1
|
Sposato MF, Miller WR. Concept Analysis of Woman-Centered Care: Implications for Postpartum Care. MCN Am J Matern Child Nurs 2024:00005721-990000000-00061. [PMID: 39012337 DOI: 10.1097/nmc.0000000000001045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/17/2024]
Abstract
ABSTRACT Approximately two-thirds of pregnancy-related deaths in the United States occur during the postpartum period, yet there is minimal research focusing on the postpartum hospital stay, a critical point of contact between women and the health care system and an important opportunity for intervention. A new approach to postpartum care is needed. "Woman-centered" postpartum care is recommended to improve maternal outcomes, but the concept of woman-centered care is not well-defined. Using Walker & Avant's method of concept analysis, we identified four defining attributes of woman-centered care in the literature: 1) choice, control, and involvement in decision-making; 2) communication and collaboration in the caregiver-woman relationship; 3) individualized and holistic care; and 4) continuity of care. Using these findings, we offer a conceptual definition of woman-centered care and apply the attributes to the postpartum hospitalization in the model and contrary cases. We discuss the potential of the concept to improve maternal health care during this critical period.
Collapse
|
2
|
Green HM, Diaz L, Carmona-Barrera V, Grobman WA, Yeh C, Williams B, Davis K, Kominiarek MA, Feinglass J, Zera C, Yee LM. Mapping the Postpartum Experience Through Obstetric Patient Navigation for Low-Income Individuals. J Womens Health (Larchmt) 2024; 33:975-985. [PMID: 38265478 DOI: 10.1089/jwh.2023.0459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024] Open
Abstract
Background: Although the postpartum period is an opportunity to address long-term health, fragmented care systems, inadequate attention to social needs, and a lack of structured transition to primary care threaten patient wellbeing, particularly for low-income individuals. Postpartum patient navigation is an emerging innovation to address these disparities. Methods: This mixed-methods analysis uses data from the first year of an ongoing randomized controlled trial to understand the needs of low-income postpartum individuals through 1 year of patient navigation. We designed standardized logs for navigators to record their services, tracking mode, content, intensity, and target of interactions. Navigators also completed semistructured interviews every 3 months regarding relationships with patients and care teams, care system gaps, and navigation process. Log data were categorized, quantified, and mapped temporally through 1 year postpartum. Qualitative data were analyzed using the constant comparative method. Results: Log data from 50 participants who received navigation revealed the most frequent needs related to health care access (45.4%), health and wellness (18.2%), patient-navigator relationship building (14.8%), parenting (13.6%), and social determinants of health (8.0%). Navigation activities included supporting physical and mental recovery, accomplishing health goals, connecting patients to primary and specialty care, preparing for health system utilization beyond navigation, and referring individuals to community resources. Participant needs fluctuated, yielding a dynamic timeline of the first postpartum year. Conclusion: Postpartum needs evolved throughout the year, requiring support from various teams. Navigation beyond the typical postpartum care window may be useful in mitigating health system barriers, and tracking patient needs may be useful in optimizing postpartum care. Clinical Trial Registration: Registered April 19, 2019, enrollment beginning January 21, 2020, NCT03922334, https://clinicaltrials.gov/ct2/show/NCT03922334.
Collapse
Affiliation(s)
- Hannah M Green
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Laura Diaz
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Viridiana Carmona-Barrera
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - William A Grobman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio, USA
| | - Chen Yeh
- Department of Preventive Medicine, Biostatistics Collaboration Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Brittney Williams
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ka'Derricka Davis
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Michelle A Kominiarek
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Joe Feinglass
- Division of General Internal Medicine, Department of Medicine and Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Chloe Zera
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Lynn M Yee
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| |
Collapse
|
3
|
Feng AH, Stanhope KK, Jamieson DJ, Boulet SL. Postpartum Psychiatric Outcomes following Severe Maternal Morbidity in an Urban Safety-Net Hospital. Am J Perinatol 2024; 41:e809-e817. [PMID: 36130668 DOI: 10.1055/a-1948-3093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE Severe maternal morbidity (SMM) may be associated with postpartum psychiatric morbidity. However, the direction and strength of this relationship remain unclear. Our goal was to estimate the association between SMM and postpartum inpatient mental health care utilization. STUDY DESIGN We examined all liveborn deliveries at a large, safety-net hospital in Atlanta, Georgia, from 2013 to 2021. SMM at or within 42 days of delivery was identified using International Classification of Disease codes. The primary outcome of interest was hospitalization with a psychiatric diagnosis in the year following the delivery. We used inverse probability of treatment weighting based on propensity scores to adjust for demographics, index delivery characteristics, and medical, psychiatric, and obstetric history. We fit log-binomial models with generalized estimating equations to calculate adjusted risk ratios (aRRs) and 95% confidence intervals (CIs). RESULTS Among 22,233 deliveries, the rates of SMM and postpartum hospitalization with a psychiatric diagnosis, respectively, were 6.8% (n = 1,149) and 0.8% (n = 169). The most common psychiatric diagnosis was nonpsychotic mood disorders (without SMM 0.4%, n = 79; with SMM 1.7% n = 24). After weighting, 2.2% of deliveries with SMM had a postpartum readmission with a psychiatric diagnosis, compared with 0.7% of deliveries without SMM (aRR: 3.2, 95% CI: [2.0, 5.2]). Associations were stronger among individuals without previous psychiatric hospitalization. CONCLUSION Experiencing SMM was associated with an elevated risk of postpartum psychiatric morbidity. These findings support screening and treatment for mild and moderate postpartum psychiatric disorders in the antenatal period. KEY POINTS · Experiencing SMM was associated with three-fold excess risk of postpartum psychiatric admission.. · Experiencing SMM was not associated with an elevated risk of outpatient psychiatric care use.. · Experience SMM was not associated with outpatient psychiatric morbidity diagnoses..
Collapse
Affiliation(s)
- Alayna H Feng
- Department of Epidemiology, Rollins School of Public Health, Atlanta, Georgia
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia
| | - Kaitlyn K Stanhope
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia
| | - Denise J Jamieson
- Department of Epidemiology, Rollins School of Public Health, Atlanta, Georgia
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia
| | - Sheree L Boulet
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia
| |
Collapse
|
4
|
Tierney KI, Pearce N, Miller E, Steiner A, Tighe K, Presberry J, Kothari C. Barriers to Postpartum Care: A Mixed Methods Study of Midwestern Postpartum Women. Matern Child Health J 2024; 28:93-103. [PMID: 37902919 DOI: 10.1007/s10995-023-03800-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2023] [Indexed: 11/01/2023]
Abstract
PURPOSE Postpartum care is an opportunity to provide essential follow-up care to people who have given birth, but inequalities in access by race and socioeconomic status (SES) are well-documented. The purpose of this study is to provide an in-depth description of the barriers to postpartum care using a mixed-methods design. METHODS Mixed method analyses using convergent design with three stages including (1) bivariate logistic regression of survey data representative of postpartum women in Kalamazoo County, Michigan, (2) thematic qualitative analyses of focus group interviews of survey participants, and (3) bivariate logistic regression and logistic regression meditation analyses using themes operationalized with survey data measures. RESULTS In Kalamazoo county, 82.0% of women attended their postpartum visit. White women and women with higher SES were 2.84 (SE = 1.35, p < .001) and 5.73 (SE = 3.10, p < .001) times more likely to attend postpartum visits than women of color and those with lower SES. Qualitative analyses identified four common barriers: (1) misaligned goals for appointments, (2) time and scheduling of appointments, (3) prioritization of children, and (4) material resources and health insurance coverage. The quantitative analyses found mixed support for these barriers and found limited evidence that these barriers mediated the relationship between race or SES and postpartum attendance. CONCLUSIONS FOR PRACTICE The qualitative findings identify barriers that are amenable to practice-level interventions including changes to scheduling procedures and employing patient-centered care. The quantitative findings further suggest that although inequalities in postpartum care are present, interventions on these barriers may benefit women regardless of race and SES.
Collapse
Affiliation(s)
- Katherine I Tierney
- Department of Sociology, Western Michigan University, 1903 W. Michigan Ave, 49008-5257, Kalamazoo, MI, USA.
| | - Nicole Pearce
- Western Michigan University Homer Stryker M.D. School of Medicine, 300 Portage Street, 49007, Kalamazoo, MI, USA
| | - Emily Miller
- Western Michigan University Homer Stryker M.D. School of Medicine, 300 Portage Street, 49007, Kalamazoo, MI, USA
| | - Agnieszka Steiner
- Western Michigan University Homer Stryker M.D. School of Medicine, 300 Portage Street, 49007, Kalamazoo, MI, USA
| | - Kathryn Tighe
- Western Michigan University Homer Stryker M.D. School of Medicine, 300 Portage Street, 49007, Kalamazoo, MI, USA
| | - Joi Presberry
- Western Michigan University Homer Stryker M.D. School of Medicine, 300 Portage Street, 49007, Kalamazoo, MI, USA
| | - Catherine Kothari
- Western Michigan University Homer Stryker M.D. School of Medicine, 300 Portage Street, 49007, Kalamazoo, MI, USA
| |
Collapse
|
5
|
Bully P, Artieta-Pinedo I, Paz-Pascual C, García-Álvarez A, Espinosa M. Development and evaluation of the psychometric properties of a digital questionnaire for the self-management of health and well-being in the postpartum period. BMC Pregnancy Childbirth 2023; 23:610. [PMID: 37626320 PMCID: PMC10463739 DOI: 10.1186/s12884-023-05899-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 08/04/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Despite the fact that the Global Strategy for Women's, Children's and Adolescents' Health (2016-2030) recognises the special importance of care for women during the postpartum period, thus highlighting the need to identify and measure any condition that may affect the welfare of pregnant women in any way, this is one of the most neglected stages in the health system. Given the absence in our area of global, efficient instruments, the objective of this study was to design a complete, specific measurement tool with good metric qualities in digital format for the evaluation of self-reported health and well-being during the puerperium, to conform to what was proposed by the ICHOM. METHODS A cross-sectional study was carried out to evaluate the psychometric characteristics of a digital measurement tool. The development of the tool was carried out in 4 steps, following the recommendations of the International Test Commission. It was tested on 280 puerperas attending primary healthcare appointments in the Basque Healthcare System (Osakidetza), and they did the newly created survey, answering all the questions that had been selected as the gold standard. The average age of the women was 34.93 (SD = 4.80). The analysis of the psychometric characteristics was based on mixed procedures of expert judgment (a focus group of healthcare professionals, an item evaluation questionnaire and interviews with users) and quantitative evaluations (EFA, CFA, and correlation with gold standard, ordinal alpha and McDonald's omega). RESULTS The final version of the tool comprised 99 items that evaluate functional state, incontinence, sexuality, breastfeeding, adaptation to the role of mother and mental health, and all of these questions can be used globally or partially. It was found that the scores were valid and reliable, which gives metric guarantees for using the tool in our area. CONCLUSIONS The use of this comprehensive concise tool with good psychometric properties will allow women to take stock of their situation, assess if they have the necessary resources, in psychological and social terms, and work together with midwives and other healthcare professionals on the most deficient areas.
Collapse
Affiliation(s)
- Paola Bully
- University of the Basque Country, Barrio Sarriena, S/N, 48940, Leioa, Spain.
- Paola Bully Methodological and Statistical Consultant, C/ Barrio La Sota, Sopuerta, 48190, Spain.
| | - Isabel Artieta-Pinedo
- Osakidetza-Basque Health Service, Biocruces-Bizkaia Health Research Institute, C/ Edificio Biocruces 3. Plaza De Cruces, 48903, Barakaldo, Spain
- Primary Care Midwife Zuazo Health Centre, Osi Barakaldo-Sestao-Osakidetza, C/ Lurkizaga Kalea, S/N, 48902, Barakaldo, Spain
- School of Nursing, University of the Basque Country, C/ Barrio Sarriena S/N, Leioa, 48940, Spain
| | - Carmen Paz-Pascual
- Osakidetza-Basque Health Service, Biocruces-Bizkaia Health Research Institute, C/ Edificio Biocruces 3. Plaza De Cruces, 48903, Barakaldo, Spain
- School of Nursing, University of the Basque Country, C/ Barrio Sarriena S/N, Leioa, 48940, Spain
- Midwifery Training Unit of the Basque Country, Hospital de Basurto-Osakidetza, C/ Montevideo Etorbidea 18, Bilbao, 48013, Spain
- Primary Care Midwife Markonzaga Health Centre, OSI Barakaldo-Sestao-Osakidetza, C/ Antonio Trueba Kalea, 17, Sestao, 48910, Spain
| | - Arturo García-Álvarez
- Osakidetza-Basque Health Service, Biocruces-Bizkaia Health Research Institute, C/ Edificio Biocruces 3. Plaza De Cruces, 48903, Barakaldo, Spain
| | - Maite Espinosa
- Osakidetza-Basque Health Service, Biocruces-Bizkaia Health Research Institute, C/ Edificio Biocruces 3. Plaza De Cruces, 48903, Barakaldo, Spain
| |
Collapse
|
6
|
Prince A, Wade J, Power ML, Gunawansa N, Cruz-Bendezú A, Schulkin J, Macri CJ. Postpartum care: Discussions and counseling for the peripartum period. J Neonatal Perinatal Med 2023; 16:657-664. [PMID: 38043027 DOI: 10.3233/npm-230167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2023]
Abstract
BACKGROUND Traditionally, postpartum care is confined to inpatient care immediately post birth and one appointment approximately six weeks postpartum. Data supports a continuum of care model as best for the health of mother and baby. Despite most women having significant concerns about the postpartum period, these concerns are frequently incompletely addressed by providers. We surveyed prenatal and postpartum patients to understand their concerns and experiences discussing postpartum care with providers. METHODS Cross sectional surveys were administered between June 2019 and May 2021. Principal component analysis was used to show higher than average (positive) or lower than average (negative) conversations with providers about postpartum care examined by race, education, and parity. Chi squared tests were conducted to examine the significance of specific postpartum concerns. RESULTS 421/450 patient surveys were analyzed, based on completion. Most patients were White (193), had post graduate degrees (188), privately insured (236), married (248), first time pregnant (152), and used doctors as their primary provider (267). Patients with lower education, higher parity and Black patients without postgraduate degrees reported higher than average postpartum counseling. Additionally, most patients expressed significant concerns about postpartum exhaustion (65.8%), breastfeeding (62.3%), pain (61.2%), physical activity (54.9%) and the baby blues (50.4%). CONCLUSIONS Postpartum concerns are incompletely and inconsistently addressed amongst patients based on race, parity, and education. A continuum of care approach, beginning in the third trimester, through the postpartum period, may provide better counseling to address all patients' concerns.
Collapse
Affiliation(s)
- A Prince
- The George Washington School of Medicine and Health Sciences, Washington, DC, USA
| | - J Wade
- The George Washington School of Medicine and Health Sciences, Washington, DC, USA
| | - M L Power
- Center for Species Survival, Smithsonian's National Zoo and Conservation Biology Institute, Washington, DC, USA
- Pregnancy-Related Care Research Network (PRCRN), Seattle, WA, USA
| | - N Gunawansa
- The George Washington School of Medicine and Health Sciences, Washington, DC, USA
| | - A Cruz-Bendezú
- Department of Urology, George Washington University, Washington, DC, USA
| | - J Schulkin
- Pregnancy-Related Care Research Network (PRCRN), Seattle, WA, USA
| | - C J Macri
- Department of Obstetrics and Gynecology, GWU MFA, Washington, DC, USA
| |
Collapse
|
7
|
Trajectories and Correlates of Anger During the Perinatal Period. J Obstet Gynecol Neonatal Nurs 2022; 51:599-611. [PMID: 35987262 DOI: 10.1016/j.jogn.2022.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 07/23/2022] [Accepted: 07/25/2022] [Indexed: 10/15/2022] Open
Abstract
OBJECTIVES To investigate trajectories of anger during pregnancy and the early postpartum period; to identify baseline psychosocial predictors of anger trajectory group membership; and to examine correlates of anger trajectory group membership, including symptoms of depression, anxiety, insomnia, and social support, in the postpartum period. DESIGN Longitudinal descriptive design. SETTING We recruited participants from a maternity clinic in Calgary, Alberta, Canada. PARTICIPANTS The sample included a convenience sample of 143 pregnant women who had basic fluency in English, were older than 17 years of age, and were less than 19 weeks gestation with a single fetus at the time of recruitment. METHODS Participants completed online questionnaires at four time points: early, mid-, and late pregnancy and 2 months after birth. We used group-based semiparametric mixture modeling to estimate patterns of anger. We used multinomial logistic regression to explore associations between baseline predictors and trajectory membership. RESULTS We identified four distinct trajectories of anger during pregnancy through 2 months after birth: minimal-stable anger (52.4%), mild-stable anger (27.5%), moderate-stable anger (12.7%), and high-decreasing anger (7.4%). Membership in the moderate-stable group was associated with greater baseline symptoms of depression, anxiety, and insomnia severity scores compared to the minimal-stable anger group. Moderate-stable trajectory group membership was also associated with greater symptoms of anxiety, depression, and insomnia at 2 months after birth. CONCLUSION Higher levels of anger were associated with worse mental health in pregnancy and after childbirth in our participants. Women should be made aware of anger as a possible mood disturbance by clinicians, and researchers should investigate the consequences of anger during the perinatal period.
Collapse
|
8
|
Leiferman JA, Jewell JS, Huberty JL, Lee-Winn AE. Women's Mental Health and Wellbeing in the Interconception Period. MCN Am J Matern Child Nurs 2021; 46:339-345. [PMID: 34653032 DOI: 10.1097/nmc.0000000000000767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Promoting women's health during the interconception period is critical for the health of future pregnancies. METHODS This was a cross-sectional study to better understand interconception mental health and wellbeing using a convenience sample of women recruited on social media who completed an online survey. RESULTS Women who participated in the survey (N = 146) were 1 to 4 years since last pregnancy, primarily non-Hispanic White (81.2%), with an average age of 30 years (SD = 5.0; range = 19-47 years); 20% were insured by Medicaid. Depression, anxiety, stress, social support, mindfulness, and resilience were assessed. Approximately 22.9% reported depressive symptomatology, 18.8% symptoms of anxiety, 6.5% high stress, and 52.9% moderate stress. These patterns differed across years after giving birth, with percentages peaking for depressive symptoms during the first to second year (χ2 = 9.81, p = 0.007), and anxiety symptoms peaking after the third year (χ2 = 7.28, p = 0.026). Women reported moderate scores on wellbeing measures, with resilience scores decreasing as years since last pregnancy increased (F = 3.24, p = 0.042). Less than 25% reported that a provider discussed depressed mood during the interconception period. CLINICAL IMPLICATIONS Our findings revealed high prevalence and temporal patterns of depressive and anxiety symptoms during the interconception period, identifying a need for nurses to continue to follow-up with their patients about mental health concerns well after the traditionally defined 1 year postpartum. Further investigation of women's mental health and wellbeing and their unique needs during the interconception period is warranted.
Collapse
|
9
|
Dol J, Hughes B, Tomblin Murphy G, Aston M, McMillan D, Campbell-Yeo M. Canadian Women's Experience of Postnatal Care: A Mixed Method Study. Can J Nurs Res 2021; 54:497-507. [PMID: 34704508 PMCID: PMC9596944 DOI: 10.1177/08445621211052141] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background The postnatal period remains unstandardized in terms of care and postnatal visits with a dearth of information on the experience from Canadian women. Purpose To explore (1) with whom and how often women receive postnatal follow-up visits and (2) the postnatal care experiences of Canadian mothers. Methods Using a cross-sectional design, women who had given birth within the past 6 months were recruited to complete an online survey. Frequencies were computed for quantitative outcomes and thematic analysis was used for qualitative responses. Results A total of 561 mothers completed the survey. Women saw on average 1.9 different postnatal healthcare providers, primarily family doctors (72.4%). 3.2% had no postnatal visits and 37.6% had 4 or more within 6 weeks. 76.1% women were satisfied with their postnatal care. Women's satisfactory care in the postnatal period was associated with in-person and at home follow-ups, receiving support, and receiving timely, appropriate care for self and newborn. Unsatisfactory care was associated with challenges accessing care, experiencing gaps in follow-up visits, and having unsatisfactory assessment for their own recovery. Conclusion There is considerable variation in the timing and frequency of postnatal visits. While many women are experiencing satisfactory care, women are still reporting dissatisfaction and are facing challenges.
Collapse
Affiliation(s)
- Justine Dol
- Faculty of Health, Dalhousie University, Halifax, NS, Canada
- Justine Dol, Faculty of Health, Dalhousie University, Halifax, NS, Canada.
| | - Brianna Hughes
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | | | - Megan Aston
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Douglas McMillan
- Division of Neonatal Perinatal Medicine, Department of Pediatrics, Faculty of Medicine, Dalhousie University and IWK Health Centre, Halifax, NS, Canada
| | - Marsha Campbell-Yeo
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, Canada
- Division of Neonatal Perinatal Medicine, Department of Pediatrics, Faculty of Medicine, Dalhousie University and IWK Health Centre, Halifax, NS, Canada
| |
Collapse
|
10
|
Morris MH, Barton M, Zane M, Hutson SP, Raman R, Heidel RE. A Nurse-Navigated, Postpartum Support Text Messaging Intervention: Satisfaction Among Primiparous Women. J Perinat Neonatal Nurs 2021; 35:330-339. [PMID: 34726650 PMCID: PMC8567297 DOI: 10.1097/jpn.0000000000000596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
More than 50% of maternal deaths in the United States occur during the first year following childbirth. Nearly 40% of these deaths occur between days 1 and 41 of the postpartum period. Historically, women receive less attention from healthcare providers during the postpartum period when compared with the care provided during pregnancy and childbirth. Women may not return for scheduled follow-up care until 4 to 6 weeks after birth, if they return at all. The role of postpartum nurse navigator (PPNN) was developed to deliver a novel, text messaging intervention as part of a randomized controlled trial to 43 primiparous women who experienced an unplanned cesarean birth. Through daily, interactive text messaging, the PPNN assessed study participants' general well-being, assisted with symptom navigation, offered anticipatory guidance, and provided informational support until 4 weeks postpartum. Satisfaction with the intervention was evaluated using a survey that incorporated quantitative and qualitative responses. Overwhelmingly, 93% of participants rated their overall experience with the text messaging intervention as outstanding or good. At least 95% of the participants indicated that they would likely choose to receive daily text messaging from a PPNN following a subsequent birth. Convenient access to professional nurse support for women postbirth warrants further evaluation.
Collapse
Affiliation(s)
- Melanie Hall Morris
- Vanderbilt University School of Nursing, Vanderbilt University, Nashville, Tennessee (Dr Morris and Ms Barton); TriStar Summit Medical Center, Hermitage, Tennessee (Ms Zane); College of Nursing, The University of Tennessee, Knoxville (Dr Hutson); Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee (Dr Raman); and Office of Biostatistics & Research Consultation, University of Tennessee Graduate School of Medicine, Knoxville (Dr Heidel)
| | | | | | | | | | | |
Collapse
|
11
|
Laureij LT, van der Hulst M, Lagendijk J, Been JV, Ernst-Smelt HE, Franx A, Lugtenberg M. Insight into the process of postpartum care utilisation and in-home support among vulnerable women in the Netherlands: an in-depth qualitative exploration. BMJ Open 2021; 11:e046696. [PMID: 34489272 PMCID: PMC8422309 DOI: 10.1136/bmjopen-2020-046696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To gain insight into the process of postpartum care utilisation and in-home support among vulnerable women. DESIGN, METHOD, PARTICIPANTS AND SETTING A qualitative interview study was conducted among 23 pregnant and postpartum vulnerable women in the Netherlands, following a grounded theory approach. Women were determined as vulnerable by their healthcare providers. Theoretical sampling of participants was applied and was alternated by data analysis to include information-rich cases until saturation was achieved. RESULTS A conceptual framework of postpartum care utilisation was generated consisting of three phases: pregnancy, early postpartum period and late postpartum period. Within these phases, information provision, parenting self-efficacy and social network were identified as overarching themes. Perceived inadequate information on content of postpartum care posed a major barrier to forming realistic expectations during pregnancy and hindered its utilisation. Low self-efficacy facilitated postpartum care utilisation. All women experienced increased self-efficacy during and after postpartum care. Support from a social network influenced expectations regarding the added value of postpartum care during pregnancy, and lowered actual utilisation during the postpartum period. The costs of postpartum care and the role of the maternity care assistant acted as general barriers or facilitators influencing the three overarching themes and therefore postpartum care utilisation indirectly. CONCLUSIONS Our findings suggest that postpartum care utilisation among vulnerable women may be improved by considering the particular phase and relevant themes applying to individual women, and adapt care accordingly. We recommend to provide comprehensive, understandable information and to emphasise the gains of postpartum care in improving self-efficacy for vulnerable women. Moreover, involving a woman's social network in postpartum care may add value to this care for this population.
Collapse
Affiliation(s)
- Lyzette T Laureij
- Department of Obstetrics and Gynaecology, Erasmus MC, Rotterdam, The Netherlands
| | - Marije van der Hulst
- Department of Obstetrics and Gynaecology, Erasmus MC, Rotterdam, The Netherlands
| | - Jacqueline Lagendijk
- Department of Obstetrics and Gynaecology, Erasmus MC, Rotterdam, The Netherlands
| | - Jasper V Been
- Department of Paediatrics, Erasmus MC, Rotterdam, The Netherlands
| | - Hiske E Ernst-Smelt
- Department of Obstetrics and Gynaecology, Erasmus MC, Rotterdam, The Netherlands
| | - Arie Franx
- Department of Obstetrics and Gynaecology, Erasmus MC, Rotterdam, The Netherlands
| | | |
Collapse
|
12
|
McCloskey L, Bernstein J, The Bridging The Chasm Collaborative, Amutah-Onukagha N, Anthony J, Barger M, Belanoff C, Bennett T, Bird CE, Bolds D, Brenna BW, Carter R, Celi A, Chachere B, Crear-Perry J, Crossno C, Cruz-Davis A, Damus K, Dangel A, Depina Z, Deroze P, Dieujuste C, Dude A, Edmonds J, Enquobahrie D, Eromosele E, Ferranti E, Fitzmaurice M, Gebel C, Blount LG, Greiner A, Gullo S, Haddad A, Hall N, Handler A, Headen I, Heelan-Fancher L, Hernandez T, Johnson K, Jones E, Jones N, Klaman S, Lund B, Mallampalli M, Marcelin L, Marshall C, Maynard B, McCage S, Mitchell S, Molina R, Montasir S, Nicklas J, Northrup A, Norton A, Oparaeke E, Ramos A, Rericha S, Rios E, Bloch JR, Ryan C, Sarfaty S, Seely E, Souter V, Spain M, Spires R, Theberge S, Thompson T, Wachman M, Yarrington T, Yee LM, Zera C, Clayton J, Lachance C. Bridging the Chasm between Pregnancy and Health over the Life Course: A National Agenda for Research and Action. Womens Health Issues 2021; 31:204-218. [PMID: 33707142 PMCID: PMC8154664 DOI: 10.1016/j.whi.2021.01.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 01/09/2021] [Accepted: 01/12/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Many pregnant people find no bridge to ongoing specialty or primary care after giving birth, even when clinical and social complications of pregnancy signal need. Black, indigenous, and all other women of color are especially harmed by fragmented care and access disparities, coupled with impacts of racism over the life course and in health care. METHODS We launched the initiative "Bridging the Chasm between Pregnancy and Health across the Life Course" in 2018, bringing together patients, advocates, providers, researchers, policymakers, and systems innovators to create a National Agenda for Research and Action. We held a 2-day conference that blended storytelling, evidence analysis, and consensus building to identify key themes related to gaps in care and root causes of inequities. In 2019, more than 70 stakeholders joined six working groups to reach consensus on strategic priorities based on equity, innovation, effectiveness, and feasibility. FINDINGS Working groups identified six key strategic areas for bridging the chasm. These include: 1) progress toward eliminating institutional and interpersonal racism and bias as a requirement for accreditation of health care institutions, 2) infrastructure support for community-based organizations, 3) extension of holistic team-based care to the postpartum year and beyond, with integration of doulas and community health workers on the team, 4) extension of Medicaid coverage and new quality and pay-for-performance metrics to link maternity care and primary care, 5) systems to preserve maternal narratives and data across providers, and 6) alignment of research with women's lived experiences. CONCLUSIONS The resulting agenda presents a path forward to remedy the structural chasms in women's health care, with key roles for advocates, policymakers, researchers, health care leaders, educators, and the media.
Collapse
Affiliation(s)
- Lois McCloskey
- Community Health Sciences Department, Boston University School of Public Health, Boston, Massachusetts(b) The names and affiliations of all authors in the Bridging the Chasm Collaborative are listed in Table 1..
| | - Judith Bernstein
- Community Health Sciences Department, Boston University School of Public Health, Boston, Massachusetts(b) The names and affiliations of all authors in the Bridging the Chasm Collaborative are listed in Table 1
| | | | | | | | - Mary Barger
- University of San Diego, Hahn School of Nursing
| | | | - Trude Bennett
- University of North Carolina Gillings School of Global Public Health
| | | | | | | | | | - Ann Celi
- Brigham and Women's Hospital, Harvard Medical School
| | | | | | - Chase Crossno
- University of North Texas Health Sciences Center/Texas Christian University School of Medicine
| | | | - Karla Damus
- Boston University Medical Campus, Office of Human Research Affairs
| | | | | | | | | | - Annie Dude
- University of Chicago School of Medicine
| | | | | | | | | | | | | | | | | | | | | | | | - Arden Handler
- University of Illinois at Chicago School of Public Health
| | - Irene Headen
- Drexel University Dornsife School of Public Health
| | | | | | | | - Emily Jones
- University of Oklahoma Health Sciences Center, Ziegler College of Nursing
| | | | - Stacey Klaman
- University of North Carolina Gillings School of Global Public Health
| | | | | | | | | | | | | | | | - Rose Molina
- Beth Israel Deaconess Medical Center / The Dimock Center
| | | | | | | | | | | | | | | | | | | | | | | | - Ellen Seely
- Brigham and Women's Hospital, Harvard Medical School
| | | | | | | | | | | | - Madi Wachman
- Boston University Center for Innovation in Social Work and Health
| | | | - Lynn M Yee
- Northwestern University, Feinberg School of Medicine
| | - Chloe Zera
- Beth Israel Deaconess Medical Center, Harvard Medical School
| | | | | |
Collapse
|
13
|
Digital Educational Support Groups Administered through WhatsApp Messenger Improve Health-Related Knowledge and Health Behaviors of New Adolescent Mothers in the Dominican Republic: A Multi-Method Study. INFORMATICS (MDPI) 2021; 7. [PMID: 33747831 PMCID: PMC7971517 DOI: 10.3390/informatics7040051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: In limited-resource settings such as the Dominican Republic, many factors contribute to poor health outcomes experienced by adolescent mothers, including insufficient support and/or health knowledge. In response, we designed a digital educational support group, administered through WhatsApp Messenger, for new adolescent mothers. The purpose of this study was to assess if participation in this digital support group could improve health outcomes and health behaviors. Methods: Participants completed questionnaires with a health literacy screener, demographic items, knowledge questions, the Index of Autonomous Functioning, and five Patient Reported Outcomes Measurement Information System scales before and after the moderator-led intervention. Differences between pre- and post-intervention scores were calculated and perceptions of the intervention were explored through in-depth interviews analyzed with content analysis. Participants’ well-baby visit attendance and contraceptive use were compared to that of controls and a national sample. Results: Participants’ (N = 58) knowledge scores increased (p < 0.05). Participants were 6.58 times more likely to attend well-baby visits than controls (95% CI: 2.23–19.4) and their contraceptive use was higher than that of the national sample (p < 0.05). Participants indicated the intervention was enjoyable and beneficial. Conclusion: This adolescent-centered digital intervention is a promising method to improve health outcomes and health behaviors of young mothers in limited-resource settings.
Collapse
|
14
|
Albanese AM, Geller PA, Sikes CA, Barkin JL. The Importance of Patient-Centered Research in the Promotion of Postpartum Mental Health. Front Psychiatry 2021; 12:720106. [PMID: 34603105 PMCID: PMC8481568 DOI: 10.3389/fpsyt.2021.720106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 08/23/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ariana M Albanese
- Women's Health Psychology Laboratory, Department of Psychology, Drexel University, Philadelphia, PA, United States
| | - Pamela A Geller
- Women's Health Psychology Laboratory, Department of Psychology, Drexel University, Philadelphia, PA, United States
| | - Christina A Sikes
- Houston Country Health Department, Georgia Department of Public Health, Warner Robbins, GA, United States
| | - Jennifer L Barkin
- Department of Community Medicine, Mercer University School of Medicine, Macon, GA, United States
| |
Collapse
|
15
|
Stonbraker S, Haight E, Soriano L, Guijosa L, Davison E, Bushley D, Messina L, Halpern M. Establishing content for a digital educational support group for new adolescent mothers in the Dominican Republic: a user-centered design approach. Int J Adolesc Med Health 2020; 34:219-232. [PMID: 32857722 DOI: 10.1515/ijamh-2020-0054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 05/24/2020] [Indexed: 11/15/2022]
Abstract
Background As digital interventions to improve health become widespread globally, it is critical to include target end-users in their design. This can help ensure interventions are maximally beneficial among intended populations. Objectives To generate the content of a digital educational support group, administered through WhatsApp, for new adolescent mothers and establish participants' cellular access and WhatsApp use. Participants Adolescent mothers with new babies. Methods We completed a two-phase user-centered design process. In phase I design sessions, participants discussed their postpartum experiences and completed an activity to elucidate their health and wellbeing information needs. In phase II sessions, participants individually identified which health information topics were important to them, then all topics were prioritized as a group. Phase II participants also completed a brief survey on cell phone access and WhatsApp use. Results Phase I included 24 participants, 21 of whom completed phase II. Priority health and wellbeing information topics in the postpartum period were identified as: child growth and development, understanding your baby, common childhood illnesses, breastfeeding, childhood nutrition, family planning, and self-care. Of phase II participants, 45% had cellular phone access and none had a data plan. Cellular service was inconsistently obtained with data packages or Wi-Fi. 30% of participants had no experience using WhatsApp. Conclusions Participants identified numerous health information needs, which will serve as the content for our planned digital support group and provides valuable insight for health care providers globally. Less than half of participants had consistent cellular phone access, and none had reliable access to cellular service.
Collapse
Affiliation(s)
- Samantha Stonbraker
- Columbia University School of Nursing, New York, NY, USA
- Clínica de Familia La Romana, La Romana, Dominican Republic
| | - Elizabeth Haight
- Planned Parenthood of the Great Northwest and the Hawaiian Islands, Seattle, WA, USA
| | - Leidy Soriano
- Clínica de Familia La Romana, La Romana, Dominican Republic
| | - Linda Guijosa
- Planned Parenthood of the Great Northwest and the Hawaiian Islands, Seattle, WA, USA
| | - Eliza Davison
- Planned Parenthood of the Great Northwest and the Hawaiian Islands, Seattle, WA, USA
| | - Diane Bushley
- Planned Parenthood of the Great Northwest and the Hawaiian Islands, Seattle, WA, USA
| | - Luz Messina
- Clínica de Familia La Romana, La Romana, Dominican Republic
| | - Mina Halpern
- Clínica de Familia La Romana, La Romana, Dominican Republic
| |
Collapse
|
16
|
Laureij LT, Breunis LJ, Steegers-Theunissen RPM, Rosman AN. Identifying the Needs for a Web-Based Postpartum Platform Among Parents of Newborns and Health Care Professionals: Qualitative Focus Group Study. JMIR Form Res 2020; 4:e16202. [PMID: 32452805 PMCID: PMC7284398 DOI: 10.2196/16202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 02/03/2020] [Accepted: 02/24/2020] [Indexed: 01/01/2023] Open
Abstract
Background During the turbulent postpartum period, there is an urgent need by parents for support and information regarding the care for their infant. In the Netherlands, professional support is provided during the first 8 days postpartum and for a maximum of 8 hours a day. This care is delivered by maternity care assistants (MCAs). Despite the availability of this extensive care, a majority of women prefer to make use of a lesser amount of postpartum care. After this period, access to care is less obvious. Where parents are automatically offered care in the first 8 days after birth, they must request care in the period thereafter. To compensate for a possible gap in information transfer, electronic health (eHealth) can be a valuable, easily accessible addition to regular care. Objective We explored the needs and preferred content by new parents and health care professionals of a web-based platform dedicated to the postpartum period and identified barriers and facilitators for using such a platform. Methods We conducted 3 semistructured focus groups among (1) parents of newborns, (2) MCAs, and (3) clinicians and administrators in maternity care. A topic list based on a framework designed for innovation processes was used. Thematic content analysis was applied. Results In the focus group for parents, 5 mothers and 1 male partner participated. A total of 6 MCAs participated in the second focus group. A total of 5 clinicians and 2 administrators—a member of a stakeholder party and a manager of a maternity care organization—participated in the third focus group. All user groups underlined that a platform focusing on the postpartum period was missing in current care, especially by parents experiencing a gap following the intensive care ending after the first week of childbirth. Parents indicated that they would perceive a postpartum platform as a proper source of reliable information on topics regarding breastfeeding, growth, and developmental milestones, but also as a tool to support them in seeking care with appropriate professionals. They also emphasized the need to receive personalized information and the opportunity to ask questions via the platform. MCAs acknowledged added value of providing additional information on topics that they address during the early postpartum period. MCAs as well as clinicians and administrators would guide parents to such a platform for additional support. All user groups experienced disadvantages of using an authentication procedure and filling out extra questionnaires to receive tailored information. Conclusions Our research shows that parents of newborns, MCAs, and clinicians and administrators foresee the additional value of a web-based postpartum platform for at least the whole postpartum period. The platform should be easily accessible and personalized. Content on the platform should contain information regarding breastfeeding, growth, and developmental milestones. A chat function with professionals could be considered as an option.
Collapse
Affiliation(s)
- Lyzette T Laureij
- Department of Obstetrics and Gynecology, Sophia Children's Hospital, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Leonieke J Breunis
- Department of Obstetrics and Gynecology, Sophia Children's Hospital, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Regine P M Steegers-Theunissen
- Department of Obstetrics and Gynecology, Sophia Children's Hospital, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Ageeth N Rosman
- Department of Obstetrics and Gynecology, Sophia Children's Hospital, Erasmus University Medical Center, Rotterdam, Netherlands.,Department of Health Care Studies, Rotterdam University of Applied Sciences, Rotterdam, Netherlands
| |
Collapse
|
17
|
Hooker L, Versteegh L, Lindgren H, Taft A. Differences in help-seeking behaviours and perceived helpfulness of services between abused and non-abused women: A cross-sectional survey of Australian postpartum women. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:958-968. [PMID: 31833144 DOI: 10.1111/hsc.12927] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 11/11/2019] [Accepted: 11/28/2019] [Indexed: 06/10/2023]
Abstract
New mothers may face substantial physical and mental health challenges during the postpartum period and are at a greater risk of intimate partner violence. Healthcare services provide support, however, acknowledging a problem and seeking help for it can be difficult. Research on where postpartum women seek help and how helpful they perceive it is limited. Additionally, little is known of how these help-seeking behaviours differ between abused and non-abused postpartum women. The aim of this study was to examine the help-seeking behaviour and perceived helpfulness of services in abused and non-abused postpartum women. Secondary analysis was undertaken of data collected during the MOVE (Improving Maternal and Child Health Care for Vulnerable Mothers) cluster randomised controlled trial of a nurse, intimate partner violence screening and supportive care intervention. MOVE was set in eight community-based nurse teams in Melbourne, Australia. The trial (2010-2013) included a survey of n = 2,621 postpartum Australian women who had given birth within the previous 8 months. Data were analysed using descriptive and interferential statistics. Findings indicate that abused women who had experienced partner violence sought informal family support less frequently (81.3% compared with 92.4%, p < .001) and were more frequent users of hospital emergency departments (p = .03), nurse home visiting programs (p = .02) and some breastfeeding services (p = .001), compared with non-abused women. They were also more frequent users of psychiatrists (p ≤ 0.001), early parenting centres (both day stay (p = .006) and residential (p = .008), child welfare services (p < .001), and were generally less satisfied with the help received. Postpartum women experiencing partner violence seek help from certain formal services more frequently and are less satisfied with the care received, compared with non-abused women. Access to potential protective supports from family and friends is limited. Further qualitative research is needed to gain a greater understanding of abused postpartum women's experiences and help-seeking behaviours.
Collapse
Affiliation(s)
- Leesa Hooker
- Department of Rural Nursing and Midwifery, La Trobe Rural Health School, Bendigo, Vic, Australia
- Judith Lumley Centre (for mother, infant and family health research), School of Nursing and Midwifery, La Trobe University, Bundoora, Vic, Australia
| | - Leonie Versteegh
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Helena Lindgren
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Angela Taft
- Judith Lumley Centre (for mother, infant and family health research), La Trobe University, Melbourne, Vic, Australia
| |
Collapse
|
18
|
Sijpkens MK, van den Hazel CZ, Delbaere I, Tydén T, Mogilevkina I, Steegers EAP, Shawe J, Rosman AN. Results of a Dutch national and subsequent international expert meeting on interconception care. J Matern Fetal Neonatal Med 2019; 33:2232-2240. [PMID: 30606078 DOI: 10.1080/14767058.2018.1547375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Introduction: The potential value of preconception care and interconception care is increasingly acknowledged, but delivery is generally uncommon. Reaching women for interconception care is potentially easier than for preconception care, however the concept is still unfamiliar. Expert consensus could facilitate guidelines, policies and subsequent implementation. A national and subsequent international expert meeting were organized to discuss the term, definition, content, relevant target groups, and ways to reach target groups for interconception care.Methods: We performed a literature study to develop propositions for discussion in a national expert meeting in the Netherlands in October 2015. The outcomes of this meeting were discussed during an international congress on preconception care in Sweden in February 2016. Both meetings were recorded, transcribed and subsequently reviewed by participants.Results: The experts argued that the term, definition, and content for interconception care should be in line with preconception care. They discussed that the target group for interconception care should be "all women who have been pregnant and could be pregnant in the future and their (possible) partners". In addition, they opted that any healthcare provider having contact with the target group should reach out and make every encounter a potential opportunity to promote interconception care.Discussion: Expert discussions led to a description of the term, definition, content, and relevant target groups for interconception care. Opportunities to reach the target group were identified, but should be further developed and evaluated in policies and guidelines to determine the optimal way to deliver interconception care.
Collapse
Affiliation(s)
- Meertien K Sijpkens
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Céline Z van den Hazel
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Ilse Delbaere
- Department of Health Care, VIVES University College, Kortrijk, Belgium
| | - Tanja Tydén
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Iryna Mogilevkina
- Educational and Research Center of Continuous Medical Education, Bogomolets National Medical University, Kiev, Ukraine
| | - Eric A P Steegers
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Jill Shawe
- Institute of Health & Community, Faculty of Health and Human Sciences, University of Plymouth, Plymouth, UK
| | - Ageeth N Rosman
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Health Care Studies, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
| |
Collapse
|
19
|
Mitra M, Parish SL, Akobirshoev I, Rosenthal E, Moore Simas TA. Postpartum Hospital Utilization among Massachusetts Women with Intellectual and Developmental Disabilities: A Retrospective Cohort Study. Matern Child Health J 2018; 22:1492-1501. [PMID: 29948759 PMCID: PMC6150791 DOI: 10.1007/s10995-018-2546-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Objectives This study examined the risk of postpartum hospital admissions and emergency department (ED) visits among US women with intellectual and developmental disabilities (IDD). Methods We used the 2002-2012 Pregnancy to Early Life Longitudinal Data System and identified deliveries to women with and without IDD. Women with IDD (n = 1104) or case subjects were identified from the International Classification of Diseases and Related Health Problems 9th Revision (ICD-9 CM) codes. The study primary outcome measures were any postpartum hospital admission and any ED visit during three critical postpartum periods (1-42, 43-90, and 1-365 days). We conducted unadjusted and adjusted survival analysis using Cox proportional hazard models to compare the occurrence of first hospital admission or ED visits between women with and without IDD. Results We found that women with IDD had markedly higher rates of postpartum hospital admissions and ED visits during the critical postpartum periods (within 1-42, 43-90, and 91-365 days) after a childbirth. Conclusion for Practice Given the heightened risk of pregnancy complications and adverse birth outcomes and the findings of this study, there is an urgent need for clinical guidelines related to the frequency and timing of postpartum care among new mothers with IDD. Further, this study provides evidence of the need for evidence-based interventions for new mothers with IDD to provide preventive care and routine assessments that would identify and manage complications for both the mother and the infant outside of the traditional postpartum health care framework.
Collapse
Affiliation(s)
- Monika Mitra
- The Heller School for Social Policy and Management, Lurie Institute for Disability Policy, Brandeis University, 415 South Street, Mailstop 035, Waltham, MA, 02453, USA.
| | - Susan L Parish
- Bouvé College of Health Sciences, Northeastern University, 360 Huntington Avenue, Boston, MA, 02115, USA
| | - Ilhom Akobirshoev
- The Heller School for Social Policy and Management, Lurie Institute for Disability Policy, Brandeis University, 415 South Street, Mailstop 035, Waltham, MA, 02453, USA
| | - Eliana Rosenthal
- Bouvé College of Health Sciences, Northeastern University, 360 Huntington Avenue, Boston, MA, 02115, USA
| | - Tiffany A Moore Simas
- Department of Obstetrics and Gynecology, University of Massachusetts Medical School, 119 Belmont Street, Worcester, MA, 01605, USA
| |
Collapse
|
20
|
Khan A, DeYoung SE. Maternal health services for refugee populations: Exploration of best practices. Glob Public Health 2018; 14:362-374. [DOI: 10.1080/17441692.2018.1516796] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Aishah Khan
- Department of Health Policy and Management, University of Georgia College of Public Health, Athens, GA, USA
| | - Sarah E. DeYoung
- Department of Health Policy and Management, University of Georgia College of Public Health, Athens, GA, USA
| |
Collapse
|
21
|
Baldwin MK, Hart KD, Rodriguez MI. Predictors for follow-up among postpartum patients enrolled in a clinical trial. Contraception 2018; 98:228-231. [PMID: 29750924 PMCID: PMC6129217 DOI: 10.1016/j.contraception.2018.04.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 04/24/2018] [Accepted: 04/27/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To identify risk factors for failure to attend postpartum follow-up within 3 months of delivery, including social support, intrinsic motivation, insurance type and prenatal care attendance. STUDY DESIGN This planned secondary analysis is derived from a randomized controlled trial of patients intending intrauterine device (IUD) use following their delivery (n=197). Subjects were postpartum from a vaginal or cesarean birth at ≥32 weeks' gestation. We obtained baseline demographics and certainty about their plan to receive a postpartum IUD. We administered validated scales for social support and intrinsic motivation at enrollment. We then reviewed health records for prenatal visits and any postpartum visit by 3 months and performed logistic regression to assess for predictors of follow-up. RESULTS A total of 38/197 subjects (19.3%) failed to attend any postpartum visit by 3 months. Subjects who failed to follow up were more likely to have Medicaid versus private insurance (92% versus 8%, p<.01). Income <$50,000, no car, younger age, unplanned pregnancy, unemployment, multiple children, missed prenatal visits and late initiation of prenatal care were also associated with failure to follow up. Higher scores for social support and goal-directed motivation were not significantly associated with follow-up. CONCLUSIONS In our cohort, we found that one in five participants did not attend a postpartum visit by 3 months. Several socioeconomic indicators are associated with loss to follow-up, most notably Medicaid insurance. Having high motivation and social support is not sufficient to predict successful follow-up. IMPLICATIONS The main predictors for not attending a postpartum visit are Medicaid insurance or limited prenatal care, and not social support or intrinsic motivation. Interventions to improve postpartum contraception uptake should focus efforts on provision of immediate postpartum contraception for this population.
Collapse
Affiliation(s)
- Maureen K Baldwin
- Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mailcode UHN 50, Portland, OR 97239.
| | - Kyle D Hart
- Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mailcode UHN 50, Portland, OR 97239
| | - Maria I Rodriguez
- Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mailcode UHN 50, Portland, OR 97239
| |
Collapse
|
22
|
Mitra M. Postpartum Health of Women with Intellectual and Developmental Disabilities: A Call to Action. J Womens Health (Larchmt) 2017; 26:303-304. [PMID: 28355095 DOI: 10.1089/jwh.2017.6382] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Monika Mitra
- The Lurie Institute for Disability Policy, The Heller School for Social Policy and Management, Brandeis University , Waltham, Massachusetts
| |
Collapse
|