‘Fourth trimester’ can be a dangerous time for new mothers

The United States has one of the highest rates of infant mortality. We also have a poor track record when it comes to the health of the mother — especially after childbirth.

Too many American women die or suffer life-threatening or disabling complications of pregnancy and childbirth. In egregious cases, doctors may be liable for malpractice for simply sending new moms on their way without any follow-up.

Health complications do not magically disappear once the baby is born

Mothers who experienced a difficult pregnancy, a difficult birth or a caesarean delivery are at elevated risk for ongoing complications. For example, symptoms of gestational diabetes and pre-eclampsia may subside once the baby is born. But those women are still at elevated risk of stroke, heart attack and other medical conditions long after they leave the hospital.

Women who gave birth by C-section have a significant risk of hemorrhage, blood clots, intestinal blockage and other life-threatening conditions. Yet often they discharged within days with little more than a congratulatory balloon.

Any mother can develop post-partum depression, but the risk is higher for moms of “preemie” babies, especially if she has not bonded with an infant who has spent weeks in neonatal intensive care.

Too many new mothers have a gap in their medical care

Doctors have traditionally advised that new moms visit their OB/GYN within 6 to 12 weeks of giving birth. But the reality is that too few actually see their doctor, or don’t seek care until there is a medical emergency.

A National Public Radio feature stated that 20 to 40 percent of women do not get that fourth trimester visit. And the rate is even lower for women on Medicare. About 1 in 7 new moms do not even have a primary care doctor to go to.

The American College of Obstetricians and Gynecologists now recommends that new moms see their doctor within three weeks of delivery. The ACOG also advises that women who have had complications of pregnancy or childbirth be seen much sooner.

What is the doctor’s responsibility?

The doctor who performs the delivery is not always the mother’s regular OB-GYN. The delivering physician and neonatal nurses are responsible for monitoring the mother during her hospital stay, and for documenting any complications or health concerns that merit follow-up.

But a disconnect can occur once the mother leaves the hospital. Too often there is no formal hand-off or communication with the “aftercare” provider. The mother may be advised to see her doctor. She may even have an appointment on the calendar. But if she doesn’t show up, are the health care providers absolved of liability?

Failure to follow up might constitute medical malpractice if there is a known health risk, such as dangerously high blood pressure, hemorrhage after surgery, or observed indications of post-partum depression. The hospital can also be liable for prematurely discharging new moms who are still in the danger zone.

Physician organizations and women’s health advocates are working to bridge the gap in fourth trimester care. Part of the problem is insurance coverage and access to care. Conscientious doctors and nurses can also do more to educate patients during pregnancy and to reach out if they haven’t heard from a new mom within those first weeks.