A two‐generation approach to postpartum care: Building on the well‐baby visit

Abstract

Background Although postpartum (PP) care is essential for the health and well‐being of women and their infants, many women in the United States do not receive PP care. In order to ensure that women's PP needs are met, it is essential to develop delivery models that address their barriers to care. The objective of the current study was to obtain women's feedback and perspectives about delivering women's health care at the well‐baby visit (WBV) using a modified mixed‐methods approach including open‐ended interviews and surveys. Methods Twenty brief open‐ended interviews were conducted with PP women at a large urban medical center in Chicago. The interviews were recorded, transcribed, and coded following a mixed deductive and inductive approach and analyzed using Dedoose. Following the interview analysis, surveys with 50 immediate PP women and 50 who were 2‐4 months PP were conducted. Statistical analyses included frequencies and chi‐square tests to determine differences between participants interviewed at the two time periods. Results Key themes that emerged from the open‐ended interviews include the tension between the desire for continuity of care (prenatal to PP) and the desire for convenient care. The surveys found that 86%‐94% of women would be interested in receiving PP care at the same clinic site and time as their new baby. Conclusions One approach to addressing women's PP health and need for convenient care is the provision of components of women's health care at the WBV. Therefore, we present an innovative two‐generation model for PP care focusing on needs of both the woman and infant.

Postpartum Family Planning in Pediatrics: A Survey of Parental Contraceptive Needs and Health Services Preferences

“…In addition, our study demonstrates broader generalizability of the findings from previous smaller studies on the acceptability of addressing parental contraception during a well-baby visit 14 – 16 , 28 and adds some specific, actionable targets for future interventional research. We found some statistically significant variation in the overall acceptability of pediatric clinic-based contraceptive services across parent characteristics, including the type of insurance, postpartum depression, and status of contraceptive need.…”

Preparing for the Postpartum Medicaid Extension Evaluation in Illinois

“…Beyond this, to maximize the benefits of the PME, new approaches to care are needed, including elevation of the medical care home for women's primary/interconception care, 30 and postpartum care models such as the Two-Generation approach which in some manifestations provides comprehensive and holistic dyadic postpartum care. [31][32] Promoting enhanced postpartum care packages that include reimbursement for services to address the structural/social determinants of health is also essential. 8,25 Finally, development of a Performance Measurement System within Medicaid focused on the extended postpartum period is necessary as a way to hold providers accountable for ensuring that postpartum persons receive the care that they are entitled to during these extra months of coverage.…”

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“…Co-located and integrated postpartum and newborn care at the doorstep of the family's home addressed many barriers to postpartum care noted in the maternal and infant health literature. 5,6 Table 2 identifies these barriers, the response of the mobile unit visit to those barriers, and potential benefits to the postpartum patient, newborn, and family.…”

“…Although most newborns typically present for well-care within 7 days of discharge, many postpartum patients do not return for a visit for themselves in the first 6 weeks following birth. 4,5 This discrepancy is heightened in families of low socioeconomic status: up to 40% of publicly insured women do not receive a single postpartum visit. 4 The reasons for low postpartum visit attendance have been explored in both qualitative and quantitative studies.…”

“…Despite these expert recommendations, many maternal‐infant dyads do not receive the recommended care in the first 6 weeks postpartum. Although most newborns typically present for well‐care within 7 days of discharge, many postpartum patients do not return for a visit for themselves in the first 6 weeks following birth 4,5 . This discrepancy is heightened in families of low socioeconomic status: up to 40% of publicly insured women do not receive a single postpartum visit 4 .…”