Abstract
Purpose Postpartum care can provide the critical link between pregnancy and well-woman healthcare, improving women’s health during the interconception period and beyond. However, little is known about current utilization patterns. This study describes the patterns of postpartum care experienced by Illinois women with Medicaid-paid deliveries. Methods Medicaid claims for women delivering infants in Illinois in 2009–2010 were analyzed for the receipt, timing and patterns of postpartum care, as identified through International Classification of Diseases Revision 9—Clinical Modification and Current Procedural Terminology© codes for routine postpartum care (43.4 % of visits), other postpartum services (e.g., depression screening, family planning), and other office visits for non-acute care. Results Over 90,000 visits to 55,577 women were identified, with 81.1 % of women experiencing any care during the first 90 days postpartum. Approximately 40 % had one visit, while 31 and 29 % had two and three or more visits, respectively. Thirty-four percent had their first visit <21 days postpartum, while 56 % had the first visit between 21 and 56 days postpartum. Compared with non-Hispanic whites, African-Americans had lower rates of receiving any care (73.6 vs. 86.5 %), fewer visits (48.0 vs. 33.5 % with only one visit), and later first visits (13.6 vs. 7.3 %, >56 days). Conclusions for Practice The vast majority of Illinois women with Medicaid-paid deliveries interact with the healthcare system during the first 3 months postpartum, though not always for a routine postpartum visit. Strategies to optimize postpartum health should encourage a higher level of coordination among services and linkage to well-woman care to improve subsequent women and infants’ health outcomes.
Highlights
Recent evidence supporting the importance of women’s pre- and inter-conception health has led to prioritization of these time periods for interventions to improve maternal and child health (MCH) outcomes [4, 7, 19, 21, 23]
An important component of interconception care is postpartum care, which can provide the critical link between pregnancy and ongoing well-woman healthcare, especially among women who only first became engaged with the healthcare system during pregnancy or at delivery
The American Congress of Obstetricians and Gynecologists (ACOG) and American Academy of Pediatrics (AAP) recommend scheduling a postpartum visit approximately 4–6 weeks after delivery to provide the opportunity to address health risks that may have risen or been exacerbated by pregnancy, to assess emergent risks such as postpartum depression, to address infant care issues such as breastfeeding and safe sleep, and to offer the opportunity to assist women to transition to a focus on preventive care including reproductive goals and birth spacing [2, 21]
Summary
Recent evidence supporting the importance of women’s pre- and inter-conception health has led to prioritization of these time periods for interventions to improve maternal and child health (MCH) outcomes [4, 7, 19, 21, 23]. The postpartum period is a challenging time for women due to emotional transitions associated with parenting a newborn, sleep deprivation, physiological changes, an increased risk for depression, and risk for rapid repeat pregnancy [12, 13], so the delivery of high quality postpartum care is essential. The American Congress of Obstetricians and Gynecologists (ACOG) and American Academy of Pediatrics (AAP) recommend scheduling a postpartum visit approximately 4–6 weeks after delivery to provide the opportunity to address health risks that may have risen or been exacerbated by pregnancy, to assess emergent risks such as postpartum depression, to address infant care issues such as breastfeeding and safe sleep, and to offer the opportunity to assist women to transition to a focus on preventive care including reproductive goals and birth spacing [2, 21]. A [15] goal focuses on increasing the receipt of postpartum visits with a health worker [15] and the Centers for Medicaid and Children’s Health Insurance Program (CHIP) Services (CMCS) Maternal and Infant Health Initiative aims to increase the rate of postpartum visits by 10 % among women in Medicaid and CHIP in at least twenty states over a 3-year period [11]
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