Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Comment
  • Published:

Bringing postpartum care to the NICU—An opportunity to improve health in a high-risk obstetric population

Journal of Perinatology volume 43, pages 1–2 (2023)Cite this article

Subjects

The mortality rate for women of childbearing age has been increasing for the past 10 years and pregnancy-related deaths have more than doubled [1]. There are large inequities in maternal morbidity and mortality, with Black individuals experiencing more than triple the rates compared to their White counterparts. Novel interventions for the healthcare system to address declining health and health inequities are needed. Pregnancy initiates a period of intense interaction with the healthcare system. During an uncomplicated pregnancy, there are prenatal care visits every four weeks for the first 28 weeks of gestation, every two weeks until 36 weeks of gestation, and weekly thereafter, providing opportunities for health promotion and screening [2]. After the birth hospitalization, there is an abrupt decline in routine healthcare for postpartum patients.

The American College of Obstetricians and Gynecologists (ACOG) promotes the “fourth trimester” as an opportunity to optimize health and improve maternal outcomes [3]. During this 12-week period, full assessment of physical, social, and psychological wellbeing is recommended with an emphasis on lactation support, parenting guidance, hypertensive disorder treatment, and postpartum weight management [3]. However, only 50-60% of patients attend postpartum visits, even among those with complicated pregnancies [2]. Reasons that patients forgo postpartum visits may include lack of access or competing priorities [4, 5]. Innovation to improve postpartum care delivery is possible. With the COVID pandemic, healthcare has changed with widespread adoption of telehealth [6] resulting in increases in postpartum visit attendance and postpartum depression screening [7].

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

References

  1. Gemmill A, Berger BO, Crane MA, Margerison CE. Mortality rates among U.S. women of reproductive age, 1999–2019. Am J Prev Med. 2022;62:548–57.

    Article  Google Scholar 

  2. American Academy of Pediatrics, American College of Obstetricians and Gynecologists, editors. Guidelines for perinatal care. Eighth edition. Elk Grove Village, IL: Washington, DC: American Academy of Pediatrics; The American College of Obstetricians and Gynecologists; 2017. 691 p.

  3. American College of Obstetricians and Gynecologists. Committee Opinion 736: Optimizing Postpartum Care. 2018;131:e140–50.

  4. 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 1:132–43.

    Article  Google Scholar 

  5. Verbiest S, Ferrari R, Tucker C, McClain EK, Charles N, Stuebe AM. Health needs of mothers of infants in a neonatal intensive care unit: a mixed-methods study. Ann Intern Med. 2020;173 Suppl 11:S37–44.

    Article  Google Scholar 

  6. McKenney KM, Lundsberg LS, Burris HH, Ledyard RF, Son M, Greenspan J, et al. The Uptake of Telemedicine in Obstetric Care During the Early Acute Phase of the Coronavirus 2019 Pandemic. Telemedicine and e-Health [Internet]. 2022 Sep [cited 2022 Sep 6]; Available from: https://www.liebertpub.com/doi/10.1089/tmj.2022.0291

  7. Arias MP, Wang E, Leitner K, Sannah T, Keegan M, Delferro J, et al. The impact on postpartum care by telehealth: a retrospective cohort study. Am J Obstetrics Gynecol. MFM [Internet]. 2022 May [cited 2022 Jun 21];4. Available from: https://www.ajogmfm.org/article/S2589-9333(22)00053-2/fulltext#%20

  8. Verbiest S, McClain E, Stuebe A, Menard MK. Postpartum health services requested by mothers with newborns receiving intensive care. Matern Child Health J. 2016;20:125–31.

    Article  Google Scholar 

  9. Schecter R, Pham T, Hua A, Spinazzola R, Sonnenklar J, Li D, et al. Prevalence and longevity of PTSD symptoms among parents of NICU infants analyzed across gestational age categories. Clin Pediatr (Philos). 2020;59:163–9.

    Article  Google Scholar 

  10. Hans SL, Edwards RC, Zhang Y. Randomized Controlled Trial of Doula-Home-Visiting Services: Impact on Maternal and Infant Health. Matern Child Health J. 2018;22 Suppl 1:105–13.

    Article  Google Scholar 

Download references

Acknowledgements

LDI-Optum Labs supported the work presented. While not all birthing people identify as “women,” for consistency with cited studies, we used language such as “women” and “birth parents” throughout the manuscript. Funding for this work is from OptumLabs and Leonard Davis Institute at the University of Pennsylvania. The time of Dr. Montoya-Williams was supported by NIH/NICHD K23HD102526 and the time of Dr. Lewey was supported by NIH/NHLBI K23HL153667.

Author contibutions

MTT wrote the manuscript with mentorship from Dr. Burris. ND, KP, KTT, LC, SCH, SLK, MEP, DMW, JL, EFG, SAL, SBD, LDL all provided concepts, critically edited, and approved the final manuscript. HHB conceived of the concept, mentored MTT throughout the writing of the manuscript, and critically edited the final manuscript.

Author information

Authors and Affiliations

  1. Drexel University College of Medicine, Philadelphia, PA, USA

    Marie T. Tan

  2. Division of Neonatology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Niesha Darden, Lori Christ, Sara C. Handley, Diana Montoya-Williams, Scott A. Lorch, Sara B. DeMauro & Heather H. Burris

  3. KMP Doula Service, Childbirth and Postpartum Professional Association (CAPPA), Lansdowne, PA, USA

    Karen Peterson

  4. Univeristy of Pennsylvania School of Nursing, Philadelphia, PA, USA

    Kimberly K. Trout & Maggie E. Power

  5. Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA

    Lori Christ, Sara C. Handley, Diana Montoya-Williams, Emily F. Gregory, Scott A. Lorch, Sara B. DeMauro & Heather H. Burris

  6. Leonard Davis Institute, University of Pennsylvania, Philadelphia, PA, USA

    Sara C. Handley, Diana Montoya-Williams, Emily F. Gregory, Scott A. Lorch & Heather H. Burris

  7. Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA

    Sara L. Kornfield

  8. Division of Cardiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA

    Jennifer Lewey

  9. Division of General Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Emily F. Gregory

  10. Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA, 19104, USA

    Lisa D. Levine

Authors
  1. Marie T. Tan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Niesha Darden
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Karen Peterson
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kimberly K. Trout
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Lori Christ
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Sara C. Handley
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Sara L. Kornfield
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Maggie E. Power
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Diana Montoya-Williams
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Jennifer Lewey
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Emily F. Gregory
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Scott A. Lorch
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Sara B. DeMauro
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Lisa D. Levine
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Heather H. Burris
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Heather H. Burris.

Ethics declarations

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tan, M.T., Darden, N., Peterson, K. et al. Bringing postpartum care to the NICU—An opportunity to improve health in a high-risk obstetric population. J Perinatol 43, 1–2 (2023). https://doi.org/10.1038/s41372-022-01525-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41372-022-01525-z

This article is cited by

Search

Advanced search

Quick links