New Mothers’ Perspectives on New Mothers’ Perspectives on Maternal Health Care Access and Maternal Health Care Access and

Quality in Genesee County, MichiganQuality in Genesee County, Michigan

Thomas M. Reischl, PhD Susan Franzen, BSThomas M. Reischl, PhD Susan Franzen, BS

Prevention Research CenterPrevention Research Center

University of MichiganUniversity of Michigan

www.sph.umich.edu/prcwww.sph.umich.edu/prcFunded by the Ruth Mott Foundation, Flint, MI

FR-11D1A Primary Data Report No. 1

AcknowledgementsAcknowledgements

• Lawton and Rhea Chiles Center for Healthy Mothers and Babies at the Lawton and Rhea Chiles Center for Healthy Mothers and Babies at the University of South FloridaUniversity of South Florida

• Lori Kunkel and staff at Greater Flint Health CoalitionLori Kunkel and staff at Greater Flint Health Coalition

• Yvonne Lewis and staff at Faith Access to Community Economic Yvonne Lewis and staff at Faith Access to Community Economic Development (FACED)Development (FACED)

• Deborah Cummings and staff at McLaren Regional Medical CenterDeborah Cummings and staff at McLaren Regional Medical Center

• Andy Kruse and staff at Genesys Regional Medical CenterAndy Kruse and staff at Genesys Regional Medical Center

• Vicki McKinney and staff at Hurley Medical CenterVicki McKinney and staff at Hurley Medical Center

• Members of the Flint/Genesee County Friendly Access Project Members of the Flint/Genesee County Friendly Access Project Leadership Team and Steering CommitteeLeadership Team and Steering Committee

Study of New Mothers’ Ratings of Study of New Mothers’ Ratings of Prenatal and Perinatal Health CarePrenatal and Perinatal Health Care

• Sample: Sample: – 358 new mothers whose birth was paid for by Medicaid or by self-358 new mothers whose birth was paid for by Medicaid or by self-

pay at three hospitalspay at three hospitals

• Quota sampling strategyQuota sampling strategy– Based on population counts of Medicaid-paid & self-paid births at Based on population counts of Medicaid-paid & self-paid births at

three hospitals in Genesee County: Hurley (n=198), Genesys three hospitals in Genesee County: Hurley (n=198), Genesys (n=130), McLaren (n=30)(n=130), McLaren (n=30)

• Interview proceduresInterview procedures– Interviews 12-24 hours after giving birth (after 36 hrs for C-Interviews 12-24 hours after giving birth (after 36 hrs for C-

section births)section births)– 45 minutes structured interview protocol45 minutes structured interview protocol– $15 gift certificate incentive$15 gift certificate incentive

New Mothers Sample CharacteristicsNew Mothers Sample Characteristics

• Mother’s average age: Mother’s average age: 25.4 years25.4 years

• Average number of Average number of children: children: 2.42.4

• Mother’s education:Mother’s education:– 23.7% with no HS Diploma23.7% with no HS Diploma– 34.6% with HS Diploma34.6% with HS Diploma– 41.6% beyond HS41.6% beyond HS

• Mother’s race– Hispanic or Latino: 7.3%

– African American: 39.8%

– European American: 54.5%

– Other: 5.7%

• Marital statusMarital status– 24.6% married24.6% married

– 66.5% never married66.5% never married

– 8.9% divorced or separated8.9% divorced or separated

New Mothers Sample CharacteristicsNew Mothers Sample Characteristics

Compared to population data (from birth Compared to population data (from birth records), our sample was:records), our sample was:

– Slightly olderSlightly older– Had 1 more child (on average)Had 1 more child (on average)– More likely to have education beyond HSMore likely to have education beyond HS– Less likely to be African AmericanLess likely to be African American– More likely to be marriedMore likely to be married– More likely to have had a C-sectionMore likely to have had a C-section

Most Frequent Life EventsMost Frequent Life Events

55%

39%

36%

33%

28%

28%

0% 10% 20% 30% 40% 50% 60%

Moved to New Address

Family Member VerySick

Argued with PartnerMore

Bills Not Paid

Someone Close Died

Someone Close withDrinking/Drug Problem

Birth Control & Becoming PregnantBirth Control & Becoming Pregnant

• Using birth control at time of conception: Using birth control at time of conception: 25.5%25.5%

• Feelings about becoming pregnant:Feelings about becoming pregnant:– Wanted to become pregnant later: 33.5%Wanted to become pregnant later: 33.5%

– Didn’t want to be pregnant then or in future: 31.5%Didn’t want to be pregnant then or in future: 31.5%

Finding a Prenatal ProviderFinding a Prenatal Provider

• How many mothers did not have a prenatal provider: How many mothers did not have a prenatal provider: 6 (2%)6 (2%)

• How did you find your provider?How did you find your provider?– Friend or Family Recommendation: 27.2%Friend or Family Recommendation: 27.2%– Doctor Recommendation: 21.8%Doctor Recommendation: 21.8%– Same provider as last pregnancy: 19.0%Same provider as last pregnancy: 19.0%

• Type of ProviderType of Provider– Doctor: 70.9%Doctor: 70.9%– Group practice: 24.2%Group practice: 24.2%– Midwife or Nurse: 2.9%Midwife or Nurse: 2.9%

• More than 1 Provider:More than 1 Provider: 19.1%19.1% →→ Ave. # of Providers: Ave. # of Providers: 3.443.44

Appointments with Prenatal ProviderAppointments with Prenatal Provider

• Average wait to see provider: Average wait to see provider: 20.4 minutes20.4 minutes

• Average 5-point ratings of provider (1=never; 5=always)Average 5-point ratings of provider (1=never; 5=always)

– Provider understood what mother said or asked: Provider understood what mother said or asked: 4.684.68– Mother felt comfortable telling the provider worries: Mother felt comfortable telling the provider worries: 4.674.67– Provider gave mother enough time to talk about worries:Provider gave mother enough time to talk about worries: 4.664.66– Provider spent enough time with mother:Provider spent enough time with mother: 4.534.53– Provider reviewed lab test results with mother:Provider reviewed lab test results with mother: 4.524.52– Provider discussed beliefs and religious practices:Provider discussed beliefs and religious practices: 1.591.59

• Average time provider spent with mother: Average time provider spent with mother: 18.1 minutes18.1 minutes

Ratings of Prenatal ProvidersRatings of Prenatal Providers

• Average 5-point ratings of providers Average 5-point ratings of providers (1=poor; 5=excellent)(1=poor; 5=excellent)

– Respect shown by the provider:Respect shown by the provider: 4.244.24– Technical skills of the provider: Technical skills of the provider: 4.204.20– How well the provider explained procedures:How well the provider explained procedures: 4.154.15– Concern shown by the provider:Concern shown by the provider: 4.094.09– Comfort the mother felt with provider:Comfort the mother felt with provider: 4.084.08

– Respect the receptionist (office staff) showed:Respect the receptionist (office staff) showed: 4.114.11– Comfort the mother felt with nurses or receptionist: Comfort the mother felt with nurses or receptionist: 3.953.95– Concern shown by the nurses or receptionist:Concern shown by the nurses or receptionist: 3.823.82

Prenatal CarePrenatal Care

• Month when prenatal care began (ave.): Month when prenatal care began (ave.): 2.562.56

• Did not receive prenatal care as early as desired:Did not receive prenatal care as early as desired: 31.2% 31.2%

• Number of prenatal care visitsNumber of prenatal care visits– 1 to 3 visits:1 to 3 visits: 2.0% 2.0%– 4 to 7 visits:4 to 7 visits: 7.7% 7.7%– 8 to 10 visits:8 to 10 visits: 24.1%24.1%– 11 or more visits:11 or more visits: 66.2%66.2%

• Race of provider different than mother’s: Race of provider different than mother’s: 50.9%50.9%

• Race of provider made a difference in care: Race of provider made a difference in care: 4.0%4.0%

More Ratings of Prenatal CareMore Ratings of Prenatal Care

• Prenatal care was…Prenatal care was…– Better than expected:Better than expected: 48.7%48.7%– About what expected:About what expected: 43.3%43.3%– Worse than expected:Worse than expected: 7.4% 7.4%

• Quality ratings (0=low, 10=high)Quality ratings (0=low, 10=high)– Ave. rating of prenatal provider:Ave. rating of prenatal provider: 8.758.75– Ave. rating of prenatal care:Ave. rating of prenatal care: 8.978.97

• Would recommend provider to friend/relative: Would recommend provider to friend/relative: 91.2%91.2%

• Would change providers if it was easy to do:Would change providers if it was easy to do: 18.1%18.1%

Labor and Delivery ExperienceLabor and Delivery Experience

• Mother decided when family members were present: Mother decided when family members were present: 86.7%86.7%

• Mother had some control over what happened during labor and Mother had some control over what happened during labor and delivery: delivery: 72.8%72.8%

• Labor and delivery staff…Labor and delivery staff…– Respected mother’s wishes during labor and delivery: 92.7%Respected mother’s wishes during labor and delivery: 92.7%– Asked what the mother wanted during labor and delivery: 75.6%Asked what the mother wanted during labor and delivery: 75.6%

• Provider who delivered baby…Provider who delivered baby…– Was as helpful as she/he could be: 92.7%Was as helpful as she/he could be: 92.7%– Treated mother with courtesy and respect: 95.5%Treated mother with courtesy and respect: 95.5%

Ratings of Hospital ExperienceRatings of Hospital Experience

• 5-point ratings of health care professionals (1=never, 5=always):5-point ratings of health care professionals (1=never, 5=always):– Treated mother with courtesy & respect: Treated mother with courtesy & respect: 4.694.69– As helpful as mother thought they should be: As helpful as mother thought they should be: 4.594.59

• 5-point ratings of hospital support staff (1=never, 5=always):5-point ratings of hospital support staff (1=never, 5=always):– Treated mother with courtesy & respect: Treated mother with courtesy & respect: 4.684.68– As helpful as mother thought they should be: As helpful as mother thought they should be: 4.574.57

• Ratings of hospital (0=low, 10=high)Ratings of hospital (0=low, 10=high)– Overall rating of delivery care: Overall rating of delivery care: 8.498.49– Overall rating of hospital: Overall rating of hospital: 8.938.93

• Care at the hospital was…Care at the hospital was…– Better than expected: Better than expected: 45.2%45.2%– About what expected:About what expected: 49.4%49.4%– Worse than expected:Worse than expected: 4.8% 4.8%

Post-Delivery CarePost-Delivery Care

• Mother decided amount of contact with baby: Mother decided amount of contact with baby: 79.3%79.3%

• Mother decided how they wanted to feed the baby: Mother decided how they wanted to feed the baby: 95.8%95.8%

• Feeding method chosen:Feeding method chosen:– Formula onlyFormula only 49.6%49.6%– Breastfeed only:Breastfeed only: 25.5%25.5%– Both formula and breastfeed:Both formula and breastfeed: 23.8%23.8%– Undecided:Undecided: 1.1% 1.1%

• Hospital staff offered to teach breastfeeding: Hospital staff offered to teach breastfeeding: 68.0%68.0%

• Mother had chosen a health care provider for baby: Mother had chosen a health care provider for baby: 74.1%74.1%

Health Insurance, Payments, BenefitsHealth Insurance, Payments, Benefits

• On Medicaid before pregnancy: On Medicaid before pregnancy: 44.1%44.1%

• On other health insurance before pregnancy: On other health insurance before pregnancy: 22.5%22.5%

• Entire pregnancy covered by any insurance: Entire pregnancy covered by any insurance: 92.7%92.7%

• Had trouble paying for prenatal care: Had trouble paying for prenatal care: 2.0%2.0%

• Received WIC during pregnancy: Received WIC during pregnancy: 72.7%72.7%

• May have trouble paying for birth: May have trouble paying for birth: 3.1%3.1%

Summary of ResultsSummary of Results

• Most of the new mothers reported high ratings of the prenatal and Most of the new mothers reported high ratings of the prenatal and perinatal care they received.perinatal care they received.

• Across many of the rating questions, about 10% of the new mothers Across many of the rating questions, about 10% of the new mothers were unhappy with their care.were unhappy with their care.

• The new mothers also report some areas of concern:The new mothers also report some areas of concern:– Many have experienced life changing stressful circumstancesMany have experienced life changing stressful circumstances– Most of the mothers did not want to get pregnantMost of the mothers did not want to get pregnant– 31% of mothers said they initiated prenatal care later than they wished.31% of mothers said they initiated prenatal care later than they wished.– Wait times to see provider averaged 20 minutesWait times to see provider averaged 20 minutes

• Nearly all mothers were insured during pregnancy, but only 67% were Nearly all mothers were insured during pregnancy, but only 67% were insured before pregnancy.insured before pregnancy.