Study: 60% of New Mothers Miss Key Postpartum Care

By Matt Phillion

A new report from Cedar Gate Technologies finds that the majority of new mothers are missing critical postpartum care, with younger women experiencing the greatest barriers.

According to the study, 57% of patients fail to attend postpartum follow-up visits between three to eight weeks after giving birth. That the number is more prevalent for younger mothers underscores an urgent equity gap in maternal care in the U.S.

The American College of Obstetrics and Gynecology (ACOG) recommends new mothers see a provider within the first three weeks after delivery, with a comprehensive follow up between three and twelve weeks. The appointments are invaluable for identifying and addressing complications such as postpartum depression, hypertension, and recovery issues.

Previous estimates found about 40% of women missed their second visit, but this new study from Cedar Gate finds an even wider gap, highlighting a need for care coordination, patient outreach, and data-driven interventions to improve outcomes, particularly for at-risk populations.

Additionally, the research found that over 60% of women between the ages of 20 and 24 miss their postpartum care within three to eight weeks of giving birth. Postpartum mothers between 40 and 44 were most likely to attend these appointments, but with 55% missing their follow-up care, more than half of the population is not connecting with their follow-up care.

The study points to a distinct divergence between the attention and excitement of a new birth versus the focus on the mothers, when issues can commonly arise, such as:

• Postpartum bleeding and uterine infections
• Incision healing issues
• Preeclampsia
• Breastfeeding issues (such as mastitis)
• Postpartum depression and anxiety
• Sleep, fatigue, or pain issues
• Contraception and future pregnancy planning

“One of the first things we looked at was that the numbers were surprisingly high for this group,” says Gregory Shelton, MD, FACOG, an OBGYN in Houston and member of the Global Women’s Health Provider network, when discussing the finding that younger women are far more likely to miss postpartum visits. “It could be due to any number of reasons: Not having childcare, a lack of a social network (though as providers we’re happy to have your children come with you), lack of transportation, or economic reasons.”

But part of those low follow numbers may be a part of the patients’ age, Shelton notes.

“They’re young and may feel they’ve bounced back, they’re ready to go, and don’t need that official sign-off,” he says.

And for many patients, they’re not wrong, Shelton says. But without a follow-up appointment it’s impossible to know if they actually are in that majority of young patients who do bounce back.

“They’re younger, healthy, at much less risk of lingering effects like cardiac problems or long-term diabetes, but these are things we screen for,” Shelton says.

And there are other risk factors that postpartum follow-up appointments can assess that are more nuanced than checking for something like diabetes.

“This is a group that is less likely to have support for things like postpartum depression or domestic violence,” he says.

They’re also more at risk for issues like short-interval pregnancies which can make recovery more difficult and open the patient up to additional risks.

“Those follow-up appointments typically take care of things like birth control needs,” says Shelton.

Explaining the needs for a follow-up

How can providers help ensure these patients don’t let these important postpartum visits fall to the wayside?

“We need to talk to them even before the delivery,” says Shelton. “Here’s what to expect, you’re in the hospital for a few days, and we will need to see you a few weeks afterward.”

Having a baby changes everything of course, and so outreach is important. If they do drop off, reconnecting to get them back in for a visit is key. Pediatricians can actually play a powerful role in this.

“They are seeing the patient more often than we are in tandem with the baby. They’re good at screening for more subtle signs of postpartum depression and other things, and while they’re not necessarily the right person to address it, they can identify those issues and bring it up,” says Shelton. “We’ve all had patients who thought they were doing okay, but their pediatrician recommended they come in and get that visit in before it becomes an even more pressing issue.”

Pediatricians aren’t the only resources who can keep an eye out for new moms and nudge them toward taking care of themselves postpartum, Shelton notes. Government resources, and particularly support groups, can be good at noting when someone is struggling and may not be aware or want to admit it.

“They can pull them aside and say, ‘We’re noticing this is going on,’ and then refer them to appropriate resources,” he explains.

It’s not uncommon for mothers to be conscientious about their child’s care without worrying about their own, which is a culture shift providers hope to change, Shelton says.

A wide-ranging issue

The number of women not making follow-up appointments was surprisingly high across the board, Shelton notes.

“It’s not a huge surprise we see younger women not keeping that appointment, but 50% as a whole is higher than we’d expect to see,” he says. “It’s important to identify where those numbers are, where the fall-off is, and who may be at the highest risk of not following up.”

It’ s too soon to see widespread changes, but there are moves toward a more proactive approach to prevent losing these patient appointments.

“We generally know when they’re going to deliver, and so we can schedule the follow-up appointment a month and a half out, and if they don’t’ show up, that’s an easy outreach opportunity,” says Shelton.

There is value in drilling down into the categories of patients who drop off. While younger moms were the group that stood out the most, every practice can look at their patient populations who may be at risk.

“The other part of this is that the women at risk of not keeping their appointment are more at risk of other socioeconomic issues that may put them in additional risk categories,” Shelton notes. “They may be at risk of poor social support, postpartum depression or blues, or they may just benefit from additional resources they can avail themselves of” by scheduling a follow-up.

Shelton adds that it’s often not so much a lack of resources but a lack of awareness that gets in the way.

“Part of the provider side is making sure the patients are aware. These appointments are important, and there are resources to help you keep your appointment if you’re having issues,” he says.

Age is an easy category to pick out from the data, Shelton says, but there are other large groups or characteristics that can put a patient at risk for missing their follow-ups and this can offer providers a direct opportunity to help patients increase compliance with their care plans.

“These numbers were surprisingly high for everyone,” he says. “We’d like to get the point cross that closing the book on a pregnancy means everyone is doing well and recovering. This goes beyond just those postpartum visits. Annual visits, other screening opportunities, more proactive things in terms of scheduling, outreach, and follow-up. Even just a phone call to make sure they’re getting all the necessary screenings.”

Matt Phillion is a freelance writer covering healthcare, cybersecurity, and more. He can be reached at matthew.phillion@gmail.com.