Postpartum care

Many traditional forms of postpartum confinement exist throughout the world. Chinese Zuo Yuezi (sitting the month) and European Lying-in are examples.{{cn|date=September 2024}}

Sanhujori is Korea's version of postpartum care. It draws on principles that emphasize activities and foods that keep the body warm, rest and relaxation to maximize the body's return to its normal state, maintaining cleanliness, eating nutritious foods, and peace of mind and heart.{{Cite journal|last=Kim|first=Jeongeun|date=March 2003|title=Survey on the Programs of Sanhujori Centers in Korea as the Traditional Postpartum Care Facilities|journal=Women & Health|language=en|volume=38|issue=2|pages=107–117|doi=10.1300/j013v38n02_08|issn=0363-0242|pmid=14655798|s2cid=26722305}} The confinement period is known as samchil-il (three seven days).{{cite journal|last1=Dennis|first1=Cindy-Lee|last2=Fung|first2=Kenneth|last3=Grigoriadis|first3=Sophie|last4=Robinson|first4=Gail Erlick|last5=Romans|first5=Sarah|author-link5=Sarah Romans|last6=Ross|first6=Lori|date=July 2007|title=Traditional Postpartum Practices and Rituals: A Qualitative Systematic Review|journal=Women's Health|volume=3|issue=4|pages=487–502|doi=10.2217/17455057.3.4.487|issn=1745-5065|pmid=19804024|doi-access=free}}

In Columbia, new mothers in a process called dieta are traditionally told to avoid sunlight and imbibe sancocho and hot chocolate for 40 days. Before reentering her normal routine, she takes a bath of water and herbs.{{Cite book |last=Foss |first=Richard |author-link=Richard Foss |title=Food Cultures of the World Encyclopedia |publisher=Greenwood |year=2011 |isbn=978-0-313-37626-9 |editor-last=Albala |editor-first=Ken |editor-link=Ken Albala |volume=2: The Americas |location=California |page=45 |chapter=Columbia}}

Access to comprehensive health insurance has been associated with higher rates of postpartum visit attendance, as well as lower rates of preventable hospital readmissions and emergency department use during the postpartum period. These findings suggest that structural healthcare coverage plays a significant role in promoting continuity of postpartum care.

Traditionally, women were taken care of by their elders: their mother, mother-in-law, sister, or aunt. The lying-in hospitals provided an institutional variation which gave women weeks of bedrest and a respite from household chores. Increasingly, these older women are unavailable or unwilling to take on this role; given the lingering effects of the one-child policy, many older Chinese women had limited experience of newborn babies, having only had one themselves. Replacements for this familial help are commercial services, both in the home and at residential centres.{{Cite book |last=DESATIVADO |first=DOI DESATIVADO |url=https://doi.org/10.29327/5333831 |title=DOI DESATIVADO |last2=DOI |first2=DOI DESATIVADO |date=2023-11-23 |publisher=DOI DESATIVADO}}

Agencies provide specialist carers that come to the new parents' home. This job used to be known as the monthly nurse, as she came and lived with the family for a month. Now more common terms are maternity nurse, newborn care specialist, or confinement nanny; the worker is not a registered health care professional such as the word "nurse" usually implies in current English. In Indian English the role is called a "japa maid".{{cn|date=September 2024}}

A doula is best known as a birth companion, but some provide practical and emotional post-birth support. A lactation consultant and a health visitor are trained health professionals who may assist the new mother at this time. In the Netherlands, the in-home support is known as kraamzorg, and standard within the national health insurance system.{{cn|date=September 2024}}

The use of yue sao, a specialist carer translated in Canada as "postpartum doula",{{cite news|last1=Quan|first1=Douglas|date=January 15, 2017|title=Underground industry serves moms who follow Chinese custom of 'sitting the month' after childbirth|publisher=National Post|url=https://nationalpost.com/news/canada/buyer-beware-underground-industry-serves-moms-who-follow-chinese-custom-of-sitting-the-month-after-childbirth|access-date=28 October 2017}} is also very common in China. Yue sao typically are live-in domestic helpers who care for both the new mother and baby for the first month after birth. Salaries as at 2017 vary from RMB8000 to RMB20000 per month depending on city and experience.{{Cite web|title=Yue Sao|url=http://www.ayicheng.com/yue-sao-baby-china-blog/?lang=en|url-status=dead|archive-url=https://web.archive.org/web/20171013015258/http://www.ayicheng.com/yue-sao-baby-china-blog/?lang=en|archive-date=2017-10-13|access-date=2017-07-24|website=Ayicheng}} They are described as "mothering the mother".{{cite web|title=ownyourbirth|url=https://www.ownyourbirth.ca/single-post/2017/11/07/Zuo-Yue-Zi-%E5%9D%90%E6%9C%88-Sitting-the-Month|url-status=dead|archive-url=https://web.archive.org/web/20181030035456/https://www.ownyourbirth.ca/single-post/2017/11/07/Zuo-Yue-Zi-%E5%9D%90%E6%9C%88-Sitting-the-Month|archive-date=30 October 2018|access-date=17 April 2018|website=ownyourbirth|language=en}} Australian documentary-maker Aela Callan called them "Chinese supermums" but says they are colloquially known as "confinement ladies".{{cite web|title=China's Supermums|url=https://www.sbs.com.au/news/dateline/story/chinas-supermums|access-date=17 April 2018|website=News|publisher=SBS (Australian TV channel)|language=en}}

Postpartum care kits are all-in-one packages that contain several postpartum care essentials that a new mom requires right after delivery. These kits may include items like Maternity Pads, Postpartum Underwear, Peri Bottle & more depending on the brand. Postpartum Kits have become quite popular as a part of hospital bags that expecting parents prepare a few weeks before their due date. One of the major advantages of these kits is that it brings all the essentials items at one place, which makes it a very convenient option. Another benefit is that it makes new moms and expecting mothers feel more confident as they step into motherhood. Some of the popular Postpartum Kits available are as follows:

1. [https://frida.com/pages/mom Frida Mom]: Chelsea Hirschhorn, the Founder & CEO of Frida (parent company) and a mom of four, launched a range of postpartum essentials dedicated to supporting women through their postpartum journey. The idea came from her personal experience and the lack of support she experienced. Consequently, she decided to overhaul the type of products that were available to women and bring forth a range of Postpartum Essentials.
2. [https://itsbodily.com/ Bodily]: Since its launch in November 2019, Bodily has established itself as a resource for women's health and bodies with products ranging from Pregnancy to Postpartum. Tova Haim, the Founder & CEO of Bodily launched the company as a response to the lack of information, cultural taboo and the lack of quality products relating to women's health. The inspiration came from her own experience after the birth of her first child. Since the initial launch, the company has also expanded as a resource for breastfeeding and pregnancy loss.
3. [https://junomom.com/ Juno Mom:] Juno Mom is India's 1st Postpartum Care Brand launched in 2024 by Founder & CEO, Akriti Gupta. The idea struck during her pregnancy as she sought to prepare for the journey ahead. She became fascinated by the forgotten wisdom of Postpartum Care in India & other Asian Countries. The struggle to find the right products for herself made it clear that there was a large gap that needed to be addressed. There wasn't only a lack of quality products but also a lack of information about Postpartum Care among the general consumers. Hence, the company was launched with its first product - Juno Mom's Postpartum Kit, front and center. The aim is to democratize postpartum care for all women in India and make the journey smoother.

There are several other companies like [https://healofy.com/ Healofy], [https://mamaandwish.com/ Mama & Wish] & more offering a range of postpartum essentials varying from skincare and nutrition to physical recovery products

Companies have sprung up to offer extended postpartum care outside the home, sometimes in a hotel-like environment. Luxury options are a business.{{cite web|date=21 September 2015|title=Where a new baby means relaxation|url=http://www.news.com.au/lifestyle/parenting/babies/where-a-new-baby-means-relaxation/news-story/b5ebe958a84a9c6e560883a073e94730|access-date=17 April 2018|website=NewsComAu}} Private postpartum care centres were introduced to Korea in 1996 under the name of sanhujoriwon.{{Cite journal|last=Michiyo|first=Nomura|date=2016|title=A Study on the Continuance and Variation of Korean Traditional Postnatal Care in a Modern Postpartum Care Center|journal=The Korean Folklore Society|volume=63|pages=37–77|doi=10.21318/TKF.2016.05.63.37}} Within the Chinese tradition, specialist businesses such as Red Wall Confinement Centre charge up to $27,000 for one month.{{Cite news|last1=Levin|first1=Dan|date=October 2015|title=Red Wall Confinement Centre|newspaper=New York Times|url=https://www.nytimes.com/2015/10/02/business/international/china-confinement-care-for-new-mothers-now-27000-a-month.html|access-date=2017-07-24}} In Taiwan, postpartum nursing centres are popular, for those who can afford them.{{cite journal|last1=Yeh|first1=Yueh-Chen|last2=St John|first2=Winsome|last3=Venturato|first3=Lorraine|date=1 June 2016|title=Inside a Postpartum Nursing Center: Tradition and Change|journal=Asian Nursing Research|language=en|volume=10|issue=2|pages=94–99|doi=10.1016/j.anr.2016.03.001|issn=1976-1317|pmid=27349665|doi-access=free|hdl=10072/100393|hdl-access=free}}

Birth tourism centres operating under the radar in the United States for Chinese women offer "sitting the month".{{cite news|last1=Ni|first1=Ching-Ching|date=25 March 2011|title='Birthing tourism' center in San Gabriel shut down|work=Los Angeles Times|url=https://www.latimes.com/archives/la-xpm-2011-mar-25-la-me-birthing-center-20110325-story.html|access-date=14 April 2018}}

Modern postpartum care in Western countries is typically delivered through family, peers, professional consultants, coordinated care teams, or via information and communication technology.{{cn|date=September 2024}}

Outcomes during the postpartum period that have received the most research attention include breastfeeding, greater attendance at postpartum visits, readmissions and emergency room visits, anxiety and depression, oral glucose tolerance testing, hemoglobin A1c testing and contraceptive use.Saldanha IJ, Adam GP, Kanaan G, Zahradnik ML, Steele DW, Danilack VA, Peahl AF, Chen KK, Stuebe AM, Balk EM. Postpartum Care up to 1 Year After Pregnancy: A Systematic Review and Meta-Analysis. Comparative Effectiveness Review No. 261. (Prepared by the Brown Evidence-based Practice Center under Contract No. 75Q80120D00001.) AHRQ Publication No. 23-EHC010. [https://www.pcori.org/research-results/2021/postpartum-care-women-one-year-after-birth-systematic-review PCORI Publication No. 2023-SR-01]. Rockville, MD: Agency for Healthcare Research and Quality; June 2023. {{doi|10.23970/AHRQEPCCER261}}.

Based on the 2023 meta-analysis conducted by the Patient-Centered Outcomes Research Institute, in the United States more comprehensive health insurance is likely associated with greater attendance at postpartum visits and may be associated with fewer preventable readmissions and emergency room visits.

Research into modern postpartum care strategies in the U.S. and Canada have focused on comparative effectiveness of different care delivery models, analyzing where, how, when, and who provides care, and the impact of health insurance coverage extensions.{{Cite report |url=https://effectivehealthcare.ahrq.gov/products/postpartum-care-one-year/research |title=Postpartum Care up to 1 Year After Pregnancy: A Systematic Review and Meta-Analysis |last=Saldanha |first=Ian J. |last2=Adam |first2=Gaelen P. |last3=Kanaan |first3=Ghid |last4=Zahradnik |first4=Michael L. |last5=Steele |first5=Dale W. |last6=Danilack |first6=Valery A. |last7=Peahl |first7=Alex Friedman |last8=Chen |first8=Kenneth K. |last9=Stuebe |first9=Alison M. |date=2023-06-02 |publisher=Agency for Healthcare Research and Quality (AHRQ) |doi=10.23970/ahrqepccer261}}

Further research explores the management of postpartum hypertension, including the use of home blood pressure monitoring, pharmacological treatments, and magnesium sulfate regimens for preeclampsia, with emphasis on addressing disparities in care access and outcomes relating to race, ethnicity, and social determinants of health.{{Cite report |url=https://effectivehealthcare.ahrq.gov/products/hypertensive-disorders-pregnancy/research |title=Management of Postpartum Hypertensive Disorders of Pregnancy |last=Steele |first=Dale W. |last2=Adam |first2=Gaelen P. |last3=Saldanha |first3=Ian J. |last4=Kanaan |first4=Ghid |last5=Zahradnik |first5=Michael L. |last6=Danilack |first6=Valery A. |last7=Stuebe |first7=Alison M. |last8=Peahl |first8=Alex Friedman |last9=Chen |first9=Kenneth K. |date=2023-05-31 |publisher=Agency for Healthcare Research and Quality (AHRQ) |doi=10.23970/ahrqepccer263 |language=en}}

Nearly 80% of current studies focus on specific intervention targets of postpartum care. More research is needed to look into the profound topic of general postpartum care.

Evidence suggests that postpartum visits from home or by telephone compared to at the clinic, are associated with similar levels of depression or anxiety symptoms up to 1-year post pregnancy.

There is also no reliable evidence that integration of care across multiple types of providers has an impact on depression symptoms or substance use up to 1 year post pregnancy.{{cn|date=September 2024}}

Contraceptive Care

Intrauterine device (IUD) use at 3 and 6 months is similar to early contraceptive use. However, at 6 months, there is greater use of the implant.

Breastfeeding support is one of the most common forms of postpartum care in both the US and Canada. Research evaluating its effectiveness has shown that peers as well as professional lactation consultants can be effective in promoting breastfeeding during the postpartum period. Compared with no peer support, having peer support for breastfeeding has been found to be associated with higher rates of any breastfeeding at 1 month and 3 to 6 months and of exclusive breastfeeding at 1 month. Based on a meta-analysis of randomized control trials and nonrandomized comparison studies, peer support is not related to breastfeeding outcomes past 6 months post pregnancy. Compared with no lactation consultant, breastfeeding care provided by a lactation consultant is associated with higher rates of any breastfeeding at 6 months but not at 1 month or 3 months post pregnancy. The use of information or communication technology for the delivery of breastfeeding care is not associated with higher breastfeeding rates in the months following pregnancy.

Evidence suggests that peer support interventions are associated with increased rates of any breastfeeding at 1 to 6 months postpartum, and exclusive breastfeeding at 1 month. Similarly, lactation consultant care has been found to improve the likelihood of breastfeeding continuation up to 6 months.{{Cite web |last=DOI desativado |first=DOI desativado |date=2023-10-11 |title=DOI desativado |url=https://doi.org/10.29327/7321905 |access-date=2025-04-15 |website=doi.org}}

Provision of reminders for testing has been found to be associated with greater adherence to oral glucose tolerance testing up to 1 year postpartum but not random glucose testing or hemoglobin A1c testing.

Research Limitations

Research on postpartum care is almost exclusively based on healthy postpartum individuals. Little is known about the impact of postpartum care on those individuals at high risk of postpartum complications due to chronic conditions,{{Cite journal |last=Appleton |first=Sarah |date=May 2018 |title=Postpartum Care of Women With Chronic Health Conditions: A Review |url=https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2018/05/optimizing-postpartum-care |journal=The American College of Obstetricians and Gynecologists |pages=875–886}} pregnancy-related conditions{{cite journal | url=https://doi.org/10.1097/AOG.0000000000002114 | doi=10.1097/AOG.0000000000002114 | title=Pregnancy-Related Mortality in the United States, 2011–2013 | date=2017 | last1=Creanga | first1=Andreea A. | last2=Syverson | first2=Carla | last3=Seed | first3=Kristi | last4=Callaghan | first4=William M. | journal=Obstetrics & Gynecology | volume=130 | issue=2 | pages=366–373 | pmid=28697109 | pmc=5744583 }} or systemic bias in health care provision.Williams, D. R., & Rucker, T. D. (2000). Understanding and addressing racial disparities in health care. Health care financing review, 21(4), 75–90. A new way for researchers to provide high-quality research in this field would be to look into the outcome of extended health insurance on postpartum health by using interventions that are aimed at healthcare providers.

See also

• Parental leave
• Postpartum confinement
• Postpartum physiological changes
• Puerperal disorder

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