I keep seeing hospitals and campaigns tout “healthy moms,” but when you look under the hood the care model still revolves around a single 6-week postpartum visit, a pap at some point, and a lot of “that’s normal, give it time.” I’ve been around this forum long enough to watch the same issues resurface every few months: incontinence shrugged off, persistent pain dismissed, sexual dysfunction minimized, iron deficiency missed, blood pressure spikes waved away if they’re not catastrophic, thyroid stuff ignored unless it’s screaming. If “healthy moms” is the mantra, why aren’t we defining and measuring what that actually means beyond survival and a living baby?
Here’s the status quo I’m questioning, and what I’d like to discuss with both clinicians and patients who’ve seen better:
- Outcomes that matter: Which patient-reported outcomes should be standard in postpartum and routine gyn care? Continence, sexual function, pelvic pain, mental health, sleep, fatigue, return-to-work readiness, feeding satisfaction, and relationship health all seem fundamental, yet I rarely see them captured in charts or used to drive follow-up.
- Baseline tests and follow-up schedules: Why isn’t there a risk-stratified, opt-out postpartum pathway that goes beyond one visit? For example, automatic serial blood pressure checks for anyone with hypertensive disorders, iron studies for heavy bleeders, validated mental health screens at multiple time points, and targeted glucose/lipid follow-up for those with GDM or late pregnancy dyslipidemia. Is anyone standardizing this?
- Pelvic floor and musculoskeletal care: Given the prevalence of pelvic floor dysfunction after both vaginal birth and C-section, why isn’t pelvic floor PT “opt-out” instead of “opt-in if you know to ask”? Same question for scar assessment (perineal and abdominal), dyspareunia counseling, and graded return-to-activity plans that don’t just rubber-stamp “cleared at 6 weeks.”
- Thyroid and autoimmune surveillance: Postpartum thyroiditis and autoimmune flares are not rare. Are any practices doing proactive screening in a targeted way, and does it change outcomes? Or is this another “we’ll catch it if it’s bad enough” situation?
- Cardiometabolic risk handoff: We keep calling pregnancy a “cardiometabolic stress test,” but where’s the standardized handoff to primary care with explicit risk flags and follow-up intervals? Does anyone here use a “maternal health passport” that lives in the EHR and actually triggers care?
- Surgical aftercare parity: After hysterectomy or oophorectomy, why isn’t there a structured pelvic health protocol (hormone counseling when appropriate, bone health planning, sexual function follow-up, bladder/bowel retraining) rather than a surgical wound check and “see you if you need me”?
- Equity and language: “Healthy moms” also erases non-gestational parents and trans/non-binary people who birth. Has anyone implemented inclusive, outcomes-based care bundles that don’t hinge on mom-centric marketing but still deliver comprehensive postpartum and gyn health?
Concrete asks to the community:
- If you work in a practice that’s moved beyond the one-and-done postpartum visit, what does your pathway look like (timing, screenings, default referrals)? What data got leadership and payers on board?
- Patients: Have you been offered an integrated postpartum plan without having to fight for it? What was included, what actually helped, and what was missing?
- Does anyone have templates for EHR smart sets, PRO questionnaires, or insurer-facing justification language that we can share or adapt?
- Are there published models with hard outcomes (reduced readmissions, better PRO scores, lower long-term hypertension/diabetes rates) that we can point to when advocating locally?
If “healthy moms” is more than a slogan, it should be transparent, measurable, inclusive, and funded. Who’s actually doing this, and how do we push the rest of the system to catch up?