When Standard Care Isn't Standard EnoughHow

How One Policy Change Could Have Saved My Career

I still remember the day I walked out of my job. My first baby was ten months old, and I had been drowning under a cloud I didn't recognize as postpartum depression. I thought this exhaustion, this overwhelming sense that I couldn't do anything right, was just my new reality as a working mother. It was supposed to be expected, wasn't it?

I was wrong. But I didn't know that until much later.

As an OB-GYN already working eighty hours a week, I had experienced the healthcare system from both sides - as a provider and as a patient. Even with all my medical training, I couldn't see what was happening to me. The problem with being a new mom is simple: you don't know what's normal and what's not.

I almost gave up my entire career because of something that could have been caught, treated, and managed much earlier. All it would have taken was a structured postpartum visit somewhere between that standard six-week appointment and my breaking point at ten months. But under the old system, that visit would have been out-of-pocket, another burden for a struggling new mother.

When "Standard of Care" Becomes a Barrier

For decades, we've accepted that postpartum care means one visit at six weeks, and that's it. Insurance would cover that single appointment, and anything beyond was the patient's responsibility. We accepted this because it's what we were taught forty years ago, and somehow decided that's the way it had to be.

But why do we do things the way we do in medicine? I've always wondered about this, but like most of us in healthcare, I often just accepted "this is standard of care" without questioning the why behind it.

The old system was failing everyone. As providers, we were locked into rigid prenatal visit schedules that didn't account for individual risk levels. I remember trying to carve out time for routine prenatal appointments when I was myself a low-risk patient - it felt cumbersome and often unnecessary given my demanding schedule. Meanwhile, patients who needed more support in those crucial months after delivery were left to navigate the fourth trimester alone.

COVID: The Catalyst We Didn't Know We Needed

Then COVID happened, and it was traumatic across the board for all of us in healthcare. But sometimes the most challenging experiences force the innovation we desperately needed.

With no choice but to adapt our care for patient safety, we discovered something remarkable: not every prenatal visit needed to happen in person. Low-risk pregnancies could be managed with a combination of telehealth visits and strategic in-person appointments. We could individualize care based on actual need rather than arbitrary schedules set decades ago.

Suddenly, we were providing better care while using resources more efficiently. And that efficiency created an opportunity we hadn't seen before.

The Game-Changing Policy Shift

Thanks to federal policy changes stemming from the American Rescue Plan Act, forty-five states now offer a full year of postpartum insurance coverage instead of just those critical first sixty days. This isn't just a billing change - it's a complete reimagining of maternal care.

Here's the brilliant part: we're funding this expanded postpartum coverage by optimizing prenatal visits through telehealth and risk-based scheduling. The resources saved during pregnancy can now be reinvested in the fourth trimester, when patients truly need ongoing support.

My lightbulb moment came during Dr. Haywood Brown's recent talk at the GOGS 74th Annual Educational Meeting. As a former ACOG president and Maternal-Fetal Medicine specialist, his insights hit differently when he asked: "Why do we do things this way?" His experience in North Carolina showed that much of the monitoring and interventions we routinely perform may not be as evidence-based as we assumed.

The Power of Individualized Care

What excites me most about these changes is the move toward individualized care. Not every person is the same, not every pregnancy is the same, and our care shouldn't be either. It's hard to explain to patients why they need to come back after a certain number of weeks when their needs might be completely different from the patient in the next room.

This individualization isn't just better medicine - it's the key to unlocking genuinely improved maternity outcomes. We can now catch postpartum depression earlier, address breastfeeding challenges when they arise, and provide the support that new families actually need rather than what a decades-old protocol dictates.

From Personal Pain to Professional Progress

Looking back at my own experience, I see how this policy change could have altered everything. Regular postpartum check-ins throughout that first year might have identified my depression months earlier. I might never have reached that breaking point. I certainly wouldn't have felt so alone in what I thought was my failing as a mother.

What started as something traumatic for all of us - COVID's disruption of normal care patterns - has transformed into an expansion of maternity care that addresses real needs. We've taken a system that was rigid and outdated and made it flexible and responsive.

Times have changed. Medicine is becoming more individualized, and we're taking better care of people by innovating rather than blindly following protocols established when our understanding of maternal mental health was primitive at best.

The Future of Maternal Care

This shift represents more than policy reform - it's a fundamental change in how we think about supporting families. We're moving from a one-size-fits-all approach to personalized care that acknowledges the reality of modern parenthood.

For patients, it means getting the support they need when they need it, not when an arbitrary schedule dictates. For providers, it means practicing medicine that makes sense rather than simply following tradition.

And for someone like me, who nearly lost her career to an undiagnosed condition that could have been caught with better postpartum care, it means other mothers won't have to suffer in silence, wondering if their struggles are just "normal."

The fourth trimester deserves the same attention and resources we give to the other three trimesters of pregnancy. Finally, our healthcare system is catching up to that reality.

What other "standard practices" in your field deserve a fresh look? Sometimes the best innovations come from simply asking: "Why do we do things this way?"