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The 4^th Trimester, the first 12 weeks following delivery, is a sensitive period of time that influence the wellbeing of generations, including the way families seek health care and information across the lifespan.

Mothers with limited resources must also 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 experience considerable, interrelated biopsychosocial challenges that are insufficiently supported by health care providers, employers, and the community. Women and their families are under-educated about and therefore unprepared for postpartum health and recovery. Women often receive critical postpartum health information solely at birthing facility discharge when they are exhausted, then in the US, they may wait 6 weeks for care and information even when it is needed immediately. Further, 40% of American women do not receive a postpartum visit. There is much work to be done, and UNC CMIH proposes that we begin where the mothers first led us – accessible, credible, at-your-fingertips information.

 Women have clearly expressed that they need more resources about postpartum health and improved support and communication from clinicians and families. Our first step, therefore, is to make accurate information easily available to demystify postpartum recovery and advance wellness. With support from funders, we will use a human-centered design approach to create and launch the Fourth Trimester & Beyond website hub – offering comprehensive, shareable postpartum health and wellness information for women, families, and clinicians on a common platform.

 To truly create a mother-centered design hub, we are listening to the experiences of mothers, their providers, and their support systems. We need your voice! Please take a few minutes to anonymously share your experience as a new mother or supporter of a new mother: http://bit.ly/4thtrimestersurvey. Thank you!

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Amid these concerns, postpartum care is often fragmented among maternal and pediatric providers, and 20 to 40% of women do not attend a postpartum visit. Rising maternal mortality and morbidity in the US have made this work an even greater priority. Our goal is to bring together mothers, health care providers, and other stakeholders to define what families need most during the 4th Trimester.

Based on the unmet health priorities that stakeholders identify, we will design research studies to deliver optimal care during this critical period, improving outcomes for mothers, infants and families.

The post What is the 4th Trimester Project? appeared first on UNC Collaborative for Maternal & Infant Health.

The 4th Trimester Project will engage stakeholders around these issues for two in-person meetings, interim webinars and online discussions. The first conference will be held in March in Chapel Hill, NC, immediately following the Breastfeeding and Feminism 2016 Conference.

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Key questions

Patients: What did you know about perinatal mood disorders? What guidance was provided prenatally? In the hospital? By pediatric and maternity providers?

If you were screened for depression with a questionnaire, how was it explained / put in context? If you screened positive or had symptoms, what care was offered? If medications were prescribed, how were you counseled? Did you fill your prescription? Start therapy? If a referral was made, was it timely? Did you keep your appointment? Why / why not? What community resources were provided?

For providers: What is your screening practice? What training do you have on managing perinatal depression? What is your “comfort zone” on this topic? To whom do you refer? What resources do you have within your practice? What would you like?

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Key questions

Patients: What aspects of recovery were most challenging for you? What do you wish you’d been told before birth? What questions did you have that your health providers unable to answer? What did your maternity provider say about weight gain during pregnancy & weight loss postpartum? What advice was helpful? What was not? What were your expectations for postpartum weight loss? What would be helpful to achieving those expectations? What do you consider “successful” postpartum weight loss?

Providers: What do you know about prevalence and management about common postpartum complications? What would you like to know and understand? What recommendations do you consider to be evidence-based? What concerns are unaddressed or poorly studied, and what research is needed to determine appropriate treatment? How do you discuss weight with your maternity patients? What educational materials do you offer? Have you been trained in motivational interviewing? Have staff members? Are there resources in your community to which you refer mothers?

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Key questions

Patients: What prenatal, intrapartum, and postpartum support did you find helpful? How do you define successful breast-feeding? What clinical services and support were unhelpful? When you needed help, was it easy to access? Did they receive consistent advice and messaging? What problems were particularly challenging?

Providers: What training have you had regarding management of common breastfeeding challenges? What do you feel comfortable managing? What’s outside your scope? What evidence do you rely on to address your patients’ breastfeeding challenges? What is not known?

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Key questions

Patients: What did you hear about sleep and fatigue during pregnancy? What advice did you get during your birth hospitalization? After discharge? From your provider? From your infant’s provider? From friends and family? What resources were helpful and why? What information would have made the first 12 weeks easier for you?

Providers: What guidance do you provide for families about sleep and fatigue? How do you discuss shared sleep surfaces? How do you advise mothers to cope with fatigue? What evidence do you use to inform this advice? Are there educational materials that you recommend?

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Key questions

Patients: What guidance did you receive about sexuality, contraception and birth spacing during pregnancy? What was helpful? Not helpful? When was guidance provided? What understanding did you have about the methods that were recommended? How were these issues discussed with you during your maternity hospitalization? What did you hear about the effects of contraceptive methods on your sexuality? On breastfeeding? What did you hear about the effects of breastfeeding on pregnancy risk?

Providers: What training and experience do you have addressing sexuality, birth spacing, and contraception with your patients? How do you start these conversations? When do you bring up these topics? What are barriers to counseling about these topics and providing effective care for your patients? What tools would improve the care you provide? What skills would you like to develop / practice?

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