4th Stage of Pregnancy: Optimizing Maternal Health through Nurse Navigation

Gap in practice: Pregnancy has been scientifically recognized as a stress test or window to future health conditions. Maternal mortality and morbidity in the United States (US) has reached alarming numbers. This has contributed to extreme racial inequities and disparities in the US. Obstetrical official visits occur every 4 weeks until 28 weeks, every 2 weeks until 36 weeks and weekly until delivery. Despite the evidence demonstrating that postpartum care helps set the stage for lifelong health and well-being, a postpartum office visit is a one-time appointment leaving gaps in practice management. The time has come to strategize efforts on the fourth stage of pregnancy, reducing disparities and improving the health of women in the community we serve.
Need for practice change: Armed with the knowledge of pregnancy as a blueprint for future health, Morristown Medical Center Women’s Health (MMC) Clinic developed a program aimed to decrease barriers and improve maternal outcomes.
Target audience: Nurses, midwives, advanced practice nurses, physicians and interdisciplinary teams working in women's health.
Practice change: Fourth stage of pregnancy nurse navigator (NN) designed to navigate postpartum patients through transitions of care during a 12-month period after delivery.
Practice change implementation method: Philanthropic funding has enabled the MMC Women’s Health Clinic to put their vision into action. In April 2023, our vision became reality by creating a part-time position for a NN. What was once a 4-6-week postpartum visit is now reimaged as continuum of care that transitions patients from pregnancy to lifelong optimization. All deliveries in the clinic are handed off to the NN. The NN assesses pregnancy complications, mental health, postpartum complications, adverse pregnancy outcomes, chronic health conditions, lactation, and birth control counseling. Referrals will be made and followed up for compliance.
Metrics: From April 2023 through August 2024, there were 1077 deliveries. Of the 1077 deliveries, 1303 (83%) referrals have been generated through nurse navigation.
Application to/implications for WH, O, or N practice: Pregnant women receiving care in the MMC clinic have NN in their fourth stage of pregnancy. Education topics and strategies are based on evidence-based literature. Clinical referrals will be recorded on a secure database and analysis conducted and verified for those women who have delivered thus far.