A pregnant woman in America receives more sustained medical attention than at almost any other point in her life. Her blood is drawn, her glucose monitored, her weight and blood pressure tracked. She sees a doctor every four weeks, then every two, then every week.
Then she has the baby — and the system moves on.
I know how quickly care recedes because I am living it. One year after my daughter’s birth, I still begin most days in a body I no longer fully recognize. I sustained a third-degree tear during delivery and spent months dealing with urinary incontinence. Pregnancy separated my abdominal muscles, and their stubborn refusal to reknit rendered even the most ordinary movement, like lifting my daughter from her crib, a willful act.
I had nowhere obvious to turn. My obstetric specialist discharged me at six weeks after delivery, and the general OB clinic was stretched so thin it had stopped scheduling new postpartum patients. My primary care physician said postpartum recovery was outside her scope. So I assembled my own care: researching my symptoms, calling pelvic floor therapists, coordinating referrals.
I am a physician who runs her state’s health agency. I had good insurance, paid leave and a fluency with institutions most new mothers should never need. What I did not have was a single provider who could serve as a quarterback for my care.
The dominant obstetric care model treats postpartum recovery as a brief coda to pregnancy: a short follow-up interval, punctuated by a three- to six-week clinic visit. Our reimbursement system reinforces that assumption, bundling prenatal care, delivery and immediate postpartum care into a single global fee, even as recovery extends months longer.
Beginning next year, the American Medical Association will replace that global fee with new codes that allow providers to bill for each piece of care separately. But fragmenting the bill may deepen the underlying problem: Beyond the first few weeks after delivery, no single clinician owns accountability for the mother’s recovery and well-being. Her baby will see a pediatrician seven or more times in the first year of life. Whether the mother sees a doctor will depend largely on whether something goes wrong
That gap in care would matter in any era. It is especially consequential now, as the United States openly debates how to persuade women to have more children. The White House has called itself “the most pro-family administration in history,” and Vice President JD Vance has said that the government should “make it easier for young moms and dads to afford to have kids.”
But that postpartum year is when many families quietly decide whether to try again. Women who experience significant complications are up to 20 percent less likely to have another child, and when they do, they wait longer.
It is also a period of profound vulnerability. Mental illness spikes in the months following delivery. And for many women, the demands of caring for a baby and a lack of paid leave too often conspire to deter them from seeking necessary care. Two-thirds of pregnancy-related deaths in the United States happen in the year after giving birth, and more than 80 percent are preventable.
A mother and her newborn’s health are inextricably intertwined. When a mother’s depression goes untreated, infant cognitive development suffers. When her baby falls ill, she produces targeted antibodies in her breast milk to fight infection. States with the worst maternal mortality rates tend also to have the worst infant outcomes.
It’s true that there has been some recent good news for maternal health. Most notably, all but one state will extend Medicaid postpartum coverage from 60 days to a full year after birth by the end of this summer. But coverage is not the same as ensuring that patients have ongoing, coordinated medical care. To achieve that, we should design a model that treats mother and infant as a single unit of care, both clinically and financially, through the first year of life.
This could start by having maternal and pediatric services in the same location, such as placing midwives, mental health counselors and pelvic floor therapists inside pediatrician offices. After all, we know mothers reliably appear for their baby’s appointments even when they neglect their own. Better still would be taking advantage of babies’ built-in schedule of checkups to screen both mother and baby for common conditions at the same visit (some pediatric offices are already starting to screen mothers for postpartum depression).
Providers across maternal and pediatric services could be paid to work collaboratively and rewarded for keeping both patients healthy. That would require significant changes to the way the health system delivers and reimburses providers for care, but the deeper shift is conceptual: that medicine has a clear responsibility for both lives.
None of this is fanciful. Finland, for example, has long followed mother and child together at its public maternity clinics, assigning the same nurse to care for both patients through the early years. It’s a system based around the simple truth that a mother’s recovery matters as much as her newborn’s growth.
My husband and I always imagined we would have more than one child. I understand more viscerally now why so many women stop at one — not because they don’t want another child, but because they know how swiftly the system lets go once the baby arrives.
Sejal Hathi is an assistant professor at Stanford School of Medicine.
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