Abstract

BackgroundA new movement towards improved postpartum care calls for restructuring how that care is provided. As professional guidelines evolve, understanding how providers prioritize and practice postpartum care can offer insights about elements of care that may be currently performed more routinely than providers deem a priority to do so, as well as those that may warrant more routine practice.MethodsWe surveyed 600 randomly-sampled U.S. postpartum care providers about their priorities for and the frequency with which specific elements of care are provided, as well as the feasibility of remote delivery of postpartum care provision (i.e., telemedicine).ResultsThe survey response rate was 43% across medical specialties. Providers reported an average of only 24.4 ± 11.7 min available to spend on the postpartum visit. Certain types of postpartum care were highly prioritized and routinely performed, such as depression screening. Yet, there were also noted discrepancies between prioritized and performed care, revealing competing demands on providers’ time. For example, pelvic exams were performed more often than similarly prioritized care, whereas screening for intimate partner violence and substance use were performed less often than similarly-prioritized care. Certain types of care were identified as important that are not explicitly addressed by national practice guidelines (e.g. transitioning to parenthood). Approximately 25% of respondents regarded telemedicine as a feasible remote care delivery alternative to much of the care currently provided in-person.ConclusionsThe time providers have available to offer comprehensive postpartum care is constrained. Understanding how certain elements of care may be competing with one another at a single postpartum visit highlights those elements of care, which may be currently underperformed, as well as those elements of care that may warrant evaluation for future inclusion in standard care. For some providers experiencing time constraints, complementary remote care represents a potentially viable approach to implementing recommendations for transitioning the traditional visit to a more frequent, ongoing postpartum care process. In calling for a new approach to postpartum care delivery, professional organizations should consider the practices and priorities of their constituency as they revise guidelines and shape future research about the value of specific postpartum services.

Highlights

  • A new movement towards improved postpartum care calls for restructuring how that care is provided

  • Study sample and recruitment The mailing addresses of 6000 active obstetriciangynecologist (OB-GYN) physicians, 3000 active family medicine physicians and 6542 active nurse-midwives were acquired from the official databases of three professional organizations: The American Medical Association (AMA), The American Academy of Family Physicians (AAFP) and The American College of Nurse-Midwives (ACNM)

  • Of the 50 excluded, 29 surveys were returned to sender as an undeliverable address (55% were from the AMA list, 21% were from the ACNM list, and 24% were from the AAFP list) and 21 recipients returned an uncompleted survey due to being retired or having a non-relevant specialty

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Summary

Introduction

A new movement towards improved postpartum care calls for restructuring how that care is provided. The traditional practice of a single postpartum appointment 6 weeks after birth has lately been called into question. The American College of Obstetricians and Gynecologists (ACOG) published new guidelines in 2018 recommending postpartum care “become an ongoing process, rather than a single encounter, with services and support tailored to each woman’s individual needs” [1]. Maternal mortality review committees report that over 60% of U.S maternal deaths may have been prevented with more timely diagnoses and effective treatment for postpartum onset conditions, as well as improved patient knowledge of warning signs [4]. Traditional practices may result in a lack of care during a critical time, for those women at baseline higher risk of maternal mortality

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