(M-504) Individualizing Postpartum Care and Empowering Mothers

Introduction:: The postpartum period is considered to be the time from birth until 4-6 weeks after birth, which is a time of many changes for new mothers. This period is also when approximately 60% of pregnancy related maternal deaths occur. Both physiological and potentially pathological changes can be concerning for women with barriers to postpartum care. The American College of Obstetricians and Gynecologists (ACOG) recommends at least one healthcare checkup within the first three weeks of the postpartum period with a comprehensive evaluation done no less than 12 weeks postpartum. Literature notes that up to 40% of women miss these postpartum visits, which can increase the risk of potentially preventable but time-sensitive complications. Of the 40% of patients that miss their appointments, about 10-20% of them will obtain medical attention in only severe emergency situations. Understanding the reason behind these missed appointments is crucial to developing a solution that would address the clinical needs of patients such that they can receive the appropriate and comprehensive care they need.


Materials and Methods:: The stakeholders for this specific problem were identified as patients who have recently delivered as well as obstetricians. Interviews and surveys were performed with a population of 40 total patients and obstetricians. The patients are of diverse socioeconomic backgrounds, ethnicities, and regions in the United States. Patient-centered interviews and surveys focused on current gaps in postpartum care, barriers to access this care, and the effectiveness of postpartum care appointments. The obstetricians are employed by Houston Methodist Hospital and St. Joseph’s Hospital, both of which serve a large diverse patient population. Interviews with the obstetricians focused on assessing specific aspects to postpartum care that they deemed necessary and vital in preventing potentially harmful complications in the postpartum period. At the end of each interview and survey, participants were asked to share which shortcomings of current practices they would like to see be addressed.

A market analysis was also conducted to better understand the landscape of interventions available to address the need of improving postpartum care. This analysis was conducted after all stakeholder interviews and surveys were performed so that the landscape under review could be tailored towards what participants envision the solution to address.


Results, Conclusions, and Discussions:: From the stakeholder interviews and surveys, it was found that about 50% of patients miss their first postpartum appointment. The patient surveys showed that the most common reasons for missing the postpartum appointment were due to feeling that further care was unnecessary, lack of time and childcare, fatigue, insurance, and lack of transportation. Moreover, about 50% of the patients who did attend their first appointment reported getting less than adequate information and guidance about topics such as physiologic changes, contraception, birth spacing, and depression. 100% of the physicians interviewed shared that the most important aspect of the postpartum visits is obtaining basic information regarding mental health, blood pressure measurements, contraception considerations, breast health, and any current symptoms the patient may be encountering. 100% of the patients described their use of online resources and phone applications during their pregnancy as education materials. They also noted that a more efficient method of contacting a healthcare provider during their postpartum period to obtain information would have been useful.

From the stakeholder interviews and surveys as well as additional literature review, it was understood that digitizing postpartum care would be an effective way of addressing the current gaps in postpartum care. With 79% of American women owning a smartphone, of which 65% use a pregnancy related phone application, a method of customizing and individualizing postpartum care could empower patients to be consistent and knowledgeable about their postpartum care. A works-like prototype of a phone application has been developed addressing stakeholder needs and the overall clinical problem of the gaps in current postpartum care. The application involves symptom journal entries, records for vitals, mental health questionnaires, and resources for childcare, transportation, and general well being items such as exercise and nutritional guides. Abnormal inputs recorded are designed to be flagged by the application and reported to the patient’s healthcare provider for further management. This allows for telehealth communication between the patients and providers to strengthen consistency in following up during the postpartum period. The goal of this application is to reduce preventable maternal mortality and morbidity in the postpartum period.


Acknowledgements (Optional): : We would like to thank Dr. Konrad Harms, M.D. and Dr. Nicholas Sears, Ph.D. for their mentorship and guidance throughout this project.

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