A Qualitative Study of Provider Perspectives on Barriers and Facilitators to Optimal Postpartum Care for High-Risk Patients.

Abstract

Despite the existence of guidelines on optimal postpartum care from the American College of Obstetricians and Gynecologists, gaps in their implementation persist, particularly for high-risk patients. This case study explores provider perspectives on barriers and facilitators to postpartum care for high-risk patients and reflections on a specialized postpartum clinic's strategies to address them. Ten months after launching a specialized clinic in the United States for high-risk postpartum patients, we conducted semi structured interviews (April-July 2023) with 7 key providers involved in implementation and care delivery. Data were analyzed using thematic analysis with themes mapped to a social ecological framework. Providers cited individual-level barriers to postpartum care, such as traumatic birth experiences, complex social needs, and medical mistrust. Organizational factors, such as poor communication with patients and between providers, were identified as contributors to poor transitions of care and loss to follow up. The community health worker (CHW) from the postpartum clinic was viewed as an effective resource in building trust and addressing logistical challenges, like childcare and transportation. Providers viewed a multidisciplinary care model with CHW support as a promising strategy to reduce barriers to high-quality postpartum care for high-risk patients.