The fourth trimester: A critical transition period with unmet maternal health needs
Abstract
After childbirth, most American women are not scheduled for follow-up care for 6 weeks, and this visit is poorly attended. Many new mothers feel unprepared for the common health issues they encounter and are uncertain of whom to contact. To improve care, the 4 th Trimester Project is bringing together mothers, health care providers, and other stakeholders to explore what families need most from birth to 12 weeks postpartum. Eighty-seven individuals convened in March 2016 in Chapel Hill, NC. Four major topic areas emerged: (1) the intense focus on women's health prenatally is unbalanced by infrequent and late postpartum care; (2) medical practice guidelines often do not align with women's experiences and constraints; (3) validation of women as experts of their infants and elevating their strengths as mothers is necessary to achieve health goals; and (4) mothers need comprehensive care, which is difficult to provide because of numerous system constraints. Considerations for improving postpartum services include enabling more convenient care for families that is holistic, culturally appropriate, conversation based, and equitable. Maternal health issues in the fourth trimester intersect and can compound one another. Enhanced collaboration among health care providers may improve the focus of clinical interactions to address the interrelated health issues most important to women.
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Unmet needs for education in physical self-care and infant care, breastfeeding initiation, emotional support, and anticipatory guidance are also of concern.
“However, unmet needs for education in physical self-care and infant care, breastfeeding initiation, emotional support, and anticipatory guidance are also of concern (Suplee, Kleppel, Santa-Donato, et al. 2016; Tully et al., 2017).”
From Scoping Review of Postpartum Discharge Education Provided by Nurses (2022) · cites this paper as Tully et al., 2017
Retrospective reports indicated unmet learning needs among postpartum women.
“Women were generally satisfied and felt ready at time of discharge in contrast to retrospective reports of unmet learning needs (Martin et al., 2014; Tully et al., 2017).”
From Scoping Review of Postpartum Discharge Education Provided by Nurses (2022) · cites this paper as Tully et al., 2017
Women were generally satisfied and felt ready at time of discharge.
“Women were generally satisfied and felt ready at time of discharge in contrast to retrospective reports of unmet learning needs (Martin et al., 2014; Tully et al., 2017).”
From Scoping Review of Postpartum Discharge Education Provided by Nurses (2022) · cites this paper as Tully et al., 2017
63% of pregnancy-related deaths occur within twelve months of delivery.
“The fi rst postpartum year is especially critical: 63% of pregnancy-related deaths occur within twelve months of delivery. 6,8,9”
From Care utilization and clinical outcomes among high-risk patients enrolled in a postpartum navigation program: a retrospective matched cohort study (2026) · cites this paper as [9]
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- Authors
- Tully, K. P., Stuebe, A. M., & Verbiest, S. B.
- Affiliations
- University of North Carolina at Chapel Hill (US)
- Corresponding author
- Tully, Kristin P.
- Venue
- American Journal of Obstetrics and Gynecology
- Publisher
- Elsevier BV
- Published
- 2017-07
- Volume
- 217
- Issue
- 1
- Pages
- 37-41
- ISSN
- 0002-9378 (ISSN-L)
- OpenAlex
- W2604340266
- Cited by
- 338
- References
- 10
- Citations by year
- 2026: 39 · 2025: 32 · 2024: 40 · 2023: 45 · 2022: 61 · 2021: 48 · 2020: 30 · 2019: 25 · 2018: 14 · 2017: 3
- FWCI
- 31.78
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Obstetrics and Gynecology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Health Professions › General Health Professions › Maternal and Neonatal Healthcare
- Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
- Keywords
- fourth trimester, postpartum care, postpartum follow-up, patient-provider partnership, clinical guidelines, maternal empowerment, culturally appropriate care, health equity, holistic care, health system constraints
- MeSH terms
- Maternal Health, Female, Humans, Maternal Health Services, Postnatal Care, Pregnancy, Prenatal Care, Puerperal Disorders, Quality of Health Care, Quality of Life, Postpartum Period
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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