Improving Postpartum Follow-Up with Telehealth: Did the Pandemic Nudge Us in a Better Direction?

Objective: To investigate if a telehealth option as the initial postpartum visit would increase postpartum visit attendance.

Methods: This was a retrospective cohort study of women receiving prenatal care through a federally qualified health center, Westside Family Health in Delaware, comparing attendance at a postpartum visit before telehealth was an option (2018) versus after the onset of the pandemic (2021). Representative random samples were taken from one year of deliveries pre- and post-implementation of the telehealth visit option. The primary outcome of this study was attendance of any postpartum visit before and after the option of a telehealth visit.

Results: A total of 700 subjects were enrolled, with 349 subjects pre-telehealth and 351 subjects post-telehealth implementation. Our population was >50% Hispanic/Latina and >40% Spanish- speaking. The post-implementation group had a significantly higher attendance of the postpartum visit (83.95% vs. 90.60%, p-value 0.0092, OR 1.887, 95% CI 1.171-3.043).

Conclusion: There was a significant increase in the rate of postpartum visit attendance with the addition of a telehealth visit option. Postpartum depression screening was negatively impacted by the introduction of the telehealth visit.

Public health implications: The recommendation for all women post-delivery is to see their obstetric provider within the first 3 weeks postpartum. This includes assessing for complications, postpartum wellness and interconception care planning before 12 weeks post-delivery. We found that there was a significant increase in the rate of postpartum visit attendance with the addition of a telehealth visit option. Telemedicine has increased dramatically with the COVID-19 pandemic, and patients are satisfied with telehealth as an option for care. Telemedicine offers the convenience of portable health care. However, those in underserved populations may or may not be able to access care through telemedicine, as telehealth requires reliable internet service, a smartphone or computer, and digital literacy. Lack of access to any of these may create health care disparities, especially in disadvantaged or vulnerable populations.