Becoming a mother can be difficult under any circumstances, but for some women, everyday obstacles can make getting medical care after childbirth especially challenging. Limited health literacy, unreliable transportation, difficulty navigating a complicated healthcare system, lack of childcare, and unstable housing can all determine whether a new mother receives needed care or goes without it.
New research from Northwestern Medicine suggests that patient navigators can help remove many of those barriers. These trained guides work with patients and healthcare teams to connect people with medical care, services, and other resources. Among low-income pregnant individuals, the approach was linked to better postpartum health care and stronger connections to primary care that continued well beyond childbirth.
The study was published Oct. 2 in JAMA Health Forum. According to the researchers, it is among the first studies to describe what an ideal model of postpartum care in the U.S. could look like.
Patient Navigators Improved Postpartum Care
Compared with patients who received usual postpartum care without a patient navigator, those who worked with a navigator were more likely to:
- Attend postpartum care visits (96% vs. 80% among those receiving usual postpartum care without a patient navigator)
- Be counseled about all needed postpartum topics (65% vs. 51%)
- Have screening and care for postpartum depression (86% vs. 72%) in the critical “fourth trimester” months
- Attend a primary care visit (57% vs. 30%) at one year after giving birth
- Be using their desired family planning method, such as birth control, at one year to help space out their pregnancies (65% vs. 43%)
- Receive preventive health testing (i.e. blood pressure (85% vs 62%), lipids (28% vs 13%) and glucose (31% vs 16%)
“Pregnancy and the postpartum periods are complex, and people often deprioritize themselves, particularly if they don’t have much support or have complex social needs,” said corresponding author Dr. Lynn Yee, chief of maternal-fetal medicine in the department of obstetrics and gynecology at Northwestern University Feinberg School of Medicine and a Northwestern Medicine physician. “Combined with a fragmented healthcare system, many people do not receive the care they need.”
“That makes a perfect storm of suboptimal women’s health in this very key postpartum period, which is when we know many women drop out of care. If we can address this gap early and sustain their engagement with healthcare, we can make a difference in the health and well-being of women over the long run.”
Patient navigation is already widely used in cancer care and is even funded by Medicaid, Yee said. However, the approach has received far less attention in postpartum care and has remained both understudied and underused.
The researchers said this is the first large-scale study to investigate the benefits of patient navigation among pregnant and postpartum individuals. The results could provide a foundation for additional research and potentially support future funding for postpartum navigation programs.
How Patient Navigators Helped New Mothers
The study included 405 pregnant individuals receiving care at Prentice Women’s Hospital in Chicago between 2020 and 2024. Participants assigned a patient navigator began working with that person near the end of pregnancy and continued receiving support throughout the first year after delivery.
The navigators spoke both English and Spanish and worked closely with patients to develop postpartum care plans, which were also shared with the medical team. They scheduled and attended appointments, helped coordinate transportation and childcare, communicated with doctors and nurses, and helped patients make sense of complicated medical information. They also worked to strengthen health literacy and give patients greater confidence in managing their own care.
The transition from pregnancy care to primary care can have important long-term consequences. Previous research has shown that complications such as gestational diabetes and preeclampsia can affect health years later, making continued medical follow-up especially important.
Even people who have healthy pregnancies can encounter serious challenges after delivery. Postpartum depression, limited partner support, housing problems, domestic violence, and other unmet social or safety needs can make it harder for new mothers to prioritize their own health, Yee said.
The researchers said the program’s success in connecting postpartum patients with primary care demonstrates how navigators may help close some of these gaps.
“Cumulatively not engaging in health-promotion behaviors in the postpartum period has reverberating implications for the family unit, too,” Yee said.
Navigators Also Helped Healthcare Teams
The benefits were not limited to patients. The study found that healthcare professionals also valued the support provided by navigators.
For example, if a patient was unable to attend an appointment, a navigator could notify the doctor, arrange a new appointment, or handle administrative tasks that might otherwise fall to clinical staff. Navigators also helped make sure patients completed important follow-up steps after appointments, including glucose tolerance testing and subsequent medical visits.
“One of the goals of navigators was not just to help patients, but to help clinicians too, and doctors were happy at how much more efficient and engaged patients were,” said co-author Joseph Feinglass, research professor of general internal medicine at Feinberg.
One Navigator’s Experience
Before taking part in the study, patient navigator Viridiana Carmona-Barrera had worked in hospital, insurance and women’s health settings. That background gave her experience with many of the obstacles pregnant patients can encounter.
She recalled helping one pregnant patient with chronic health conditions who was in danger of missing an important appointment because she lacked reliable transportation and childcare. After other attempts to reach a solution were unsuccessful, Carmona-Barrera coordinated both transportation and childcare so the patient could make the appointment.
“I like being someone who can help make these processes easier,” Carmona-Barrera said. “As committed as health care organizations are to supporting patients, navigating the system can still be challenging.”
Helping Patients Become Independent
An important goal of the program was not to make patients permanently dependent on navigators. Instead, the researchers wanted participants to become more comfortable interacting with the healthcare system and more capable of managing their own care.
By building those skills over the first year after childbirth, the team hoped patients would eventually feel confident arranging appointments, seeking primary care, and navigating the healthcare system without additional assistance.
“Their goal was to put themselves out of business, to be able to get to the end of the year and say, ‘You don’t need me anymore,'” Yee said. “That’s success for a navigation program.”
