Popular in Professional

Human Rights Law

Human Rights and Corruption: Problems and Potential of Individualising a Systemic Problem

Max Planck Institute Anne Peters

Law

A statistical approach to law school citation rankings

University of Virginia Joshua Fischman

Education

High school change

Boston College Andrew Hargreaves

Constitutional Law

What is constitutional ideology?

University of Oxford Nick Barber

Civil Procedure Law

Politics, Identity, and Class Certification on the U.S. Courts of Appeals

University of Pennsylvania Sean Farhang

Culture and Society

The City as a Growth Machine: Toward a Political Economy of Place

New York University Harvey Moltoch

Education

The Role of Education in Reducing Racial Inequality

University of Southern California Pedro A. Noguera

Clinician care priorities and practices in the fourth trimester

View more insights in Professional - Medicine - Obstetrics and Gynaecology

View more figures from UC Berkeley

View the page of Sylvia Guendelman

Next in Medicine

Seroprevalence of hepatitis B antibodies among international and domestic university students

Anita Heywood | UNSW Sydney

Environmental factors in health data reporting

Arnagretta Hunter | Australian National University

How are clinicians balancing the demands of postpartum care with limited resources, and what gaps do they face in adhering to professional guidelines during the critical fourth trimester?

Image courtesy of interviewee. November 19, 2024

Log-in or Sign-up to Faculti
Currently viewing this subject insight as a guest. You have insight(s) remaining for this month. Login to view 8000+ figures on the platform.

Generating Workspace...

Export as PDF

In the fall of 2023 and early 2024, a study was conducted through an anonymous online survey targeting obstetricians, midwives, and family medicine physicians in California. The survey aimed to explore two main topics: how clinicians prioritize various clinical responsibilities within their time and resource constraints and the degree to which they adhere to guidelines from the American College of Obstetrics and Gynecology (ACOG) regarding postpartum care.

The study was motivated by rising concerns over maternal mortality and morbidity rates, as well as significant disparities in maternal health. ACOG provided recommendations in 2018 to improve care in the first 12 weeks postpartum, outlining 26 components of care that clinicians should follow. The survey results indicated that while clinicians rarely perform all recommended components of postpartum care, they prioritize certain aspects such as mental health (depression and anxiety), breast health, vaginal birth complications, and family planning, which they tend to check consistently.

Conversely, components related to social health drivers, such as diet monitoring and screening for intimate partner violence, were less prioritized, suggesting room for improvement in adherence to ACOG guidelines. The study highlighted challenges faced by clinicians, including time constraints and patient readiness to discuss complex issues during early postpartum visits. Additionally, it was noted that years of practice experience impacted clinicians' ability and willingness to address social and behavioral health issues.

The findings emphasized the need for better collaboration among healthcare professionals to address comprehensive postpartum care and highlighted strategies such as enhancing awareness of social determinants of health, integrating community resources, and improving guideline accessibility in clinical settings.

Notably, obstetricians and midwives displayed different priorities in care components based on their practice settings and patient needs. Midwives tended to spend more time with patients, focusing more on social and emotional support, whereas obstetricians emphasized clinical complications. The study concluded that a collaborative model of care involving both midwives and obstetricians could better meet the diverse needs of postpartum patients.

Lastly, the study participants advocated for extending Medicaid coverage to 12 months postpartum to ensure continuity of care, which could enhance support for chronic conditions and improve overall maternal health outcomes. The California Department of Healthcare Services is also working on initiatives to transform maternal health services, aiming for better coordination of care.

Language:

Export as PDF

Export as PDF
Here are five key points from the video:

1. **Survey Overview and Purpose**: In fall 2023 and early 2024, an anonymous online survey was conducted with obstetricians, midwives, and family medicine physicians in California to understand how they prioritize clinical responsibilities within time and resource constraints, and to examine adherence to the American College of Obstetrics and Gynecology (ACOG) recommendations for postpartum care.

2. **ACOG Recommendations and Prioritized Care Components**: ACOG issued recommendations addressing postpartum care components in response to rising maternal mortality and morbidity rates. The study identified 26 care components, discovering that clinicians prioritized four key components: anxiety assessment, breast health, vaginal birth complications, and family planning counseling, with most clinicians reporting they address these during postpartum visits.

3. **Adherence Challenges**: The study revealed that adherence to ACOG guidelines was only at a median score of 62%, indicating significant room for improvement. Factors affecting adherence included clinicians feeling overwhelmed by time constraints, patients being unprepared to discuss multiple issues during their first postpartum visit, and concerns about the stigma attached to discussing sensitive social and behavioral issues.

4. **Collaboration and Support**: Findings indicated that more experienced clinicians are better at addressing social and behavioral components of care, likely due to increased confidence and collaborative relationships with other healthcare providers. Strategies to enhance care include encouraging multidisciplinary teamwork, making guidelines more accessible at the point of care, and providing appropriate referrals tailored to patient preferences.

5. **Insights on Practice Differences and Future Care**: The study highlighted differences in practice between midwives, who prioritize social drivers of health and provide longer visits, and obstetricians, who focus on medical complications often within shorter appointment times. The potential for collaborative care models was noted as beneficial in addressing diverse patient needs, alongside discussing policy changes like extending Medi-Cal postpartum coverage to enhance continuity of care and improve maternal health outcomes.

Export as PDF
Here are some key quotes and summarized points from the video:

1. **Purpose of the Study**
- "We really wanted to understand two issues: How do clinicians prioritize multiple clinical responsibilities within their existing time and resource constraints? And second, we also wanted to examine the recommendations of the American College of Obstetrics and Gynecology (ACOG) issued in response to rising concerns about increasing rates of maternal mortality and morbidity in the US."

2. **ACOG Recommendations**
- "ACOG issued multiple recommendations to optimize care in the first 12 weeks postpartum... Altogether, we identified 26 care components that ACOG recommends, and we focused on those for our study."

3. **Findings on Clinician Prioritization**
- "We found that clinicians rarely performed all the postpartum care components recommended by ACOG."
- "Of the 26 care components, anxiety, breast health, vaginal birth complications, and family planning counseling rank highly as the top priorities for the first postpartum visit."

4. **Adherence to ACOG Guidelines**
- "The median score of adhering to ACOG guidelines is 62%. That is, 50% or more of clinicians will complete 62% while the other 50% will do less than that."

5. **Challenges in Addressing Care Components**
- "Aside from assessing anxiety and depression, other mental health and social issues might just be too time intensive to approach... Patients might be reticent to discuss social and behavioral issues because of perceived stigma."

6. **Factors Influencing Adherence**
- "Years of practice as a clinician is associated with better follow-through with the social and behavioral care components."

7. **Recommendations for Improvement**
- "Strategies to help prioritize the social components include encouraging collaboration with multidisciplinary teams and understanding the social structure of cultural drivers that affect health."
- "Making guidelines more accessible at the point of care or computerized clinical decision supports can help remind clinicians to screen and monitor key components."

8. **Role Differentiation Between Midwives and Obstetricians**
- "Midwives and obstetricians perform under different settings, different models of care... A collaborative model of care in which midwives and OB GYNs work in partnership may be the way to balance different patient needs in the postpartum."

9. **Benefits of Extended Care**
- "Extension of Medi-Cal allows for continuity of care, which can improve breastfeeding support, chronic disease management, and preventive care."

10. **Recruitment and Study Participation**
- "We cast a wide net across the state and enlisted the help of leaders from several professional organizations... Prior to launching the survey, we sharpened the focus with support from the ACOG Public Health Committee."

These quotes and insights encapsulate the main themes of the study, including the challenges facing postpartum care, the prioritization of different care components by healthcare professionals, and recommendations for increasing adherence to guidelines and improving care delivery.

Export as PDF
Here are some articles that cover similar themes to the video you've , which focuses on postpartum care, clinician practices, maternal health, and the implications of various clinical recommendations:

1. **Postpartum Care Quality and Maternal Health**:
- "Improving Quality of Postpartum Care: Understanding Maternal Perspectives" - This article explores the challenges and expectations mothers have regarding postpartum care, highlighting gaps in health services.

2. **Implementation of Clinical Guidelines in Maternal Health**:
- "Barriers to Adherence to Clinical Guidelines in Postpartum Care" - This article discusses the obstacles clinicians face in following established guidelines for postpartum care and provides recommendations for improvement.

3. **Maternal Mortality and Morbidity Rates in the US**:
- "Rising Maternal Mortality: The Need for Effective Interventions" - This article analyzes the increasing rates of maternal morbidity and mortality, calling attention to the urgency of implementing comprehensive postpartum care.

4. **Interdisciplinary Care Models in Obstetrics**:
- "Integrating Multidisciplinary Teams in Maternal Healthcare" - This article presents the benefits of collaborative approaches, involving obstetricians, midwives, and other health professionals in enhancing postpartum care.

5. **Social Determinants of Health in Postpartum Care**:
- "The Role of Social Determinants Influencing Maternal Health Outcomes" - This piece emphasizes how social drivers impact health care accessibility and outcomes for postpartum individuals.

6. **Challenges in Screening for Behavioral Health Issues**:
- "Screening for Depression and Anxiety in Postpartum Women: What Clinicians Need to Know" - This article discusses the importance of mental health screenings during postpartum visits and the associated challenges.

7. **Maternity Leave Policies and Maternal Health**:
- "The Impact of Paid Maternity Leave on Maternal Health Outcomes" - The article analyzes how maternity leave policies can influence postpartum recovery and mental health for new mothers.

8. **Follow-Up Care After Birth**:
- "The Importance of Continuity of Care Postpartum: Lessons from Recent Studies" - This article evaluates the role that follow-up visits play in the health outcomes of mothers and infants, stressing the need for improved models of care.

9. **Experiences of Obstetricians vs. Midwives**:
- "Comparing Care Models: Obstetricians and Midwives" - This article discusses the differing approaches between obstetricians and midwives in postpartum care, highlighting patient satisfaction and care effectiveness.

10. **Innovations in Maternal Healthcare Policies**:
- "Transforming Maternal Health Services: Policy Recommendations for Better Care" - Discussing recent health policy initiatives aimed at enhancing maternal care, including the proposed extensions to coverage that address postpartum needs.

These articles collectively highlight various aspects of postpartum care, including clinical practices, policy implications, and the vital role of collaborative care in improving maternal health outcomes.

X-TIMESTAMP-MAP=LOCAL:00:00:00.000,MPEGTS:90000

1
00:00:00.145 --> 00:00:03.325
In the fall of 2023, early 24,

2
00:00:04.145 --> 00:00:07.605
we conducted an, an anonymous online survey

3
00:00:08.265 --> 00:00:11.165
of practicing obstetricians, midwives

4
00:00:11.545 --> 00:00:14.565
and family medicine physicians in California.

5
00:00:15.265 --> 00:00:17.805
We really wanted to understand two issues.

6
00:00:18.785 --> 00:00:21.085
How do clinicians prioritize

7
00:00:21.845 --> 00:00:25.765
multiple clinical responsibilities within their existing

8
00:00:25.795 --> 00:00:27.925
time and resource constraints?

9
00:00:28.825 --> 00:00:33.325
And second, we also wanted to examine to

10
00:00:33.325 --> 00:00:37.605
what extent do clinicians follow AOC guidelines?

11
00:00:37.715 --> 00:00:40.405
That is the American College of Obstetrics

12
00:00:40.465 --> 00:00:44.455
and Gynecology, which issued,

13
00:00:45.135 --> 00:00:46.335
multiple recommendations

14
00:00:46.435 --> 00:00:49.735
to optimize care in the first 12 weeks postpartum

15
00:00:50.475 --> 00:00:55.215
in 2018, they were doing this, in response

16
00:00:55.435 --> 00:00:59.935
to rising concerns about increasing rates

17
00:01:00.035 --> 00:01:01.375
of maternal mortality

18
00:01:01.475 --> 00:01:04.095
and morbidity in the US as well

19
00:01:04.155 --> 00:01:07.175
as large inequalities in maternal health

20
00:01:07.875 --> 00:01:10.495
and growing behavioral health problems.

21
00:01:11.475 --> 00:01:16.375
So the wide ranging recommendations that ACOG issued

22
00:01:17.245 --> 00:01:20.295
include, many different kinds of elements,

23
00:01:20.975 --> 00:01:25.735
clinical care components, family planning,

24
00:01:26.755 --> 00:01:28.855
infant health, social

25
00:01:29.355 --> 00:01:34.295
and social drivers of health, behavioral health,

26
00:01:34.995 --> 00:01:37.215
as well as planning for future care.

27
00:01:38.895 --> 00:01:42.975
Altogether, we identified 26 care components

28
00:01:43.565 --> 00:01:48.015
that AOK recommends, and we focused on those for our study.

29
00:01:48.315 --> 00:01:52.175
We found that clinicians rarely performed

30
00:01:52.715 --> 00:01:56.575
all the postpartum care components recommended by acog.

31
00:01:57.085 --> 00:02:00.815
However, what clinicians did prioritize highly,

32
00:02:01.045 --> 00:02:06.015
they were likely to perform of the 26 care components,

33
00:02:06.395 --> 00:02:08.295
we found that depression

34
00:02:08.295 --> 00:02:13.135
and anxiety, breast health, including breastfeeding issues,

35
00:02:13.965 --> 00:02:15.975
vaginal birth complications,

36
00:02:16.235 --> 00:02:18.255
and family planning counseling,

37
00:02:18.905 --> 00:02:21.575
those four components rank highly

38
00:02:22.275 --> 00:02:26.015
as the top priorities for the first postpartum visit.

39
00:02:27.945 --> 00:02:32.845
We also found that the majority of clinicians reported

40
00:02:32.955 --> 00:02:35.725
that they always check these four components

41
00:02:35.985 --> 00:02:38.005
or check them when the patient needs it.

42
00:02:38.745 --> 00:02:39.845
But in contrast,

43
00:02:40.025 --> 00:02:43.405
and this is our fourth finding care components,

44
00:02:43.555 --> 00:02:48.245
that very few clinicians consider the top priority

45
00:02:49.195 --> 00:02:50.725
more often went and checked,

46
00:02:51.745 --> 00:02:54.685
and such was the case, for instance, for diet

47
00:02:54.825 --> 00:02:56.125
and weight monitoring

48
00:02:56.745 --> 00:03:00.365
and many care components that constitutes social drivers

49
00:03:00.545 --> 00:03:02.845
of health, such as screening

50
00:03:03.185 --> 00:03:06.565
and counseling for intimate partner violence, food

51
00:03:06.565 --> 00:03:11.085
and housing insecurity, substance abuse,

52
00:03:11.945 --> 00:03:16.785
the, the adverse childhood health experiences,

53
00:03:17.405 --> 00:03:20.305
as well as assessment of the work environment,

54
00:03:20.775 --> 00:03:22.705
including maternity leave.

55
00:03:22.965 --> 00:03:26.625
We have been doing a follow-up, study on adherence

56
00:03:27.165 --> 00:03:28.865
to the AOP guidelines,

57
00:03:29.525 --> 00:03:33.825
and we're finding that the median score of, following

58
00:03:33.825 --> 00:03:37.865
through on these components is 62%.

59
00:03:38.015 --> 00:03:40.105
That is 50%

60
00:03:40.165 --> 00:03:44.585
or more of clinicians will complete 62%

61
00:03:44.965 --> 00:03:47.545
of the components,

62
00:03:47.655 --> 00:03:51.265
whereas the other 50% will do less than that.

63
00:03:51.365 --> 00:03:56.305
So obviously there is room for improving,

64
00:03:57.215 --> 00:04:00.465
adherence to performing ACO components.

65
00:04:01.025 --> 00:04:03.145
A quality of care is to improve.

66
00:04:03.355 --> 00:04:04.985
Let's start with the challenges.

67
00:04:05.845 --> 00:04:09.665
Um, aside from assessing anxiety

68
00:04:09.725 --> 00:04:11.065
and depression, as I said,

69
00:04:11.065 --> 00:04:14.385
which are two prevalent conditions in the postpartum

70
00:04:15.135 --> 00:04:18.265
that are often reimbursed by health plans,

71
00:04:19.075 --> 00:04:20.105
other mental health

72
00:04:20.205 --> 00:04:24.345
and social issues might just be too in time intensive

73
00:04:24.605 --> 00:04:25.825
to approach, and

74
00:04:25.895 --> 00:04:28.345
therefore clinicians might be ask skewing them.

75
00:04:29.895 --> 00:04:33.225
Alternatively, I think clinicians may be determining

76
00:04:33.225 --> 00:04:37.305
that patients may just not be ready to absorb

77
00:04:38.145 --> 00:04:41.185
multiple messages at that first postpartum visit.

78
00:04:42.255 --> 00:04:45.145
When they're just beginning to recover from delivery,

79
00:04:45.335 --> 00:04:46.745
they're sleep deprived

80
00:04:47.285 --> 00:04:50.545
and they're transitioning to the new demands

81
00:04:50.935 --> 00:04:54.305
that a new infant, brings at home.

82
00:04:56.045 --> 00:04:59.505
Uh, from another standpoint, patients might be reticent

83
00:04:59.605 --> 00:05:02.065
to discuss social and behavioral issues

84
00:05:02.615 --> 00:05:04.505
because of perceived stigma

85
00:05:04.885 --> 00:05:09.345
or maybe fear of negative consequences, such as,

86
00:05:09.945 --> 00:05:12.585
bringing forth social services involvement,

87
00:05:12.675 --> 00:05:17.105
child protective services, which is not something

88
00:05:17.105 --> 00:05:18.745
that they would look forward to

89
00:05:19.525 --> 00:05:23.305
or else they might be, concerned about costs.

90
00:05:25.225 --> 00:05:29.405
We have in our study been studying specific factors

91
00:05:29.635 --> 00:05:32.925
that might be a associated with adherence

92
00:05:33.145 --> 00:05:34.685
to the ACO guidelines.

93
00:05:35.545 --> 00:05:39.325
And we're finding, interestingly that years of practice

94
00:05:39.905 --> 00:05:43.965
as a clinician is associated with better follow through

95
00:05:43.995 --> 00:05:46.925
with the social and behavioral care components.

96
00:05:48.085 --> 00:05:51.365
I guess that with more years of experience come more skills,

97
00:05:51.795 --> 00:05:54.005
more confidence and efficiency

98
00:05:54.825 --> 00:05:56.725
and maybe this allows clinicians

99
00:05:56.745 --> 00:06:00.925
to feel comfortable facilitating difficult conversations

100
00:06:01.675 --> 00:06:05.045
with their patients to address their social needs.

101
00:06:06.235 --> 00:06:08.965
More years of clinical practice, it turns out,

102
00:06:09.065 --> 00:06:11.125
is also associated with better

103
00:06:11.225 --> 00:06:16.005
or more collaboration with other providers,

104
00:06:16.515 --> 00:06:19.685
such that through evolved networks, they might be able

105
00:06:19.745 --> 00:06:23.285
to address, these social needs

106
00:06:23.545 --> 00:06:25.045
and behavioral guidelines.

107
00:06:25.665 --> 00:06:28.645
So for instance, collaboration with doulas

108
00:06:28.865 --> 00:06:33.645
and lactation consultants, nutritionists, psychologists,

109
00:06:33.665 --> 00:06:38.125
social workers, these are all, collaborations

110
00:06:38.315 --> 00:06:41.725
that might better cover the spectrum of,

111
00:06:42.015 --> 00:06:43.085
postpartum care.

112
00:06:43.525 --> 00:06:45.405
I think that strategies that

113
00:06:45.465 --> 00:06:49.525
and can help, prioritize the social,

114
00:06:50.265 --> 00:06:54.205
behavioral needs, is

115
00:06:55.065 --> 00:06:58.045
one, just what I said, encourage collaboration

116
00:06:58.195 --> 00:07:00.245
with multidisciplinary teams

117
00:07:00.665 --> 00:07:03.525
and interaction with community resources.

118
00:07:04.225 --> 00:07:08.285
We have to understand that many clinical practices are under

119
00:07:08.845 --> 00:07:11.005
resourced to tackle complex social

120
00:07:11.185 --> 00:07:14.925
and behavioral health needs, so that better integration

121
00:07:15.105 --> 00:07:17.045
of community health resources

122
00:07:17.145 --> 00:07:20.685
and promotion of teamwork can be really, really be helpful.

123
00:07:21.745 --> 00:07:24.845
Second, I think that clinicians should be made aware

124
00:07:25.505 --> 00:07:29.565
and understand the social structure of cultural drivers

125
00:07:29.915 --> 00:07:31.205
that affect health

126
00:07:32.065 --> 00:07:36.005
and that promote inequities in practice settings.

127
00:07:36.625 --> 00:07:39.685
And I think that clinicians must also be helped

128
00:07:40.065 --> 00:07:43.005
to feel comfortable screening their patients

129
00:07:43.275 --> 00:07:45.125
through appropriate questions.

130
00:07:46.055 --> 00:07:48.585
Another strategy to consider

131
00:07:49.245 --> 00:07:52.705
is making guidelines more accessible at the point of care

132
00:07:53.215 --> 00:07:55.665
through either electronic medical records

133
00:07:56.045 --> 00:07:59.105
or computerized clinical decision supports.

134
00:07:59.595 --> 00:08:02.145
These reminds the clinician to screen

135
00:08:02.445 --> 00:08:04.745
and monitor key components.

136
00:08:06.285 --> 00:08:11.065
Uh, fourth strategy would be to provide referrals

137
00:08:11.125 --> 00:08:12.745
to appropriate agencies.

138
00:08:13.525 --> 00:08:15.705
And these referrals really need

139
00:08:15.705 --> 00:08:19.705
to be presented in acceptable way that both matches

140
00:08:20.265 --> 00:08:23.985
patients' preferences and enables them to access care.

141
00:08:24.965 --> 00:08:28.625
And finally, I think clinicians could consistently assess

142
00:08:28.625 --> 00:08:31.185
working mother's work environment

143
00:08:31.925 --> 00:08:34.865
and support them to get paid maternity leave

144
00:08:35.005 --> 00:08:37.665
and maternity leave extinctions something

145
00:08:37.665 --> 00:08:40.465
that's not easily done in the us

146
00:08:41.165 --> 00:08:43.385
and also help support them

147
00:08:43.535 --> 00:08:47.465
with work accommodations in the workplace if needed.

148
00:08:47.725 --> 00:08:51.785
As we said, there were these four components that,

149
00:08:52.485 --> 00:08:57.325
all clinicians regardless of type really prioritize highly

150
00:08:57.505 --> 00:08:58.965
and therefore they perform.

151
00:08:59.825 --> 00:09:04.605
But there are others that are perhaps more favored

152
00:09:04.745 --> 00:09:07.285
or unique to obstetricians

153
00:09:07.505 --> 00:09:09.805
and some that are favored by midwives.

154
00:09:09.865 --> 00:09:12.205
So for instance, c-section,

155
00:09:12.335 --> 00:09:16.725
birth complications meaning cesarean, birth complications

156
00:09:17.025 --> 00:09:19.405
and pregnancy related complications.

157
00:09:19.915 --> 00:09:23.325
When there are complications related to let's say diabetes

158
00:09:23.905 --> 00:09:28.565
or hypertension, were ranked highly by the obstetricians,

159
00:09:28.785 --> 00:09:30.165
but not by midwives.

160
00:09:30.705 --> 00:09:34.965
And probably because these elements are at the core of what,

161
00:09:35.625 --> 00:09:39.845
the expertise is of obstetricians, that's

162
00:09:39.845 --> 00:09:40.885
what they're asked to do.

163
00:09:42.465 --> 00:09:44.325
Um, in contrast, social

164
00:09:44.505 --> 00:09:49.445
and emotional support, focusing on the physical recovery

165
00:09:49.695 --> 00:09:52.325
after labor and maternal sleep

166
00:09:53.095 --> 00:09:55.765
we're more ha highly ranked by midwives.

167
00:09:56.605 --> 00:10:01.045
I guess midwives are trained in relationship centered models

168
00:10:01.185 --> 00:10:04.125
of care, and that might help explain differences.

169
00:10:05.365 --> 00:10:10.005
Midwives support the innate capabilities of birthing people

170
00:10:10.585 --> 00:10:13.445
during labor and delivery with breastfeeding

171
00:10:13.585 --> 00:10:15.165
and attachment buildings.

172
00:10:15.355 --> 00:10:18.765
That is one explanation, but it also might be

173
00:10:18.765 --> 00:10:22.685
because it might be related to patients expectations.

174
00:10:23.645 --> 00:10:25.205
Midwives either select

175
00:10:25.205 --> 00:10:26.885
or end up with different types

176
00:10:27.065 --> 00:10:29.645
of patients than obstetricians,

177
00:10:30.305 --> 00:10:33.605
and they also practice in different types of settings.

178
00:10:33.925 --> 00:10:37.445
Midwives in our sample, for instance, were much more likely

179
00:10:37.545 --> 00:10:41.605
to practice in community clinics, community hospitals,

180
00:10:41.665 --> 00:10:46.045
and in private practice, while obstetricians tended

181
00:10:46.165 --> 00:10:50.045
to practice in university and academic settings.

182
00:10:51.095 --> 00:10:54.835
Now, a really interesting finding in our study was

183
00:10:54.835 --> 00:10:58.155
that despite midwives spending an average

184
00:10:59.055 --> 00:11:03.275
of 60 minutes with their patients compared with an average

185
00:11:03.335 --> 00:11:06.915
of 20 minutes by obstetricians at

186
00:11:06.915 --> 00:11:11.755
that first postpartum visit, midwives were not more likely

187
00:11:11.895 --> 00:11:15.915
to prioritize the components of so social drivers of health.

188
00:11:17.055 --> 00:11:20.595
Um, perhaps they do so in subsequent visits.

189
00:11:21.535 --> 00:11:24.435
We know that midwives are more likely to hold,

190
00:11:24.505 --> 00:11:27.595
follow-up visits, with their patients compared

191
00:11:27.595 --> 00:11:28.955
with OBGYNs.

192
00:11:29.665 --> 00:11:34.075
Obstetricians in our study, reported,

193
00:11:34.695 --> 00:11:39.235
that often they did not offer more than one

194
00:11:39.365 --> 00:11:41.515
postpartum visit to their patients.

195
00:11:41.775 --> 00:11:45.995
In fact, 46% reported that they only offered

196
00:11:46.065 --> 00:11:47.235
that single visit.

197
00:11:48.915 --> 00:11:51.295
So we conclude that midwives

198
00:11:51.475 --> 00:11:55.725
and obstetricians perform under different settings,

199
00:11:55.915 --> 00:11:58.645
different models of care, and

200
00:11:58.645 --> 00:12:02.805
therefore a collaborative model of care in which midwives

201
00:12:02.985 --> 00:12:07.005
and OB GYNs work in partnership may be the way

202
00:12:07.005 --> 00:12:10.805
to balance different patient needs in the postpartum.

203
00:12:12.345 --> 00:12:13.725
In the USO,

204
00:12:14.205 --> 00:12:17.805
obstetrician gynecologists outnumber midwives

205
00:12:18.385 --> 00:12:21.965
in many European countries, Australia, New Zealand,

206
00:12:22.275 --> 00:12:26.485
it's the reverse and midwives there are considered the

207
00:12:26.845 --> 00:12:29.485
backbone of the reproductive healthcare system.

208
00:12:30.025 --> 00:12:34.125
So there's certainly a dearth of midwives in California.

209
00:12:34.425 --> 00:12:38.805
Our study participants, men mentioned several Ben benefits

210
00:12:38.865 --> 00:12:43.165
of extending medical to the F fall 12 months

211
00:12:43.165 --> 00:12:47.445
after childbirth because many postpartum conditions

212
00:12:47.705 --> 00:12:52.445
or a cure much beyond the six to eight week window of

213
00:12:52.445 --> 00:12:55.685
that traditional postpartum care, visit.

214
00:12:56.105 --> 00:13:00.165
So extension of Medi-Cal allows

215
00:13:00.225 --> 00:13:02.045
for continuity of care,

216
00:13:03.025 --> 00:13:07.765
and as our participants may mention, continuity

217
00:13:07.905 --> 00:13:12.405
of of care allows for better breastfeeding support,

218
00:13:12.985 --> 00:13:15.245
better assessment, monitoring

219
00:13:15.265 --> 00:13:19.525
and support for conditions such as depression and anxiety.

220
00:13:20.425 --> 00:13:23.325
It improve, it allows for improved management

221
00:13:23.465 --> 00:13:27.445
of chronic diseases and other high risk conditions,

222
00:13:28.385 --> 00:13:29.885
and also empowers mothers

223
00:13:29.905 --> 00:13:33.485
to continue learning about their neuros

224
00:13:33.825 --> 00:13:35.045
as, mothers.

225
00:13:36.905 --> 00:13:39.915
Many women do not have a primary care provider

226
00:13:40.455 --> 00:13:43.475
and do not seek care outside of pregnancy.

227
00:13:43.575 --> 00:13:47.835
So extending care can also allow for more preventive care.

228
00:13:48.865 --> 00:13:52.395
Very quickly at the more at the policy level,

229
00:13:52.895 --> 00:13:55.715
the California Department of Healthcare Services

230
00:13:56.575 --> 00:13:58.355
is transforming Medi-Cal

231
00:13:59.135 --> 00:14:01.395
to enhance maternal health services.

232
00:14:01.815 --> 00:14:05.395
It is working on a birthing pathway initiative

233
00:14:06.565 --> 00:14:10.335
from conception through 12 months of postpartum care.

234
00:14:10.635 --> 00:14:13.375
And that should lead to less fragmentation

235
00:14:14.275 --> 00:14:16.135
and better coordination of care.

236
00:14:17.965 --> 00:14:21.905
So we're hopeful that those policy recommendations,

237
00:14:22.235 --> 00:14:26.945
which are due to come any time this year will be helpful

238
00:14:27.365 --> 00:14:30.425
to the extension of medical coverage.

239
00:14:30.745 --> 00:14:33.465
I think it happened because we put a big emphasis on

240
00:14:33.535 --> 00:14:37.705
recruitment by casting a wide net across the state.

241
00:14:38.445 --> 00:14:40.825
We listed the help of leaders

242
00:14:41.575 --> 00:14:45.425
from several professional organizations such as acog,

243
00:14:45.595 --> 00:14:48.145
California chapter,

244
00:14:48.325 --> 00:14:51.025
the California Maternal Quality Control

245
00:14:51.445 --> 00:14:54.045
Collaborative, which is a very distinguished,

246
00:14:54.045 --> 00:14:57.005
group here in California, March of Dimes.

247
00:14:57.625 --> 00:15:01.045
And also we enlisted collaboration from the California

248
00:15:01.095 --> 00:15:02.565
Department of Public Health.

249
00:15:03.425 --> 00:15:06.005
And all these folks were really excited

250
00:15:06.025 --> 00:15:08.365
to see the STU Study launched.

251
00:15:09.805 --> 00:15:12.385
One my colleague at Stanford University

252
00:15:13.125 --> 00:15:15.225
put effort into recruiting at Stanford.

253
00:15:15.865 --> 00:15:20.585
I cast a large network through my contacts at UCSF,

254
00:15:20.585 --> 00:15:21.665
school of Medicine

255
00:15:21.845 --> 00:15:25.865
and uc, Davis, as well as uc, Berkeley, where I,

256
00:15:26.845 --> 00:15:31.645
I'm part of our champions personally communicated

257
00:15:31.715 --> 00:15:35.685
with their contacts and sent a written announcement that

258
00:15:35.965 --> 00:15:37.605
provided a good description

259
00:15:38.145 --> 00:15:42.485
and linked to the survey requesting that they participate

260
00:15:42.545 --> 00:15:46.325
and several actual participants gave us

261
00:15:46.965 --> 00:15:51.005
feedback saying that they found the survey, enjoyable

262
00:15:51.105 --> 00:15:55.085
to fill out, and they were also very eager to be helpful.

263
00:15:56.655 --> 00:15:58.245
Prior to launching the survey,

264
00:15:58.425 --> 00:16:01.485
we conducted three focus groups with mem members

265
00:16:02.225 --> 00:16:05.805
of the Acco Public Health Committee in California,

266
00:16:06.025 --> 00:16:09.365
and they helped us sharpen the focus of the survey.

267
00:16:10.195 --> 00:16:12.725
They also became staunch supporters

268
00:16:13.785 --> 00:16:16.725
and dedicated their efforts to help us recruit.

269
00:16:18.065 --> 00:16:21.885
We all also offered some soft financial incentives in the

270
00:16:21.885 --> 00:16:25.445
way of a hundred dollars gift cards that we raffled out

271
00:16:25.905 --> 00:16:28.525
to those who had completed data collection.

272
00:16:29.305 --> 00:16:32.645
And I think we got reliable responses, partly

273
00:16:32.645 --> 00:16:36.205
because the survey was anonymous, completed online,

274
00:16:37.105 --> 00:16:39.885
and our consent form alerted clinicians

275
00:16:39.885 --> 00:16:41.605
that they could skip any question

276
00:16:41.635 --> 00:16:43.645
that they did not want to answer.

277
00:16:43.755 --> 00:16:45.765
Fortunately, there weren't many of those.

278
00:16:46.755 --> 00:16:48.685
However, we must acknowledge

279
00:16:48.715 --> 00:16:50.925
that ours was a convenient sample

280
00:16:51.155 --> 00:16:54.725
that may represent motivated clinicians who strive

281
00:16:54.745 --> 00:16:57.045
to improve the quality of postpartum care

282
00:16:57.665 --> 00:17:00.765
and also might have strong opinions about

283
00:17:00.905 --> 00:17:02.445
the delivery of healthcare.

284
00:17:02.905 --> 00:17:05.685
And we're very grateful to those participants

285
00:17:06.265 --> 00:17:08.365
for giving us insight into

286
00:17:08.395 --> 00:17:11.725
what is happening in the postpartum care from the

287
00:17:11.725 --> 00:17:14.365
clinician's point of view here in California.

Examining Postpartum Care Prioritization Among California Clinicians

00:00:00 - In the fall of 2023, early 24, we conducted an, an anonymous online survey of practicing obstetricians, midwives and family medicine physicians in California. We really wanted to understand two issues. How do clinicians prioritize multiple clinical responsibilities within their existing time and resource constraints? And second, we also wanted to examine to

00:00:37 - That is the American College of Obstetrics and Gynecology, which issued, multiple recommendations to optimize care in the first 12 weeks postpartum in 2018, they were doing this, in response to rising concerns about increasing rates of maternal mortality and morbidity in the US as well

00:01:07 - and growing behavioral health problems. So the wide ranging recommendations that ACOG issued include, many different kinds of elements, clinical care components, family planning, infant health, social and social drivers of health, behavioral health,

Prioritization of Postpartum Care Components by Clinicians

00:01:38 - Altogether, we identified 26 care components that AOK recommends, and we focused on those for our study. We found that clinicians rarely performed all the postpartum care components recommended by acog. However, what clinicians did prioritize highly, they were likely to perform of the 26 care components,

00:02:08 - and anxiety, breast health, including breastfeeding issues, vaginal birth complications, and family planning counseling, those four components rank highly as the top priorities for the first postpartum visit. We also found that the majority of clinicians reported that they always check these four components or check them when the patient needs it.

00:02:40 - and this is our fourth finding care components, that very few clinicians consider the top priority more often went and checked, and such was the case, for instance, for diet and weight monitoring and many care components that constitutes social drivers of health, such as screening and counseling for intimate partner violence, food and housing insecurity, substance abuse,

Challenges in Postpartum Care Adherence

00:03:17 - as well as assessment of the work environment, including maternity leave. We have been doing a follow-up, study on adherence to the AOP guidelines, and we're finding that the median score of, following through on these components is 62%. That is 50% or more of clinicians will complete 62%

00:03:47 - whereas the other 50% will do less than that. So obviously there is room for improving, adherence to performing ACO components. A quality of care is to improve. Let's start with the challenges. aside from assessing anxiety and depression, as I said, which are two prevalent conditions in the postpartum

00:04:19 - other mental health and social issues might just be too in time intensive to approach, and therefore clinicians might be ask skewing them. Alternatively, I think clinicians may be determining that patients may just not be ready to absorb multiple messages at that first postpartum visit. When they're just beginning to recover from delivery,

Barriers to Discussing Postpartum Care

00:04:47 - and they're transitioning to the new demands that a new infant, brings at home. from another standpoint, patients might be reticent to discuss social and behavioral issues because of perceived stigma or maybe fear of negative consequences, such as, bringing forth social services involvement, child protective services, which is not something

00:05:19 - or else they might be, concerned about costs. We have in our study been studying specific factors that might be a associated with adherence to the ACO guidelines. And we're finding, interestingly that years of practice as a clinician is associated with better follow through with the social and behavioral care components.

00:05:51 - more confidence and efficiency and maybe this allows clinicians to feel comfortable facilitating difficult conversations with their patients to address their social needs. More years of clinical practice, it turns out, is also associated with better or more collaboration with other providers, such that through evolved networks, they might be able

Enhancing Postpartum Care through Collaborative Strategies

00:06:23 - and behavioral guidelines. So for instance, collaboration with doulas and lactation consultants, nutritionists, psychologists, social workers, these are all, collaborations that might better cover the spectrum of, postpartum care. I think that strategies that and can help, prioritize the social,

00:06:55 - one, just what I said, encourage collaboration with multidisciplinary teams and interaction with community resources. We have to understand that many clinical practices are under resourced to tackle complex social and behavioral health needs, so that better integration of community health resources and promotion of teamwork can be really, really be helpful.

00:07:25 - and understand the social structure of cultural drivers that affect health and that promote inequities in practice settings. And I think that clinicians must also be helped to feel comfortable screening their patients through appropriate questions. Another strategy to consider is making guidelines more accessible at the point of care

Enhancing Postpartum Care: Strategies for Support and Referral

00:07:56 - or computerized clinical decision supports. These reminds the clinician to screen and monitor key components. fourth strategy would be to provide referrals to appropriate agencies. And these referrals really need to be presented in acceptable way that both matches patients' preferences and enables them to access care.

00:08:28 - working mother's work environment and support them to get paid maternity leave and maternity leave extinctions something that's not easily done in the us and also help support them with work accommodations in the workplace if needed. As we said, there were these four components that, all clinicians regardless of type really prioritize highly

00:08:59 - But there are others that are perhaps more favored or unique to obstetricians and some that are favored by midwives. So for instance, c-section, birth complications meaning cesarean, birth complications and pregnancy related complications. When there are complications related to let's say diabetes or hypertension, were ranked highly by the obstetricians,

Contrasting Care Approaches: Obstetricians vs. Midwives

00:09:30 - And probably because these elements are at the core of what, the expertise is of obstetricians, that's what they're asked to do. in contrast, social and emotional support, focusing on the physical recovery after labor and maternal sleep we're more ha highly ranked by midwives. I guess midwives are trained in relationship centered models

00:10:05 - Midwives support the innate capabilities of birthing people during labor and delivery with breastfeeding and attachment buildings. That is one explanation, but it also might be because it might be related to patients expectations. Midwives either select or end up with different types of patients than obstetricians, and they also practice in different types of settings.

00:10:37 - to practice in community clinics, community hospitals, and in private practice, while obstetricians tended to practice in university and academic settings. Now, a really interesting finding in our study was that despite midwives spending an average of 60 minutes with their patients compared with an average of 20 minutes by obstetricians at

Collaboration Between Midwives and Obstetricians in Postpartum Care

00:11:11 - to prioritize the components of so social drivers of health. perhaps they do so in subsequent visits. We know that midwives are more likely to hold, follow-up visits, with their patients compared with OBGYNs. Obstetricians in our study, reported, that often they did not offer more than one

00:11:41 - In fact, 46% reported that they only offered that single visit. So we conclude that midwives and obstetricians perform under different settings, different models of care, and therefore a collaborative model of care in which midwives and OB GYNs work in partnership may be the way to balance different patient needs in the postpartum.

00:12:14 - obstetrician gynecologists outnumber midwives in many European countries, Australia, New Zealand, it's the reverse and midwives there are considered the backbone of the reproductive healthcare system. So there's certainly a dearth of midwives in California. Our study participants, men mentioned several Ben benefits of extending medical to the F fall 12 months

Enhancing Postpartum Care Through Medi-Cal Expansion

00:12:47 - or a cure much beyond the six to eight week window of that traditional postpartum care, visit. So extension of Medi-Cal allows for continuity of care, and as our participants may mention, continuity of of care allows for better breastfeeding support, better assessment, monitoring

00:13:20 - It improve, it allows for improved management of chronic diseases and other high risk conditions, and also empowers mothers to continue learning about their neuros as, mothers. Many women do not have a primary care provider and do not seek care outside of pregnancy. So extending care can also allow for more preventive care.

00:13:52 - the California Department of Healthcare Services is transforming Medi-Cal to enhance maternal health services. It is working on a birthing pathway initiative from conception through 12 months of postpartum care. And that should lead to less fragmentation and better coordination of care. So we're hopeful that those policy recommendations,

Collaborative Efforts in Expanding Medical Coverage

00:14:27 - to the extension of medical coverage. I think it happened because we put a big emphasis on recruitment by casting a wide net across the state. We listed the help of leaders from several professional organizations such as acog, California chapter, the California Maternal Quality Control Collaborative, which is a very distinguished,

00:14:57 - And also we enlisted collaboration from the California Department of Public Health. And all these folks were really excited to see the STU Study launched. One my colleague at Stanford University put effort into recruiting at Stanford. I cast a large network through my contacts at UCSF, school of Medicine and uc, Davis, as well as uc, Berkeley, where I,

00:15:31 - with their contacts and sent a written announcement that provided a good description and linked to the survey requesting that they participate and several actual participants gave us feedback saying that they found the survey, enjoyable to fill out, and they were also very eager to be helpful. Prior to launching the survey,

Engaging Clinicians for Improved Postpartum Care

00:16:02 - of the Acco Public Health Committee in California, and they helped us sharpen the focus of the survey. They also became staunch supporters and dedicated their efforts to help us recruit. We all also offered some soft financial incentives in the way of a hundred dollars gift cards that we raffled out to those who had completed data collection.

00:16:32 - because the survey was anonymous, completed online, and our consent form alerted clinicians that they could skip any question that they did not want to answer. Fortunately, there weren't many of those. However, we must acknowledge that ours was a convenient sample that may represent motivated clinicians who strive to improve the quality of postpartum care and also might have strong opinions about

00:17:11 - And we're very grateful to those participants for giving us insight into what is happening in the postpartum care from the clinician's point of view here in California.

Faculti AI can make mistakes

Faculti

Popular in Professional

Human Rights and Corruption: Problems and Potential of Individualising a Systemic Problem

A statistical approach to law school citation rankings

High school change

What is constitutional ideology?

Politics, Identity, and Class Certification on the U.S. Courts of Appeals

The City as a Growth Machine: Toward a Political Economy of Place

The Role of Education in Reducing Racial Inequality

Clinician care priorities and practices in the fourth trimester

Next in Medicine

Guide

Platform and Category Pages

Contact Us

FAQs

What is Faculti?

How do you select interviews?

Interview Process

Page Structure

Popular in Professional

Guide

Platform and Category Pages

Contact Us

FAQs

What is Faculti?

How do you select interviews?

Interview Process

Accessibility Options

Contrast Adjustment

Text Size Adjustment

Text Spacing Adjustment

Line Height Adjustment

Cursor Size Adjustment

Page Structure Options

Page Structure