Dyadic Care Mobile Units: A Collaborative Midwifery and Pediatric Response to the COVID‐19 Pandemic

Abstract

Often dubbed the fourth trimester, the first 6 weeks of the postpartum period is a critical time that sets the stage for future health outcomes for both women and children. Leading maternal and child health advocates agree that intervention in the first 6 weeks of life is crucial. Although most new parents prioritize their newborn's well‐care, many postpartum patients do not attend appointments for themselves, missing critical opportunities for identification and treatment of leading causes of maternal morbidity and mortality. Racial disparities in rates of postpartum complications highlight the increased importance of close postpartum follow‐up for women of color. Barriers to attending routine postpartum visits were exacerbated by the coronavirus disease 2019 (COVID‐19) pandemic. Additionally, in traditional models of care, maternal‐infant dyads experience fragmented care across multiple departments and patient care settings and only 1 to 2 routine visits for the postpartum patient. To address the challenges of providing in‐person postpartum care during the COVID‐19 pandemic in Boston, the Midwifery Service, and the Pediatrics Department of Boston Medical Center partnered to launch a mobile postpartum clinic that provided comprehensive, high‐touch, dyadic care to postpartum patients and newborns in the first 6 weeks of life. Integrative mobile visits catered to the interplay of maternal and newborn health in the early postpartum period, providing an average of 3 visits to each dyad. This novel clinic concept addresses structural inequities by decreasing barriers to care and reimagines an ideal state of postpartum dyadic care with frequent visits addressing the complete needs of each postpartum patient and newborn. For more than 2 decades, maternal health advocates have been calling for change from health care birth systems to improve health care outcomes. This collaborative, interdepartmental initiative—conceived in the context of a pandemic—is an answer to that call.

Addressing Postnatal Challenges: Effective Strategies for Postnatal Care

“…Other ways of managing postpartum psychologic challenges include hospital/facility-based care [24], and community and out-stationed care where networks and support groups are formed to help such clients [25]. The recent pandemic equally saw the introduction of mobile dyadic clinics to cater to the needs of such clients who would otherwise not assess care due to difficult social situations [26].…”

Innovations in Midwifery Practice and Care

“…When clinicians identified a need to provide more accessible care to postpartum patients and their newborns during the COVID‐19 pandemic, an ambulance was converted to an examination room, offering a dyadic mobile postpartum clinic with services from a nurse practitioner and a midwife. Family members could participate in services such as postpartum follow‐up and lactation support, and immunizations were provided literally at their doorstep 9 . The Early Care model was developed to provide early access to prenatal services with the goal of improving outcomes and reducing health disparities.…”

“…Family members could participate in services such as postpartum followup and lactation support, and immunizations were provided literally at their doorstep. 9 The Early Care model was developed to provide early access to prenatal services with the goal of improving outcomes and reducing health disparities. Because pregnant persons often do not see a prenatal care provider until later the first trimester, telehealth was used to provide referrals for urgent social and clinical issues as well as information about care provider options for prenatal care.…”