Postpartum care is an essential but often overlooked component of reproductive health. The postpartum visit marks the end of the previous pregnancy and provides a forum for the new mother and the practitioner to discuss future reproductive plans. However, most vulnerable and underserved women fail to attend postpartum visits, which often results in inadequate or lack of contraceptive use and increased unintended and mistimed pregnancies. While the ACOG recommendation for the timing of the postpartum visit is 6-8 weeks post-delivery, there is increased interest in shortening the time interval between delivery and this visit. Contraceptive education and counseling within the month after delivery has been shown to increase contraceptive use and decrease the number of unplanned pregnancies in a variety of populations.In addition, health service utilization theory suggests that women may be more likely to attend a postpartum visit scheduled closer to the time that they deliver their babies. Theproposedrandomized control trial (RCT) will compare the effectiveness of a shortened postpartum interval, postpartum visits scheduled 3-4 weeks post-delivery, with the standard postpartum interval, postpartum visits scheduled 6-8 weeks post-delivery,on the rates of postpartum visit attendance, contraceptive use, and Rapid Repeat of Pregnancy (RROP) in 348 predominantly underserved, low income, postpartum women recruited from a large, inner city, academic medical center hospital. Women will be followed for 18 months post-delivery. The study will also examine racial differences in postpartum attendance rate,contraceptive use, and ultimately RROP between the two postpartum intervals. Additionally, the study will evaluate the cost-effectiveness of the different visit schedules. The proposed research will be instrumental in helping to establish evidence-based guidelines for postpartum care that optimize family planning as well as health care delivery and utilization. The focus on low-income, urban, largely-minority women will provide much-needed data to help practitioners better meet the needs of their patients who are most at risk for unintended pregnancies and RROP.

Public Health Relevance

The postpartum visit is critical for the implementation of contraceptive plans to avoid unintended pregnancies and rapid repeat of pregnancy~ however, the visit is not kept by many women at highest risk for mistimed pregnancies, precluding effective reproductive health planning. The proposed Randomized Controlled Trial will compare the effectiveness of a shortened time interval to postpartum visit to the standard interval on attendance rates, contraceptive use, and rapid repeat of pregnancy in a predominantly underserved, African American population at high risk for unintended and poorly timed pregnancies. This study will provide crucial evidence-based data regarding optimal postpartum visit timing, resulting in better reproductive care for women, more informed decisions by patients, and ultimately, healthier women.

Agency
National Institute of Health (NIH)
Institute
Agency for Healthcare Research and Quality (AHRQ)
Type
Research Project (R01)
Project #
1R01HS021504-01A1
Application #
8642724
Study Section
Health Care Quality and Effectiveness Research (HQER)
Program Officer
Ricciardi, Richard
Project Start
2013-09-30
Project End
2017-09-29
Budget Start
2013-09-30
Budget End
2014-09-29
Support Year
1
Fiscal Year
2013
Total Cost
Indirect Cost
Name
Virginia Commonwealth University
Department
None
Type
Organized Research Units
DUNS #
105300446
City
Richmond
State
VA
Country
United States
Zip Code
23298