Abstract
Introduction For uncomplicated pregnancies in the United States, a healthcare visit 4 to 6 weeks postpartum is recommended to assess a woman’s mental, social, and physical health. We studied whether sociodemographic characteristics and pregnancy and delivery factors were related to the likelihood of missing a postpartum checkup. Methods We conducted a cross-sectional analysis of 64,952 women who completed the United States Centers for Disease Control Pregnancy Risk Assessment Monitoring System (PRAMS) Phase 6 survey in 2009–2011 from 17 states and New York City that included a Yes/No question about receiving a maternal postpartum checkup. We calculated risk ratios (RR) with 95% confidence intervals (CI) to assess the association between maternal factors and lack of a postpartum checkup. Results Compared to women who attended a postpartum checkup (89.4%), women who missed the visit (10.6%) were younger, unmarried, less educated, with lower income, without insurance, and smokers (all p < 0.05). Compared to women with adequate prenatal care, women with intermediate (RR 1.79 (95% CI 1.70–1.88)) or inadequate (RR 2.71 (95% CI 2.53–2.91)) care were more likely to miss the checkup. Women were more likely to miss this checkup if their infant was born at a residence compared to a hospital (RR 2.27 (95% CI 1.71–3.01)), and were less likely to miss the checkup if their newborn had a 1-week well visit (RR 0.70 (95% CI 0.61–0.81)). Discussion Sociodemographic factors and noncompliance with other medical care were associated with missing a postpartum checkup. Women with a high-risk of not attending a postpartum visit should be targeted for interventions to increase their accessibility to care.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Bryant, A. S., Hass, J. S., McElrath, T. F., & McCormick, M. C. (2006). Predictors of compliance with the postpartum visit among women living in health start project areas. Maternal and Child Health Journal, 10(6), 511–516.
Centers for Disease Control and Prevention (CDC). (2017). PRAMS questionnaires. Resource document. CDC. Retrieved July 12, 2017, from https://www.cdc.gov/prams/questionnaire.htm.
Centers for Disease Control and Prevention (CDC). (2017). What is PRAMS? Resource document. CDC. Retrieved July 28, 2017, from https://www.cdc.gov/prams/index.htm.
Eutrope, J., Thierry, A., Lempp, F., Aupetit, L., Saad, S., Dodane, C., et al. (2014). Emotional reactions of mothers facing premature births: Study of 100 mother-infant dyads 32 gestations weeks. PLoS ONE, 9(8), e104093.
Henderson, V., Stumbras, K., Caskey, R., Hairder, S., Rankin, K., & Handler, A. (2016). Understanding factors associated with postpartum visit attendance and contraception choices: Listening to low-income postpartum women and health care providers. Maternal and Child Health Journal, 20, 132–143.
Kessner, D., Singer, D., Kalk, C., & Schlesinger, E. (1973). Infant death: An analysis by maternal risk and health care. Washington, DC: Institute of Medicine.
Lu, M. C., & Prentice, J. (2002). The postpartum visit: Risk factors for nonuse and association with breast-feeding. American Journal of Obstetrics & Gynecology, 187(5), 1329–1336.
Masho, S. W., Cha, S., Charles, R., McGee, E., Karjane, N., Hines, L., & Kornstein, S. G. (2016). Postpartum visit attendance increases the use of modern contraceptives. Journal of Pregnancy. https://doi.org/10.1155/2016/2058127.
Melnyk, B. M., Feinstein, N. F., & Fairbanks, E. (2002). Effectiveness of information/behavioral intervention with parents of low birth weight (LBW) premature infants: An evidence base to guide clinical practice (evidence based practice). Journal of Pediatric Nursing, 28(5), 511–516.
Rai, S., Pathak, A., & Sharma, I. (2015). Postpartum psychiatric disorders: Early diagnosis and management. Indian Journal of Psychiatry, 57(Suppl 2), S216–S221.
The American College of Obstetricians and Gynecologists (ACOG). (2016). Committee opinion number 666: Optimizing postpartum care. Obstetrics & Gynecology, 127, e187–92.
Tully, K., Stuebe, A., & Verbiest, S. (2017). The fourth trimester: A critical transition period with unmet maternal health needs. American Journal of Obstetrics & Gynecology, 217(1), 37–41.
Wilcox, A., Levi, E. E., & Garrett, J. M. (2016). Predictors of non-attendance to the postpartum follow-up visit. Maternal and Child Health Journal, 20, 22–27.
Acknowledgements
This study would like to acknowledge the 17 states and 1 city that used the standard question from which our outcome data stems. These places chose to include Question L8 from the PRAMS, which reads: “Since your new baby was born, have you had a postpartum checkup for yourself? (A postpartum check is the regular checkup a woman has about 6 weeks after she gives birth).” These sites are: Arkansas, Georgia, Hawaii, Massachusetts, Michigan, Minnesota, Missouri, New Jersey, New York, Ohio, Rhode Island, Tennessee, Texas, Utah, Washington, West Virginia, Wisconsin, and New York City. We would also like to acknowledge the Center for Disease Control and Prevention (CDC) and the PRAMS Working Group for their permission to use Phase 6 data for the PRAMS, 2009–2011. PRAMS Working Group: Alabama—Izza Afgan, MPH; Alaska—Kathy Perham-Hester, MS, MPH; Arkansas—Mary McGehee, PhD; Colorado—Alyson Shupe, PhD; Connecticut —Jennifer Morin, MPH; Delaware—George Yocher, MS; Florida—Elizabeth C. Stewart, MSPH; Georgia—Florence A. Kanu, MPH; Illinois—Patricia Kloppenburg, MT (ASCP), MPH; Iowa —Sarah Mauch, MPH; Louisiana—Rosaria Trichilo, MPH; Maine—Tom Patenaude, MPH; Massachusetts—Emily Lu, MPH; Michigan—Peterson Haak; Minnesota—Kathy Raleigh, PhD, MPH; Mississippi—Brenda Hughes, MPPA; Missouri—David McBride, PhD; Montana—Emily Healy, MS; Nebraska—Jessica Seberger; New Hampshire—David J. Laflamme, PhD, MPH; New Jersey—Lakota Kruse, MD; New Mexico—Oralia Flores; New York State—Anne Radigan; New York City—Pricila Mullachery, MPH; North Carolina—Kathleen Jones-Vessey, MS; North Dakota—Sandra Anseth; Ohio—Connie Geidenberger, PhD; Oklahoma—Ayesha Lampkins, MPH, CHES; Oregon—Claudia W. Bingham, MPH; Pennsylvania—Tony Norwood; Rhode Island—Karine Tolentino Monteiro, MPH; South Carolina—Mike Smith, MSPH; Texas—Tanya Guthrie, PhD; Tennessee—Ramona Lainhart, PhD; Utah—Nicole Stone; Vermont—Peggy Brozicevic; Virginia—Christopher Hill, MPH, CPH; Washington—Linda Lohdefinck; West Virginia—Melissa Baker, MA; Wisconsin—Christopher Huard; Wyoming—Lorie Chesnut, PHD.
Funding
Funding was provided by Agency for Healthcare Research and Quality (Grant No. K01HS025013), National Institute of Child Health and Human Development (Grant No. 5K12HD050108).
Author information
Authors and Affiliations
Corresponding author
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Danilack, V.A., Brousseau, E.C., Paulo, B.A. et al. Characteristics of women without a postpartum checkup among PRAMS participants, 2009–2011. Matern Child Health J 23, 903–909 (2019). https://doi.org/10.1007/s10995-018-02716-x
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10995-018-02716-x