How home-based postpartum care could improve health for women and children

The majority of the postpartum period in the hospital is a blur. Even with a relatively uncomplicated delivery, the days following the birth of my first child flew by with many visits per day (and night) by doctors, nurses, lactation consultants, and nutritional staff. I never got more than an hour of sleep between the baby’s needs and the staff visits, but despite the delirium, there was a comfort in knowing that as a new parent any of the resources I might need were just a tap of a button away. Fast forward 72 hours, and in most cases in the United States, parents and their newborns are discharged from the hospital and sent home with the assurance that they will be fine! Pediatric appointments fall onto the calendar like clockwork for the day after you get home and later that week, and the next week, and the next month and so on for the rest of the year. However, birthing parents are typically seen three to six weeks after birth by their OB-GYN for a physical exam, mental health check, birth control consultation, and clearance to resume normal activities. But caring for a newborn and yourself after birth is hard and many parents are living in a support vacuum within the walls of their home.

Eight years later, I still remember the relief of a postpartum home nurse visit through a local public health program. The nurse came about two weeks after the birth and spent two hours with me and my daughter. I asked many questions about what was normal when it came to infant feeding, diapering, and my own recovery. The nurse was there to answer those questions, while also conducting a maternal postpartum assessment, looking for signs of postpartum depression and assessing my wellbeing. Those hours gave me confidence that I was doing well as a parent and that I had access to additional resources if needed. (The nurse even left her cell phone number and texted me a few times to follow up. How often does that happen in healthcare?!) It turns out that home-based programs like these significantly affect maternal and child health outcomes. 

A 2024 randomized control trial of 75 people assessed whether postpartum home visits or digital/mobile-based support could help reduce physical symptoms after childbirth and improve breastfeeding self-efficacy. The study found that women in the home care group experienced the least severe physical symptoms over time and exhibited the highest breastfeeding self-efficacy, outperforming both the digital group and the control group. (Since this is Digital Health Insights, I have to note that the digital group outperformed the control group but not as highly as the home care group.) Another study of over 5,000 Medicaid-enrolled mothers in South Carolina found that those participating in the Nurse-Family Partnership, which provided both prenatal and postpartum home visits, had reduced Emergency Department usage in the twelve weeks postpartum compared to those who didn’t participate in the partnership. 

Home visits also improve health outcomes and reduce care costs for infants. A study of the Family Connects program found that “children randomly assigned to Family Connects had significantly less total emergency medical care (by 37%) through age 24 months.” Not only does this decreased emergency department usage reduce healthcare costs, it indicates that families may feel more confident and supported in navigating newborn and maternal postpartum healthcare needs. A ​​home-based care monitoring and phototherapy program for infants with severe hyperbilirubinemia utilized the Bilicocoon® Bag for home treatment. Only two patients (1% of study population) needed readmission in a conventional hospital, for less than 24 hours. This study demonstrated that phototherapy is a feasible hospital at home intervention for neonates with high risk of severe hyperbilirubinemia.  

Postpartum home health programs can help birthing parents and their newborns, from supporting new mothers with the litany of questions that arise when they are caring for a baby for the first time, to addressing more acute care needs like treating hyperbilirubinemia for infants with jaundice. The next frontier is figuring out how to scale these programs in maternity care deserts. 

Katie D. McMillan, MPH is the CEO of Well Made Health, LLC, a business strategy consulting firm for health technology companies. She is also a curious researcher and writer focusing on digital health evidence, healthcare innovation, and women’s health. Katie can be reached at [email protected] or LinkedIn.