Postpartum health care within Department of Defense military treatment facilities: A 3-year retrospective analysis

Abstract: There is a substantial knowledge gap on the health care impact of mothers following childbirth in the literature. Specifically, there is a dearth of understanding how factors such as mode of delivery (MOD), postpartum follow-up visit attendance (PVA), and birthing an infant with complications (IWC) affect a mother’s postpartum care. This dissertation aims to address some of the gaps in the literature. A retrospective study of the Department of Defense Birth and Infant Health Research database identified all women who had a live delivery in a Military Treatment Facility (MTF) from January 2012 to September 2015 (N = 143,891). All analyses were stratified by active-duty service. MOD, PVA, and IWC were regressed on postpartum use of physical therapy visits, inpatient visits, outpatient visits, and dichotomized pelvic or abdominal surgery in separate analyses while adjusting for intrinsic (e.g., race and age) and pregnancy related (e.g., previous cesarean and obesity) risk factors. Dichotomous outcomes used multivariable binary logistic models, while count outcomes used negative binomial regression models estimating measures of association and 95% confidence intervals (95% CI).Cesarean delivery (CD) was associated with increased incidence of inpatient visits (MTF: IRR = 1.42, 95% CI = 1.34 - 1.50) and outpatient visits (MTF: IRR = 1.12, 95% CI = 1.11 - 1.14) in the population. PVA was associated with increased incidence of postpartum physical therapy (MTF: IRR = 1.25, 95% CI = 1.17 - 1.34), outpatient visits (MTF: IRR = 1.06, 95% CI = 1.05 - 1.07), and a decreased incidence of inpatient visits (MTF: IRR = 0.80, 95% CI = 0.76 - 0.84). IWC was associated with increased incidence of a mother using postpartum inpatient (MTF: IRR = 1.26, 95% CI = 1.19 - 1.34) and outpatient (MTF: IRR = 1.08, 95% CI = 1.07 - 1.10) visits. The MTF population may not well represent the United States population due to variation in risk factors. Analyzed pregnancy risk factors increase the odds of CD, while increasing maternal age and prepregnancy health care use of the same kind increases the incidence of postpartum health care use. Controlling for demographics and risk factors, CD, PVA, and IWC associated with higher incidence of postpartum outpatient health care use, but PVA alone associated with a decreased incidence of postpartum inpatient health care use.