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Focusing on the ‘Fourth Trimester’: UPMC Increases Emphasis on Postpartum Health

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Picture: Wayne Evans

UPMC is increasing its emphasis on postpartum health, which could be especially important for patients living in rural communities.

For some moms, post-birth recovery is relatively straightforward. Although changes — both physically and mentally — are inevitable, postpartum transition can occur without many problems.

But for some mothers, health officials say, postpartum life can lead to anxiety and depression, significant health problems and even death. And in rural communities, like parts of Beaver and Lawrence counties, there is a higher risk for maternal health issues.

According to a story by the Pew Charitable Trusts, rural areas have a greater risk for postpartum health issues, including high blood pressure and heart conditions.

Dr. Jacoby Spittler, an obstetrics and gynecology specialist at UPMC Magee-Womens Hospital in Pittsburgh, said lack of maternal health facilities can increase postpartum health problems, saying some pregnant patients from rural communities could have undiagnosed conditions.

“Coming into pregnancy, sometimes their health isn’t as good and they may have underlying medical conditions,” he said.

Common postpartum health issues can typically be prevented and include depression and other mental health conditions, high blood pressure, seizures and heart conditions, according to the federal Centers for Disease Control and Prevention.

A study conducted by the CDC took data from 14 maternal mortality review committees between 2008 and 2017 and found that among the 454 pregnancy-related deaths, 65 percent were preventable.

Emphasizing the 'Fourth Trimester'

Health-care professionals say the first-year postpartum, or what many maternal health providers are now calling the “fourth trimester,” is crucial in reducing maternal morbidity and mortality.

Dr. Gabey Gosman, UPMC Magee-Womens’ chief medical officer, said postpartum maternal health can be overlooked.

“There are a lot of healthy things that women are dealing with during that (postpartum) time that they may be so focused on the baby, they put their own health aside,” Gosman said. “Pregnancy is really a window into women’s long-term health.”

Gosman is heavily involved with the American College of Obstetricians and Gynecologists, which coined Jan. 23 as Maternal Health Awareness Day.

“We worked with the Legislature to get Jan. 23 named Maternal Health Awareness Day largely to have the opportunity to have communities celebrate this day and really allow us to focus on the women who have given birth and been through a pregnancy, and how critical their health is,” Gosman said.

She hopes each year can focus on a different area of maternal health.

“This year we decided to focus on the ‘fourth trimester’ -- the end of a pregnancy through the first year,” she said.

On Jan. 23, UPMC Magee-Womens hosted a symposium in honor of Maternal Health Awareness Day, called Focus on the Fourth.

Throughout the morning, women’s health and behavioral health providers discussed what to look out for following childbirth.

“After you have a delivery, you have this expectation that things will be different and you’ll have a bunch of symptoms. And I think it’s really hard as an individual to know what range of symptoms is normal when you’re recovering,” Gosman said.

“We’re really trying to help women to know, ‘OK, this symptom is too much.’ And also to be educating on the health-care side for health-care professionals to take those complaints seriously.”

According to the CDC, every day two women die in the United States after childbirth. An additional 1,000 women are affected every week by severe complications during delivery, and maternal morbidity affects around 52,000 women each year.

More than half of maternal deaths occur post-delivery, according to the CDC.

How the Community Can Help

Spittler said family and friends can help new mothers by watching for potential signs of postpartum depression and health issues, and to check in on new moms.

“The biggest thing is just asking someone. A lot of (new mothers) don’t have anyone ask them (how they’re doing),” Spittler said.

Sometimes new mothers are preoccupied with transitioning to life with a newborn and tend to neglect their own needs.

“The way the community structures have developed, we used to have more tight-knit communities. Now, you don’t have that community feel that allows you to see those struggles of other people, and have that support,” Spittler said.

Postpartum health and mental health issues are common, and Splitter said comparing yourself to others — especially on social media — can be unrealistic and unhealthy.

“There’s the connotation of mom’s being superheroes and taking everything on and being successful at it,” Splitter said, but it’s important to get help when you need it.

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Schedule26 Jun 2022
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