A Randomized, Controlled Trial of Nurse-Navigated Texting Support for Primiparous Women After an Unplanned Cesarean Birth

Abstract

To investigate the relationship between daily, interactive, nurse-navigated texting support and the outcomes of postpartum symptom experience and perceived availability of social support in women who have unplanned first-birth cesareans. We used a randomized, repeated measures, pretest–posttest design guided by symptom-management theory. Recruitment occurred at a southeastern medical center that has more than 4,250 births annually. Women ages 18–34 years with unplanned first-birth cesarean of a single fetus at 37.0 or more weeks gestation (N = 41). Experienced maternity registered nurses designated as postpartum nurse navigators (PPNNs) for this study implemented an innovative, patient-centered, interactive texting intervention to bridge an existing gap between hospital discharge after childbirth and subsequent health care not typically scheduled until several weeks postpartum. The intervention began the day after hospital discharge and continued until 4 weeks postbirth. PPNNs texted participants daily and used decision-tree guidelines created for the study with their clinical expertise to assess participants’ general well being, assist with postpartum symptom navigation and breastfeeding, and address questions related to recovery and newborn care. The control group received normal care. All participants completed three electronic surveys at 2–4-days postbirth and at 2-weeks and 4-weeks postbirth. Data analyses were completed before reaching statistical power; preliminary findings demonstrated no differences between the intervention and control groups on the outcomes of overall postpartum symptom experience and perceived availability of social support. Preliminary findings revealed satisfaction with the texting intervention: 85.7% rated the experience good or outstanding, 90.5% expressed they would likely choose texting again after a future birth, and 61.9% indicated the availability of a professional resource as most helpful. Availability of a PPNN offers easy access to individualized professional nursing support during the early postpartum period. Access to a PPNN during childbirth recovery can help to foster maternal well being. Care from PPNNs can be implemented electronically without regard to location. In addition, because of their clinical expertise, nurses can offer guidance regarding when immediate follow-up care is needed if unexpected postpartum or newborn concerns occur.