Guidelines and Interventions Related to the Postpartum Visit for Low-Risk Postpartum Women in High and Upper Middle Income Countries

Stumbras, Katrina; Rankin, Kristin; Caskey, Rachel; Haider, Sadia; Handler, Arden

doi:10.1007/s10995-016-2053-6

Cited by 27 publications

(12 citation statements)

References 36 publications

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“…9,21,22 Continued health care engagement in the postpartum period has the potential to address health concerns among women with OUD, including postpartum depression, breastfeeding support, contraception, and the provision of family planning services. 23 To wit, our study found that Pennsylvania Medicaid expansion in 2015 due to the ACA significantly reduced dis-enrollment following delivery. After Medicaid expansion, 87% of women remained continuously enrolled during the 300 days after delivery, compared with 81% prior to expansion.…”

Section: Discussionmentioning

confidence: 66%

The Impact of Medicaid Expansion on Postpartum Health Care Utilization among Pregnant Women with Opioid use Disorder

et al. 2019

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Background: Opioid use disorder (OUD) during pregnancy has increased dramatically over the past decade, as have associated adverse maternal health outcomes. Although Medicaid has long been the largest payer for deliveries in the United States, states' decisions to expand Medicaid eligibility to low-income adults has the potential to increase access to care for women in the postpartum period. This study aimed to determine the impact of the 2015 Pennsylvania Medicaid expansion on postpartum insurance coverage and preventive care utilization among pregnant women with opioid use disorder (OUD). Methods: In 2017, we conducted a retrospective cohort study using 2013-2015 administrative Medicaid data provided by the Pennsylvania Department of Human Services. We identified 1562 women with opioid use disorder who had a live birth delivery in a pre-Medicaid expansion or postexpansion study period. We compared length of continuous enrollment in Medicaid following delivery, postpartum visit attendance, and contraception initiation between groups. Results: More women in the post-expansion group remained enrolled in Medicaid at 300 days postpartum, relative to the pre-expansion group (87% vs. 81%). Medicaid expansion was not associated with differences in postpartum visit attendance or contraceptive use. However, women who remained enrolled in Medicaid for at least 300 days post delivery had an increased odds of postpartum visit attendance (odds ratio [OR]: 1.6, 95% confidence interval [CI]: 1.04, 2.4).

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Section: Discussionmentioning

confidence: 66%

The Impact of Medicaid Expansion on Postpartum Health Care Utilization among Pregnant Women with Opioid use Disorder

et al. 2019

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“…In addition, we tested for multicollinearity to eliminate redundant variables and decided a priori to include ethnicity, age, and parity, which are known predictors of postpartum visit completion, in the logistic regression model. 2,5 We used the REDCap electronic data system for data management 13 and SPSS 24 (IBM, Armonk, NY) for statistical analysis.…”

Section: Methodsmentioning

confidence: 99%

Comparing Postpartum Visit Attendance with a Scheduled 2- to 3-Week or 6-Week Visit after Delivery

et al. 2018

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Objective To evaluate whether scheduling a 2- to 3-week versus 6-week postpartum visit results in higher visit attendance. Study Design We conducted a secondary analysis of a quasi-experimental before–after study to compare postpartum visit attendance after changing routine scheduling of visits from 6 weeks to 2 to 3 weeks after delivery. Secondary outcomes include patient satisfaction and breastfeeding continuation at 3 and 6 months postpartum. We collected postpartum visit information through a chart review and conducted telephonic interviews at 3 and 6 months postpartum to assess satisfaction with visit timing and breastfeeding status. We performed multivariable analyses to assess predictors of visit attendance. Results Women scheduled at 2 to 3 weeks postpartum demonstrated higher visit attendance (90.2%; 95% confidence interval [CI]: 86.6–93.9%) compared with 6 weeks (81.6%; 95% CI: 76.3–86.2%; p < 0.01). Predictors for visit attendance include postpartum visit timing, age, education, parity, prior miscarriage, and high-risk index pregnancy in multivariate analysis. Scheduling at 2 to 3 weeks postpartum increased visit completion in women who were younger and had lower educational attainment, high-risk index pregnancy, and no prior miscarriages. We found no differences in patient satisfaction or breastfeeding continuation at 3 and 6 months postpartum related to postpartum visit timing. Conclusion Scheduling a 2- to 3-week postpartum visit is associated with higher attendance.

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“…Despite the clear expectation of post-birth care planning set-out in policy, there is little evidence of such care plans being utilised in practice. Much of the literature and policy documents quantify women’s experience of postnatal services, that is, describe the number and timing of post-birth visits, rather than discuss the content of visits [41]. Adequate contact from professionals is important in ensuring that women receive appropriate care during the post-birth period [6, 7].…”

Section: Resultsmentioning

confidence: 99%

Policy, evidence and practice for post-birth care plans: a scoping review

Crowther

MacIver

Lau

2019

BMC Pregnancy Childbirth

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Background Postnatal care continually attracts less attention than other parts of the childbirth year. Many regions consistently report poor maternal satisfaction with care in the post-birth period. Despite policy recommending post-birth planning be part of maternity services there remains a paucity of empirical evidence and reported experience using post-birth care plans. There is a need to report on post-birth care plans, identify policy and guideline recommendations and gaps in the current empirical research, as well as experiences creating and using post-birth care plans. Methods This scoping review accessed empirical literature and government and professional documents from 2005 to present day to build a picture of current understanding of policy imperatives and existent published empirical evidence. The review was informed by the Arksey and O’Malley approach employing five stages. Results The review revealed that post-birth care planning is promoted extensively in health policy and there is emergent evidence for its implementation. Yet there is a paucity of practice examples and only one evaluation in the UK. The review identified four overarching themes: ‘Positioning of post-birth care planning in policy; ‘Content and approach’; ‘Personalised care and relational continuity’; Feasibility and acceptability in practice’. Conclusions Empirical evidence supports post-birth care planning, but evidence is limited leaving many unanswered questions. Health care policy reflects evidence and recommends implementation of post-birth care plans, however, there remains a paucity of information in relation to post-birth care planning experience and implementation in practice. Women need consistent information and advice and value personalised care. Models of care that facilitate these needs are focused on relational continuity and lead to greater satisfaction. It remains unclear if a combination of post-birth care planning and continuity of carer interventions would improve post-birth outcomes and satisfaction. Gaps in research knowledge and practice experience are identified and implications for practice and further research suggested.

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Guidelines and Interventions Related to the Postpartum Visit for Low-Risk Postpartum Women in High and Upper Middle Income Countries

Cited by 27 publications

References 36 publications

The Impact of Medicaid Expansion on Postpartum Health Care Utilization among Pregnant Women with Opioid use Disorder

The Impact of Medicaid Expansion on Postpartum Health Care Utilization among Pregnant Women with Opioid use Disorder

Comparing Postpartum Visit Attendance with a Scheduled 2- to 3-Week or 6-Week Visit after Delivery

Policy, evidence and practice for post-birth care plans: a scoping review

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