Postpartum care orpostnatal care is a service provided to individuals in thepostpartum period, to help with postpartum recuperation and restoration. Additionally, the service aids in the transition to parenthood while also mitigating any health risks.[1] In the United States, about two‑thirds of pregnancy‑related deaths occur during the postpartum period, most of which are considered preventable; barriers such as fragmented care and lapses in insurance coverage contribute to these risks.[2]
Many traditional forms ofpostpartum confinement exist throughout the world. ChineseZuo Yuezi (sitting the month) and EuropeanLying-in are examples.[citation needed]
Sanhujori is Korea's version of postpartum care. It draws on principles that emphasize activities and foods that keep the body warm, rest and relaxation to maximize the body's return to its normal state, maintaining cleanliness, eating nutritious foods, and peace of mind and heart.[3] The confinement period is known assamchil-il (three seven days).[4]
In Columbia, new mothers in a process calleddieta are traditionally told to avoid sunlight and imbibesancocho and hot chocolate for 40 days. Before reentering her normal routine, she takes a bath of water and herbs.[5]
Traditionally, women were taken care of by their elders: their mother, mother-in-law, sister, or aunt. The lying-in hospitals provided an institutional variation which gave women weeks of bedrest and a respite from household chores. Increasingly, these older women are unavailable or unwilling to take on this role; given the lingering effects of theone-child policy, many older Chinese women had limited experience of newborn babies, having only had one themselves. Replacements for this familial help are commercial services, both in the home and at residential centres.[6]
Agencies provide specialist carers that come to the new parents' home. This job used to be known as themonthly nurse, as she came and lived with the family for a month. Now more common terms are maternity nurse, newborn care specialist, orconfinement nanny; the worker is not a registered health care professional such as the word "nurse" usually implies in current English. InIndian English the role is called a "japa maid".[citation needed]
Adoula is best known as a birth companion, but some provide practical and emotional post-birth support. Alactation consultant and ahealth visitor are trained health professionals who may assist the new mother at this time. In the Netherlands, the in-home support is known askraamzorg, and standard within the national health insurance system.[citation needed]
The use ofyue sao, a specialist carer translated in Canada as "postpartum doula",[7] is also very common in China.Yue sao typically are live-in domestic helpers who care for both the new mother and baby for the first month after birth. Salaries as at 2017 vary from RMB8000 to RMB20000 per month depending on city and experience.[8] They are described as "mothering the mother".[9] Australian documentary-makerAela Callan called them "Chinese supermums" but says they are colloquially known as "confinement ladies".[10]
Companies have sprung up to offer extended postpartum care outside the home, sometimes in a hotel-like environment. Luxury options are a business.[11] Private postpartum care centres were introduced to Korea in 1996 under the name ofsanhujoriwon.[12] Within the Chinese tradition, specialist businesses such as Red Wall Confinement Centre charge up to $27,000 for one month.[13] In Taiwan, postpartum nursing centres are popular, for those who can afford them.[14]
Birth tourism centres operating under the radar in the United States for Chinese women offer "sitting the month".[15]
Additionally, women will often visit obstetricians, gynecologists, pediatrictians, lactation consultants and/or research staff for care and advice during postpartum.[1]
Access to comprehensive health insurance has been associated with higher rates of postpartum visit attendance, as well as lower rates of preventable hospital readmissions and emergency department use during the postpartum period. These findings suggest that structural healthcare coverage plays a significant role in promoting continuity of postpartum care.[1]
Outcomes during the postpartum period that have received the most research attention includebreastfeeding, greater attendance at postpartum visits, readmissions and emergency room visits,anxiety anddepression,[16]oral glucose tolerance testing,hemoglobin A1c testing andcontraceptive use.[17]
Based on the 2023meta-analysis conducted by the Patient-Centered Outcomes Research Institute, in theUnited States more comprehensivehealth insurance is likely associated with greater attendance at postpartum visits and may be associated with fewer preventable readmissions and emergency room visits.[17]
Research into modern postpartum care strategies in the U.S. and Canada have focused on comparative effectiveness of different care delivery models, analyzing where, how, when, and who provides care, and the impact of health insurance coverage extensions.[18]
Further research explores the management of postpartum hypertension, including the use of home blood pressure monitoring, pharmacological treatments, and magnesium sulfate regimens for preeclampsia, with emphasis on addressing disparities in care access and outcomes relating to race, ethnicity, and social determinants of health.[19]
Nearly 80% of current studies focus on specific intervention targets of postpartum care. More research is needed to look into the profound topic of general postpartum care.[18]
Evidence suggests that postpartum visits from home or by telephone compared to at the clinic, are associated with similar levels of depression or anxiety symptoms up to 1-year post pregnancy.[18]
There is also no reliable evidence that integration of care across multiple types of providers has an impact on depression symptoms or substance use up to 1 year post pregnancy.[2]
A 2023 systematic review of postpartum care, up to a year after pregnancy, concluded that more comprehensive healthcare coverage was associated with high attendance rates for scheduled postpartum visits.[20] There is not reliable evidence of the effect of attendance for postpartum visits on maternal and child outcomes.[1]
A 2021 randomized control trial (RCT) observed that postpartum mothers who are visited by human service professionals or public health nurses were more likely to begin breastfeeding and breastfeed longer than those who received no home visits.[2]
Woman going through postpartum are more susceptible to unexpected pregnancies. Keeping into consideration the health of the mother, the postpartum period is one year.[21] Intrauterine device (IUD) use at 3 and 6 months is similar to early contraceptive use. However, at 6 months, there is greater use of the implant.[18]
Breastfeeding support is one of the most common forms of postpartum care in both the US and Canada. Research evaluating its effectiveness has shown that peers as well as professionallactation consultants can be effective in promoting breastfeeding during the postpartum period.[17] Compared with no peer support, having peer support for breastfeeding has been found to be associated with higher rates of any breastfeeding at 1 month and 3 to 6 months and of exclusive breastfeeding at 1 month. Based on a meta-analysis ofrandomized control trials andnonrandomized comparison studies, peer support is not related to breastfeeding outcomes past 6 months post pregnancy.[17] Compared with no lactation consultant, breastfeeding care provided by a lactation consultant is associated with higher rates of any breastfeeding at 6 months but not at 1 month or 3 months post pregnancy. The use of information or communication technology for the delivery of breastfeeding care is not associated with higher breastfeeding rates in the months following pregnancy.[17]
Evidence suggests that peer support interventions are associated with increased rates of any breastfeeding at 1 to 6 months postpartum, and exclusive breastfeeding at 1 month. Similarly, lactation consultant care has been found to improve the likelihood of breastfeeding continuation up to 6 months.[22]
Provision of reminders for testing has been found to be associated with greater adherence tooral glucose tolerance testing up to 1 year postpartum but notrandom glucose testing orhemoglobin A1c testing.[17]
Research on postpartum care is almost exclusively based on healthy postpartum individuals. Little is known about the impact of postpartum care on those individuals at high risk of postpartum complications due to chronic conditions,[23] pregnancy-related conditions[24] or systemic bias in health care provision.[25] A new way for researchers to provide high-quality research in this field would be to look into the outcome of extended health insurance on postpartum health by using interventions that are aimed at healthcare providers.[18]
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