The American College of Obstetricians and Gynecologists (ACOG) advises additional visits, as needed, starting in the first three weeks after the baby is born, with a final checkup within the first 12 weeks after giving birth. Some women may require continued medical visits, especially if they experienced any pregnancy complications.
Treatment for perinatal depression is important for the health of both the mother and the baby, as perinatal depression can have serious health effects on both. With proper treatment, most women feel better and their symptoms improve.
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After the birth of a child, many women experience a drop in certain hormones, which can lead to feelings of depression. FDA has approved one medication, called brexanolone, specifically to treat severe postpartum depression. Administered in a hospital, this drug works to relieve depression by restoring the levels of these hormones. To learn more, visit the FDA's press announcement on the approval of brexanolone to treat post-partum depression .
Maternal mortality is unacceptably high. About 287 000 women died during and following pregnancy and childbirth in 2020. Almost 95% of all maternal deaths occurred in low and lower middle-income countries in 2020, and most could have been prevented.
Most maternal deaths are preventable, as the health-care solutions to prevent or manage complications are well known. All women need access to high quality care in pregnancy, and during and after childbirth. Maternal health and newborn health are closely linked. It is particularly important that all births are attended by skilled health professionals, as timely management and treatment can make the difference between life and death for the women as well as for the newborn.
Fertility rates in the United States gradually declined from 1990 to 2019. In 1990, there were about 70.77 births each year for every 1,000 women ages 15-44. By 2019, there were about 58.21 births per 1,000 women in that age group.
It is not clear what portion of the fertility decline to foreign-born Hispanics can be attributed to the economic downturn since the decline began before the Great Recession started. This decline may partially be due to the end of the mini baby boom for foreign-born Hispanic women and a return to long-term downward fertility trend.
Hormone changes that happen after birth may cause the baby blues. After delivery, the amount of the hormones estrogen and progesterone suddenly decreases, causing mood swings. For some people, the hormones made by the thyroid gland may drop sharply, which can make them feel tired and depressed. Not getting enough sleep and not eating well can add to these feelings.
Yes. Up to 10 percent of partners can have feelings of sadness or depression after the birth of a baby. It happens most often during the first 3 to 6 months after the baby is born, but can develop up to a year afterward.
Midwives in many countries are key care providers trained to provide a wide range of services. Among these are helping to manage a normal pregnancy, assisting with childbirth, and providing care during the postpartum period. Placing a priority on natural reproduction processes and relationship-building, midwives also can help address the social and personal needs of mother, baby, and family.8 Ob-gyns, meanwhile, are physicians trained to identify and intervene in abnormal conditions that come up before, during, and after pregnancy. They typically provide care in hospital-based settings.
Racial disparities. The high maternal mortality rate in the U.S. masks dramatic variation by race and ethnicity: the number of deaths per 100,000 births for black non-Hispanic women in 2018 (37.1) was more than two times higher than that for white mothers (14.7). Hispanic women have the lowest rate (11.8).39 The pandemic has the potential to exacerbate existing U.S. racial disparities in maternal outcomes, as Black and Latino people have faced higher rates of economic hardship and mental health problems during the pandemic compared to their white counterparts.40
Black and American Indian and Alaska Native (AIAN) women have higher rates of pregnancy-related death compared to White women. Pregnancy-related mortality rates among Black and AIAN women are over three and two times higher, respectively, compared to the rate for White women (41.4 and 26.2 vs. 13.7 per 100,000). Black, AIAN, and Native Hawaiian and Other Pacific Islander (NHOPI) women also have higher shares of preterm births, low birthweight births, or births for which they received late or no prenatal care compared to White women. Infants born to Black, AIAN, and NHOPI people have markedly higher mortality rates than those born to White women. Maternal death rates increased during the COVID-19 pandemic and racial disparities widened for Black women.
Black and AIAN women have pregnancy-related mortality rates that are about three and two times higher, respectively, compared to the rate for White women (41.4 and 26.5 vs. 13.7 per 100,000 live births) (Figure 1). These disparities increase by maternal age. For example, the pregnancy-related mortality rate for Black women between ages 30 to 34 widens to over four times higher than the rate for White women (48.6 vs. 11.3 per 100,000), while the rate for AIAN women in the same age group is nearly four times as high as the rate for White women (41.2 per 100,000). Moreover, they persist across education levels. Notably, the pregnancy-related mortality rate for Black women who completed college education or higher is 5.2 times higher than the rate for White women with the same educational attainment and 1.6 times higher than the rate for White women with less than a high school diploma. There are small differences in the rate pregnancy-related death between Asian and Pacific Islander and White women (14.1 vs. 13.7 per 100,000), and the rate for Hispanic women is lower compared to that of White women (11.2 vs. 13.7 per 100,000). These findings may mask underlying differences in subgroups of these populations. Other research also shows that Black women are at significantly higher risk for severe maternal morbidity, such as preeclampsia, which is significantly more common than maternal death. Further, Black women have higher rates of admission to the intensive care unit during delivery compared to White women, which is considered a marker for severe maternal morbidity.
Black, AIAN, and NHOPI women are more likely than White women to have certain birth risk factors that contribute to infant mortality and can have long-term consequences for the physical and cognitive health of children. Preterm birth (birth before 37 weeks gestation) and low birthweight (defined as a baby born less than 5.5 pounds) are some of the leading causes for infant mortality. Receiving pregnancy-related care late in a pregnancy (defined as starting in the third trimester) or not receiving any pregnancy-related care at all can also increase risk of pregnancy complications. Black, AIAN, and NHOPI women have higher shares of preterm births, low birthweight births, or births for which they received late or no prenatal care compared to White women (Figure 3). Notably, NHOPI women are four times more likely than White women to begin receiving prenatal care in the third trimester or to receive no prenatal care at all (19% vs. 5%). Black women also are nearly twice as likely compared to White women to have a birth with late or no prenatal care compared to White women (9% vs. 5%).
Disparities in maternal and infant health, in part, reflect increased barriers to care for people of color. Research shows that coverage before, during, and after pregnancy facilitates access to care that supports healthy pregnancies, as well as positive maternal and infant outcomes after childbirth. Overall, people of color are more likely to be uninsured and face other barriers to care. Medicaid helps to fill these coverage gaps during pregnancy and for children. However, women of color are at increased risk of being uninsured prior to their pregnancy and, historically, many have lost coverage at the end of the 60-day Medicaid postpartum coverage period due to lower eligibility levels for parents compared to pregnant women, particularly in states that have not implemented the Affordable Care Act (ACA) Medicaid expansion. Beyond health coverage, people of color face other increased barriers to care, including limited access to providers and hospitals and lack of access to culturally and linguistically appropriate care. These challenges may be particularly pronounced in rural and medically underserved areas. For example, research suggests that a rise in closures of hospitals and obstetric units in rural areas has a disproportionate impact in communities with larger shares of Black patients.
Recent federal legislation has expanded access to and helped stabilize Medicaid coverage during the postpartum period. Medicaid covers almost half of births nationally. However, historically, many pregnant women lost coverage at the end of a 60-day postpartum coverage period because eligibility levels are lower for parents than pregnant women in many states, particularly those that have not implemented the Affordable Care Act (ACA) Medicaid expansion. The American Rescue Plan Act (ARPA) of 2021 provided states a new option for five years, beginning April 1, 2022, to extend postpartum coverage to a full year. As of October 27, 2022, 27 states, including DC, had implemented a 12-month postpartum coverage extension, and an additional seven states were planning to implement the extension. KFF analysis suggests that the coverage extension could prevent hundreds of thousands of enrollees from losing coverage in the months after delivery. In addition, at the start of the pandemic, Congress enacted the Families First Coronavirus Response Act (FFCRA), which included a requirement that Medicaid programs keep people continuously enrolled through the end of the month in which the COVID-19 PHE ends in exchange for enhanced federal funding. This provision has prevented coverage gaps or losses that otherwise might have occurred during the postpartum period due to changes in eligibility and/or administrative challenges associated with maintaining coverage. However, coverage losses may occur after states resume redeterminations of eligibility when the PHE ends. Additional actions may also help to reduce disparities, including adoption of the ACA Medicaid expansion in the 12 remaining states that have not yet expanded, as nearly six in ten adults in the coverage gap in these states are adults of color. Further, Medicaid expansion promotes continuity of coverage in the prenatal and postpartum periods. The Biden Administration Blueprint encourages states to take-up the ARPA postpartum coverage option and urges Congress to close the Medicaid coverage gap and require all states to provide 12 months postpartum Medicaid and CHIP coverage. be457b7860
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