BACKGROUND: Severe maternal morbidity (SMM) is defined as having unexpected outcomes at labor and delivery that result in significant consequences to a woman’s health. The rate of SMM has risen 99% domestically between 1998 and 2015, and has been found to increase postpartum rehospitalizations, but more research needs to be done to understand the impact by race/ethnicity.
The postpartum period is a critical time for monitoring the health of women. It is possible that the impact of SMM on postpartum rehospitalizations could be mediated through more effective and frequent follow-up. However, there is a gap in the literature around the experiences of Black women and postpartum care.
METHODS: A mixed methods study was conducted to determine 90-day postpartum rehospitalization rates among a population of Black women in the state of Georgia (retrospective cohort study). Additionally, an assessment of the barriers, facilitators, and preferences for postpartum care among low-income Black women in the Atlanta Healthy Start Initiative was conducted (in-depth interviews). The quantitative analysis was based on 317,735 births between 2015-2017, while the qualitative analysis involved 26 in-depth interviews conducted May 2020-August 2020.
RESULTS: Black women had a 78% greater likelihood of experiencing SMM (207/10,000 to 116/10,000 deliveries) than White women. The relative risk of SMM was 60% higher for Blacks, compared to Whites, even after adjusting for confounders (1.6: 95% CI 1.4-1.7). The relative risk of 90-day postpartum rehospitalization for women with SMM was 100% higher (RR 2.0, 95% CI: 1.6-2.5) than without SMM, though there was no difference between the likelihood of rehospitalization for Black or White women with SMM.
Qualitatively, interviewees reported an array of difficulties in accessing Medicaid, challenges with scheduling appointments, and a lack of coordination of care. Facilitators to care included appointment reminders, consistent childcare, and positive coordination of care. Our study also documents the stigma that some Black women face in healthcare, such as unfair treatment or feeling ignored during their maternal healthcare experience.
CONCLUSION: Strategies implemented at hospital discharge and early postpartum should be explored to prevent rehospitalizations in the SMM population. In addition, reducing policy-related and organizational-related barriers are key to improving access to postpartum care for low-income Black women in Atlanta. / 2022-05-14T00:00:00Z
| Identifer | oai:union.ndltd.org:bu.edu/oai:open.bu.edu:2144/42583 |
| Date | 15 May 2021 |
| Creators | Louis, Michelle Reid |
| Contributors | Declercq, Eugene R. |
| Source Sets | Boston University |
| Language | en_US |
| Detected Language | English |
| Type | Thesis/Dissertation |
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