Sarah Verbiest1, Renée Ferrari2, Christine Tucker3, Erin K McClain4, Nkechi Charles3, Alison M Stuebe5. 1. University of North Carolina at Chapel Hill School of Medicine and School of Social Work, Chapel Hill, North Carolina (S.V.). 2. University of North Carolina at Chapel Hill Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina (R.F.). 3. University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina (C.T., N.C.). 4. University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina (E.K.M.). 5. University of North Carolina at Chapel Hill School of Medicine and the Gillings School of Global Public Health, Chapel Hill, North Carolina (A.M.S.).
Abstract
BACKGROUND: Mothers with babies in the neonatal intensive care unit (NICU) face a host of challenges following childbirth. Limited information is available on these mothers' postpartum health needs and access to services. OBJECTIVE: To identify health needs of NICU mothers, access to services, and potential service improvements. DESIGN: A mixed-methods study including a retrospective cohort study, in-depth interviews, and focus groups. SETTING: Large, Level IV, regional referral, university-affiliated hospital in the United States. PARTICIPANTS: Mothers of live-born infants born from 1 July 2014 to 30 June 2016 (n = 6849). Interviews included 50 NICU mothers and 59 stakeholders who provide services to these mothers or their infants. MEASUREMENTS: Severe maternal morbidity, chronic health conditions, health care encounters from discharge through 12 weeks postpartum, maternal health needs, care access, and system improvements. RESULTS: Compared with mothers of well babies, NICU mothers had more chronic diseases, experienced more perinatal complications, and utilized more acute care postpartum. Qualitative analyses revealed the desire to be at the baby's bedside as a driver of maternal health-seeking behaviors, with women not seeking or delaying medical care so as to stay by their infant. Stakeholders acknowledged the unique needs of NICU mothers and cited system challenges, lack of clarity about provider roles, and reimbursement policies as barriers to meeting needs. LIMITATIONS: The study was conducted within a single health care system, which may limit generalizability. Qualitative analyses did not explore the influence of fathers, other children in the home, or length of NICU stay. CONCLUSION: Universal screening and convenient access to maternal health services for NICU mothers should be explored to reduce adverse maternal health outcomes. PRIMARY FUNDING SOURCE: Maternal and Child Health Bureau, Health Resources and Services Administration, U.S. Department of Health and Human Services.
BACKGROUND: Mothers with babies in the neonatal intensive care unit (NICU) face a host of challenges following childbirth. Limited information is available on these mothers' postpartum health needs and access to services. OBJECTIVE: To identify health needs of NICU mothers, access to services, and potential service improvements. DESIGN: A mixed-methods study including a retrospective cohort study, in-depth interviews, and focus groups. SETTING: Large, Level IV, regional referral, university-affiliated hospital in the United States. PARTICIPANTS: Mothers of live-born infants born from 1 July 2014 to 30 June 2016 (n = 6849). Interviews included 50 NICU mothers and 59 stakeholders who provide services to these mothers or their infants. MEASUREMENTS: Severe maternal morbidity, chronic health conditions, health care encounters from discharge through 12 weeks postpartum, maternal health needs, care access, and system improvements. RESULTS: Compared with mothers of well babies, NICU mothers had more chronic diseases, experienced more perinatal complications, and utilized more acute care postpartum. Qualitative analyses revealed the desire to be at the baby's bedside as a driver of maternal health-seeking behaviors, with women not seeking or delaying medical care so as to stay by their infant. Stakeholders acknowledged the unique needs of NICU mothers and cited system challenges, lack of clarity about provider roles, and reimbursement policies as barriers to meeting needs. LIMITATIONS: The study was conducted within a single health care system, which may limit generalizability. Qualitative analyses did not explore the influence of fathers, other children in the home, or length of NICU stay. CONCLUSION: Universal screening and convenient access to maternal health services for NICU mothers should be explored to reduce adverse maternal health outcomes. PRIMARY FUNDING SOURCE: Maternal and Child Health Bureau, Health Resources and Services Administration, U.S. Department of Health and Human Services.