Comparing Postpartum Visit Attendance with a Scheduled 2- to 3-Week or 6-Week Visit after Delivery

Abstract

Objective To evaluate whether scheduling a 2- to 3-week versus 6-week postpartum visit results in higher visit attendance.

Study Design We conducted a secondary analysis of a quasi-experimental before–after study to compare postpartum visit attendance after changing routine scheduling of visits from 6 weeks to 2 to 3 weeks after delivery. Secondary outcomes include patient satisfaction and breastfeeding continuation at 3 and 6 months postpartum. We collected postpartum visit information through a chart review and conducted telephonic interviews at 3 and 6 months postpartum to assess satisfaction with visit timing and breastfeeding status. We performed multivariable analyses to assess predictors of visit attendance.

Results Women scheduled at 2 to 3 weeks postpartum demonstrated higher visit attendance (90.2%; 95% confidence interval [CI]: 86.6–93.9%) compared with 6 weeks (81.6%; 95% CI: 76.3–86.2%; p < 0.01). Predictors for visit attendance include postpartum visit timing, age, education, parity, prior miscarriage, and high-risk index pregnancy in multivariate analysis. Scheduling at 2 to 3 weeks postpartum increased visit completion in women who were younger and had lower educational attainment, high-risk index pregnancy, and no prior miscarriages. We found no differences in patient satisfaction or breastfeeding continuation at 3 and 6 months postpartum related to postpartum visit timing.

Conclusion Scheduling a 2- to 3-week postpartum visit is associated with higher attendance.

Keywords

postpartum visit - breastfeeding - patient satisfaction - maternal health

Note

The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

• References

• 1 ACOG Committee Opinion No. 736: optimizing postpartum care. Obstet Gynecol 2018; 131 (05) e140-e150
• 2 Stumbras K, Rankin K, Caskey R, Haider S, Handler A. Guidelines and interventions related to the postpartum visit for low-risk postpartum women in high and upper middle income countries. Matern Child Health J 2016; 20 (Suppl. 01) 103-116
• 3 Levine LD, Nkonde-Price C, Limaye M, Srinivas SK. Factors associated with postpartum follow-up and persistent hypertension among women with severe preeclampsia. J Perinatol 2016; 36 (12) 1079-1082
• 4 DiBari JN, Yu SM, Chao SM, Lu MC. Use of postpartum care: predictors and barriers. J Pregnancy 2014; 2014: 530769
• 5 Wilcox A, Levi EE, Garrett JM. Predictors of non-attendance to the postpartum follow-up visit. Matern Child Health J 2016; 20 (Suppl. 01) 22-27
• 6 Simmons KB, Edelman AB, Li H, Yanit KE, Jensen JT. Personalized contraceptive assistance and uptake of long-acting, reversible contraceptives by postpartum women: a randomized, controlled trial. Contraception 2013; 88 (01) 45-51
• 7 Tully KP, Stuebe AM, Verbiest SB. The fourth trimester: a critical transition period with unmet maternal health needs. Am J Obstet Gynecol 2017; 217 (01) 37-41
• 8 Henderson V, Stumbras K, Caskey R, Haider S, Rankin K, Handler A. Understanding factors associated with postpartum visit attendance and contraception choices: listening to low-income postpartum women and health care providers. Matern Child Health J 2016; 20 (Suppl. 01) 132-143
• 9 Batra P, Fridman M, Leng M, Gregory KD. Emergency department care in the postpartum period: California births, 2009–2011. Obstet Gynecol 2017; 130 (05) 1073-1081
• 10 Speroff L, Mishell Jr DR. The postpartum visit: it's time for a change in order to optimally initiate contraception. Contraception 2008; 78 (02) 90-98
• 11 Sharif K, Jordan J. The 6-week postnatal visit: are we doing it right?. Br J Hosp Med 1995; 54 (01) 7-10
• 12 Chen MJ, Hou MY, Hsia JK, Cansino CD, Melo J, Creinin MD. Long-acting reversible contraception initiation with a 2- to 3-week compared with a 6-week postpartum visit. Obstet Gynecol 2017; 130 (04) 788-794
• 13 Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009; 42 (02) 377-381
• 14 Tsai PJ, Nakashima L, Yamamoto J, Ngo L, Kaneshiro B. Postpartum follow-up rates before and after the postpartum follow-up initiative at Queen Emma Clinic. Hawaii Med J 2011; 70 (03) 56-59
• 15 Baldwin MK, Hart KD, Rodriguez MI. Predictors for follow-up among postpartum patients enrolled in a clinical trial. Contraception 2018; 98 (03) 228-231
• 16 Bernard C, Wan L, Peipert JF, Madden T. Comparison of an additional early visit to routine postpartum care on initiation of long-acting reversible contraception: a randomized trial. Contraception 2018; 98 (03) 223-227
• 17 Baldwin MK, Edelman AB, Lim JY, Nichols MD, Bednarek PH, Jensen JT. Intrauterine device placement at 3 versus 6 weeks postpartum: a randomized trial. Contraception 2016; 93 (04) 356-363
• 18 Zerden ML, Stuart GS, Charm S, Bryant A, Garrett J, Morse J. Two-week postpartum intrauterine contraception insertion: a study of feasibility, patient acceptability and short-term outcomes. Contraception 2017; 95 (01) 65-70
• 19 Centers for Disease Control and Prevention. Breastfeeding Report Card, 2014. Available at: https://www.cdc.gov/breastfeeding/pdf/2014breastfeedingreportcard.pdf . Accessed October 31, 2017