Pregnancy care does not end after childbirth, and many providers are renaming the weeks after delivery "the fourth trimester" to emphasize that mothers need as much care after pregnancy as they do during. The weeks after delivery are an important time for a mother's physical and emotional recovery and can bring health concerns that require medical attention.
For new moms in Arkansas, knowing the warning signs of complications in the postpartum period and where to turn for help can be especially important.
What Is the Fourth Trimester?
The fourth trimester is the postpartum period after childbirth, when a mother's body continues to recover and adjust after pregnancy. The postpartum period generally includes the first 12 weeks after birth. During this time, new mothers may experience physical, emotional, and social changes and may need continued medical care and support.
Why Postpartum Care Matters After Childbirth
“During this period of time, we lose sight of mothers,” says Dr. Nirvana Manning, chair of the Department of Obstetrics and Gynecology at the University of Arkansas for Medical Sciences (UAMS) and service line director for women’s health.
“We’re so hyper-focused on their health during pregnancy. Then they leave the hospital and typically have a six-week follow-up visit with us. But what we’ve learned from the Arkansas Maternal Mortality Review Committee is that two-thirds of Arkansas’s maternal deaths are happening prior to that six-week visit.”
A lot happens once a mother returns home with her baby. Friends, family, and advisors are visiting, and that can offset a lot of what is happening in their lives. As providers, we should think of maternal care as an extension of care and not the end of care.
“Data tells us that things are happening in the fourth trimester, and our job now is to determine how we can bridge that gap in coverage. How can we change what was routine and historical to what it should be? I think the way we do this is to individualize care for the patient,” Dr. Manning says.
If a patient has high blood pressure, they need to be seen sooner. If they have a routine pregnancy and they are relatively healthy, they may only need a clear, established process for seeing the doctor if issues arise.
“Let’s make sure to educate our patients on what is normal and what is not normal and not to only listen to family and friends,” Dr. Manning says.
Common Postpartum Complications
After pregnancy, complications can seem routine at first. One common symptom is excessive fatigue, something many mothers experience after having a baby. Bleeding is also common, but there are different levels of bleeding to be aware of. Other symptoms may include shortness of breath, fevers, and infections.
“The number one cause of maternal death is from cardiovascular issues like high blood pressure and cardiomyopathy,” Dr. Manning says.
But infections are also part of the equation, too. Mothers may feel flushed and hot after pregnancy, and sometimes, people play this off as being from breastfeeding, but the key is to recognize when something doesn’t feel right and speak with a professional who can identify what is normal and what may need a second look.
Postpartum Warning Signs: When Should You Contact a Healthcare Provider?
There is a fine line between normal postpartum issues and something more serious. Dr. Manning says it’s all about relying on family, friends, and support systems.
“Some people don’t have that, and I think that’s where healthcare can help bridge those gaps through things like doulas, community health workers, and other local support. We’re so focused on the baby at this point, and the baby is our number one priority—are they sleeping and eating normally? But we also lose sight of the mother during this time. That’s when the people who love and support us can help recognize some of these subtle changes. If patients don’t have those avenues, we need to find ways to create that for them.”
The Arkansas Center for Women’s and Infants’ Health has established a stable baseline for maternal warning signs and infant safety across the board, no matter where mothers deliver in Arkansas.
“Whether you’re an OB, a family practitioner, or a certified nurse midwife, we are standardizing the education that each patient and family receives so that they all have the same resources when they leave the hospital,” Dr. Manning says.
What are the postpartum warning signs?
- Fever
- Severe headache
- Vision changes
- Chest pain
- Trouble breathing
- Heavy bleeding
- Extreme swelling
Some of these can be very normal, and some of them can be excessive or even life-threatening. It’s hard to identify the balance. Headaches, for example, are a very common symptom after pregnancy. But they can also be an indicator of something more serious. High blood pressure, dehydration, and infection can all cause headaches, so it can be hard to really know what’s a normal headache and what is caused by something else.
When should a new mother contact a healthcare provider?
“It’s a matter of stratifying where we draw the line,” Dr. Manning says. “Do we simply treat this, or do we need to get a professional to take a look? Knowing where we are in our state with maternal mortality, if you’re at home and you’re even just a little bit worried, you should contact a healthcare provider. Telemedicine appointments at home could even be an option to help make a clinical assessment when something doesn’t feel right.”
How is Arkansas Improving Postpartum Care?
Every county in Arkansas has a maternity care desert, where it can be hard for mothers to access quality care. Some moms have to travel several miles just to consult with a provider for routine health issues. In 2019, Arkansas had 39 hospitals providing delivery services. Today, the state is down to 30. And many of these closures are happening in small corners of the state.
Telemedicine for Postpartum Care
In rural areas, mothers may have less access to pregnancy and postpartum care information and resources. These are the areas that need the most support. Dr. Manning and her team offer telehealth appointments to help bridge the gap and increase access for mothers who cannot attend in person.
The “I Gave Birth” Bracelet
In addition to implementing telehealth appointments for postpartum care, Dr. Manning and her team have started up several other initiatives across the state.
“We’ve teamed up with 21 hospitals around the state to start up maternal health initiatives,” Dr. Manning says. “One of those is the I Gave Birth bracelet, which is a blue wristband that anyone can wear that includes a QR code to our website. This helps providers identify women as postpartum so that, when they see a patient with a blood pressure of 140 over 90—a non-emergency situation for a regular patient—they can see the wristband and know that that is a postpartum mother. Then, the blood pressure reading becomes an obstetric emergency.
In the maternal health deserts, the website includes a component for moms to sign up for a telemedicine visit. During these visits, if a mother truly does need urgent care, Dr. Manning’s team can help contact the ER and facilitate a transfer.
“That’s the safety net we need around women so that they don’t feel like they’re on an island after they give birth.”
The results are promising. Since its implementation in May 2025, Dr. Manning’s team has incorporated 21 delivering hospitals through a partnership with UAMS.
Arkansas’s Postpartum Call Center
Another important initiative Dr. Manning has implemented statewide is the postpartum call center. This initiative involves actively calling postpartum moms between five and 10 days postpartum. The team goes through a scripted healthcare questionnaire that covers routine health issues and social determinants of health, identifies what mothers screen positive for, and facilitates soft handoffs to community healthcare workers or other support systems in their communities.
“We also ask mothers their insurance status because we are the only state that has not extended Medicaid coverage to 12 months postpartum,” Dr. Manning says. “Without a payor source, many of these resources are unavailable to mothers. So, if they want help with the reapplication process, we can help them with that, too.”
Dr. Manning hopes this will allow more women to receive coverage. By running through the questionnaire and screening moms for various issues, Dr. Manning’s team can see who is having issues with things like depression, lactation, housing insecurity, food insecurity, and other issues that may require connection to other resources around the state.
Another survey goes out at seven weeks, but Dr. Manning says she would love to have another phone call at four to six weeks, and then another at three months, to continue following up with patients and families and to incorporate their care into the larger community.
“We want no family to be left behind,” Dr. Manning says. We want this to be extensive throughout the state so that these resources can be available and we can begin to create trust in the community.”
Postpartum Support Goes Beyond the OB-GYN
A lot of work is being done to incorporate pediatricians and maternal care experts into this initiative. Babies are often seen between three and five days after birth, with follow-up checks to ensure they are progressing properly. A few simple questions to the mom during these checkups could be completely life-changing. Dr. Manning’s team hopes to bring providers into the conversation to help with that.
Building a Stronger Postpartum Safety Net in Arkansas
“The next step is a formalized statewide safety net where patients and providers can call a centralized number and be able to reach the right person at the right time,” Dr. Manning says.
Providers often have to call several places to get the patient to the best resource they need. Dr. Manning thinks we can do better. There are opportunities to centralize the number of providers who can call and get patients to the right place, and to help smaller communities remain open.
The fourth trimester is a unique period just after delivery. Things that may not cause alarm in someone who’s not immediately postpartum could actually be serious. If a patient presents with a headache, high blood pressure, or shortness of breath, providers must take these things seriously.
“We are doing great work to make Arkansas the safest place to have a delivery,” Dr. Manning says. “To all Arkansas moms: we are behind you, we support you, and we want you to have a successful pregnancy and an amazing postpartum period.”
For more information on postpartum care resources, visit the Arkansas Center for Women’s and Infants’ Health at https://myarkansasbirth.org/. They have tons of resources for all kinds of scenarios. Providers, family members, and mothers can all find helpful information there.
