Objectives: To describe the distribution of postpartum follow-up services within an urban population, identify gaps in services to vulnerable populations, and describe the perceived benefits of home visits and telephonic follow-up in the postpartum period. Design: Telephone survey with description and comparison across demographic groups. Population, Sample, Setting, Years: The sample consisted of 696 of 2067 eligible postpartum mothers drawn from a cohort of residents of the City of Milwaukee who gave birth between January and March, 2000 to a liveborn infant weighing at least 2000 grams without major complications or anomalies. Variables: Demographic (age, parity, marital status, race, and payor) and service data (timing, frequency, content, and satisfaction with telephone calls from providers, home visits, and follow-up visits) were collected. Methods: A structured telephone survey was conducted between 6 and 8 weeks postpartum. Names and addresses of eligible subjects were obtained from vital records data. Telephone numbers were obtained from telephone directories. Letters were sent in advance describing the study. Mailed copies of the survey were sent to women who could not be reached by telephone. Survey data were merged with vital records data. Addresses were geocoded and results plotted graphically. Findings: Of the final sample of 696 participants, 501 (82.2%) completed the telephone interview and 195 (27.8%) returned the surveys by mail. The mean age was 26.75 years (range 13 to 43) with 11.2% teens. 53.3% were primiparas, 44% were single, and 16.3% received Medicaid. Race distribution was 51.7% white, 31.9% black, 10.4% hispanic, and 3.0% asian, similar to city of Milwaukee as a whole. Home visits were conducted with 25.3% of participants. 15% received 1 visit and the 10.3 % receiving more than 1 visit. 70% of mothers were initially visited in weeks 1 or 2. These visits were conducted primarily (81.2%) by nurses associated with the delivery hospital. There were significant differences between women who did and did not receive a home visit. Young, primiparous, single, black or hispanic, Medicaid women were more likely to receive a home visit. 96.6% indicated the visit was helpful. A total of 66.8% of subjects received postpartum follow-up telephone calls and 22.4% received more than 1 call. 75.1% of calls occurred within the first 2 weeks. Only 15.1 % of first calls occurred after week 2. 82.1% of calls were conducted by the delivery hospital or organization. Older, married, and white mothers were more likely to receive a telephone follow-up call. During 22.7% of calls, there was a recommendation for the mother to call her own or her newborn’s provider and 5% of mothers were immediately referred to a provider for a specific problem. 75.8% described the call as helpful. More babies attended follow up visits to provider in the 6 week postpartum period than mothers. 98.0% reported that the baby had seen a provider since birth compared to 79.3% of mothers. However, 18.9% of babies had only seen their provider one time since birth when 2 visits were expected. 28.6% of neonatal visits and 15.6% of maternal visits were problem-related. 14.9% of babies and 9.4% of mother were reported to be currently experiencing a health problem. 7% of neonatal visits and 6.5% of maternal visits were to urgent care or emergency rooms. Four high risk groups were identified for more detailed analysis: teens, primiparas, single primiparas, young mothers (<25) with 2 or more children. There were substantial gaps in services in all groups. Teens and single primiparous women were less likely than others to obtain obstetrical follow-up services. Qualitative analysis of benefits of home and telephonic follow-up indicates that new mothers value the emotional and informational support provided during the follow-up contact. The presentation will include the results of analysis of geographic plots of the distribution of postpartum follow-up services. Conclusions: The demographic profiles of postpartum women who received home visits and women who were contacted by telephone for postpartum follow-up were different than those who did not receive services. Most follow-up was conducted by the delivery hospital. There were gaps identified in services to selected groups of high risk women and a substantial number of health problems requiring office or urgent care visits were reported for both mothers and babies. Implications: The results provide information on which to plan population-based postpartum follow-up services to an inner city population. Reductions in hospital-based follow-up programs pose a threat to potentially vulnerable mothers and their babies. The number of mothers reporting maternal and neonatal problems in the first 6 weeks postpartum suggests the need for expansion of anticipatory postpartum follow-up services.
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