Background:
Experiencing an adverse outcome in a previous pregnancy is an important predictor of future reproductive risk. Postpartum visits are an opportunity to link women to interventions designed to reduce risks to them and their future children. Nationally, only 55% of women covered by Medicaid receive postpartum checkups. The BHSI provides case management services to low-income black women in Boston and their infants up to 2 years postpartum.

Objectives:
To examine the use of postpartum care for the BHSI women who experienced adverse pregnancy outcomes.

Methods:
We analyzed the BHSI program data for women who delivered between 6/1/2005 and 12/31/2006. We calculated the percent use of postpartum services for women whose pregnancies ended with and without adverse outcomes, and compared the differences in services used between two groups using chi-square statistics. An adverse pregnancy outcome was defined as fetal loss, infant death, premature birth or low birth weight.

Results:
Of the 738 BHSI women who delivered between 6/1/2005 and 12/31/2006, 220 experienced fetal loss (N=5), infant deaths (N=2), premature births (N=85), or low birth weight (N=188). Within 8 weeks postpartum, 184 (84%) of them received at least one home visit and 165 (75%) had a medical visit. Four out of five (80%) received depression screening 8 weeks after delivery and less than three-quarters (71%) were connected to primary care. During the postpartum period, 61% received education on nutrition, 54% on family planning, and 18% on smoking/alcohol use. Compared to BHSI women without adverse outcomes, those with adverse outcomes were less likely to have a medical visit within 8 weeks postpartum (83% vs. 75%, p<0.01), while more likely to receive education on nutrition (52% vs. 61%, p<0.05).

Conclusion and implications for practice:
A higher proportion of the BHSI women had postpartum visits compared to national Medicaid women. However, a considerable proportion of those with adverse outcomes did not use postpartum care. Continuous efforts to ensure the use of postpartum care and studies to understand the reasons for not using postpartum services are needed for all the BHSI participants, especially those with adverse outcomes.