The postpartum period is one of the most challenging times for mothers of all backgrounds. In addition to providing 24-hour care for a newborn infant (and likely other members of the family) on limited, sporadic sleep, these individuals are recovering from childbirth. From c-sections and other surgical procedures to mastitis and UTI infections, new mothers face a myriad of health issues and complications in the weeks and months after delivery.
Add the transportation, childcare, and access barriers faced by many rural, minority and low-resource communities, and the challenges are amplified even further. Telehealth has emerged as an increasingly widespread strategy for mitigating these obstacles, particularly during and after the COVID-19 pandemic when health care systems were strained/disrupted and in-person care posed additional safety concerns for vulnerable populations.
Timing is everything
Supported by NIH funding awarded to health services policy and management (HSPM) associate professor Peiyin Hung and health promotion, education, and behavior professor Xiaoming Li , Arnold School researchers have been examining the role of telehealth in providing care to at-risk – and often intersecting -- populations. The team recently published a paper in Medical Care on the initiation of postpartum care among Medicaid beneficiaries in South Carolina.
The researchers found that patients who delivered around the time of the COVID-19 pandemic were slower to initiate postpartum care – but only among those scheduling in-person visits; telehealth users were not delayed in care. These differences in care initiation were even more pronounced when looking at racial/ethnic disparities.
Among in-person patients, Hispanic mothers began their postpartum care much later than white mothers. However, when using telehealth, these groups began their check-ups at about the same time. Notably, while rural residents were less likely to receive postpartum care overall, those who did in-person postpartum follow-ups were seen sooner than urban women. Among telehealth users, however, the timing of follow-up care was similar regardless of where they lived.
"Timely postpartum care can ensure maternal and child well-being through early detection and treatment of complications," says HSPM doctoral candidate and Presidential Fellow Anirban Chatterjee, who served as lead author on the paper. "Current national guidelines recommend follow-up visits by 21 and 84 days after childbirth, but we also know that there are significant racial, ethnic, and geographic disparities in who receives this essential care in a timely manner."
An unlevel playing field
Medicaid data collected prior to the rapid increase in telehealth availability indicates that only 56% of Black individuals receive postpartum care within 56 days of delivery compared to 63% of whites and 73% of Asians. These gaps in care can put vulnerable groups at even greater risk of adverse perinatal outcomes.
One postpartum complication that Arnold School researchers are tackling through telehealth is high blood pressure. Hypertensive disorders impact 10-20% of pregnancies, with 50% of these women going on to develop chronic hypertension after giving birth. Due to the challenges of the postpartum period, only 70% of patients return to clinics for recommended follow-up visits. Epidemiology faculty Jihong Liu and Nansi Boghossian are examining the efficacy of at-home blood pressure monitoring for at-risk patients to help safeguard them from the long-term impacts of high blood pressure as well as acute complications such as seizures and stroke.
As the most common complication of pregnancy and childbirth, mental health conditions affect one in every five mothers in the U.S., with the impacts extending to their 800,000 families. Researchers estimate that the pandemic increased these rates by 300 to 400% and that 75% of these individuals are undiagnosed and untreated. Research led by Hung's team into these trends revealed that members of rural and minority populations are more likely to be readmitted to the hospital for mental health and/or substance use disorders after giving birth.
"The disproportionate frequency and severity of adverse maternal outcomes experienced by rural, racial, and ethnic groups is a nationwide public health issue, and strategies like using telehealth show promise in closing gaps related to care access," Hung says. "To truly optimize the potential of telehealth, however, we must ensure equal access by investigating and addressing barriers such as Internet and technology availability, digital literacy, patient education, and cultural/community factors."
