Optimizing Care for Moms in the Postpartum Period
Published Dec 11, 2025
Improving care for moms and babies is especially urgent in Missouri, currently ranked 43rd in the United States in women’s health and reproductive care outcomes and fourth highest for maternal care deserts. Most pregnancy-related deaths occur in the postpartum period, making it a critical time to address causes of maternal morbidity and mortality.
What Is the Postpartum Period?
The postpartum period is the time after delivery that involves many transitions for mom, baby and their family.
During this time, women undergo physical changes as they recover from childbirth (a process which can extend to six weeks or even as much as six months postpartum), in addition to emotional and hormonal changes, which may extend beyond six months postpartum. While many moms and caregivers feel obligated to put their focus on the newborn, it also is essential to address the health of the mother.
The American College of Obstetricians and Gynecologists recommends that “postpartum care should be viewed as an ongoing process, rather than a single encounter, with services and support tailored to each woman’s individual needs.”i
In a state where more than half of pregnancy-related deaths occur in the year after delivery, Missouri has made it a priority to improve postpartum care.
Creation of the Missouri Optimizing Postpartum Care Task Force
In 2023, Missouri extended postpartum Medicaid benefits from 60 days following delivery to one year. This extension represents a tremendous opportunity to identify, stabilize and treat health across the care continuum for many Missouri moms that are at a greater risk of maternal mortality caused by perinatal mental health conditions, substance use disorder, complications from chronic conditions and other causes.
To optimize postpartum care recommendations for all Missouri moms, the Missouri Optimizing Postpartum Care Task Force was launched in 2024. In partnership with the Missouri Hospital Association and the Missouri Department of Health and Senior Services, the MO PQC assembled the Task Force and assigned them a complex yet direct charge: to further broaden the definition of the postpartum period and outline the standard of postpartum care and continuity of care through the full 12 months post-delivery.
The MO PQC strategically convened leaders in maternal-infant health who represented the state in terms of expertise, geographic regions and various backgrounds (see Table 1, p. 5).
Intentional consideration was given to include a broad spectrum of the maternal-infant health workforce, such as clinical and nonclinical providers, mental/behavioral health professionals, including those with expertise in treating substance use disorders during the perinatal period, specialized providers experienced in identifying and managing chronic health conditions, community-based providers and representatives, and doulas. With this team of experts, the Task Force got to work on developing a pathway of extended postpartum care.
A Look at the Postpartum Pathway
The postpartum period is a time of many transitions in care, involving various clinical providers, nonclinical providers and supports, potentially across a variety of settings that create touchpoints and opportunities to better serve across the continuum.
Existing evidence-based practices, evidence-informed practices and clinical recommendations identified by the Task Force were compiled to develop a one-year postpartum pathway that prioritizes critical care interventions, screenings and treatment plans. The pathway (Figure 3, pp. 12-13) includes the following three phases as essential frequencies of encounters with patients in the year after delivery.
- preparing for the one-year postpartum period during pregnancy and confirming this plan at delivery discharge
- addressing acute postpartum issues and stabilizing chronic or pregnancy-induced conditions immediately after delivery through the fourth trimester
- actively transitioning to primary care after the comprehensive postpartum care visit to include specific ongoing screenings significant to postpartum health outcomes
For each phase, the Task Force included encounter-specific clinical and nonclinical recommendations that have yet to be broadly implemented and that show promise to improve outcomes with further spread and scale. The pathway also includes recommendations that should recur throughout the postpartum continuum, such as screenings and care coordination best practices.
The Future of Extended Postpartum Care
Transforming postpartum care into an ongoing, structured process that supports transitioning the woman and infant into primary care, subspecialist care as needed, and ongoing social resource support is essential for improving both maternal and infant health outcomes.
A comprehensive approach — integrating patient education, provider training, community-based support, and systemic policy and reimbursement changes — is necessary to bridge existing gaps and establish a more effective postpartum care plan.
The Task Force and the MO PQC call on health care leaders, clinical providers and nonclinical providers to:
- share report recommendations (and an executive summary) with physicians, OB units, primary care services and quality teams
- build robust screening processes and resource and referral networks to identify and address needs in the year following delivery
- consider ways to support ongoing postpartum care and a transition to primary care in their communities, incorporating both clinical and nonclinical roles to address care needs
By implementing these best practices and addressing key barriers, Missouri can build a sustainable, comprehensive postpartum care model and more coordinated system that prioritizes quality maternal-infant health outcomes and improves the overall patient and workforce experience well beyond childbirth.
i American College of Obstetricians and Gynecologists. (2018, May). ACOG committee opinion number 736: Optimizing postpartum care. Obstetrics & Gynecology, 131(5), e140-e150. Retrieved from https://health.mo.gov/healthplans/pdf/state-health-assessment.pdf