A program evaluation of postpartum/newborn home visitation services in aiken county, South Carolina

Views of women and clinicians on postpartum preparation and recovery

To explore important domains of women's postpartum experiences as perceived by postpartum mothers and obstetricians/midwives, and to investigate how postpartum care could enhance patient preparation for the postpartum period. Qualitative research study was conducted to explore women's and clinicians' perceptions of the postpartum experience. Four focus groups of postpartum women (n = 45) and two focus groups of obstetric clinicians (n = 13) were held at a large urban teaching hospital in New York City. All focus groups were audio recorded, transcribed, and analyzed using grounded theory. Four main themes were identified: lack of women's knowledge about postpartum health and lack of preparation for the postpartum experience, lack of continuity of care and absence of maternal care during the early postpartum period, disconnect between providers and postpartum mothers, and suggestions for improvement. Mothers did not expect many of the symptoms they experienced after childbirth and were disappointed with the lack of support by providers during this critical time in their recovery. Differences existed in the major postpartum concerns of mothers and clinicians. However, both mothers and clinicians agreed that preparation during the antepartum period could be beneficial for postpartum recovery. Results from this study indicate that many mothers do not feel prepared for the postpartum experience. Study findings raise the hypothesis that capturing patient-centered domains that define the postpartum experience and integrating these domains into patient care may enhance patient preparation for postpartum recovery and improve postpartum outcomes.

The MOM Program: home visiting in partnership with pediatric care

OBJECTIVE

Home visiting programs aim to improve child health, reduce developmental risks, and enhance use of community resources. How these programs can work in collaboration with pediatric practice has been understudied. The MOM Program was a randomized controlled trial of an innovative home visiting program to serve urban, low-income children. Program aims included promoting child health through regular pediatric visits and enhancing school readiness through developmental screenings and referrals to early intervention. The objective of this report was to describe the partnership with the pediatric community and selected program results.

METHODS

A total of 302 mothers were enrolled in the program at the time of children's birth. Eligible infants were full-term, without identified neurologic/genetic disorder or ICU intervention, and from high-poverty zip codes. A total of 152 were randomized to the home visiting program, with 9 visits over 3 years, scheduled before well-child visits; 150 were randomized to the control condition with no home visits. Medical records and case notes provided information on pediatric appointments kept and program outcomes.

RESULTS

Eighty-nine percent of both groups were retained throughout the 3-year program; 86% of the home-visited group received at least 7 of the 9 planned home visits. Home-visited mothers were >10 times as likely to keep pediatric appointments, compared with those not visited. Barriers to service access were varied, and theory-driven approaches were taken to address these.

CONCLUSIONS

Home visiting programs can provide important partnerships with pediatric health care providers. Integrating home visiting services with pediatric care can enhance child health, and this subject warrants expansion.

Factors influencing mothers' abilities to engage in a comprehensive parenting intervention program

OBJECTIVE

This research identified the possible factors influencing the ability of mothers perceived to be at the highest risk for child maltreatment to engage in a home visitation program. This study holds significance to public health nursing since home visitation is an integral component of public health nursing practice, with engagement being essential for human interaction and thus nursing care to occur.

DESIGN AND SAMPLE

A qualitative descriptive design was used to offer a thematic summary of the experiences of program engagement from the perspective of 4 home visitation coach interventionists from health-related fields and a small sample of purposefully selected mothers involved in a longitudinal prevention study.

RESULTS

Qualitative content analysis revealed 3 major themes related to engagement: (1) mothers struggle to meet the emotional needs of the self and the child; (2) mothers lack support in navigating complicated and stressful life events; and (3) mothers' consistency with program engagement is mediated through a trusting and caring relationship with coaches.

CONCLUSIONS

Home visitation coaches in this study demonstrated a continuous process of engagement by supporting mothers to explore and discover self-care strategies and ways to navigate life struggles. Over time, a foundation of trust and caring was developed, which in turn increased relationship building and program engagement.