After the Afterbirth: A Critical Review of Postpartum Health Relative to Method of Delivery

Noelle Borders, CNM, MSN


J Midwifery Womens Health. 2006;51(4):242-248. 

In This Article

Abstract and Introduction

Four million women give birth each year in the United States, yet postpartum health has gone largely unaddressed by researchers, clinicians, and women themselves. In light of rising US cesarean birth rates, a critical need exists to elucidate the ramifications of cesarean birth and assisted vaginal birth on postpartum health. This literature review explores the current state of knowledge on postpartum health in general and relative to method of delivery. Randomized trials and other published reports were selected from relevant databases and hand searches. The literature indicates that postpartum morbidity is widespread and affects the majority of women regardless of method of delivery. Women who have spontaneous vaginal birth experience less short- and long-term morbidity than women who undergo assisted vaginal birth or cesarean birth. To maximize postpartum health, providers of obstetric care need to protect the perineum during vaginal birth and avoid unnecessary cesarean deliveries. Clinicians must initiate the discussion about postpartum health antenatally and encourage women to enlist needed support early in the postpartum period. Flexibility in the schedule of postpartum care is essential. More research from the United States is warranted.

In the United States, approximately 4 million women give birth each year. Months of frequent, intense prenatal care normally precede the birth of the baby. Once the mother has birthed her baby and made her initial recovery, she goes home and typically sees her health care provider only once: at the 6-week postpartum checkup. In the United States, once the delivery is accomplished and mother and baby are home, the mother's postpartum physical and mental health are largely ignored. For most women, the experience of having a baby and becoming a mother is a transformative event in their lives. Yet, in most Western societies, no formal or informal rituals exist to celebrate the birth of the woman as mother.[1] As a result, clinicians and new mothers have a limited understanding of what constitutes postpartum health, the typical length of recovery from childbirth, and the impact of postpartum health on the lives of new mothers and their families.[2] The postpartum period is a significant time in women's lives, but, unfortunately, has not received the attention warranted.

In the United States in 2002, 68% of women had a spontaneous vaginal birth, 5.9% had an assisted vaginal birth accomplished by vacuum extraction or forceps, and 26% had a cesarean birth. The cesarean birth rate has risen each year since 1996, and, simultaneously, assisted vaginal birth rates have decreased.[3] Because of the large proportion (32%) of women who have an assisted vaginal birth or cesarean birth, we need to understand the effect these interventions have on postpartum health. This article provides an overview of general postpartum health and details the current state of knowledge about postpartum health relative to method of delivery.


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