Addressing Health Care Gaps During the Fourth Trimester and Through One Year Postpartum

Maternal mortality in the United States has risen over the past three decades, with over half of deaths occurring between one week and one year postpartum. Despite this, most clinical guidelines and care-delivery models focus on the initial 12 weeks after birth.

This narrative review examines barriers to care beyond the fourth trimester and highlights policy, health-system, and clinical strategies for optimizing maternal health across the first postpartum year, recognizing that structural challenges-including insurance loss, workforce shortages, and adverse social determinants of health-pose additional challenges for marginalized populations. Interventions ranging from the expansion of Medicaid to patient-centered medical homes, integration of maternal and pediatric care, standardized visit protocols, home blood pressure monitoring, patient navigation, and digital tools offer promise in improving maternal health and reducing preventable maternal morbidity.

The provision of postpartum care beyond the fourth trimester is essential to reducing maternal morbidity and mortality and advancing health equity. Family physicians and primary care teams are uniquely positioned to provide longitudinal, multidisciplinary postpartum care through the postpartum year. Achieving this vision requires system-level reforms, expanded workforce capacity, clinical tools and support, along with improved transitions between obstetric, pediatric, and primary care providers and services.