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Re-engineering Postnatal Unit Care and the Transition Home to Reduce Perinatal Morbidity and Mortality

Principal Investigator: Alison Stuebe, M.D., M.Sc., University of North Carolina, Chapel Hill, NC. 
Co-PIs: Kristin Tully, Ph.D., University of North Carolina, Chapel Hill, NC; Emily Patterson, Ph.D., The Ohio State University, Columbus, OH
AHRQ Grant No.: HS027260
Project Period: 09/30/19-09/29/24
Description: This PSLL sought to improve postnatal care and hospital discharge processes to enhance maternal-infant health outcomes. Researchers identified strengths and gaps in inpatient postpartum care and developed tools through a human-centered design approach to advance respectful, equitable, and supportive postnatal services.

The specific aims were to:

  1. Define priority areas by using mixed methods: Investigators analyzed current processes and procedures for maternal-infant dyadic evaluation and management during the postnatal unit stay and discharge transition through the lens of mothers, clinicians, electronic health record data, and other key stakeholders.
  2. Conduct iterative prototyping and evaluation of interventions: Building on identified design seeds, investigators alternated between idea generation and evaluation until prototypes emerged that could be implemented and assessed for refinement in a low-stakes laboratory setting and then in the clinical setting.

The research revealed modifiable barriers to quality perinatal care, including inadequate communication, inconsistent informed consent, and insufficient access to health information.1 One study found that among new parents who used acute care within 90 days after giving birth, many felt scared and unsure about their health. Healthcare system policies about visit accommodations, such as when infants were permitted to accompany birthing parents, were not clear. The study highlighted gaps in postpartum education and support.2 The project evaluated a standardized pain management plan that reduced the overall use of opioids after childbirth.3

In response to findings, the lab developed multiple interventions aimed at improving postnatal care quality.1 It redesigned an inpatient hypoglycemia protocol to improve the management of infant blood sugar levels, providing clearer guidance for both clinicians and families. A supporting-our-community website was developed with healthcare system partners to offer patients greater transparency about institutional policies, their rights, and available community resources. 

To address postpartum hypertension management, educational text messages were developed to support maternal self-monitoring and improve care access after discharge. Animated digital storytelling videos were produced to enhance clinical training on patient-provider communication, with a focus on pain assessment, breastfeeding support, and shared decision making during postpartum care.4 The videos are available on the Postnatal Safety YouTube page. The website offers project-developed tools to promote shared decision making.

Beyond hospital-based interventions, the lab had a significant impact on national policy and practice.1 Study findings were integrated into the Alliance for Innovation on Maternal Health (AIM) Postpartum Hospital Discharge Transition Change Package, providing evidence-based strategies to improve postnatal safety in hospitals across the United States.1,5 

The team contributed to the development of maternity-specific Consumer Assessment of Healthcare Providers and Systems (CAHPS) measures, helping to standardize patient-reported quality indicators for postpartum care.3 The project’s findings informed international maternal health initiatives, including collaborations with the Pan American Health Organization and the Baby-Friendly Hospital Initiative.

To date, this PSLL’s work has resulted in at least 20 peer-reviewed journal publications, with 95 citations in other publications. The lab has presented its work at multiple national conferences, including the Society for Maternal-Fetal Medicine, the American College of Obstetricians and Gynecologists, and the Southern Nursing Research Society.

Publications

2025

2024

2023

2022

2021

2020

References

  1. Stuebe A et al. Final Report: Re-Engineering Postnatal Unit Care and the Transition Home to Reduce Perinatal Morbidity and Mortality. 2024, AHRQ, HHS: University of North Carolina at Chapel Hill. p. 1-8.
  2. Busse CE, et al. Birthing parent postpartum acute care use: multilevel opportunities for strengthening healthcare. Birth 2024 Dec;51(4):843-854.
  3. Green CA, et al. Standardized order sets do not eliminate racial or ethnic inequities in postpartum pain management. Health Equity 2023 Oct 1;7(1):685-91.
  4. Behnam Asl S, et al. A human-centered approach for sharing patient experiences through digital storytelling: a research through design study. Des Sci 2024 Jan;10:e23.
  5. Stuebe A, et al. Progress Report: Re-engineering Postnatal Unit Care and the Transition Home to Reduce Perinatal Morbidity and Mortality, AHRQ, Editor. 2021, University of North Carolina: Chapel Hill, N.C. p. 1-55.
Page last reviewed April 2025
Page originally created April 2025

Internet Citation: Re-engineering Postnatal Unit Care and the Transition Home to Reduce Perinatal Morbidity and Mortality. Content last reviewed April 2025. Agency for Healthcare Research and Quality, Rockville, MD.
https://www.ahrq.gov/patient-safety/resources/learning-lab/re-engineering-postnatal-unit-care-long-desc.html

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