating reality, it is largely preventable. Family physicians play a key role in ensuring pregnant patients and babies have the best chance at a long and healthy life. By prioritizing postpartum care, and by recognizing the unique role of family physicians, we can make significant strides towards addressing this crisis.

One of the primary strengths of family physicians lies in our ability to establish relationships with our patients. This continuity of care gives us a comprehensive understanding of their health history, lifestyle, and individual needs. When it comes to maternal health, this familiarity becomes a powerful tool in early detection, prevention, and treatment of pregnancy-related complications. A study by the American Academy of Family Physician’s Robert Graham Center shows that in 181 maternity care deserts across the country, family physicians are the only clinicians delivering babies. That means for more than 400,000 people who areable to carry a pregnancy, a family physician is their sole access to maternity care. From preconception counseling to pregnancy care to postpartum monitoring, we are guiding our patients throughout their journey into parenthood and beyond.

We know the threat of maternal mortality doesn’t end after delivery. I have seen how critically important postpartum care is during the “fourth trimester,” or the first 12 months after birth. I would argue it is just as important as the care my patients receive during pregnancy. A postpartum patients’ body is going through immense physical, hormonal, and emotional changes that cannot be overlooked but often are. I teach my students and residentsthat when they see their patients after they give birth, to screen for postpartum depression, keep track of their vitals and make sure they are also receiving the support they need outside of the office.

Studies have shown that a significant number of maternal deaths occur within weeks or months after childbirth, often due to complications that could have been addressed with proper postpartum care. This includes mental health conditions as well as cardiac and coronary conditions. Our training as family physicians equips us with a broad understanding of obstetrics and primary care, allowing us to address the full spectrum of physical, emotional, and social needs during pregnancy and the postpartum period. We help manage conditions like hypertension and diabetes, which can complicate pregnancy and require ongoing monitoring and treatment after birth.

We also cannot underestimate the impact of mental health challenges in the fourth trimester. Postpartum depression and anxiety are prevalent but often overlooked conditions that can have profound consequences for both a new parent and their family. Research has shown mental health conditions, including suicide and substance use, are a leading cause of maternal mortality in the U.S. By prioritizing postpartum care, family physicians can recognize warning signs and provide support and referrals for behavioral health care.

The fourth trimester is an important time for a new parent and their child. By checking in often with our patients during their new baby’s well visits, we can identify and manage postpartum challenges and ensure that our patients receive the support they need to navigate this time of change.

Thanks to our relationships with patients, comprehensive view of their health, and connections to our communities, family physicians are uniquely positioned to bridge maternal health gaps to ultimately save lives. By recognizing and supporting the crucial role of family physicians, we can take a significant step toward creating a health care system that ensures every birthing person, regardless of background, receives the quality care they deserve. It's time to prioritize maternal health, and family physicians are ready to lead the way.

Tochi Iroku-Malize, MD, MPH, MBA, FAAFP, is a family physician in Long Island, New York, and Board Chair of the American Aca