Dissertation

Acute Care in the Postpartum Period: Patterns of Utilization and the Perspectives of Birthing People

Busse, Clara Elizabeth

2024

Overview

More than half of pregnancy-related deaths in the United States occur a week or more after childbirth, underscoring the importance of the postpartum period. Postpartum acute care utilization (PACU), including visits to an emergency department, obstetric triage, or urgent care facility and hospital readmissions, may indicate medical complications and unmet health needs after childbirth. In this dissertation, we characterized PACU using both quantitative and qualitative methods.For the quantitative analyses, we used electronic health records to construct a retrospective cohort of birthing people who delivered ≥1 liveborn infant at [Anonymized Hospital] (2021-2022). We collected data on their PACU throughout the [Anonymized Health System] within three months of childbirth. We estimated the incidence of PACU and examined PACU patterns. We also estimated the association between elevated postnatal blood pressure and PACU. In this cohort, one in ten had ≥1 outpatient postpartum acute care encounter (PACU not resulting in hospital readmission) and one in thirty had ≥1 hospital readmission within 12 weeks of discharge from the birth hospitalization. On average, first hospital readmissions occurred 6 days after discharge and first outpatient PACU occurred 10 days after discharge. Hypertension and hypertensive-related conditions were a leading medical indication for PACU. Birthing people with elevated postnatal BP had a higher 12-week risk of PACU than those without elevated BP in both unadjusted and adjusted analyses.The qualitative analysis included the questionnaire responses, semi-structured interviews, and medical chart review of 18 English-speaking birthing people who utilized acute care at [Anonymized Hospital] within three months of childbirth to investigate contributors and barriers to PACU. Birthing people engaged in complex decision-making processes to decide where and when to utilize postpartum acute care. Many described fear and uncertainty about their postpartum health. Most participants contacted a healthcare provider before utilizing acute care.These results indicate that PACU is common and that most occurs shortly after discharge from the birth hospitalization. The insights from this study can inform multi-level strategies for strengthening perinatal healthcare so that birthing people are safe and well postpartum.

• Publisher: ProQuest Dissertations & Theses
• Subject: Epidemiology / Health sciences / Obstetrics / Obstetrics and gynecology / Public health
• ISBN: 9798383691021