Diana E. Ramos, MD, MPH, District IX treasurer; ACOG President Elect Jeanne A. Conry, MD, PhD, immediate past District IX chair; and Laurie C. Gregg, MD, District IX chair
In 2010, there were 509,979 births in California. For many women faced with limited access to care and other health barriers, the postpartum visit is often their only appointment before another pregnancy. Therefore, it is the optimal time to address any medical problems that may have developed around or during pregnancy while providing women interconception assessment and counseling. Currently, the postpartum visit is underutilized with only 64% of Medicaid patients participating and 66% of private insurance patients participating. Meanwhile, 94% of Kaiser Permanente patients are seen postpartum.
The unintended pregnancy rate in California is 56%, one of the highest in the United States, and approximately 50% of pregnant women suffer at least one medical complication. It is important to recognize that women who have had a poor birth outcome in a prior pregnancy are at increased risk for having a poor birth outcome in a subsequent pregnancy. Hospital stays with pregnancy-related complications tend to be longer (2.7–2.9 days) compared with those without complicating conditions (1.9 days). In 2008, maternal stays with complicating conditions were 50% more expensive ($8,000) compared with those without complications ($2,600). Maternal stays with pregnancy and delivery complications accounted for $17.4 billion, or 5%, of total hospital costs in the United States.
The Interconception Care Project for California, led by District IX and the Preconception Health Council of California and funded by the March of Dimes, developed postpartum visit algorithms for providers and companion patient information to address the 10 most common pregnancy and delivery complications identified using ICD-9 discharge code data in California. In May 2012, the project was recognized with a national award for excellence by ACOG.
The evidence-based provider algorithms and companion patient education materials were developed by a panel of obstetric and health experts throughout California. The provider algorithms were developed so they could be used by non-obstetric and mid-level providers, knowing that patients may miss their postpartum visit and that their next medical visit may not be with their prenatal care provider.
The algorithms were reviewed by various types of health care providers throughout California to assess their content and utility. Patient handouts in Spanish and English were reviewed by Spanish- and English-speaking patients. The patient materials provide simplified explanations of medical conditions, address implications for future pregnancies, and emphasize the importance of planning for future pregnancies, maintaining communication with health care providers, and obtaining early prenatal care. All of these resources are free to download, print, and distribute. They can be found at everywomancalifornia.org.
Our hope is that providers and patients throughout California will find these resources valuable and use them as a bridge between postpartum health and the future health of mothers and their babies. Together we can work to improve the health of postpartum women in California and make their next pregnancy healthier.