Expectant mothers may have their plate full for nine months, during which time both the developing child’s body and the mother’s are at risk for numerous complications, but after childbirth a new set of risks develops. Unfortunately, less than half of women attend postpartum care appointments designed to minimize these risks, according to a new study from Johns Hopkins University.         

New mothers face a range of risks after childbirth, all depending on the conditions they carried through gestation. Women with diabetes or high blood pressure during pregnancy were more likely to visit their primary care physician following delivery — heartening for researchers — though the overall attendance rate still fell short of the team’s goal rates.

"Women need to understand the importance of a six-week visit to the obstetrician — not only to address concerns and healing after delivery, but also to follow up on possible future health risks, review the pregnancy, and make the transition to primary care," explained assistant professor of medicine and lead researcher, Dr. Wendy Bennett, in a statement, and whose team’s study was published in the journal Medical Care.

Bennett and her team focused primarily on low-income mothers’ adherence to doctors’ postpartum recommendations. These women were either receiving their health insurance from one commercial plan or multiple Medicaid insurance plans in Maryland. Ultimately, the team sought to better understand the predicting factors for women staying on top of their postpartum check-ups in both groups.

The risks afforded by women with pre-existing conditions during their pregnancy are great, according to Bennett. Pregnancy complications can lead to chronic diseases, such as diabetes, hypertension, and heart disease. Sticking to a six-week-long follow-up program with a physician can help both women with and without gestational conditions minimize their health risks over the long-term.

Overall, the team found among women with tax-supported Medicaid insurance, 56.6 percent with a pregnancy complication followed through with physician visits within a year — compared to 51.7 percent without a complication. Meanwhile, the women on a commercial health insurance plan with a complication attended 60 percent of the time, while 49.6 without complication did so. White patients, older patients, and patients with depression or preeclampsia (high blood pressure and high protein content in a pregnant woman’s urine) were also more likely to visit their primary care doctor.

Meanwhile, three-month check-ins at the women’s obstetricians showed varying rates. Women on Medicaid with complications attended 65 percent of the time. Women without complications showed up 61.5 of the time — both rates trumping the yearly physician visit among the same cohort. The commercial health beneficiaries, however, showed up less often. Only 50.8 percent of the women with complications followed through, while a meager 44.6 percent of women without did so.

Postpartum care is a time period when both mother and child need concerted health checks, yet that fact doesn’t necessarily motivate mothers to see their doctors. Hospitals need to find more creative ways to get mothers in their doors, Bennett argues. They need to design more creative strategies that make a doctors’ visit more justified, as personal health has proven less than successful so far. One tactic is tandem mother-baby visits, where a child’s check-up could serve as a means to check the mother’s health as well.

Ultimately, Bennet says, it’s more than just the mother’s responsibility to educate themselves on the risks they should expect ahead. "Pregnancy is a teachable moment,” she noted. “Many women are very motivated to make healthier lifestyle choices to keep themselves and their babies healthy. After a birth, we need to keep them motivated.”

 

Source: Jarlenski M, Bennet W, Barry C, Bleich S. Insurance coverage and prenatal care among low-income pregnant women: an assessment of states' adoption of the "Unborn Child" option in medicaid and CHIP. Medical Care. 2014.