Key Clinical Issue

What are the results of the use of postpartum care and the clinical outcomes of that care up to one year after pregnancy that was affected by alternative strategies for postpartum health care delivery and extension of postpartum health insurance coverage?

Evidence-Based Answer

More comprehensive insurance is probably associated with increased postpartum care–visit attendance. (Strength of Recommendation [SOR]: B, inconsistent or limited-quality patient-oriented outcomes.) More comprehensive insurance, including during the postpartum period, may be associated with fewer preventable emergency department visits and hospital readmissions. (SOR: B, inconsistent or limited-quality patient-oriented outcomes.) The way that postpartum care is delivered—at home or via telephone—may not affect depression and anxiety symptoms compared with visits in the clinic. (SOR: B, inconsistent or limited-quality patient-oriented outcomes.) Breastfeeding support delivered in the patient's home vs. the pediatrics clinic may not affect depression and anxiety symptoms, hospital readmission rates, and use of unplanned care. (SOR: B, inconsistent or limited-quality patient-oriented outcomes.) Regarding timing of care, earlier vs. later postpartum contraceptive care probably results in similar intrauterine device continuation rates at three and six months and greater implant use at six months. (SOR: B, inconsistent or limited-quality patient-oriented outcomes.) Peer support and lactation consultant care for breastfeeding probably enhance breastfeeding rates in the first six months postpartum, but there was insufficient evidence regarding the impact of who provides care on other clinical outcomes or use of care. (SOR: B, inconsistent or limited-quality patient-oriented outcomes.) Completion reminders probably increase adherence rates to oral glucose tolerance testing.¹ (SOR: B, inconsistent or limited-quality patient-oriented outcomes.)