Low-Income Moms Use ER for Postpartum Care

A new study looks at how poor postpartum care may be sending more low-income moms to the ER—well before their six-week postpartum checkup. Here's why it's a problem.

Low-Income Moms Use ER for Postpartum Care Monkey Business Images/Shutterstock

Low-income women are not receiving the postpartum care they need after birth and, as a result, are visiting the ER in droves, according to a new study published in the Journal of Women's Health.

Researchers at Johns Hopkins found that moms under age 25 with preexisting pregnancy-related medical conditions are most likely to seek emergency room care, even before the recommended six-week postpartum checkup.

What's driving women to the ER?

About a quarter of the 26,047 Medicaid-insured Maryland women studied visited the ER within six months post-delivery, many of whom cited complications from pregnancy conditions like Gestational diabetes, gestational hypertension, and preeclampsia. Women with these conditions were 14 percent more likely to visit the emergency room, while moms under age 25 were 20 percent more likely to seek out emergency care and having a C-section also increased a woman's risk.

The most eye-opening statistic to come out of the study? Sixty percent of these visits took place before the six-week postpartum checkup covered by Medicaid, suggesting that six weeks is too long to wait to examine women with complicated pregnancies.

"Our results offer clues to opportunities to improve the postpartum and longer-term health of many low-income women. Further study might lead to interventions and programs that target these women for intensive discharge planning and follow-up care that could improve access to care and prevent ER use," said the study's lead author Ashley Harris, M.D., M.H.S., a senior clinical fellow in the Johns Hopkins University School of Medicine's Division of General Internal Medicine.

Certain social and economic factors, such as lack of access to child care and inflexible job schedules, may explain why the ER is being used instead of a woman's OBGYN, as could a lack of education around the long-term health implications of pregnancy complications.

Postpartum care: What to expect

The ideal postpartum care for women with a recent medically complicated pregnancy should involve several components, co-author Wendy Bennett, M.D., M.P.H., an assistant professor of medicine at Johns Hopkins, told Fit Pregnancy. "First, before she leaves the hospital, her providers will want to assess her readiness to be discharged home. Hospital stays for postpartum women are much shorter than they were in the past," she says. "Those women who have had complicated pregnancies may need a more intensive discharge plan, such as setting up phone follow-up with a nurse or social work, a home visit if a home visitation program is available, or a sooner outpatient obstetric visit to make sure she is doing well. We are also finding that it is helpful to set up mom's six-week postpartum visit before she even leaves the hospital—one less thing for her to think about."

Bennett says moms should keep in touch with their doctor's offices after giving birth if they are experiencing any problems, including feeling down or trouble with breastfeeding. "Sometimes the pediatrician's office can also be a helpful resource for many women, and there are also community resources such as breastfeeding hotlines and WIC nutrition programs, as well as support groups to prevent postpartum depression," she adds.

Lastly, it's most important to make your six-week postpartum appointment, which, according to Bennett, is more than just a check-up: "It is an opportunity to review the pregnancy, especially if there were complications, get on appropriate birth control, get approval to go back to work and learn about how to lose postpartum weight."