Implementation and Evaluation of Postpartum Midwifery Care at Home at a Federally
Qualified Health Center in Washington, DC
#MMPMID41341078
DePalma K
; Marcelle E
; Clark E
; O'Brien T
; Chimata S
; Eliason E
; Muhammad B
; Stamm S
; Vernot-Jonas N
; Olowski P
; Sherman D
; Marea CX
Health Equity
2025[]; 9
(1
): 618-630
PMID41341078
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BACKGROUND: The postpartum period is a critical time to support birthing people
and infants, address and mitigate perinatal health inequities, and promote joy
and connection. Yet many birthing people do not perceive value in postpartum
visits, particularly when measured against the competing demands and barriers to
care faced by those experiencing poverty and other systemic oppression. These
inequities are particularly acute for Black birthing people insured by Medicaid
due to structural and interpersonal racism, as well as economic
disenfranchisement. We implemented an opt-in postpartum care at home program led
by midwives at a federally qualified health center to increase the perceived
value of postpartum care and increase patient engagement. METHODS: We evaluated
implementation using the reach, effectiveness, adoption, implementation, and
maintenance framework. We assessed reach and effectiveness using electronic
health record data for 2022 (pre-implementation) and 2023 (implementation).
RESULTS: Among 473 birthing people eligible during the evaluation period, 118
(28%) had a postpartum home care visit. Postpartum visit attendance rates
increased from 78% in 2022 to 84% in 2023. In-home postpartum care increased
family involvement, enabled longer and more comprehensive visits, and improved
provider satisfaction. CONCLUSIONS: Postpartum care at home can reduce barriers
to care, increase visit attendance, and promote joy. In-home postpartum care with
a midwife has the potential to mitigate health inequities experienced by Black
birthing people by fostering trust and shifting the power dynamic in the
patient-provider relationship. Community-based care must be designed and
implemented with antiracist and emancipatory approaches.
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