Provider Perspectives on Barriers and Facilitators to Postpartum Care for Low-Income Individuals

Rachel S Ruderman, Emma C Dahl, Brittney R Williams, Ka'Derricka Davis, Joe M Feinglass, William A Grobman, Michelle A Kominiarek, Lynn M Yee, Rachel S Ruderman, Emma C Dahl, Brittney R Williams, Ka'Derricka Davis, Joe M Feinglass, William A Grobman, Michelle A Kominiarek, Lynn M Yee

Abstract

Background: Recent paradigm shifts in postpartum care have conceptualized the "fourth trimester" as a critical transitional period requiring tailored, ongoing health care. However, this concept presents challenges for providers, especially in low-resource settings. Our objective was to understand providers' perspectives on challenges in postpartum care to highlight strategies for optimizing care. Methods: Focus groups were conducted using a semistructured interview guide to elicit perspectives on barriers and facilitators to postpartum care. Participants included physicians, nurses, and social workers who care for low-income postpartum individuals. Interviews explored the provider experience of postpartum care, with a focus on barriers experienced by patients and providers, and tools for maintaining engagement. Analysis was performed using the constant comparative method and framed by the Social Ecological Model. Results: Participants (N = 26) all acknowledged the importance of the "fourth trimester" but identified multiple barriers to providing optimal postpartum care. Challenges providers perceived for patients and those they perceived for themselves often overlapped, including difficulty with appointment scheduling, insurance limitations, lack of provider continuity, and knowledge gaps. Providers identified ease of referrals to specialists, access to tangible services (e.g., contraception), and enhanced care coordination (e.g., patient navigation) as potential facilitators of improved postpartum care. Conclusions: Obstetric providers recognize the importance of postpartum care yet highlighted significant systems- and patient-based barriers to achieving optimal care. The development and implementation of postpartum care delivery system redesign, such as the use of patient navigators to improve health care utilization and resource attainment, may enhance care during this critical time. Clinical Trial No.: NCT03922334.

Keywords: health care provider; health disparities; postpartum; postpartum care; provider perspective.

Conflict of interest statement

No competing financial interests exist.

© Rachel S. Ruderman et al., 2021; Published by Mary Ann Liebert, Inc.

Figures

FIG. 1.
FIG. 1.
Continuum of challenges for patients and providers in the Social Ecological Model.

References

    1. American College of Obstetricians and Gynecologists. Committee Opinion No. 736: Optimizing postpartum care. Obstet Gynecol 2018;131:e140–e150
    1. Edwards M. The crises of the fourth trimester. Birth 1973;1:19–22
    1. Callaghan WM, Creanga AA, Kuklina EV. Severe maternal morbidity among delivery and postpartum hospitalizations in the United States. Obstet Gynecol 2012;120:1029–1036
    1. Borders N. After the afterbirth: A critical review of postpartum health relative to method of delivery. J Midwifery Womens Health 2006;51:242–248
    1. Wilcox A, Levi EE, Garrett JM. Predictors of non-attendance to the postpartum follow-up visit. Matern Child Health J 2016;20:22–27
    1. Rankin KM, Haider S, Caskey R, Chakraborty A, Roesch P, Handler A. Healthcare utilization in the postpartum period among Illinois women with Medicaid paid claims for delivery, 2009–2010. Matern Child Health J 2016;20:144–153
    1. DiBari JN, Yu SM, Chao SM, Lu MC. Use of postpartum care: Predictors and barriers. J Pregnancy 2014;2014:530769.
    1. Lu MC, Prentice J. The postpartum visit: Risk factors for nonuse and association with breast-feeding. Am J Obstet Gynecol 2002;187:1329–1336
    1. Kim MK, Lee SM, Bae SH, et al. . Socioeconomic status can affect pregnancy outcomes and complications, even with a universal healthcare system. Int J Equity Health 2018;17:2.
    1. Rich-Edwards JW, Fraser A, Lawlor DA, Catov JM. Pregnancy characteristics and women's future cardiovascular health: An underused opportunity to improve women's health? Epidemiol Rev 2014;36:57–70
    1. Sword W, Watt S. Learning needs of postpartum women: Does socioeconomic status matter? Birth 2005;32:86–92
    1. Brown MC, Bell R, Collins C, et al. . Women's perception of future risk following pregnancies complicated by preeclampsia. Hypertens Pregnancy 2013;32:60–73
    1. Buchberg MK, Fletcher FE, Vidrine DJ, et al. . A mixed-methods approach to understanding barriers to postpartum retention in care among low-income, HIV-infected women. AIDS Patient Care STDS 2015;29:126–132
    1. Howell EA, Balbierz A, Beane S, et al. . Timely postpartum visits for low-income women: A health system and Medicaid payer partnership. Am J Public Health 2020;110:S215–S218
    1. McLeroy KR, Bibeau D, Steckler A, Glanz K. An ecological perspective on health promotion programs. Health Educ Q 1988;15:351–377
    1. Boeije H. A purposeful approach to the constant comparative method in the analysis of qualitative interviews. Qual Quant 2002;36:391–409
    1. Martin A, Horowitz C, Balbierz A, Howell EA. Views of women and clinicians on postpartum preparation and recovery. Matern Child Health J 2014;18:707–713
    1. Kanotra S, D'Angelo D, Phares TM, Morrow B, Barfield WD, Lansky A. Challenges faced by new mothers in the early postpartum period: An analysis of comment data from the 2000 Pregnancy Risk Assessment Monitoring System (PRAMS) survey. Matern Child Health J 2007;11:549–558
    1. Eckert E. Preserving the momentum to extend postpartum Medicaid coverage. Womens Health Issues 2020;30:401–404
    1. Leading Health Indicators 2030. Advancing Health, Equity, and Well-Being, 2020. Available at: Accessed December28, 2020
    1. Cheng CY, Fowles ER, Walker LO. Continuing education module: Postpartum maternal health care in the United States: A critical review. J Perinat Educ 2006;15:34–42
    1. Shaw E, Levitt C, Wong S, Kaczorowski J, McMaster University Postpartum Research Group. Systematic review of the literature on postpartum care: Effectiveness of postpartum support to improve maternal parenting, mental health, quality of life, and physical health. Birth 2006;33:210–220
    1. Yee LM, Martinez NG, Nguyen AT, Hajjar N, Chen MJ, Simon MA. Using a patient navigator to improve postpartum care in an urban Women's Health Clinic. Obstet Gynecol 2017;129:925–933
    1. McKenney KM, Martinez NG, Yee LM. Patient navigation across the spectrum of women's health care in the United States. Am J Obstet Gynecol 2018;218:280–286
    1. Teng L, Robertson Blackmore E, Stewart DE. Healthcare worker's perceptions of barriers to care by immigrant women with postpartum depression: An exploratory qualitative study. Arch Womens Ment Health 2007;10:93–101
    1. Yee LM, Simon MA. Perceptions of coercion, discrimination and other negative experiences in postpartum contraceptive counseling for low-income minority women. J Health Care Poor Underserved 2011;22:1387–1400

Source: PubMed

Patrocinadores y Colaboradores

Condiciones médicas

Intervenciones de drogas

3
Suscribir