Postpartum care

Postpartum care or postnatal care is a service provided to individuals in the postpartum period, to help with postpartum recuperation and restoration.

Traditional postpartum care
Many traditional forms of postpartum confinement exist throughout the world. Chinese Zuo Yuezi (sitting the month) and European Lying-in are examples.

Korea
Sanhujori is Korea's version of postpartum care. It draws on principles that emphasize activities and foods that keep the body warm, rest and relaxation to maximize the body's return to its normal state, maintaining cleanliness, eating nutritious foods, and peace of mind and heart. The confinement period is known as samchil-il (three seven days).

Modern commercial versions
Traditionally, women were taken care of by their elders: their mother, mother-in-law, sister, or aunt. The lying-in hospitals provided an institutional variation which gave women weeks of bedrest and a respite from household chores. Increasingly, these older women are unavailable or unwilling to take on this role; given the lingering effects of the one-child policy, many older Chinese women had limited experience of newborn babies, having only had one themselves. Replacements for this familial help are commercial services, both in the home and at residential centres.

At home
Agencies provide specialist carers that come to the new parents' home. This job used to be known as the monthly nurse, as she came and lived with the family for a month. Now more common terms are maternity nurse, newborn care specialist, or confinement nanny; the worker is not a registered health care professional such as the word "nurse" usually implies in current English. In Indian English the role is called a "japa maid".

A doula is best known as a birth companion, but some provide practical and emotional post-birth support. A lactation consultant and a health visitor are trained health professionals who may assist the new mother at this time. In the Netherlands, the in-home support is known as kraamzorg, and standard within the national health insurance system.

The use of yue sao, a specialist carer translated in Canada as "postpartum doula", is also very common in China. Yue sao typically are live-in domestic helpers who care for both the new mother and baby for the first month after birth. Salaries as at 2017 vary from RMB8000 to RMB20000 per month depending on city and experience. They are described as "mothering the mother". Australian documentary-maker Aela Callan called them "Chinese supermums" but says they are colloquially known as "confinement ladies".

Residential facilities
Companies have sprung up to offer extended postpartum care outside the home, sometimes in a hotel-like environment. Luxury options are a business. Private postpartum care centres were introduced to Korea in 1996 under the name of sanhujoriwon. Within the Chinese tradition, specialist businesses such as Red Wall Confinement Centre charge up to $27,000 for one month. In Taiwan, postpartum nursing centres are popular, for those who can afford them.

Birth tourism centres operating under the radar in the United States for Chinese women offer "sitting the month".

Research
Modern postpartum care in Western countries is typically delivered through family, peers, professional consultants, coordinated care teams, or via information and communication technology.

Outcomes during the postpartum period that have received the most research attention include breastfeeding, greater attendance at postpartum visits, readmissions and emergency room visits, anxiety and depression, oral glucose tolerance testing, hemoglobin A1c testing and contraceptive use.

Based on the 2023 meta-analysis conducted by the Patient-Centered Outcomes Research Institute, in the United States more comprehensive health insurance is likely associated with greater attendance at postpartum visits and may be associated with fewer preventable readmissions and emergency room visits.

General postpartum visits
Evidence suggests that postpartum visits from home/by telephone vs. at the clinic are associated with similar levels of depression or anxiety symptoms up to 1-year post pregnancy.

There is also no reliable evidence that integration of care across multiple types of providers has an impact on depression symptoms or substance use up to 1 year post pregnancy.

Breastfeeding support
Breastfeeding support is one of the most common forms of postpartum care in both the US and Canada. Research evaluating its effectiveness has shown that peers as well as professional lactation consultants can be effective in promoting breastfeeding during the postpartum period. Compared with no peer support, having peer support for breastfeeding has been found to be associated with higher rates of any breastfeeding at 1 month and 3 to 6 months and of exclusive breastfeeding at 1 month. Based on a meta-analysis of randomized control trials and nonrandomized comparison studies, peer support is not related to breastfeeding outcomes past 6 months post pregnancy. Compared with no lactation consultant, breastfeeding care provided by a lactation consultant is associated with higher rates of any breastfeeding at 6 months but not at 1 month or 3 months post pregnancy. The use of information or communication technology for the delivery of breastfeeding care is not associated with higher breastfeeding rates in the months following pregnancy.

Testing reminders
Provision of reminders for testing has been found to be associated with greater adherence to oral glucose tolerance testing up to 1 year postpartum but not random glucose testing or hemoglobin A1c testing.

Research Limitations

Research on postpartum care is almost exclusively based on healthy postpartum individuals. Little is known about the impact of postpartum care on those individuals at high risk of postpartum complications due to chronic conditions, pregnancy-related conditions or systemic bias in health care provision.