Factors in Accessing Routine Health Care: Mental Health and Postpartum Mothers.

OBJECTIVES: One strategy proposed to decrease the maternal mortality and morbidity in the United States is to increase the rate which new mothers access routine postpartum care. Using Missouri's Pregnancy Risk Assessment Monitoring System (MO PRAMS) data, this retrospective study analyzed whether a self-reported history of depressive symptoms during the postpartum period was associated with a decreased rate of accessing the postpartum care visit (PPCV). METHODS: Data were collected on 7,357 new mothers who completed the Missouri PRAMS survey between 2009-2014. New mothers, in the Missouri's registry of birth certificates who have given birth in the last 2-4 months, were randomly selected for inclusion in the survey. A mixed-mode survey method with a prescribed protocol for data collection was utilized. RESULTS: Fourteen percent of the respondents (1,093 new mothers) reported symptoms associated with postpartum depression. A logistic regression analysis showed that among these women a weak association was found between not accessing routine PPCV and the report of depressive symptoms (p=.0254; OR=1.344 with 95%CI=1.037-1.741). This association is a new finding. CONCLUSIONS: The study finds a weakly negative association between self-reported symptoms of postpartum depression and accessing routine postpartum care. As this is a new finding, further research is needed for verification of this association.

A Retrospective Study on Infant Bed-sharing in a Clinical Practice Located in an Urban Cluster.

OBJECTIVES: This retrospective study evaluates infant bed-sharing at a Missouri family practice with OB care. METHODS: After Institutional Review Board (IRB) approval, data were extracted from the first four well-child visits of 2374 infants between Sept. 2003 and Dec. 20 11. RESULTS: Bed-sharing decreased after 2005 (25%, 39%, respectively, p = 0.000). For infants who bed-shared, the frequency of bed-sharing did not decline. CONCLUSIONS: Nearly 20% of infants bed-share before the first visit; safe sleep prenatal education is warranted.

A retrospective study on infant bed-sharing in a clinical practice population.

In 2005 the American Academy of Pediatrics published new recommendations on infant sleep environment which advised against infants bed-sharing. A retrospective study was done to determine the prevalence of infant bed-sharing and its associations in a clinical practice. Demographic data were collected from 2,405 infants from a large family practice residency program, which included OB care, in Missouri between March 2002 and February 2008. Data were extracted from electronic medical records at the first four well-child visits: 1 month, 2-3 months, 4-5 months, and 6-8 months of age. Data analysis was performed using SPSS statistical software package, version 12.0 and 15.0 (SPSS, Inc, Chicago, Ill). At the first, second, third, and fourth well-child visit 19, 18, 12, and 11% of infants bed-shared with an adult. Bed-sharing was associated with an infant missing one or more well-child visits (first and third visits only), breastfeeding (first and second well-child visits only), and low SES. Stratified analysis by residence showed that over the 6-year study the decrease in the rate of bed-sharing, in the urban and non-urban areas, was statistically significant (P = 0.005, 0.04, respectively). Infants born 2006-2007 had a decreased rate of bed-sharing compared to infants born 2002-2005 (0.22, 0.30, respectively, P = 0.00). In light of the high rate of bed-sharing recorded at the first well-child visit, the researchers recommend an increased emphasis on safe sleeping education during the third trimester of pregnancy.