Rethinking Postpartum Care: Supporting Health in the Fourth Trimester and Beyond
Published Jan 22, 2026
For decades, postpartum care in the United States was defined by a single six-week follow-up visit after delivery. Today, that model is evolving as clinicians and patients alike recognize that recovery and long-term health don’t fit neatly into a single appointment. SLUCare providers at SSM Health are helping redefine what comprehensive postpartum care can and should look like — guided by a vision to include maternal-fetal medicine, generalist obstetrician and family practice providers to add a diverse approach to care in the immediate and longer-term postpartum period.
Meet the Experts
Stephanie “Stef” Shorey, WHNP, is a women’s health nurse practitioner with the Maternal-Fetal Medicine (MFM) team at SLUCare SSM Health. She is currently in her 11th year working in MFM and her fourth year in her current role at the Fourth Trimester Integration and Transition (FIT) Center. Through her work, Stef developed a strong passion for supporting the long-term health of postpartum patients with medical conditions that increase cardiovascular risk. This passion was shared by the Department Chairman Dr. Mary McLennan, and together, they took the concept and created a new center. Stef has served as project lead for the FIT Center since it opened in the summer of 2024.
Darryl Zinck, M.D., is a family practice physician with SSM St. Mary’s/Saint Louis University. He completed medical school at the University of Missouri, residency training at the University of Wisconsin and an obstetric fellowship at Rockford Memorial Hospital. Dr. Zinck has a special interest in optimizing postpartum health care and improving transitions of care for patients with high-risk maternal conditions.
Karyn Fowler, M.D., is an obstetrician/gynecologist with SSM St. Mary’s/Saint Louis University. She completed medical school at the University of Illinois and residency training in obstetrics and gynecology at Exempla St. Joseph’s Hospital in Denver. Dr. Fowler has a special interest in comprehensive women’s health care and developing a medical home model for pregnancy and postpartum care.
Together, Dr. Zinck, Dr. Fowler and Stef are working to expand how postpartum care is delivered — moving beyond short-term recovery toward lifelong health.
What Postpartum Care Should Look Like Today
National recommendations, including those from the American College of Obstetricians and Gynecologists (ACOG), now emphasize postpartum care as an ongoing process rather than a single visit. Instead of waiting six weeks after birth, ACOG recommends that patients have contact with a maternal health care provider within the first three weeks postpartum. For those with hypertensive disorders, contact may be needed as early as three to 10 days after delivery, while other high-risk conditions may require follow-up within one to three weeks.
Care should be individualized and coordinated based on pregnancy-related complications and underlying medical conditions. For many patients, this includes a cardiovascular risk assessment and ongoing anticipatory counseling that begins during pregnancy and continues into the postpartum period.
By 12 weeks after delivery, a comprehensive postpartum visit should be completed. During this visit, patients should receive counseling about follow-up care with their obstetrician/gynecologist, a primary care provider and, when appropriate, subspecialty providers. Identifying a primary care provider and coordinating the transition of care are critical components of this visit.
The Hidden Complexities of Postpartum Wellness
Postpartum wellness involves far more than physical recovery from childbirth. It encompasses physical changes, mental and emotional health, and the management of pregnancy-related complications and chronic medical conditions.
Many patients expect to be discharged from the hospital a few days after delivery and to return for a six-week postpartum visit focused on healing and screening for postpartum depression or anxiety. While those elements are important, they represent only part of the picture. Conditions that arise during pregnancy — or that existed before pregnancy — often require close attention well into the postpartum period.
Short-term follow-up is especially important for pregnancy-related complications such as preeclampsia, wound complications and postpartum depression. Patients with preeclampsia, a condition characterized by elevated blood pressure during pregnancy, require careful monitoring of symptoms and blood pressure trends within the first week after hospital discharge. Medication adjustments and additional visits are often necessary. Patients at higher risk for wound complications, particularly after cesarean delivery, may need earlier postoperative exams. Those experiencing symptoms of postpartum depression are often supported by a team that may include medical providers, therapists and social support services, with follow-up typically occurring within one to two weeks of discharge.
Chronic medical conditions also require close postpartum monitoring. Patients with chronic hypertension are often seen within a week of discharge to monitor blood pressure and adjust medications. Diabetes management frequently changes postpartum, particularly with lactation, requiring careful medication adjustments. Patients with obesity may need earlier wound care, management of associated conditions and cardiovascular risk assessment. Individuals with chronic mental health conditions are at increased risk for postpartum mood disorders and often benefit from earlier and more frequent check-ins.
Importantly, many pregnancy-related complications carry long-term health implications. For example, a history of preeclampsia is associated not only with increased short-term health risks, but also with a higher likelihood of developing chronic hypertension, blood clots, heart attack and stroke later in life — often at younger ages than those without this history. Improving patient awareness of these risks and addressing modifiable cardiovascular risk factors can have a meaningful impact on long-term health and life expectancy.
Bridging the Gap Between Obstetric and Long-Term Care
The transition from obstetric care to primary or specialty care can be challenging for both patients and providers. New parents are navigating physical recovery, emotional changes and the demands of caring for an infant — often while managing complications from pregnancy or delivery. Nationally, just over half of patients attend their comprehensive postpartum visit.
Providers face their own challenges, including time constraints, complex transitions of care and the impact of nonmedical factors that affect an individual’s health. Even for an uncomplicated pregnancy, the comprehensive postpartum visit is expected to address nine distinct components, making it difficult to cover everything in depth during a single appointment.
Strategies to overcome these barriers include starting anticipatory guidance during pregnancy and reinforcing education before hospital discharge. There is growing evidence that adverse pregnancy outcomes are linked to long-term cardiovascular and metabolic risks, yet formal guidelines and risk calculators incorporating these factors are still evolving. Educating patients about these risks and empowering them to advocate for continued care after the postpartum period can improve long-term outcomes.
At the FIT Center, one approach to improving care transitions is documenting pregnancy-related complications and their long-term risks in a cover letter shared with the patient’s primary care provider. While nonclinical factors that affect an individual’s well-being continue to create barriers, emphasizing the “why” behind ongoing follow-up — particularly the impact on long-term health — can motivate patients to prioritize their own care.
How the FIT Center Is Changing Postpartum Care
The FIT Center was created to address the need for closer postpartum follow-up and better continuity of care for patients at increased risk for long-term health complications. Although more than half of maternal deaths occur after delivery, most maternal health care contact happens during pregnancy. FIT seeks to close this gap.
A core focus of the FIT Center is patient education. The goal is to help patients understand both the immediate and long-term risks associated with pregnancy-related complications and chronic medical conditions, such as preeclampsia, diabetes, obesity and mental health disorders. By providing actionable education, FIT empowers patients to reduce their long-term health risks.
The center also helps connect patients with primary care and subspecialty providers who can support their health over the long term. Current resources include blood pressure cuffs for at-home monitoring, close follow-up for medication adjustments, access to an on-site pharmacy to reduce barriers to adherence and personalized transition-of-care plans.
FIT’s multidisciplinary team includes specialists in maternal-fetal medicine, obstetrics and gynecology, family medicine, perinatal mental health, metabolic health, weight management, and nutrition, including dietitians and diabetes educators. Pregnancy and parenthood are often powerful motivators for individuals to improve their health, and FIT leverages that moment to connect patients with care that supports both their future well-being and the health of any pregnancies they may pursue.
In its first year of operation, the FIT Center saw steady growth in their number of patients seen, averaging 60 patients per month in the first six months and 94 patients in the last six months. The team found several strategies to be helpful in their program, including implementing a precise plan for monitoring patient blood pressure, providing educational tools on inter-pregnancy and postpartum topics and solidifying relationships with primary care providers to make easy transitions in care management. As the center moves forward, staff looks forward to more collaboration with the metabolic and cardiology teams at SSM Health as they continue to help postpartum patients with medically complex and long-term conditions.
The FIT Center was supported in part through funding provided by the Missouri Department of Health and Senior Services and the Missouri Perinatal Quality Collaborative.