Postpartum care: Discussions and counseling for the peripartum period

Article type: Research Article

Authors: Prince, A.^{a; *} | Wade, J.^a | Power, M.L.^{b; c} | Gunawansa, N.^a | Cruz-Bendezú, A.^d | Schulkin, J.^c | Macri, C.J.^e

Affiliations: [a] The George Washington School of Medicine and Health Sciences, Washington, DC, USA | [b] Center for Species Survival, Smithsonian’s National Zoo and Conservation Biology Institute, Washington, DC, USA | [c] Pregnancy-Related Care Research Network (PRCRN), Seattle, WA, USA | [d] Department of Urology, George Washington University, Washington, DC, USA | [e] Department of Obstetrics and Gynecology, GWU MFA, Washington, DC, USA

Correspondence: [*] Address for correspondences: Arianna Prince, BS, George Washington School of Medical and Health Sciences, 2300 I Street NW, Washington, DC 20037, USA. Tel.: +1 917 456 7156; E-mail: aprince14@gwu.edu.

Abstract: BACKGROUND:Traditionally, postpartum care is confined to inpatient care immediately post birth and one appointment approximately six weeks postpartum. Data supports a continuum of care model as best for the health of mother and baby. Despite most women having significant concerns about the postpartum period, these concerns are frequently incompletely addressed by providers. We surveyed prenatal and postpartum patients to understand their concerns and experiences discussing postpartum care with providers. METHODS:Cross sectional surveys were administered between June 2019 and May 2021. Principal component analysis was used to show higher than average (positive) or lower than average (negative) conversations with providers about postpartum care examined by race, education, and parity. Chi squared tests were conducted to examine the significance of specific postpartum concerns. RESULTS:421/450 patient surveys were analyzed, based on completion. Most patients were White (193), had post graduate degrees (188), privately insured (236), married (248), first time pregnant (152), and used doctors as their primary provider (267). Patients with lower education, higher parity and Black patients without postgraduate degrees reported higher than average postpartum counseling. Additionally, most patients expressed significant concerns about postpartum exhaustion (65.8%), breastfeeding (62.3%), pain (61.2%), physical activity (54.9%) and the baby blues (50.4%). CONCLUSIONS:Postpartum concerns are incompletely and inconsistently addressed amongst patients based on race, parity, and education. A continuum of care approach, beginning in the third trimester, through the postpartum period, may provide better counseling to address all patients’ concerns.

Keywords: Fourth trimester, peripartum counseling, post-partum

DOI: 10.3233/NPM-230167

Journal: Journal of Neonatal-Perinatal Medicine, vol. 16, no. 4, pp. 657-664, 2023