Pediatricians provide a crucial link in postpartum care

A unique challenge of pediatrics is the fact that the health of another, usually the mother, vastly influences the health of our youngest and most vulnerable patient. This point cannot be emphasized enough in the delicate weeks after childbirth. Pediatricians often become the main healthcare provider for both the infant and the mother bringing her child in for frequent visits.

The U.S. has some of the highest maternal mortality rates in the developed world, with 32.9 out of 100,000 women dying during or within a year after birth, according to the CDC. In Philadelphia, these numbers are even more alarming, particularly among Black women. Most of these deaths occur postpartum, when many women rarely see their own healthcare providers.

In Philadelphia, 77% of pregnancy related deaths occurred after delivery. This isn’t just a health crisis; it’s a loud call for changing how we support people after pregnancy.

On Oct. 26 I attended the inaugural Birth Justice Philly Summit organized by The Organized Voice for Action (OVA) coalition led by the Philadelphia Department of Public Health. The goal of the summit was to highlight ongoing work in Philadelphia focused on improving maternal health outcomes. A major theme threaded throughout the day was the need for an “all hands on deck” approach to solving this complicated problem. Pediatricians were identified as key stakeholders in addressing the inequities of maternal health to improve mothers’ outcomes and consequently our communities.

The American Academy of Pediatrics recommends that a healthy newborn should see their provider two to four days after birth. This visit is not only about evaluating how the baby is breastfeeding, and whether there is jaundice and weight loss. It also offers a chance to screen mothers for depression, substance use, and other social determinants of health.

Most every mother follows this advice for her baby. But only 40% of mothers attend their own postpartum follow-up visit with their obstetrician or midwife. This gap in care is where pediatricians can step in, particularly considering that a quarter of pregnancy-related deaths in Philadelphia occur after the 6-week mark.

We urge pediatricians, healthcare institutions, and policymakers to integrate maternal health screening into newborn care. This includes training for pediatricians in maternal health, policy support for integrated health checks, and funding for programs addressing social determinants of health.

A multidisciplinary approach, involving pediatricians, obstetricians, and other healthcare professionals, is crucial. Collaborative care models can effectively create a safety net for mothers during the vulnerable postpartum period.

Training like that initiated at St. Christopher’s Hospital for Children looks for early warning signs of postpartum maternal health complications and uses the early warning signs advice from the Association of Women’s Health, Obstetric and Neonatal Nurses awhonn.org), the initial letter of each sign spelling out “post birth’':

AWHONN also is improving communication with birthing hospitals and other support networks for maternal health. Collaborations with maternal health initiatives and resources for substance abuse, postpartum depression, and domestic violence are also being strengthened.

By taking these steps, we envision a future where maternal morbidity and mortality are drastically reduced. A future where every mother in Philadelphia, and across the nation, is there for every first – her baby’s first birthday, first day of school, and all the precious firsts that follow. Pediatricians, with their unique position in the health care system, have a critical role in making this vision a reality.

Daniel R. Taylor, D.O., is medical director of the outpatient center at St. Christopher’s Hospital for Children, and an associate professor at Drexel University College of Medicine.