Comparing Mothers' Postpartum Concerns Over Time

Title: Comparing Mothers’ Postpartum Concerns Over Time

Background:   Low-income mothers of full-term infants experience early postpartum hospital discharge, little to no routine follow-up  after hospital discharge, low social support, unmet learning needs, increased stress and difficulty accessing the healthcare system (Britton, 2006; Loprest et al., 2007). However, changes to the healthcare system over the past 2 decades have effected the outcomes of postpartum mothers and their infants.  Recent legislative acts and changes in health care reimbursement are forcing hospitals to eliminate many health care services in the community, especially those in maternal child health (Abraham, 2011). These changes are posing significant challenges for mothers and their infants in receiving healthcare.

Aims: The purpose of this secondary analysis was to compare mothers’ postpartum concerns over time (delivery to 8 weeks postpartum) in 2 different randomized clinical trials 20 years apart that examined Nurse Practitioner (NP) follow up care on maternal and infant outcomes and health care costs post delivery.

Methods:  Data set 1, a randomized clinical trial carried out in 1992, was compared with data set 2, a randomized clinical trials is currently ongoing. In both trials, NPs providing follow up care to low income minority mothers recorded, as close to verbatim as possible, discussions with mothers during telephone contacts and in the first trial in home and clinic visits in interaction logs. The logs documented care provided by NPs during each contact. Recorded data consisted of reason for contact, issues identified during contact, response of APN, woman’s response and outcome of contact. The mother’s concerns from both datasets were coded as  1. Mother concern 2. Infant concern or 3. Situational concern. The data was entered into SPSS.

Results: There were more maternal concerns in High Risk Pregnancy study vs. First Time Mother study (142 vs. 46).  No help/support was a main concern in the First Time Mother study (43.5%). Body image changes was a main concern for the High Risk Pregnancy study (18.3%). Feeding was the main concern in both studies (21.7% vs. 23.9%) for infant concerns. Situational concerns included  had financial concerns (23.8% vs.17.1%) in both stuidies. First Time Mother study had more than half(51.2%) had concerns about obtaining healthcare coverage while the High Risk Pregnancy study had concerns about obtaining WIC (21.4%).

Conclusion: Mothers’ post partum concerns have changed over the 2 studies. There are continuing concerns about obtaining healthcare for herself and her infant. There were fewer concerns about  the health of the mother. Healthcare providers need to be aware of the challenges new mothers have including social support, financial problems, difficulty in accessing the healthcare system. It is essential to ask about the health of new mothers since this may be overlooked by the mother herself.

Funded by:

MBRS Score National Institute of Health; Eunice Kennedy Shriver National Institute of Child Health & Human Development, 1SC2HD076043-01

National Institute of Nursing Research, NIH, RO1-NR-02867