Why Postpartum Care in America is Failing Women

Postpartum care in the United States is typically built around one visit, most often scheduled around six weeks after childbirth. If a woman delivers by cesarian section, she may have one additional visit at 2 weeks postpartum. For many women, this is the only formal medical follow-up they receive after pregnancy and delivery. One visit is not enough to support women through their transition into motherhood.

The one visit structure is not accidental, and it is not because clinicians don’t care. It is largely a result of how pregnancy and postpartum care are covered by insurance companies.

In most health care settings in the United States, pregnancy care is bundled. This means that prenatal visits, delivery, and postpartum care are grouped together into one payment known as a “global” payment.  Instead of billing for each individual visit, clinicians receive a set amount meant to cover the entire pregnancy.  This means that if your doctor or midwife sees you more frequently for postpartum visits or they see you for a long visit because you have an issue, they will be inadequately compensated for their time.

It may feel uncomfortable to think about medical care as a business. However, this how the medical system in the United States is currently framed. It costs a lot of money to run medical practices, particularly in fields such as Obstetrics and Gynecology. Therefore, it does not make financial sense for practices to focus efforts on postpartum visits when they are bundled financially into the rest of pregnancy care.  Medical practices are only compensated for a set amount, regardless of how much time is invested in the care.

Doctors and midwives are not incentivized, by insurance companies, to provide extended postpartum follow-up, even when patients clearly need it. This is not a reflection of a lack of concern or expertise. Most medical providers work for large group practices which run much like corporations. Even if your doctor wants to spend more time with you and provide you more support, their schedules are controlled by people who value productivity and profits, not quality of care.

As a result, postpartum care is often compressed into a single visit which must cover physical healing, contraception, mental health screening, breastfeeding concerns, clearance for activity and sex, and return-to-work documentation, all in a short appointment.

Beginning January 1, 2027, the shift from global obstetrical billing to billing maternity services separately could fundamentally reshape how pregnancy and postpartum care are delivered in the United States. Rather than financially structuring care around a predetermined bundle of prenatal visits, delivery, and limited postpartum follow-up, the new model allows clinicians to be reimbursed for the care a patient needs, including individualized prenatal schedules, telehealth, home monitoring, counseling, and additional postpartum visits.

Perhaps most importantly, unbundling creates an opportunity to rethink the traditional postpartum model. Instead of postpartum care being treated as a single visit at six weeks, clinicians can provide and bill for ongoing management of pelvic floor dysfunction, mental health concerns, hypertension, lactation-related issues, recovery from birth injury, and other maternal needs. It may also make team-based and multidisciplinary care more financially viable, allowing obstetricians, urogynecologists, pelvic floor therapists, behavioral health clinicians, and other specialists to participate in the “fourth trimester” rather than expecting one obstetric practice to provide all maternity care within a single bundled payment.

In effect, the change has the potential to move U.S. maternity care from a one-size-fits-all episode of care toward a more individualized continuum of pregnancy and postpartum care, while generating much better data about what services women actually receive and where gaps in maternal care remain.