IMPLICIT Network

Innovations for Maternal and PerinataL Care ImprovemenT

4th Trimester (4TM)

Redefining postpartum care
through an innovative model

We Can Do Better

The State of Care

  • Each year in the United States more than 700 women die from pregnancy-related causes.
  • Maternal mortality and severe maternal morbidity from cardiovascular conditions and other acute and chronic problems continue to increase.
  • Over 50% of postpartum strokes occur within 10 days of discharge.
  • Black women experience 3.5 times higher pregnancy-related mortality rates than their white counterparts.
  • Over 50% of pregnancy-related deaths occur after the birth of the infant.
  • Over 40% of women / birthing people in the US do not receive any postpartum care following delivery.
  • In May 2018, the American College of Obstetricians and Gynecologists (ACOG) called for a new paradigm for postpartum care that addresses the current needs for women and protects against morbidity and mortality for women after pregnancy.

The 4 Stages of 4th Trimester Care

Pregnant woman in the doctor's office

3rd Trimester Visit

28-36 week prenatal visit
  • Identify preexisting conditions/risk factors
  • Create a plan for the postpartum period
Pregnant woman in the doctor's office

Hospital Discharge

2-3 days after delivery
  • Identify delivery/recovery complications
  • Communicate with outpatient care team
Pregnant woman in the doctor's office

Early Postpartum Visit

Within 21 days (0-3 weeks) after delivery of baby
  • Assess signs of biomedical/psychosocial conditions
  • Provide support services as indicated
Pregnant woman in the doctor's office

Routine Postpartum Visit

6-8 weeks after delivery of baby
  • Review engagement with services
  • Comprehensive recovery assessment
  • Ensure connection to primary care
Stage 1 of 4

Specific Aims of the 4th Trimester Care Model

Identify Patients at Risk

Patients who are at risk may have mood concerns, obesity/wound concerns, thyroid disorders, hypertensive disorders, endocrine disorders, renal disease, or substance abuse

Attend the Early Visit

As many as 40% of mothers/birthing people do not attend a postpartum visit. This program aims to get the patient back into see their doctor between 7 and 21 days after delivery.

Establish the Care Team

Postpartum care is often fragmented among multiple providers and settings. This program aims to connect patients with psychosocial, biomedical, and other wrap around services.

I had the privilege of caring for a patient in our centering group who I saw for the majority of her prenatal visits and for her 4th trimester postpartum/dyad visits. Our patient was a refugee who did not have high health literacy and did not know of other contraception options besides condoms. Throughout the prenatal period, we discussed her plans for contraception but she was not ready to make a decision before she delivered. We continued to address her options at each postpartum visit using the ICC framework. At the 6 month visit for her daughter, the patient decided on her contraception plan and we prescribed it at that visit, and had her come in for a nursing visit the following week for her first Depo injection. She is now very content with this method and I think the continuity of care gave her the chance to learn about multiple options, ask questions at each visit, and feel comfortable ultimately deciding on her preferred method.

~ IMPLICIT Provider

Interested in implementing 4TM at your organization?

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