Unmet Maternal Health Needs: In the days, weeks, and months following delivery, women adapt to changing hormones, body image, and roles, while learning to feed and care for their newborns and navigate relationships and expectations with partners, family, friends, co-workers, and other children. These biological, physical, emotional, and social transitions occur with the expectation that women access services for themselves and their infants within systems that are often complex and not consumer-centered. During this “4th Trimester,” many women and their families – especially those with limited resources – experience considerable, interrelated challenges that are insufficiently supported (Tully, Stuebe, & Verbiest, 2017).
Women and their families are under-educated about and therefore unprepared for the postpartum period. Women often receive critical health information regarding themselves and their infants at birthing facility discharge when they are exhausted, overwhelmed, and may not even know what questions to ask. Further, almost 40% of American women do not receive a postpartum health care visit – meaning that their medical care effectively ends upon discharge. Among the women who do receive postpartum health care, there is significant misalignment between the information provided and the issues that matter to them. These gaps in care are a series of missed opportunities.
New mothers and families face multiple challenges, including social isolation, unrealistic infant and self-expectations, biased and judgmental clinical encounters, lack of attention to relationships / sexual health, and stigma around issues such as mental health, incontinence, and infant feeding. Cultural expectations of a rapid postpartum recovery, despite fatigue, limited support services, and the expense of having an infant compound these challenges. Investment in women during this sensitive time can improve wellbeing. The 4thTrimester Project seeks to elevate women’s voices to re-envision and implement comprehensive, compassionate, and effective care for new families (Verbiest, Tully, Simpson, & Stuebe, 2018).
Team: The 4th Trimester Project convenes new mothers, health care providers, researchers, public health professionals, community leaders, and other stakeholders from across the US to identify unmet postpartum health needs, build knowledge, and create sustainable, scalable solutions. The 4thTrimester Project is led by the interdisciplinary team of Dr. Sarah Verbiest, Dr. Alison Stuebe, Dr. Kristin Tully, and Suzanne Woodward at the University of North Carolina at Chapel Hill Center for Maternal and Infant Health (UNC CMIH) within the School of Medicine. UNC CMIH is a leading organization for preconception, pregnancy, and postpartum health innovation and resources. The 4th Trimester partners with the Jordan Institute for Families at the UNC School of Social Work, bringing expertise on behavioral health, poverty, substance use, and family systems to the project.
Vision: In the months following birth, every woman receives the social, emotional, physical, and economic support she needs to successfully transition through the postpartum period and into her new identity. Health care systems, businesses, and society will value and respect women not only for what they bring to families, communities, and nations, but also for who they are in and of themselves.
Mission: To transform the lived experience of the 4th Trimester through a national movement to spark real, sustained change for women and their families at individual, community, and national levels.
To achieve this mission, we will: 1) eliminate undue suffering through the provision and sharing of trustworthy, comprehensive, accessible, woman-centered resources; 2) advance research to address mother-driven health questions; 3) launch courageous conversations that challenge current norms in clinical care, business, and popular media; and 4) set standards of care and support that influence practice at the clinic, system, and societal levels. We believe that it is time to recognize women’s strengths, lift up their voices, break cycles of stigma, and build community responsibility for supporting future generations.
- Health information should be honest, accurate, clear, high quality, and based on the most current science.
- Women are resilient, strong, and entirely capable of making quality decisions for themselves and their families.
- Communities and health systems should care for the mother, rather than demanding that she access care.
- Postpartum health and care research agendas should be driven by women’s expressed needs and center the lived experiences of groups historically underrepresented in research.
- Reflection, transparency, and growth around our own potential biases and limitations is ongoing and essential.
- Partnerships are critical – this work is not focused on singular leadership but about creating a movement that effectively leverages all expertise, talent, and resources.
- The postpartum period is an experience that can be a connector among women. At the same time, historically marginalized women may have different priorities that must be uplifted.
Next Steps for Change:
While there is much work ahead – from redesigning the postpartum health care delivery system to paid family leave – we are building a movement that prioritizes women’s experiences, beginning where mothers have asked us to start. Women clearly expressed that they need more resources about postpartum health and improved support and communication between clinicians and families. There is a clear and urgent need to demystify postpartum recovery and advance wellness through information sharing. With support from the Global Health Foundation, the 4th Trimester Project is in phase one of using human-centered design to create and launch the first comprehensive, relatable, and integrated postpartum health and wellness information hub for women.