Summary of Selected Issue New Evidence Based Practice Strategies and Theoretical Basis for Strategies Many patients look forward to the end of the Labor Delivery process immediate postpartum care and discharge from the hospital They treat the discharge as the end of the process and if the transitions to care process is not properly handled many women will not return for postpartum follow up care In 2016 the American College of Obstetricians and Gynecologists ACOG presented their bulletin 666 which reported that up to 40 of these women do not return for care in the 6 8wks postpartum ACOG 2016 Issues contributing to this deficiency range from maternal lack of knowledge and competing maternal priorities to systems issues where cultural and individual patient preferences are not accommodated A number of strategies have been proposed to improve the postpartum patient return to care based on the evidence generated through research on some of the affected groups Using grounded theory Martin Horowitz Balbierz et al 2014 found that postpartum women did not return for care because they lacked knowledge were unprepared for the post partum experience didn t get early postpartum care or their goals were not aligned with those of their preceptors Whether the problem is cultural socioeconomic or access related ACOG is of the opinion that if preparation for postpartum care begins in the antepartum period with the patient and provider designing a plan of care and receiving written instructions and preparation for continuing postpartum care and ongoing communication between patient and provider ACOG 2016 I share ACOG s opinion because helping the mother understand the importance of continuing care indicates to her that this should be among her priorities in the post partum period
The data on low postpartum return visit rates can be generalized to larger populations using inductive analysis from grounded theory to look at patterns and themes emerging from the data Organizing new strategies and involving patients in their care decisions like pre planning for the post partum visit like choosing to remain with the same perinatal provider and being allowed to have an appointment at the time most suitable to herself and her family assisting with transportation and by taking her cultural preferences into consideration should help increase return for post partum care Another strategy could be to ensure that mother baby appointments are bundled through agreement of the obstetric and pediatric teams Potential Economic Impact of Your Suggested Strategies Planning for the postpartum visit during the prenatal period may be the most cost effective way to increase postpartum return visits and to decrease postpartum morbidity and mortality While 1 10 women suffer from postpartum depression Ko K Y Farr S L Dietz P M Robbins C L 2012 approximately 80 of women start to breastfeed at birth but stop early CDC 2016 denying infants the many health benefits derived from breastfeeding and increasing cost to families who feed commercial products Other potential financial and social costs are related to illness from newborn s ineffective immune system Sudden Infant Death Syndrome and other illnesses to which infant becomes susceptible For the mother there may be depression related illness that go untreated and other puerperal complications which could affect normal physical sexual and social functioning When these costs are weighed against costs of returning the patient for postpartum care and even with increasing providers to provide the care the care cost is well worth it to the individual family and community
A study to compare cost for returning postpartum patients found that despite modifying some of the unit s activity and increasing providers to administer care the cost of care for these women remained unchanged for seven months when provided with a coordinated model of care with increased midwives to meet home care needs Zemp E Signorell A Kurth E Reich O 2017 As the anchor to her family the mother who is not adequately cared for during the crucial postpartum period could present an economic burden not only to her family but to the healthcare system and the community as a whole How Could the New Practice Strategies Improve Health Care Quality The new strategies proposed are a change from what is currently occurring Presently mothers are either put into an open clinic slot for postpartum care or they are asked to call to make an appointment Even when they are asked about their preference of returning to a particular location their preferences in terms of times for appointments is not considered Furthermore because the maternal and pediatric ambulatory clinics are separate the offer is never made for mother to receive her return visit appointment on the same day as the baby which means that she may have to come to the clinic more than once within a short period Some of the mothers have meager financial needs language barriers or are struggling migrant families it would benefit them and ultimately the larger community and the institution if they could keep their appointments In conclusion the individualization and mutuality of each patient should be the focus of providers as they attend to care transitions and that process should start with anticipatory guidance in the antenatal period and continue into the postpartum discharge plan Care providers should assist where possible with helping the patient achieve her care goals
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