CHSU Discovery

Abstract

Context and Objectives: Postpartum health is in crisis in the United States, with rising pregnancy-related mortality and worsening racial inequities. The World Health Organization recommends four postpartum visits during the six weeks after childbirth, yet standard postpartum care in the US is generally one visit six weeks after birth. We present community midwifery postpartum care in the US as a model concordant with WHO guidelines, describing this model of care and its potential to improve care for birthing people and babies.
Setting/Populations: Community midwives provide perinatal care in homes and free-standing birth centers, and include Certified Nurse-Midwives (CNMs) Certified Professional Midwives (CPMs), and Licensed Midwives in CA. Intervention/Study Design: We conducted semi-structured interviews with 34 community midwives in Oregon and California. A multidisciplinary team analyzed qualitative data using reflexive thematic analysis.
Outcomes/Results: Fourteen midwives identified as people of color; 22 spoke multiple languages. Across 34 midwives, we found a consistent model of care for postpartum families including five key elements: 1) care for the parent- infant dyad; 2) continuity of personalized care; 3) relationship-centered care; 4) planning and preparation for postpartum; 5) focus on postpartum rest. The community midwifery model of postpartum care is structured, yet flexible and individualized, and involves caring for birthing parents and babies as a unit. The comprehensive dyad approach encompasses postpartum and well-baby care, typically involving 5 to 8 visits in the 6 weeks after birth. We found numerous barriers to expanding access to this model of care. Though all midwives in the study wanted to care for people insured through Medicaid, only 12 were Medicaid providers. Midwives detailed potential changes to state Medicaid policy that would greatly increase access to their care.
Conclusion: The community midwifery model of postpartum care is a guideline-concordant approach to caring for the parent-infant dyad. Addressing structural barriers to access and sustainability of community midwifery care is key to achieving perinatal health equity.

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