Top

Published in:

30-10-2023 | Care

Barriers to Postpartum Care: A Mixed Methods Study of Midwestern Postpartum Women

Authors: Katherine I. Tierney, Nicole Pearce, Emily Miller, Agnieszka Steiner, Kathryn Tighe, Joi Presberry, Catherine Kothari

Published in: Maternal and Child Health Journal | Issue 1/2024

Abstract

Purpose

Postpartum care is an opportunity to provide essential follow-up care to people who have given birth, but inequalities in access by race and socioeconomic status (SES) are well-documented. The purpose of this study is to provide an in-depth description of the barriers to postpartum care using a mixed-methods design.

Methods

Mixed method analyses using convergent design with three stages including (1) bivariate logistic regression of survey data representative of postpartum women in Kalamazoo County, Michigan, (2) thematic qualitative analyses of focus group interviews of survey participants, and (3) bivariate logistic regression and logistic regression meditation analyses using themes operationalized with survey data measures.

Results

In Kalamazoo county, 82.0% of women attended their postpartum visit. White women and women with higher SES were 2.84 (SE = 1.35, p < .001) and 5.73 (SE = 3.10, p < .001) times more likely to attend postpartum visits than women of color and those with lower SES. Qualitative analyses identified four common barriers: (1) misaligned goals for appointments, (2) time and scheduling of appointments, (3) prioritization of children, and (4) material resources and health insurance coverage. The quantitative analyses found mixed support for these barriers and found limited evidence that these barriers mediated the relationship between race or SES and postpartum attendance.

Conclusions for Practice

The qualitative findings identify barriers that are amenable to practice-level interventions including changes to scheduling procedures and employing patient-centered care. The quantitative findings further suggest that although inequalities in postpartum care are present, interventions on these barriers may benefit women regardless of race and SES.

Available only for authorised users

Agler, R., & De Boeck, P. (2017). On the Interpretation and Use of Mediation: Multiple Perspectives on Mediation Analysis. Frontiers in Psychology, 8. https://www.frontiersin.org/articles/https://doi.org/10.3389/fpsyg.2017.01984

Bellerose, M., Rodriguez, M., & Vivier, P. M. (2022). A systematic review of the qualitative literature on barriers to high-quality prenatal and postpartum care among low-income women. Health Services Research, 57(4), 775–785. https://doi.org/10.1111/1475-6773.14008CrossRefPubMedPubMedCentral

Breen, R., Karlson, K. B., & Holm, A. (2013). Total, direct, and Indirect effects in Logit and Probit models. Sociological Methods & Research, 42(2), 164–191. https://doi.org/10.1177/0049124113494572MathSciNetCrossRef

Buis, M. L. (2010). Direct and indirect effects in a logit model. The Stata Journal, 10(1), 11–29.CrossRefPubMedPubMedCentral

Cohen, S., Kamarck, T., & Mermelstein, R. (1983). A global measure of perceived stress. Journal of Health and Social Behavior, 24(4), 385–396.CrossRefPubMed

Congdon, J. L., Trope, L. A., Bruce, J. S., Chung, P. J., Dehlendorf, C., & Chamberlain, L. J. (2020). Meeting the needs of Postpartum Women with and without a recent Preterm Birth: Perceptions of maternal Family Planning in Pediatrics. Maternal and Child Health Journal, 24(3), 378–388. https://doi.org/10.1007/s10995-019-02829-xCrossRefPubMed

Cornell, A., McCoy, C., Stampfel, C., Bonzon, E., & Verbiest, S. (2016). Creating New Strategies To Enhance Postpartum Health and Wellness. Maternal and Child Health Journal, 20(1), 39–42. https://doi.org/10.1007/s10995-016-2182-yCrossRefPubMedPubMedCentral

Creswell, J. W., & Plano Clark, V. L. (2011). Designing and conducting mixed methods research. SAGE.

Danilack, V. A., Brousseau, E. C., Paulo, B. A., Matteson, K. A., & Clark, M. A. (2019). Characteristics of women without a postpartum checkup among PRAMS participants, 2009–2011. Maternal and Child Health Journal, 23(7), 903–909. https://doi.org/10.1007/s10995-018-02716-xCrossRefPubMedPubMedCentral

DiBari, J. N., Yu, S. M., Chao, S. M., & Lu, M. C. (2014). Use of postpartum care: Predictors and barriers. Journal of Pregnancy, 2014, e530769. https://doi.org/10.1155/2014/530769

Ellberg, L., Högberg, U., & Lindh, V. (2010). We feel like one, they see us as two: New parents’ discontent with postnatal care. Midwifery, 26(4), 463–468. https://doi.org/10.1016/j.midw.2008.10.006CrossRefPubMed

Erikson, R., Goldthorpe, J. H., Jackson, M., Yaish, M., & Cox, D. R. (2005). On class differentials in educational attainment. Proceedings of the National Academy of Sciences, 102(27), 9730–9733. https://doi.org/10.1073/pnas.0502433102

Fahey, J. O., & Shenassa, E. (2013). Understanding and meeting the needs of women in the Postpartum period: The perinatal maternal Health Promotion Model. Journal of Midwifery & Women’s Health, 58(6), 613–621. https://doi.org/10.1111/jmwh.12139CrossRef

Fogel, N. (2017). The inadequacies in postnatal health care. Current Medicine Research and Practice, 7(1), 16–17. https://doi.org/10.1016/j.cmrp.2016.12.006

Fowles, E. R., Cheng, H. R., & Mills, S. (2012). Postpartum health promotion interventions: A systematic review. Nursing Research, 61(4), 269–282. https://doi.org/10.1097/NNR.0b013e3182556d29CrossRefPubMed

Henderson, V., Stumbras, K., Caskey, R., Haider, S., Rankin, K., & Handler, A. (2016). Understanding factors Associated with Postpartum visit attendance and contraception choices: Listening to low-income Postpartum Women and Health Care Providers. Maternal and Child Health Journal, 20(1), 132–143. https://doi.org/10.1007/s10995-016-2044-7CrossRefPubMedPubMedCentral

Kabakian-Khasholian, T., & Campbell, O. M. R. (2005). A simple way to increase service use: Triggers of women’s uptake of postpartum services. BJOG: An International Journal of Obstetrics & Gynaecology, 112(9), 1315–1321. https://doi.org/10.1111/j.1471-0528.2004.00507.x

Karlson, K. B., Holm, A., & Breen, R. (2012). Comparing regression coefficients between same-sample nested models using Logit and Probit: A New Method. Sociological Methodology, 42(1), 286–313. https://doi.org/10.1177/0081175012444861CrossRef

Kim, S. C., Kim, S., & Boren, D. (2008). The quality of Therapeutic Alliance between patient and provider predicts general satisfaction. Military Medicine, 173(1), 85–90. https://doi.org/10.7205/MILMED.173.1.85CrossRefPubMed

Kleppel, L., Suplee, P. D., Stuebe, A. M., & Bingham, D. (2016). National initiatives to improve systems for Postpartum Care. Maternal and Child Health Journal, 20(1), 66–70. https://doi.org/10.1007/s10995-016-2171-1CrossRefPubMed

Murray Horwitz, M. E., Molina, R. L., & Snowden, J. M. (2019). Postpartum Care in the United States: New policies for a New Paradigm. Obstetric Anesthesia Digest, 39(1), 13–14. https://doi.org/10.1097/01.aoa.0000552885.29987.4eCrossRef

Preacher, K. J., & Kelley, K. (2011). Effect size measures for mediation models: Quantitative strategies for communicating indirect effects. Psychological Methods, 16(2), 93–115. https://doi.org/10.1037/a0022658CrossRefPubMed

Rankin, K. M., Haider, S., Caskey, R., Chakraborty, A., Roesch, P., & Handler, A. (2016). Healthcare utilization in the Postpartum Period among Illinois Women with Medicaid Paid Claims for Delivery, 2009–2010. Maternal and Child Health Journal, 20(1), 144–153. https://doi.org/10.1007/s10995-016-2043-8CrossRefPubMedPubMedCentral

Stumbras, K., Rankin, K., Caskey, R., Haider, S., & Handler, A. (2016). Guidelines and interventions related to the Postpartum visit for low-risk Postpartum Women in High and Upper Middle Income Countries. Maternal and Child Health Journal, 20(1), 103–116. https://doi.org/10.1007/s10995-016-2053-6CrossRefPubMed

Verbiest, S., Bonzon, E., & Handler, A. (2016). Postpartum Health and Wellness: A Call for Quality Woman-Centered Care. Maternal and Child Health Journal, 20(1), 1–7. https://doi.org/10.1007/s10995-016-2188-5

Wilcox, A., Levi, E. E., & Garrett, J. M. (2016). Predictors of non-attendance to the Postpartum Follow-Up visit. Maternal and Child Health Journal, 20(S1), 22–27. https://doi.org/10.1007/s10995-016-2184-9CrossRefPubMed

Winship, C., & Mare, R. D. (1983). Structural Equations and Path Analysis for Discrete Data. American Journal of Sociology, 89(1), 54–110.CrossRef

Yee, L. M., & Simon, M. A. (2011). Perceptions of Coercion, discrimination and other negative experiences in Postpartum Contraceptive Counseling for low-income minority women. Journal of Health Care for the Poor and Underserved, 22(4), 1387–1400. https://doi.org/10.1353/hpu.2011.0144CrossRefPubMed

Title: Barriers to Postpartum Care: A Mixed Methods Study of Midwestern Postpartum Women
Authors: Katherine I. Tierney
Nicole Pearce
Emily Miller
Agnieszka Steiner
Kathryn Tighe
Joi Presberry
Catherine Kothari
Publication date: 30-10-2023
Publisher: Springer US
Keyword: Care
Published in: Maternal and Child Health Journal / Issue 1/2024
Print ISSN: 1092-7875
Electronic ISSN: 1573-6628
DOI: https://doi.org/10.1007/s10995-023-03800-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Barriers to Postpartum Care: A Mixed Methods Study of Midwestern Postpartum Women

Abstract

Purpose

Methods

Results

Conclusions for Practice

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions for Practice

Please log in to get access to this content

Other articles of this Issue 1/2024

Preventing Job Burnout: Could Workplace Support Protect Maternal and Child Health Professionals Who Are Doing Public Health Equity Work?

Maternal and Infant Pathways HUB in NE Ohio: Influence on Birth Outcomes

The Protective Role of Maternal-Fetal Bonding for Postpartum Bonding Following a NICU Admission

A Visit to the Pediatrician as a Part of Comprehensive Prenatal Care?

Promoting Coordination and Collaboration in Tribal Home Visiting Programs in the United States

Barriers and Strategies Used to Continue School-Based Health Services During the COVID-19 Pandemic