Postpartum Care Services Research Articles

Parenting Expertise during Transitions-to-Motherhood. Exploring Transformations in Knowledge Regimes in Poland

This study explores transformations in parenting expertise in Poland, focusing on maternal knowledge perspectives during transitions-to-motherhood. It combines empirical data from two sociological studies: in-depth interviews (with to-be mothers) and expert interviews (with reproductive medicine practitioners; professionals offering antenatal, perinatal, and postpartum care services; and digital parenting advisors). Based on a thematic analysis, we describe the competing visions of parenting expertise in contemporary Poland, treating them as emanations of rapidly transforming knowledge regimes. We demonstrate vestiges of parenting expertise legitimized during state socialism; illustrate stories of granular expertise visible to mothers and experts, embracing the overflow and multiplicity of parenting experts under neoliberal intensification; and identify the potential of a new familistic framing of expertise by observing aspects of traditionalism refactored into expertise in recent years. This study argues that the characteristics of parenting expertise strongly hinge on cultural contexts and the pace of systemic changes that frame the knowledge regimes therein.

Building Capacity of Community Health Centers to Improve the Provision of Postpartum Care Services Through Data-Driven Health Information Technology and Innovation.

Maternal morbidity and mortality remain significant challenges in the United States, with substantial burden during the postpartum period. The Centers for Disease Control and Prevention, in partnership with the National Association of Community Health Centers, began an initiative to build capacity in Federally Qualified Health Centers to (1) improve the infrastructure for perinatal care measures and (2) use perinatal care measures to identify and address gaps in postpartum care. Two partner health center-controlled networks implemented strategies to integrate evidence-based recommendations into the clinic workflow and used data-driven health information technology (HIT) systems to improve data standardization for quality improvement of postpartum care services. Ten measures were created to capture recommended care and services. To support measure capture, a data cleaning algorithm was created to prioritize defining pregnancy episodes and delivery dates and address data inconsistencies. Quality improvement activities targeted postpartum care delivery tailored to patients and care teams. Data limitations, including inconsistencies in electronic health record documentation and data extraction practices, underscored the complexity of integrating HIT solutions into postpartum care workflows. Despite challenges, the project demonstrated continuous quality improvement to support data quality for perinatal care measures. Future solutions emphasize the need for standardized data elements, collaborative care team engagement, and iterative HIT implementation strategies to enhance perinatal care quality. Our findings highlight the potential of HIT-driven interventions to improve postpartum care within health centers, with a focus on the importance of addressing data interoperability and documentation challenges to optimize and monitor initiatives to improve postpartum health outcomes.

Client-centered flexible planning of home-based postpartum care: A randomized controlled trial on the quality of care.

Standardization of health systems often hinders client-centered care. This study investigates whether allowing more flexibility in the planning range of the Dutch home-based postpartum care service improves its quality of care, as innovative approach to client-centered care. A randomized controlled trial was conducted (2017-2019), in which pregnant women who intended to breastfeed were assigned into two groups (1:1). The intervention group was allowed to receive care up to the 14th-day postpartum, instead of the first 8-10 consecutive days ("usual care"). Primary outcome measure was the proportion of newborns still receiving exclusively breastmilk on final caring day of the service. This so-called successful breastfeeding rate is currently used by the Dutch health sector to measure the quality of care. Secondary outcome measures were self-care experience, overall care experience, and exclusive breastfeeding duration rate. Based on data from 1275 participants, there was no difference in exclusive breastfeeding on final caring day (86,7% intervention group vs. 88,9% control group, RR: 1.03, 95% CI: 0.98-1.07). Both groups showed similar self-care experiences. Women in the intervention group had slightly poorer overall care experience and lower exclusive breastfeeding duration rates. This study found no effect on the quality of care when allowing more flexibility in the planning range of home-based postpartum care. Women can, therefore, be offered more flexibility to suit them. Given the confusion in interpreting the sector's current main quality indicator, we call for an inclusive dialogue on how to best measure the quality of home-based postpartum care.

Postpartum care services and multi-disciplinary collaboration in Japan.

The Postpartum Care Services (PCS) programme in Japan is intended to promote physical recovery and psychological rest for mothers and their children after discharge from the delivery facility, as well as nurture the mothers' own self-care skills and support healthy childrearing for mothers, children and their families. The subsidies for PCS are based on cooperation between psychiatry and obstetrics and between multiple professions, including the local government. The services should also be implemented based on the instruction to medical institutions and the local governments that they should actively screen and approach pregnant women in need of support. This narrative review describes the challenges of expanding the PCS programme nationwide in Japan.

Maternity Care Deserts and Postpartum Outcomes: Bridging the Gap in Maternal Health Care in Florida [ID 2683485

INTRODUCTION: Over 2.2 million women of reproductive age live in areas, referred to as maternity care deserts (MCD), with inadequate access to postpartum care services. Furthermore, deaths occurring during the postpartum period account for over half of all pregnancy related deaths. This analysis serves to provide an overview of the intricate relationship between health care access and postpartum health while exploring the increased risk of delayed detection of postpartum complications and the association to increasing maternal mortality rates. METHODS: Data provided by the Area Health Resource File were used to identify counties in Florida that met the criteria of a designated MCD. Data collected on all pregnancy-related deaths verified by the Florida Department of Health (2020–2021) and geographic codes for MCD were used to identify significant associations. RESULTS: This study collected data from a total of 1,938 pregnancy related deaths. A significant increase in the number of postpartum related deaths was during that time (75%). More than a quarter were in MCD (26%). An association of postpartum related deaths with MCD showed an increase (22%). 1 in 10 women living in MCD reported to not receive a postpartum care visit, these counties were also noted to be more likely to have limited telehealth access (30%). CONCLUSION: Maternity care desert limitations to postpartum care reduce prevention efforts, increase risk for delayed complications to go undetected, and contribute to the maternal mortality rates. Potential solutions include policy revisions to expand telehealth access and efforts to increase the awareness of the importance of postpartum care.

Optimizing Postpartum Care in Rural Communities: Insights from Women in Arizona and Implications for Policy

ObjectivesOptimal postpartum care promotes healthcare utilization and outcomes. This qualitative study investigated the experiences and perceived needs for postpartum care among women in rural communities in Arizona, United States.MethodsWe conducted in-depth interviews with thirty childbearing women and analyzed the transcripts using reflexive thematic analysis to gauge their experiences, needs, and factors affecting postpartum healthcare utilization.ResultsExperiences during childbirth and multiple structural factors, including transportation, childcare services, financial constraints, and social support, played crucial roles in postpartum care utilization for childbearing people in rural communities. Access to comprehensive health information and community-level support systems were perceived as critical for optimizing postpartum care and utilization.Conclusions for PracticeThis study provides valuable insights for policymakers, healthcare providers, and community stakeholders in enhancing postpartum care services for individuals in rural communities in the United States.

The characteristics of users of postpartum care services: A longitudinal study at 35 weeks gestation and one month postpartum

The characteristics of users of postpartum care services: A longitudinal study at 35 weeks gestation and one month postpartum

Post-natal care: a vital chance to save mothers and infants! Exploring barriers and factors associated with it: a mixed study.

The most effective maternal health intervention for enhancing mother and baby survival is postnatal care, yet it is also the most neglected service in Ethiopia. Less is known about postnatal care despite earlier studies concentrating on pregnancy and delivery service utilization. Postnatal care is the subject of few national and local area studies. Therefore this research aims to evaluate postnatal care utilization and barriers and associated characteristics among women in Ilubabor Zone and Buno Bedele Zone. A mixed-methods study involving women who visited immunization clinics was conducted in Southwest Ethiopia. For the quantitative part, a cross-sectional survey was conducted between June 12 and July 12, 2022. The data collected through interviews was analyzed using SPSS version 26. An adjusted odds ratio (AOR) with a 95% confidence interval (CI) and p-value was constructed to evaluate the associations between postnatal care service utilization and explanatory variables. The usage of postnatal care services was determined to be significantly correlated with explanatory variables in multivariable logistic regression with a p-value less than 0.05. This qualitative study used two focused group discussions and two in-depth interviews to gather data from purposely selected mothers, and thematic analysis was used to analyze the data. A total of 422 participants with a 100% response rate were included in the analysis. 234 (55.5%) of these underwent postnatal checks. In the quantitative section, postnatal care counseling and appointment setting, counseling on danger signs, and prior postnatal care utilization all demonstrated a statistically significant association with the use of postnatal care services (AOR = 3.6, 95% CI (1.47-7.23)), [AOR = 2, 95% CI (1.05-3.64)], and [AOR = 3, 95% CI (1.36-58), respectively). At the qualitative level, it was determined that the themes of knowledge and access were obstacles to the use of postpartum care services. Generally this study revealed that the Ilubabor Zone and Buno Bedele Zone have a poor total PNC service utilization rate. Furthermore, ignorance, conventional wisdom, religious activity, distance from facilities, environmental exposure, and waiting time were identified as barriers to postnatal care service utilization. To optimize this service, all parties involved should address these factors.

Factors affecting the provision of high-quality postnatal care services in Zanzibar: a qualitative study

BackgroundIn Sub-Saharan Africa, the postnatal period is associated with high mortality and accounts for a substantial proportion of maternal deaths. Although postnatal care has been identified as critical in reducing maternal mortality, the quality of care provided is often inadequate. Tanzania and Zanzibar have not made sufficient progress towards achieving the Sustainable Development Goals on maternal health, and there is limited knowledge about the utilization and quality of postnatal follow-up. The aim of this study was therefore to explore factors affecting the provision of high-quality postnatal care services in the urban area of Zanzibar.MethodsFive focus group discussions were performed in Swahili with 25 healthcare providers from primary healthcare units in urban Zanzibar. Interviews were audio-recorded, transcribed verbatim, translated into English, and analysed using qualitative content analysis with an inductive approach.ResultsFactors affecting provision of high-quality postpartum care services could be divided into three generic categories. Difficulty achieving high attendance comprised three subcategories: long waiting times, low awareness among women, and out-of-pocket payment. Lack of basic resources also comprised three subcategories: shortage of healthcare providers, lack of adequate space, and inadequate medical equipment. Insufficient care routines comprised two subcategories: lack of guidelines and deficient chain of information.ConclusionsThe present findings suggest that the women’s perceptions of postnatal care do not align with the intended purpose of routine postnatal care. Instead, the postnatal period primarily leads to visits to health facilities only when urgent care is required, and there is a lack of awareness about the importance of postnatal care. Moreover, limited resources, including equipment, staff, and space, as well as long waiting times, hinder the delivery of high-quality care and contribute to a negative reputation of postnatal care services. To effectively reach all women and improve postnatal care, it is necessary to increase basic resources, modify health education approaches, and enhance the flow of information between different levels of care using context-specific strategies.

Promoting adolescent mother self-efficacy for parenting roles, and self-care after childbirth: protocol for a mixed methods study

BackgroundPregnancy, and childbirth can encounter many challenges for the teen mother, family, and health system. The simultaneity of two transition periods, i.e. transition to adulthood and post-partum period may disrupt the acceptance of new roles. Lack of knowledge, information and life skills in managing this situation may threaten the physical and mental health of the mother, and child, as well as reduce the level of role adaptation. One way to increase women's empowerment in postpartum care is self-efficacy promotion training program. The current mixed methods study will be conducted to provide an interventional program sensitive to the culture of the Iranian society for adolescent mothers to improve their self-efficacy.MethodThis study will be conducted as an exploratory sequential mixed methods study (Qual-quan) based on a pragmatism paradigm in four phases. In the first phase, a qualitative study will be performed using a directed content analysis method to explore the needs and strategies related to promote postpartum self-efficacy from the viewpoint of teen mothers, their family, healthcare providers, and policymakers. In the second phase, using a scoping review, self-efficacy promotion strategies, and postpartum care service packages, programs, guidelines, and protocols in other countries will be identified. In the third phase, with integrating the results of qualitative phase and scoping review, the first draft of program will be developed, and validated by an expert panel based on the Delphi approach in three rounds. In the last step, the effectiveness of the interventional program will be evaluated on postpartum self-efficacy of teen mother.DiscussionDeveloping an interventional program that includes teen mother’s experiences, evidence based practice principles, and health staff opinions in a distinct cultural and social context can supply new direction to lead manager, policymakers, and other health care provider to improve the maternal self-efficacy in infant, family, and self-care with considering their age characteristics.

IMPLEMENTASI KLASIFIKASI KEHAMILAN BERESIKO DENGAN METODE NAIVE BAYES PADA PUSKESMAS KELURAHAN MALAKA JAYA

Pregnancy risk is classified into three categories: Low Risk Pregnancy (KRR), High Risk Pregnancy (KRT), and Very High Risk Pregnancy (KRST). Examination data recorded in the Maternal and Child Health (MCH) book at Puskesmas is used to categorize pregnancy risk. Although the maternal mortality rate has decreased, recent surveys show a significant increase. The causes include lack of counseling on obstetric and gynecological health, lack of emergency obstetric and neonatal care, and the use of ineffective traditional medicine. To overcome this problem, it is necessary to improve quality maternal health services. Efforts to accelerate the reduction of maternal mortality rate (MMR) include access to appropriate health services, postpartum care, and family planning services. Data processing uses data mining techniques with the Naïve Bayes classification method, which has high accuracy and short execution time. This study aims to develop a Naïve Bayes classification model in early detection of pregnancy risk, so that it can help diagnose pregnant women with low or high risk.

Community and Systems Contributors and Strategies to Reduce Racial Inequities in Maternal Health in the Deep South: Provider Perspectives.

Black pregnant individuals in Alabama are disproportionately affected by severe maternal morbidity and mortality (SMM). To understand why racial disparities in maternal health outcomes persist and identify potential strategies to reduce these inequities, we sought perspectives from obstetric health care providers, health administrators, and members of local organizations who provide pregnancy, delivery, and postpartum care services in Alabama. We conducted qualitative in-depth interviews with stakeholders (n=20), purposively recruited from community-based organizations, clinical settings, government organizations, and academic institutions. Interview guides were based on Howell's conceptual model of pathways to racial disparities in maternal mortality. Data were coded using a modified framework theory approach and analyzed thematically. Racism, unjust laws and policies, and poverty/lack of infrastructure in communities emerged as major themes contributing to racial disparities in maternal health at the community and systems levels. Inadequate health insurance coverage was described as a strong driver of the disparities. Service providers suggested strategies for Alabama should be community focused, evidence based, and culturally sensitive. These should include Medicaid expansion, expanded parental leave, and removal of laws restricting choice. Community- and systems-level interventions should include community infrastructure improvements, choice in maternity services, and provision of digital communication options. Providers shared perspectives on community and structural areas of intervention to reduce racial inequities in SMM. These results can inform discussions with health system and community partners about Alabama and other Deep South initiatives to improve maternal health outcomes in black communities.

Midwives' experiences with providing home-based postpartum care during the COVID-19 pandemic: A qualitative study.

To explore midwives' experiences with providing home-based postpartum care during the COVID-19 pandemic in Norway. A descriptive and explorative qualitative study. The study is based on semi-structured individual interviews with 11 midwives experienced in offering home-based postpartum care. We explored their experiences of such care during the first wave of the COVID-19 pandemic. Data collection occurred from October through November 2020. An inductive thematic analysis was performed using Systematic Text Condensation (STC) by Malterud (2012). The following two main results emerged from the analyses: (1) the midwives adapted quickly to changes in postpartum care during the pandemic and (2) midwives saw the experience as an opportunity to re-evaluate their practices. This study highlights midwives' resilience and adaptability during the first wave of COVID-19 pandemic. It emphasises the crucial role of face-to-face interactions in postpartum care, while recognising the value of technology when direct access is limited. By shedding light on midwives' experiences, this research contributes to improving postpartum care in unforeseen circumstances. It underscores the significance of interdisciplinary integration in planning postpartum care services and the lasting influence of lessons learned on addressing future challenges. The valuable insights gained from lessons learned during the COVID-19 pandemic may have a lasting influence on the postpartum care system, empowering it to tackle unforeseen challenges both today and in the future. The current study addressed midwives' experience with providing home-based postpartum care during the COVID-19 pandemic in Norway. Midwives received an opportunity to re-evaluate their own practices and valued being included when changes were implemented. The current findings should alert policy makers, leaders and clinicians in postpartum care services when planning future practice.

Survey of Postpartum People in the United States During the First Wave of the COVID-19 Pandemic to Explore Their Perspective on Support After Discharge.

The purpose of this study was to capture the experiences of postpartum people during the first wave of COVID-19, specifically their access to contraception and lactation support. This cross-sectional study surveyed individuals in the United States who used the Ovia Pregnancy and Parenting app. The survey was administered via an email Web link sent to postpartum people who gave birth between March 1, 2020, and June 11, 2020. Quantitative and qualitative analyses were conducted. A total of 388 postpartum people completed the survey. Most participants had just given birth to their first baby (68.5%; n = 261) at term gestation (37-41 weeks) (92.9%; n = 355). From the qualitative data, using content analysis, we derived 6 themes and 2 subthemes: quarantine, changes in postpartum care, loneliness and isolation, stress, resource changes, and positive impact. The theme loneliness and isolation had 2 subthemes: depression/sadness/hopelessness and anxiety. The experience of being postpartum during the COVID-19 pandemic brought unforeseen challenges. Providing care and support to postpartum people during a pandemic, specifically during a time of quarantine, should be reimagined. Increased use of virtual postpartum care services and expanded mental health support could serve to fill the gaps identified by participants.

Factors Associated with Postpartum Care during the Fourth Stage of Labor in Nepal: A Hospital-based Cross-sectional Study

Postnatal care is an important part of maternal and neonatal care, and life-threatening complications can occur during the postpartum period. Empirical information on the level of postpartum care services is generally scarce in Nepal. Key elements of postpartum care during the fourth stage of labor include providing proper nutrition, promoting breastfeeding, and helping the mother manage any physical discomforts or challenges that may arise. This study investigated the level of postpartum care services delivered during the fourth stage of labor in a tertiary-level hospital in the Chitwan district of Nepal. A descriptive cross-sectional hospital-based study was conducted among 148 women admitted for vaginal delivery. A set of structured observation checklists was developed and finalized based on the WHO Recommended Interventions for Improving Maternal and Newborn Health: Integrated Management of Pregnancy and Childbirth. The structured observation checklist had twenty-two items, including twelve critical steps. A good level of care was valid with a score of ≥ 90% based on total items, including all twelve critical steps of care, and a poor level of care was valid with a score <90%. The purpose of the study was explained to and written informed consent was obtained from all respondents. Ethical approval was received from the Institutional Review Committee of Chitwan Medical College. One third (33.8%) of the women received a good level of postpartum care services. Women’s residence (<em>p</em> = .021), number of pregnancies (<em>p</em> =.002), and number of antenatal visits (<em>p</em> =.029) were significantly associated with the level of postpartum care during the fourth stage of labor. Going forward, it will be important for Nepal to enhance the capacity of clinicians or nurses to provide postpartum care as per WHO guidelines.

The Factors Associated with Utilization of Postnatal Care Service in Sheka Zone, South-West Ethiopian Peoples Region

Within the first month of life, most deaths of mothers and infants occur. Within the first 24 hours, about half of all maternal deaths occur. In the Sheka zone, southwest of the Ethiopian Peoples area, the study sought to investigate the parameters associated with postnatal care service consumption. From January 2021 to March 2022, a cross-sectional study based in the community was carried out. 1779 individuals in all were enrolled in the study. Variables having a bivariate logistic regression p-value of less than 0.25 were included in the multivariate logistic regression model as statistically significant variables. A P-value of less than 0.05 was used to indicate statistical significance. In the first six weeks after giving birth, this survey found that 54.9% of women used at least one postnatal care service. The vast majority of women who had four or more antenatal visits in the first six weeks accessed postpartum care services (68.48 %) Women who had four or more prenatal visits were 1.834 times more likely to receive postpartum care in the first six weeks than those who had fewer visits (AOR=1.834, 95% CI=1.413-2.380). Compared to women who give birth at home, those who give birth in medical facilities are more likely to receive postpartum care (AOR=1.473, 95% CI=1.163-1.867). Compared to other age groups, women between the ages of 20 and 24 were more likely to receive postpartum care (AOR=3.570, 95% CI=2.419-5.268). Women who attended Elementary school (AOR=2.356, 95% CI=1.717-3.233) and Secondary and above School (AOR=1.690, 95% CI=1.174-2.431) were more likely to receive Postnatal Care services than uneducated women. Women who had a job were more likely to receive Postnatal care than hadn’t job women (OR=5.857, 95% CI=14.013-8.549). Married women were more likely to receive Postnatal care services than Never married women (AOR=1.572, 95% CI=1.149-2.149). Women who gave birth to twins were more likely to receive Postnatal Care than women who gave birth to a child (AOR=0.360, 95% CI=0.250-0.519). This study showed that postnatal care services were underutilized in the Sheka Zone, Southwest Ethiopian People Regions. The utilization of postnatal care services will therefore rise if routine antenatal care is encouraged to be followed by institutional delivery along with integrated health education about postnatal care both during pregnancy and delivery. The research area's government and stakeholders should arrange skill development for using postnatal care.

Atenção puerperal em uma região de fronteira: fragilidades agravadas pela pandemia de COVID-19

Abstract Objective To understand the health care of puerperal women in a border region during the COVID-19 pandemic. Method Grounded Theory qualitative research, straussian strand, conducted in a border region, in primary health care, with 30 participants, who formed three sample groups among women, health professionals, and managers through semi-structured interviews conducted by voice call and in-person between August 2021 and May 2022. Results Five categories were identified, according to the paradigmatic model, namely: Identifying postpartum care services; returning to primary health care in the postpartum; identifying factors that interfered in the care of postpartum women; pointing out strategies for health promotion in the postpartum period; and having fragile postpartum care. Conclusion and implications for practice Existing weaknesses were exacerbated during the pandemic by COVID-19. It is recommended to qualify the counter-referral to ensure continuity of postpartum care on time; teleservice to enable follow-up when epidemiological conditions pose a risk to maternal health; public policies can strengthen assistance to foreign women and migrants in the border region.

Society for Maternal-Fetal Medicine Special Statement: Telemedicine in obstetrics—quality and safety considerations

The frequency of telemedicine encounters has increased dramatically in recent years. This review summarizes the literature regarding the safety and quality of telemedicine for pregnancy-related services, including prenatal care, postpartum care, diabetes management, medication abortion, lactation support, hypertension management, genetic counseling, ultrasound examination, contraception, and mental health services. For many of these, telemedicine has several potential or proven benefits, including expanded patient access, improved patient satisfaction, decreased disparities in care delivery, and health outcomes at least comparable to traditional in-person encounters. Considering these benefits, it is suggested that payors should reimburse providers at least as much for telemedicine as for in-person services. Areas for future research are considered.

Depression, anxiety, and stress symptoms among Jordanian midwives: A hospital-based study

ObjectiveTo investigate the prevalence of depression, anxiety, and stress symptoms in Jordanian midwives and identify associated factors. DesignSetting and participants: This descriptive, cross-sectional study was conducted with a sample of 321 registered midwives from 18 public hospitals in Jordan that provide antepartum, intrapartum, postpartum care, and family planning services. The survey included the Depression, Anxiety, and Stress Scale (DASS-21) and demographic and professional data forms. FindingsHigh rates of depression (76.2%); anxiety (85.3%) and stress (66.8%) symptoms were reported among midwives in Jordan. Midwives aged between 22 - 30 years reported more depression, anxiety, and stress symptoms than midwives in the other age groups. Married midwives had higher depression symptoms than single midwives. Midwives with < 10 years in practice had higher depression, anxiety, and stress symptoms compared to midwives with ≥ 10 years in practice. Midwives providing care for > 10 women per shift had higher anxiety and stress symptoms than midwives caring for five or less women per shift. Midwives who rotated between shifts had higher depression and stress symptoms than midwives who did not rotate. ConclusionsRates of depression, anxiety, and stress symptoms reported by Jordanian midwives were higher than rates reported by midwives in other countries. The high rates of distress highlight the urgent need for national strategies to support the emotional wellbeing and retention of midwives within Jordanian settings.

Operationalizing Whole-Person Postpartum Care: Health Care Provider-Level Strategies

Postpartum mothers report feeling unsupported and unprepared by their health care providers to meet the challenges of the postpartum period. This gap perpetuates a cycle of disappointment with and disengagement from postpartum care services. The need to revamp postpartum care has been recognized at the population level but implementing changes at the health care provider level is challenging without practical guidance. The needs of new mothers are broad in scope and variable between individuals, requiring a whole-person care approach that is comprehensive yet nimble. Presented here are provider-level strategies to promote care that both elicits and is responsive to the unique care goals of this population.