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


  • Noelle Borders CNM, MSN

    Corresponding authorSearch for more papers by this author
    • Noelle Borders, CNM, MSN, has a BA in anthropology and religion from the College of William and Mary. She graduated from the nurse-midwifery program at the University of New Mexico in May 2005 and is working as a CNM with University Midwifery Associates in Albuquerque. She has worked as a doula and volunteered as a nurse in a public health clinic in rural Honduras.

Noelle Borders, 4213 Courtney Avenue NE, Albuquerque, NM 87108. E-mail:


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 shortand 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.