A Retrospective Study Examining the Importance of Early Postpartum Follow Up in Uncomplicated Vaginal Deliveries




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Purpose: Holistic postpartum care, including a comprehensive postpartum visit, is essential for long-term maternal and fetal health. However, many women navigate the early postpartum period independently until the traditional postpartum visit 4-6 weeks after delivery. In a national study, less than half of women attending a postpartum visit reported that they received adequate information on postpartum depression, birth spacing, healthy eating, exercise, or changes in their sexual health. This lack of attention to maternal health needs impedes identification and adequate management of postpartum depression, breastfeeding challenges, access to effective contraception, and chronic health conditions. In efforts to remediate this gap in care, the American College of Obstetrics and Gynecology recommends that all women have contact with their obstetric care provider within the first 3 weeks postpartum. This should be followed with ongoing care with a comprehensive postpartum visit no later than 12 weeks after birth. Preliminary studies incorporating these guidelines have indicated favorable health outcomes among mothers in the early postpartum period. In a randomized controlled trial, 15 minutes of discharge instructions, followed by a phone call at 2 weeks, reduced symptoms of depression and increased breastfeeding duration through 6 months postpartum among African American and Hispanic women. While previous studies have analyzed the benefit of earlier postpartum follow up for specific health challenges, few studies have holistically investigated the benefit of the earlier postpartum follow up in office. This study aims to characterize and compare outcomes of early postpartum follow up in uncomplicated vaginal deliveries. Methods: The medical records for all patients receiving prenatal care over a 2-year interval at the Medical City Arlington GME clinic were retrospectively reviewed to identify 228 patients that had received a postpartum visit within 3 weeks of delivery. The early postpartum visit records were reviewed for evidence of PPD screening and intervention, hypertension assessment and intervention, breast-feeding support and intervention, contraceptive counseling, hospital readmission or emergency room transfer, and primary care referral. Results:68% of patients were counseled on contraception, 2% were referred to a PCP for ongoing care, and 1% were sent for hospital readmission. Of the 45 patients who had a blood pressure check, 5% were initiated on anti-hypertensive therapy. Of the 172 patients screened for PPD, 5% received initial treatment for PPD. Utilizing Chi-square analyses, it was found that multiparous patients were 2.47 times more likely to get contraceptives ordered compared to nulliparous patients (p < .0109). Furthermore, there was a statistically significant difference in the frequency of PCP referrals and initial prenatal care (p= 0.0308). Those who started their prenatal care early were more likely to be referred to a PCP (7.78%) compared to those with late prenatal care (1.45%). Conclusion: Early postpartum follow-up allows for timely recognition and intervention of hypertension and mood disorders, earlier initiation of contraception, and earlier transition of care to a PCP. These interventions may improve long term maternal health outcomes and reduce the likelihood of preventable complications.