Pregnancy Care Ends Too Soon. How The Postpartum System Fails Mothers.

Pregnancy care in the United States consists of prenatal visits that are purposeful, recurrent, and often celebratory. Postpartum, however, the mother’s support system often drops precipitously. For many, especially first-time parents, the transition to parenthood is so disorienting that struggle feels inevitable. Without a structured network of care, mothers course physical, emotional, and social challenges alone, or with limited support, at a time meant for healing, not hardship.

“Most mothers receive one six-week visit after birth,” says Dr. Phindile Chowa, an emergency medicine physician, mother, and founder of EMCare2U, a postpartum care program in Atlanta. “Not because that’s when the body fully heals, but because that’s what the system dictates.”

That single appointment, Chowa argues, is often a targeted check-up to clear a mother for “work, exercise, and intercourse.” While that isolated visit is considered standard postpartum care in the U.S., “true recovery has only just begun,” she says.

A System Stuck in the Past

National organizations have long called for change. In a 2018 committee opinion, the American College of Obstetricians and Gynecologists (ACOG) urged that postpartum care become “an ongoing process, rather than a single encounter,” with services tailored to each patient’s needs. Among its key recommendations was that women be seen within three weeks after delivery.

Yet, follow-through remains low. While data vary by population, a 2025 analysis of commercially insured patients found that nearly 60% miss their postpartum follow-up visit. These appointments are critical for screening postpartum mental health, managing chronic or pregnancy-related conditions, and supporting physical recovery after birth.

Although the call for more comprehensive care is clear, the workforce and system capacity to provide it remain limited. “More than one-third of U.S. counties are maternity care deserts,” says Chowa, leaving over five million women with little or no access to obstetric services. The challenges in maternal and reproductive health are deeply rooted in systemic issues.

“When I round with patients, I stress the importance of coming in for their postpartum visit—and of scheduling additional visits if they have any concerns,” says Dr. Sussannah Walsh, an obstetrics hospitalist. “But because insurance coverage for postpartum care often falls short, the cost can be high for both patients and providers.” She’s hopeful that upcoming reimbursement changes will make postpartum care a greater priority.

Walsh notes that the culture of care in the United States often fails to recognize that “the woman who embarks on a pregnancy journey is not the same woman who emerges from labor and delivery, regardless of the route of that delivery.” Recovery, she emphasizes, can take a full year, or even longer.

When Care Comes Too Late

The consequences of not having medical care can be deadly. As of 2021, nearly 70% of maternal deaths occur during the postpartum window, most within the first six weeks after delivery. “Eighty-seven percent of pregnancy-related deaths are preventable,” says Chowa. “Yet we continue to underfund and underdeliver care when women need it most.”

Postpartum complications like hypertension, depression, infection, and hemorrhage often appear days or weeks after delivery, well before the six-week mark. “Half of my hypertensive postpartum patients have no symptoms,” says Chowa. She tells every new mom to buy a blood pressure monitor and follow their values for weeks.

Even well-informed women are not immune to gaps in care. Dr. Anikia Nelson, a physician, endured years of dismissal within the very industry she worked in, illustrating how easily patients can fall through the cracks.

Her journey mirrors a tragic path many women take, especially Black women, who face disproportionately higher maternal and postpartum health risks.

“All three of my pregnancies were impacted by systemic racism,” Nelson says. During her first birth, her care team dismissed her complaint that her water had broken. She was told, “most moms don’t know for sure” and sent home. Her newborn developed an infection the day after birth and spent a week in the NICU for intravenous antibiotics. Two years later, she lost a twin pregnancy amid delayed pain control and poor communication.

By her third pregnancy, Nelson was determined to advocate for herself, though the system wasn’t ready to believe her. Six days postpartum she developed severe flank pain and swelling. Suspecting preeclampsia, she called the on-call doctor who told her to come in for an evaluation. But instead of being examined by the doctor, she saw a midwife who said: “You’re probably just doing too much. Eat more carbs, drink more water, and rest.” When Nelson asked if her symptoms were normal, she was told, “I don’t know. We usually don’t see patients until six weeks, and you’re only six days out.”

Nelson recalls sitting in tears, worried and wondering, as a physician in the community, how to have her complaints taken seriously.

Desperate, Nelson turned to an online community of mothers and found Dr. Chowa. “When I told her what was going on, she immediately offered to come to my home,” Nelson says. “No waiting. No hoops. Just deep concern and skilled care.”

Chowa examined her at home, tested her urine, and confirmed postpartum preeclampsia. She coordinated Nelson’s hospital admission and later managed her medications and recovery. Her blood pressure on arrival to the hospital was 179/109, a critically high number in a postpartum patient.

“To be seen. To be heard. To be believed. That’s the kind of care Dr. Chowa gave me—and it changed everything,” Nelson says. Inspired, Nelson launched Birthright Circle, where she helps Black moms navigate pregnancy and postpartum through yoga and self-advocacy.

Rebuilding the System Mothers Deserve

Chowa is trying to prove that postpartum care is both critical and achievable. In her view, postpartum care should involve a collaborative network of professionals: obstetricians, midwives, nurses, doulas, mental health providers, pelvic floor therapists, and lactation consultants. “When care is siloed, mothers fall through the cracks. When it’s connected, lives are saved,” she states.

She hopes employers and insurers will soon recognize postpartum care not as a luxury, but as a public health necessity. “Every ER visit we avoid pays for dozens of home visits and mental-health check-ins,” she adds.

Education on PostPartum Complications

Chowa wants mothers to pay attention to severe headache, vision changes or facial swelling, heavy vaginal bleeding, fever or foul-smell discharge, shortness of breath or chest pain, and thoughts of self-harm or harming others, such as a newborn or older children.

She reminds mothers to ask questions early in pregnancy: “What is your postpartum follow-up schedule, does it differ if I am high-risk? What symptoms should I call you for, and when should I go straight to the ER? Who manages my care after discharge? How do you handle postpartum depression screening? Do you have resources for lactation, pelvic floor, and nutrition support?’

Through education, empowerment, and advocacy, she hopes more women and clinicians can see childbirth not as the finish line, but as the beginning of a journey full of support and healing.