A Toolkit for Implementing Two-Generation Postpartum Care

The Role of Postpartum Care in Maternal Health

The United States is facing a maternal health crisis, with rates of maternal morbidity and mortality continuing to increase, especially for Black women. In the U.S., more than 60,000 women experience life-threatening maternal morbidity each year, resulting in more than 700 pregnancy-related deaths annually.1 As these rates have increased, two critical shifts have happened. First, pregnancy-related deaths have become predominantly caused by cardiovascular diseases and preexisting medical conditions, and mental health and substance use disorders in states like Illinois are also playing a critical role.2,3 The second shift is that most pregnancy-related deaths now occur in the postpartum period, with 1 in 5 deaths taking place even after 42 days postpartum.1 These shifts highlight the critical importance of primary and behavioral healthcare for mothers in the postpartum period.

Unfortunately, many mothers do not receive postpartum care, and rates of not attending a postpartum visit are higher among mothers with Medicaid insurance.4 To address this, the American College of Obstetricians and Gynecologists has called for postpartum care to transition from a single encounter to an initial visit within the first three weeks postpartum followed by regular, ongoing care concluding with a comprehensive visit no later than 12 weeks after birth.5 Beyond these early postpartum visits, care throughout the extended postpartum period (12 months postpartum) can provide crucial chronic condition management, behavioral health support, and access to contraception and education, ultimately leading to improved maternal health and healthier future pregnancies.6

Since 2020, the University of Illinois Health System (UI Health) has operated Two-Generation care clinics in the west and south sides of Chicago using a care model that combines dyadic care with behavioral health and support for social needs for postpartum families during the extended postpartum period (and up to two years after birth). This model, called UI Health Two-Gen, has begun to provide benefits for postpartum families beyond what would be expected in traditional postpartum care.

We have assembled this Toolkit to describe UI Health Two-Gen and to invite healthcare leaders to envision and introduce postpartum care enhancements into their own organizations. Enhancing and reimagining postpartum care using new approaches is essential, especially to effectively leverage the Medicaid Postpartum Extension6 now being implemented in multiple states. In this Toolkit, we share the UI Health Two-Gen approach, provide multiple resources, and offer ideas for other healthcare organizations to improve postpartum care, even under tight resource constraints.

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