Postpartum care fails to provide women with key recommended services

Most women are receiving fewer than half the services recommended during their comprehensive postpartum medical checkup, according to a study by University of Massachusetts Amherst researchers.

“These findings underscore the importance of efforts to reconceptualize postpartum care to ensure women have access to a range of supports to manage their health during this sensitive period,” concludes the study, published Nov. 10 in JAMA Network Open. “There is substantial room to improve the delivery of postpartum care.”

Authors Kimberley Geissler and Laura Attanasio, both assistant professors of health policy and management in the School of Public Health and Health Sciences, were joined in the study by graduate student Brittany Ranchoff and undergraduate Michael Cooper. The study received funding from the National Heart, Lung and Blood Institute and the Agency for Healthcare Research and Quality.

“This research is very important because we were able to look at care that was actually provided and really understand what happened during health care visits, not just that the visits are happening. This information is critical for improving the quality of care,” says Geissler.

The medical visits averaged about 17 minutes, the researchers found, which may help explain the incomplete postpartum care. “Is that enough time to provide these services? I don’t know,” Geissler says. “The pressure to see more patients in an increasingly short time is a known issue in the U.S. health care system, so it’s not surprising we see that here, too.”

In one of the most startling findings, despite an increased awareness of perinatal depression, only one in 11 patients received a screening for depression, part of the assessment of physical, social and psychological well-being recommended by the American College of Obstetricians and Gynecologists (ACOG).

“We need to look at why depression screening is not happening,” Attanasio says. “This is an important factor in women’s health for the rest of their lives. Even if you’re missing some of the recommended services, this one should be universal among this population.”

Previous studies have shown that women with Medicaid insurance receive fewer preventive services than women with private insurance, leading the UMass Amherst team to examine insurance type in their review. “We hypothesized recommended services would be less frequently provided during postpartum visits for women with Medicaid insurance compared to women with other coverage types,” the researchers write.

However, Attanasio says, “we found that there were not significant differences in the services received between women with Medicaid coverage and private insurance. That could reflect the fact that a lot of these services were not provided to most of the women.”

The researchers analyzed data from the National Ambulatory Medical Care Survey, which represented more than 20 million postpartum office visits to an ob-gyn or family medicine doctor from 2009 to 2016.

Recommended services include blood pressure screening; depression screening; pelvic exam; pap test; breast exam; blood glucose exam; contraceptive counseling or provision; counseling for weight reduction, exercise, stress management, diet/nutrition, and/or tobacco use; medication review; and referral to another physician, if needed.

The study calculated the percentage of visits during which the recommended postpartum care services were provided, including the following:

Blood pressure, 91.1%
Depression screening, 8.7%
Pelvic exam, 47.3%
Pap test, 15.9%
Breast exam, 21.9%
Contraceptive counseling or provision, 43.8%