Decomposing the Disparity in 1-Year Postpartum Readmission between People with and without a Potentially Traumatic Birth Event

Abstract

Objective

Traumatic birth, characterized by high perceived risk to the life of the birthing person or fetus and intense fear, is associated with poor postpartum mental health. However, little is known about the relationship between potentially traumatic birth and postpartum physical health. The goal of this study was to estimate the difference in 1-year postpartum readmission between individuals who experienced a potentially traumatic birth event (severe maternal morbidity [SMM], stillbirth, extremely preterm birth [EPTB]) and those who did not, and to quantify the proportion explained by medical, demographic, and care use variables.

Study Design

We used data from deliveries at Grady and Emory Health Systems between 2016 and 2021 to identify deliveries to individuals who experienced a potentially traumatic birth (stillbirth, SMM, or EPTB <28 weeks) or did not. We fit Blinder–Oaxaca decomposition models to estimate the proportion of the disparity in 1-year postpartum readmissions explained by pre-existing obstetric and medical risk (Obstetric Comorbidity Index [OCI], psychiatric diagnoses at delivery, delivery mode), sociodemographic characteristics (age, parity, race, insurance, delivery hospital), and perinatal care use (postpartum visit timing [early, late, on time, and/or none], prenatal care use [any/none], postpartum contraceptive receipt [any/none]).

Results

We included 33,153 deliveries, 2498 of which were characterized as a potentially traumatic birth due to stillbirth (331, 1.0%), SMM (1957, 5.9%), and/or EPTB (344, 1.0%). People experiencing any one of these events were more likely to be readmitted in the 12 months postpartum (6.4 vs. 2.4%, risk difference: 4.01 per 100 deliveries, 95% CI: 3.03, 4.99). 54.3% of this excess risk was explained by medical, demographic, and site of care variables, with the largest percent explained by the OCI (46.4%).

Conclusion

People who experience SMM, stillbirth, or EPTB experienced elevated postpartum readmission risk, half of which cannot be explained by medical risk or demographics.

Key Points

• Postpartum risk is elevated following poor delivery outcomes, yet the reasons are not well-characterized.

• Medical, psychiatric, demographic, and site of care factors explained 54% of the excess postpartum readmission risk among individuals following stillbirth, EPTB, or SMM at delivery.

• Unexplained risk of readmission in the postpartum year cannot be fully explained by medical risk, demographics, or care use.

Keywords

stillbirth - postpartum - maternal - severe maternal morbidity - preterm birth

• References

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