The year after birth has four quarters. Who owns them?
A birth plan covers one day. A Post-Birth Plan covers the 52 weeks that follow, with a question, a person, and a date for every quarter.
Q1Weeks 1 to 13Am I safe?
Q2Weeks 14 to 26Who is my doctor now?
Q3Weeks 27 to 39How am I really doing?
Q4Weeks 40 to 52What comes next?
ACOG guidance: to 12 weeks
3 in 10 deaths: week 7 to 1 year
ACOG's postpartum guidance covers the first quarter. Pregnancy-related deaths are counted, and happen, through the whole year (1, 2).
2 in 3pregnancy-related deaths happened after the day of delivery (654 of 1,002 with a known date).CDC, MMRCs in 36 states, 2017 to 2019 (1)
3 in 10happened between six weeks and one year after birth (301 of 1,002).CDC, MMRCs in 36 states, 2017 to 2019 (1)
8 in 10were judged preventable by the review committees (84%).CDC, MMRCs in 36 states, 2017 to 2019 (1)
You write this plan during pregnancy, with your obstetrician. You update it before you go home, because the birth you had may not be the birth you planned. Each quarter of the year answers one question and names one person who owns it.
It takes about 15 minutes. Nothing you type leaves your browser.
Publications used in this tool
1
Centers for Disease Control and Prevention. Pregnancy-related deaths: data from maternal mortality review committees in 36 US states, 2017-2019 [Internet]. Atlanta (GA): CDC; 2022 [updated 2024 May 28; cited 2026 Oct 4]. Available from: https://archive.cdc.gov/www_cdc_gov/maternal-mortality/php/data-research/mmrc-2017-2019.html
Data: timing, causes, preventability1,018 pregnancy-related deaths; source of every death statistic in this tool.
Data: timing, causes, preventability1,018 pregnancy-related deaths; source of every death statistic in this tool.
2
ACOG Committee Opinion No. 736: Optimizing postpartum care. Obstet Gynecol. 2018;131(5):e140-e150. doi:10.1097/AOG.0000000000002633
Guideline: postpartum carePostpartum care plan written in pregnancy; contact within 3 weeks; comprehensive visit by 12 weeks.
Guideline: postpartum carePostpartum care plan written in pregnancy; contact within 3 weeks; comprehensive visit by 12 weeks.
3
Suplee PD, Kleppel L, Santa-Donato A, Bingham D. Improving postpartum education about warning signs of maternal morbidity and mortality. Nurs Womens Health. 2016;20(6):552-67.
Education: POST-BIRTH warning signsThe AWHONN warning-sign list used in Quarter 1.
Education: POST-BIRTH warning signsThe AWHONN warning-sign list used in Quarter 1.
4
Health Resources and Services Administration. National Maternal Mental Health Hotline [Internet]. Rockville (MD): HRSA; [cited 2026 Oct 4]. Available from: https://mchb.hrsa.gov/national-maternal-mental-health-hotline
Resource: mental health supportFree, confidential, 24/7 call or text line used in Quarter 3.
Resource: mental health supportFree, confidential, 24/7 call or text line used in Quarter 3.
5
National Academy for State Health Policy. Strengthening postpartum care coordination to improve maternal health [Internet]. Washington (DC): NASHP; 2025 [cited 2026 Oct 4]. Available from: https://nashp.org/strengthening-postpartum-care-coordination-to-improve-maternal-health/
Policy: insurance coverageMedicaid postpartum coverage extended from 60 days to 12 months in nearly all states.
Policy: insurance coverageMedicaid postpartum coverage extended from 60 days to 12 months in nearly all states.
The four-quarter structure and the quarterly reviews are Dr. Amos Grünebaum's proposal. They are built from the guidance above but have not been tested as a schedule. Every other number and recommendation in this tool cites its source.
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You and your birth
The plan follows the birth you actually have.
Where are you right now?
How was, or how is, the baby planned to be born?
Anything from this pregnancy or birth? Check all that apply. Each one adds items to your plan.
We are sorry.
This plan is for your health, and it still matters this year. Your plan will leave out items about feeding and caring for a baby, and it will add follow-up care that ACOG recommends for you after a stillbirth or the death of a baby (2).2of 8
Your owners
Every quarter needs a name on it.
ACOG recommends that the plan name a care team: family and friends who will help, and the clinicians responsible for your care after birth (2). Fill in what you know. Blank lines show up in your plan as questions to ask.
Clinicians
People
Coverage
Nearly all states have extended Medicaid coverage after birth from 60 days to 12 months (5). Ask your plan what applies to you.
Q1wk 1-13
Quarter 1: Am I safe?
Know the signs. Know who to call.
In the CDC data, about 1 in 3 pregnancy-related deaths happened between day 1 and day 42 after birth (353 of 1,002) (1). This quarter is about recognizing an emergency early and getting your first visits on the calendar.
POST-BIRTH warning signs
Call 911
- Pain in the chest
- Obstructed breathing or shortness of breath
- Seizures
- Thoughts of hurting yourself or your baby
Call your obstetrician or midwife now
- Bleeding that soaks a pad in an hour, or large clots
- Incision that is not healing
- Red or swollen leg that is painful or warm
- Temperature of 100.4°F or higher
- Headache that does not get better, or vision changes
If you cannot reach them, call 911.
First visits
Because you had high blood pressure in pregnancy
ACOG recommends an early blood pressure check after you go home (2). Ask your obstetrician for the exact day and write it here.Because of your cesarean birth
Watch the incision every day. An incision that is red, opening, or draining is a POST-BIRTH warning sign (3). Ask your obstetrician when you can drive and lift, and write the answers here.Because you had heavy bleeding at birth
Ask before you go home whether you need a blood count or iron after discharge, and who will check it.Because your baby is in the NICU
Your own appointments still count. Name one person who will track them while your attention is on the baby.Follow-up care for you
ACOG recommends follow-up care for you after a stillbirth or the death of a baby (2). Name the person who will call you to schedule it, so you do not have to.Help at home
Q2wk 14-26
Quarter 2: Who is my doctor now?
The handoff is where women get lost.
ACOG's guidance ends at 12 weeks. The risk does not: 3 in 10 pregnancy-related deaths happened after the sixth week (1). ACOG says the comprehensive postpartum visit should hand you on to ongoing care for chronic conditions and include counseling about future heart disease risk (2).
Blood pressure
High blood pressure in pregnancy is part of the heart disease risk counseling ACOG recommends (2). Make sure your ongoing doctor knows, and write who is following your blood pressure.Blood sugar
Ask your obstetrician when your blood sugar should be tested after birth, and who will do it.Your condition from before pregnancy
Name the doctor who manages it after birth, and the date of the first visit.Going back to work or school
Q3wk 27-39
Quarter 3: How am I really doing?
One person who asks. One clinician who answers.
Mental health conditions, including deaths from suicide and from overdose linked to substance use disorder, were the leading cause of pregnancy-related death in the CDC data: 224 of the 987 deaths with a known cause, more than 1 in 5 (1). These deaths are counted through the full year after birth.
Right now, if you have thoughts of hurting yourself or your baby
- Call 911. This is a POST-BIRTH warning sign (3).
- Or call or text 988, the Suicide and Crisis Lifeline.
For support any time
National Maternal Mental Health Hotline: call or text 1-833-TLC-MAMA (1-833-852-6262). Free, confidential, 24 hours a day, in English and Spanish, with interpreters for other languages (4). It is not an emergency line.Because you have had depression or anxiety
Choose your mental health clinician during pregnancy, not during a crisis. Put their name in your owners list, and ask how quickly they can see you if you need them.Q4wk 40-52
Quarter 4: What comes next?
The end of this year can be the start of the next pregnancy.
ACOG includes a reproductive life plan, with birth spacing and contraception, as part of postpartum care (2). This quarter is when you decide what comes next and make sure someone is still your doctor when the year ends.
Another pregnancy?
Coverage
If your coverage ends before the year does, know that in advance, not at the pharmacy counter. Add the end date on the Owners step.QRreviews
The quarterly review Proposal
Companies review every quarter. So should you.
One contact at the end of each quarter: a visit, a call or a message from a named clinician, who asks that quarter's question. ACOG's guidance already covers the first one. The other three are Dr. Grünebaum's proposal, not established guidance.
Questions and answers
What the Post-Birth Plan is, why it has four quarters, and what to do in each one.
The plan
What is a Post-Birth Plan?
A written plan for your own health in the 52 weeks after birth. It is divided into four quarters of 13 weeks. Each quarter answers one question and names one person who owns it. The plan is not about the baby. The baby already has a pediatrician, a vaccine schedule, and a car seat that was checked twice.
I already have a birth plan. Why do I need this?
A birth plan covers one day. Most of the danger comes after it. In CDC data from 36 states, 654 of 1,002 pregnancy-related deaths with a known date happened after the day of delivery, and 301 happened between six weeks and one year after birth. The review committees judged more than 8 in 10 of all these deaths preventable (1).
Isn't the time after birth only six weeks?
No. ACOG recommends that postpartum care be an ongoing process rather than a single visit, with a comprehensive visit no later than 12 weeks after birth (2). The CDC counts pregnancy-related deaths through one full year after the end of pregnancy (1). The six-week visit is a custom, not a boundary.
Why four quarters?
Pregnancy lasts nine months, so we divide it into trimesters. The year after birth lasts twelve months, so it divides into quarters. ACOG called the first 12 weeks the "fourth trimester" (2). That name covers the first quarter. The other three quarters have had no name and no schedule.
When should I write it?
During pregnancy, at prenatal visits, with your obstetrician or midwife. ACOG recommends that the postpartum care plan be developed during prenatal care (2). The third trimester is a practical time, because you will know your hospital, your team, and your support people. Then update it before you go home.
Who should have a copy?
You, your main support person, your obstetrician or midwife, and the doctor who will take over your care in Quarter 2. Keep one copy where the people helping you at home can find it, for example on the refrigerator next to the POST-BIRTH warning signs.
Is this plan evidence-based?
Its parts are. The death data come from the CDC (1), the visit schedule from ACOG (2), the warning signs from AWHONN (3), and the hotline from HRSA (4). The four-quarter structure and the quarterly reviews are Dr. Grünebaum's proposal. They organize that evidence into one year, but no study has tested them as a schedule. The tool labels them as a proposal wherever they appear.
Does anything I type get saved or sent?
Nothing leaves your browser. The tool can keep your answers on this device so you can come back later. "Start over" erases them.
Quarter 1, weeks 1 to 13: Am I safe?
Which warning signs mean I should call 911?
The first four POST-BIRTH signs: pain in the chest, obstructed breathing or shortness of breath, seizures, and thoughts of hurting yourself or your baby (3).
Which signs mean I should call my obstetrician or midwife?
The last five: bleeding that soaks a pad in an hour or passing large clots, an incision that is not healing, a red or swollen leg that is painful or warm, a temperature of 100.4°F or higher, and a headache that does not get better or comes with vision changes (3). If you cannot reach them, call 911. Tell whoever answers that you gave birth and on what date.
When is my first visit after birth?
ACOG recommends contact with your obstetric team within the first 3 weeks, by phone or in person, and a comprehensive visit no later than 12 weeks after birth (2). Book both before delivery, and write the dates in your plan.
Does it matter if I skip the postpartum visit?
Yes. The comprehensive visit is where your care is handed on for the rest of the year (2). In ACOG's 2018 estimate, as many as 4 in 10 women did not attend a postpartum visit at all (2). A visit booked before delivery is harder to lose.
Who helps at home?
Write names, not intentions: who cooks, who drives, and who takes a night so you can sleep. ACOG recommends that the plan include the family and friends who will give social and material support in the months after birth (2).
Quarter 2, weeks 14 to 26: Who is my doctor now?
Who takes care of me after the 12-week visit?
That is the question this quarter answers. ACOG says the comprehensive postpartum visit should transition you to ongoing care, including care for chronic conditions (2). Your plan should name that doctor and the date of the first appointment. If the line is blank, ask at the 12-week visit.
I had high blood pressure in pregnancy. Is that over now?
Not for planning purposes. ACOG recommends counseling after birth about future heart disease risk (2). Make sure the doctor who takes over knows about it, and name who follows your blood pressure.
I had diabetes in pregnancy. What should I ask?
Ask your obstetrician when your blood sugar should be tested after birth and who orders the test. Write both in your plan.
I am going back to work. What changes?
Your appointments now compete with work. The plan should say how you will keep them: which days, who covers, and whether visits can be by phone or video.
Quarter 3, weeks 27 to 39: How am I really doing?
Why does mental health get a whole quarter?
Because it was the leading cause of pregnancy-related death in the CDC data: 224 of the 987 deaths with a known cause, more than 1 in 5. These include deaths from suicide and from overdose linked to substance use disorder, and they are counted through the full year after birth (1). Mental health is part of every quarter; this one makes sure someone is still asking.
Where can I get help right now?
If you have thoughts of hurting yourself or your baby, call 911 (3), or call or text 988, the Suicide and Crisis Lifeline. For support at any hour, call or text the National Maternal Mental Health Hotline at 1-833-TLC-MAMA (1-833-852-6262). It is free, confidential, and available 24 hours a day in English and Spanish, with interpreters for other languages. It is not an emergency line (4).
What does the check-in person do?
They ask, every month, how you are really doing, and they know the name and number of your mental health clinician. Choose someone who will notice if the answer changes.
I had depression or anxiety before. Should I do anything differently?
Choose your mental health clinician during pregnancy, not during a crisis. Ask how quickly they can see you if you need them, and put their number in your plan.
Quarter 4, weeks 40 to 52: What comes next?
What is a reproductive life plan?
Your decision about whether and when to have another pregnancy, and the contraception that fits it. ACOG includes contraception and birth spacing in postpartum care (2). Ask your obstetrician about spacing if you want another pregnancy.
What happens with my insurance?
Nearly all states have extended Medicaid coverage after birth from 60 days to 12 months (5). Private plans differ. Write down when your coverage ends, and ask before the year is over what happens next.
How do I know the year is finished?
When the last line of your plan has an answer: at week 52, who is your doctor now? If that name is blank, the year is not finished.
When birth changes the plan
My birth did not go as planned. What now?
Update the plan before you go home. The four quarters stay the same. What fills them changes. Bring the plan to your delivery team and ask them to review it with you.
I had a cesarean birth. What changes?
Quarter 1 adds wound care. An incision that is red, opening, or draining is a POST-BIRTH warning sign (3). Ask your obstetrician when you can drive and lift, write the answers down, and make sure someone can drive you to your visits.
I had heavy bleeding at birth. What changes?
Ask before you go home whether you need a blood count or iron after discharge, and who will check it. Bleeding that soaks a pad in an hour is a POST-BIRTH warning sign (3).
My baby is in the NICU. Does my plan still matter?
Yes. Your own appointments compete with the baby's. Name one person who tracks your visits, your blood pressure check if you need one, and your warning signs while your attention is on the baby.
Our baby died. Is this plan still for me?
Yes. The plan is about your health, and your year still has four quarters. ACOG recommends follow-up care for you after a stillbirth or the death of a baby (2). Name a person who will call you to schedule it, so you do not have to make that call yourself. The tool leaves out items about feeding and caring for a baby.
For clinicians
Whose job is the Post-Birth Plan?
Ours. ACOG recommends that the woman and her obstetric clinician develop the plan during prenatal care (2). Writing it is not the patient's homework. In the preventive ethics and professional responsibility framework, the conversation happens before the crisis, and the clinician is responsible for making sure each quarter has a named owner. This is Dr. Grünebaum's position, stated as such.
What are the quarterly reviews?
One contact at weeks 13, 26, 39 and 52, each asking that quarter's question. The week 13 review corresponds to ACOG's comprehensive visit by 12 weeks (2). The other three are a proposal, not established guidance, and have not been tested.
Does postpartum planning in pregnancy improve outcomes?
ACOG recommends it (2), but outcome evidence for any specific planning format is limited. The CDC data establish when the deaths happen (1). Whether a written year-long plan reduces them has not been tested. That should be said plainly to colleagues and patients.