Spelke Bridget, Werner Erika
Warren Alpert Medical School of Brown University, Women & Infants Hospital of Rhode Island, Department of Obstetrics and Gynecology, Providence, RI.
Associate Professor of Obstetrics and Gynecology, Associate Professor of Epidemiology, The Warren Alpert Medical School of Brown University, Women & Infants Hospital of Rhode Island, Department of Obstetrics and Gynecology, Providence, RI.
R I Med J (2013). 2018 Oct 1;101(8):30-33.
The postpartum period is a time of significant challenge and need as women adapt to hormonal and physical changes, recover from delivery, experience shifting family responsibilities, and endure sleep deprivation, all while caring for and nourishing their newborn. It is also a period of significant maternal health risk. Recent data on U.S. maternal mortality indicate a shift in the timing of maternal deaths over the past 10 years, with the majority of maternal deaths now occurring postpartum, from one day to one year after delivery. Postpartum care also marks a period of transition, as women shift from pregnancy-centered care to interpregnancy and primary care, yet current systems of care are marked by poor coordination of care between providers and patient care settings. Suboptimal postpartum follow-up is particularly worrisome for women with chronic health conditions or pregnancy complications who face both short- and long-term health risks. Given known challenges and medical risks, the single, 6-week postpartum visit women receive is woefully inadequate in addressing maternal health needs. Postpartum visits often fail to address the unique postpartum needs identified by mothers, inadequately connect women with primary care services, and have low attendance. Recognition of these unmet needs of "the Fourth Trimester" have led national organizations, including the American College of Obstetricians and Gynecologists (ACOG), to call for a restructuring of postpartum care to reduce postpartum and long-term morbidity and improve postpartum well-being. Rhode Island has several recent initiatives with the potential to improve outcomes for mother-baby dyads including the Baby Friendly Hospital Initiative (BFHI), the provision of long-acting reversible contraception (LARC) immediately postpartum, and the addition of HPV immunization postpartum. These initiatives remove barriers of access to care and provide vital women's health services prior to discharge. The Fourth Trimester provides a rich opportunity for maternal risk reduction and health promotion at a time when women are motivated and engaged with health care.
产后时期是一个充满重大挑战和需求的阶段，在此期间，女性要适应激素和身体变化，从分娩中恢复过来，应对家庭责任的转变，忍受睡眠不足，同时还要照顾和养育新生儿。这也是产妇面临重大健康风险的时期。美国产妇死亡率的最新数据表明，在过去10年中，产妇死亡时间发生了变化，现在大多数产妇死亡发生在产后，即分娩后一天到一年之间。产后护理也标志着一个过渡时期，因为女性从以怀孕为中心的护理转向孕间期和初级护理，但目前的护理系统存在提供者与患者护理环境之间护理协调不佳的问题。对于患有慢性健康问题或妊娠并发症、面临短期和长期健康风险的女性来说，产后随访不佳尤其令人担忧。鉴于已知的挑战和医疗风险，女性产后仅进行一次为期6周的访视，远远不足以满足产妇的健康需求。产后访视往往无法满足母亲们确定的独特产后需求，未能充分将女性与初级护理服务联系起来，且就诊率较低。认识到“孕晚期”这些未得到满足的需求，包括美国妇产科学会（ACOG）在内的全国性组织呼吁对产后护理进行重组，以降低产后发病率和长期发病率，并改善产后健康状况。罗德岛最近有几项举措有可能改善母婴的结局，包括“爱婴医院倡议”（BFHI）、产后立即提供长效可逆避孕措施（LARC）以及产后增加人乳头瘤病毒（HPV）疫苗接种。这些举措消除了获得护理的障碍，并在出院前提供了重要的妇女健康服务。孕晚期为降低产妇风险和促进健康提供了丰富的机会，此时女性有积极性并参与医疗保健。
