Postpartum care in the neonatal intensive care unit, PeliCaN: a randomized controlled trial

Abstract

BACKGROUND

Postpartum parents of hospitalized infants in neonatal intensive care units have higher rates of chronic disease and pregnancy complications than parents of well newborns. Neonatal intensive care unit parents may prioritize remaining at their infants’ bedsides over their healthcare.

OBJECTIVE

This study aimed to determine whether embedding doulas and certified nurse midwives for postpartum care in the neonatal intensive care unit (PeliCaN) would reduce the time to receive postpartum healthcare, with the hypothesis that the intervention would shorten the time and improve the comprehensiveness of postpartum care.

STUDY DESIGN

This was a parallel randomized controlled trial from November 29, 2022, to November 7, 2023, in a single-center, level 3 neonatal intensive care unit in a tertiary hospital in Philadelphia, Pennsylvania, with approximately 4200 births annually. Postpartum parents of infants who were born at <34 weeks of gestation, <2 weeks old, and anticipated to remain in the neonatal intensive care unit ≥1 week, were eligible. Of the 135 potentially eligible parents, the staff screened 78 for eligibility (constrained by access to just 4 hours per week of midwifery care), contacted 52 of 71 eligible parents, and enrolled 37 by 2 weeks after delivery. There were 20 parents randomized to the intervention group and 17 parents randomized to the control group via block randomization stratified by gestational age (<29 and ≥29 weeks) and insurance (public and private). The intervention consisted of postpartum doula support and midwifery clinical care in the neonatal intensive care unit for the duration of the infant’s hospitalization. Participants in the control group received usual care. The outcomes were measured at 12 weeks after delivery. All participants had complete follow-up data. The primary outcome was days to receive any postpartum care and to completion of 3 care components: blood pressure measurement and treatment if needed; depression screening and referral and treatment if indicated; and contraception counseling (if no sterilization procedure had been performed) and provision if patients desired. Planned secondary analyses included stratification by gestational age and insurance as well as assessing the rates of any postpartum care receipt.

RESULTS

Six participants (30.0%) in the intervention group and 6 participants (35.0%) in the control group were parents of infants born at <29 weeks of gestation, and 16 participants (80.0%) in the intervention group and 15 participants (88.2%) in the control group were publicly insured. The median times to the first postpartum visit were 11 days (interquartile range, 10–12) in the intervention group and 31 days (interquartile range, 26–37) in the control group (P<.001). In addition, 1 participant (5%) in the intervention group and 6 participants (35%) in the control group missed at least 1 of 3 care components, most commonly blood pressure measurements. Of note, 4 participants (23%) in the control group did not have a blood pressure measurement, one of whom had preeclampsia. There were no differences in outcomes by infant gestational age or insurance.

CONCLUSION

In this single-center randomized controlled trial, the postpartum care in the neonatal intensive care unit model of on-site doula and midwifery care, PeliCaN, expedited and enhanced postpartum care. Multicenter trials and implementation science work are urgently needed to establish broader utility and feasibility.