AMHERST — The American College of Obstetricians and Gynecologists (ACOG) recommends that those who give birth receive a comprehensive postpartum checkup no later than 12 weeks after delivery. But according to new a study by University of Massachusetts researchers, most who get these screenings receive fewer than half of the recommended services.
The study, led by UMass assistant professors of health policy and management Kimberley Geissler and Laura Attanasio, used information from a sample of 650 postpartum visits and found that “the overall delivery of recommended services were low,” Geissler said. It was published Nov. 10 in JAMA Network Open, an open access journal of the American Medical Association.
One of the most striking findings was a “surprisingly low” rate of depression screenings, with only one in 11 women screened, Geissler said.
This statistic was striking not only for its low incidence, but because of the increased attention that postpartum depression has received in recent years, Geissler said. According to the U.S. Office on Women’s health, one in nine women experience postpartum depression, and depression screenings are recommended by the ACOG.
“Doctors are becoming increasingly aware of how many women experience postpartum depression, and there’s been a real emphasis on making sure women are screened and referred to appropriate treatment,” Geissler said.
“Basically, 100% of women should be screened for postpartum depression, and we found much lower numbers than that.”
Attanasio agreed the the low incidence of depression screenings was particularly troubling.
“We need to look at why depression screening is not happening,” she said in a statement. “This is an important factor in women’s health for the rest of their lives. Even if you’re missing some of the recommended services, this one should be universal among this population.”
In addition to depression screenings, ACOG recommends services such as blood pressure screening, pelvic and breast exams, and contraceptive counseling.
Some services occurred commonly, such as blood pressure screening, which was provided at 91% of visits. But pelvic exams were performed at just 47% of checkups, breast exams at 22% and contraceptive counselor or provision at 44%.
While the research did not focus on why recommended services are often skipped over, Geissler suspects that physicians may be stretched thin and short on time
“There’s this very long list of recommended services, and we found that visit times last around 17 minutes,” Geissler said, “so there’s a lot of ground to cover in a very short time period.”
While the researchers aren’t certain if this is the primary driver of their findings, “it certainly is an indicator that maybe physicians don’t have enough time to go through all of the different things that the guidelines recommend that they do,” Geissler said.
The research relies on what physicians noted during the visits, Geissler said, meaning that it’s possible that some services, such as depression screening, were carried out but not noted.
But “it’s important to know whether or not they were screened,” Geissler said. “It’s important to know how they were doing at the time,” she added, noting that recent research shows that postpartum depression can show up later than was recently expected.
While previous research has shown that most patients using Medicaid receive fewer preventative services than those with private insurance, the study found little difference in the services provided to these two groups.
“It wasn’t necessarily that women with Medicaid were doing worse,,” Geissler said, “it was that both groups were doing not as well as we expected.”
Most research so far has looked at how many women follow up with these visits after giving birth, according to Geissler. But with more attention to what services are provided, she said, researchers can gain a better understanding of what happens during these visits and use the information to improve services.
The research sample was drawn from a National Ambulatory Medical Care Survey comprising more than 20 million postpartum office visits to an OB-GYN or family medicine physician between 2009 and 2016.
Researchers received funding from the National Heart, Lung and Blood Institute and the Agency for Healthcare Research and Quality.
Jacquelyn Voghel can be reached at jvoghel@gazettenet.com.