Advancing Postpartum Care for Black Women in Wisconsin by Engaging Community Partners With a Home Telehealth Service for Hypertension– A Feasibility Project

At a Glance

The goal of this project was to increase compliance in postpartum care among Black women by incorporating community partnerships into the “Staying Healthy After Childbirth” (STAC) care model, which is a telehealth hypertension management program offered by UnityPoint Health-Meriter. Hypertension disorders affect around 22 percent of pregnancies in Wisconsin, with preeclampsia and eclampsia being 60 percent more common and substantially more severe in Black women than white women. While the American Congress of Obstetricians and Gynecologists recommends early outpatient follow-up for postpartum women with hypertension disorders, up to 40 percent do not attend. Initial data from the STAC program showed that it was successful in obtaining blood pressure readings from 94 percent of women, compared to 60 percent in standard follow-up, however, compliance with remote blood pressure monitoring varied 23 percent between Black and white women.

The project successfully enrolled 48 out of 55 planned participants and integrated community-based, racially concordant doulas into their postpartum care. Preliminary findings revealed a significant improvement in health care engagement for Black mothers with doula support, as evidenced by their total blood pressure readings during the 42-day postpartum period. Qualitative feedback from study participants emphasized the program’s live-saving impact, particularly in postpartum recovery and medication management, with emotional support from doulas contributing to positive well-being and overall experience.

The Challenge

Hypertension disorders affect around 22 percent of pregnancies in Wisconsin, with preeclampsia and eclampsia being 60 percent more common and substantially more severe in Black women than white women, contributing to health disparities. Although the American Congress of Obstetricians and Gynecologists recommends early outpatient follow-up for postpartum women with hypertension disorders, up to 40 percent do not attend, particularly among those with limited resources. Furthermore, up to 15 percent of women with hypertension disorders screen positive for depression, and the stigmatization of mental health in the Black community may hinder seeking care. Disparities in breast feeding initiation and exclusivity also exist between Black and white women, and focus groups engaging Black women revealed challenges such as isolation, lack of health care support and increased anxiety as contributing factors.

Innovative and cost-effective, telehealth-based interventions may improve postpartum care for hypertension as well as breastfeeding and social and mental wellbeing. The “Staying Healthy After Childbirth” (STAC) is a telehealth hypertension management program offered by UnityPoint Health-Meriter. Initial data demonstrated that the STAC program was successful in obtaining blood pressure readings from 94 percent of women, compared to 60 percent in standard follow-up, however, compliance with remote blood pressure monitoring varied 23 percent between Black and white women.

Project Goals

This project’s goal was to increase compliance in all clinical measures of postpartum care among Black women by incorporating community partnerships into the STAC care model. Clinical measures of postpartum care included improving hypertension care, promoting breastfeeding initiation and continuation and increasing the utilization of postpartum mental health and social support. This goal was addressed through three specific aims:

1. Expand a remote monitoring-based postpartum hypertension program by incorporating community-partnerships to offer basic postpartum care, lactation, social and mental health support for Black women in Wisconsin.
2. Investigate the improvement in participation of all clinical measures of postpartum care with the inclusion of community-partnerships in the care model.
3. Perform qualitative assessment of the women’s experiences in the postpartum telehealth for hypertension with and without the community partnership.

Results

The project successfully enrolled 48 of its 55 planned participants. Community based, racially concordant doulas were incorporated into the postpartum care of these women. Preliminary results demonstrated that the addition of a doula significantly improved the healthcare engagement of Black mothers, specifically in the total blood pressure readings reported over the course of the 42-day postpartum period by Black mothers with doula support compared those without.

Qualitative feedback from participants highlighted the program’s life-saving impact, particularly in aiding postpartum recovery and medication management. Emotional support from doulas was also recognized, contributing to a positive experience and emphasizing the program’s broader influence on overall well-being in addition to medical care.

Looking to the Future

Plans for replication and expansion involve creating implementation toolkits for remote patient blood pressure monitoring and doula support, with ongoing efforts to disseminate the program statewide. The project is preparing for a CDC-funded grant to support dissemination and implementation, aiming to provide bidirectional referrals and care for patients at risk of developing chronic hypertension and cardiovascular disorders.