Postpartum Health Care Data Dashboard

The Wisconsin Pregnancy Risk Assessment Monitoring System (PRAMS) collects information from people about their attitudes and experiences before, during, and after pregnancy.

The end of the PRAMS survey asks, "We would love to hear more about your story! Is there anything else you would like to share with us about your experiences around the time of your pregnancy?"

Many mothers share their thoughts and stories. These comments provide valuable insights into many maternal health topics, including postpartum health care.

Many mothers expressed a need for expanded care after pregnancy, including additional postpartum visits.

“While I was fortunate enough to feel healthy at my 6 week postpartum appointment, I was shocked it was my only postpartum appointment for me. Even a few additional phone calls from a nurse would have been helpful to at least provide me an opportunity to discuss any issues or surprises. Unfortunately, even with insurance the cost of a visit to a doctor outside of a check-up for myself or my daughter still affects my decision on when to call or see a doctor.”

“I think there needs to be more post-partum care for mothers. I have experienced a lot of post-partum bleeding and have been proactive in reaching out to my OBGYN but if there was encouraged more post-partum care than I think it would benefit many women who wonder, suffer, or trust "Dr. Google" for everything.”

“I think postpartum education and support is SO important, especially for new moms and it's not emphasized enough. You have to attend to many Dr. appointments while you are pregnant, but you are pretty much cut loose with a brief 6 week postpartum appointment and that's all you're really given. It's an area I think the U.S. could improve in.”

Many mothers shared how postpartum care was important for their mental and physical health.

“Answering the questionnaire for depression and anxiety at my 6 week postpartum appointment helped me significantly. If I didn't do that, I wouldn't have gotten the help/medication that I needed for postpartum anxiety/depression.”

“I had a very kind and helpful midwife who did check-ups at my house, and offered help and support for my post partum anxiety.”

“At my 6 week postpartum appointment, my OB/GYN sent me to take the glucose test again, the 2 hour test to determine if I still had [diabetes] or not.”

Some mothers wanted more supportive care after their pregnancy.

“After 6 weeks I had my post-partum visit and had elevated blood pressure. They told me to keep an eye on it and that's the last I have heard from any nurse or doctor… I've had no support from any health care providers especially post-partum”

“Birthing costs are outrageous! Health insurance is very expensive. I need more time at home with my child. I feel I was not cared for enough by health care professionals post-partum.”

The Wisconsin Maternal Mortality Review Team (MMRT) reviews all deaths that occur during or within one year of the end of pregnancy. The team is composed of experts who represent organizations involved in the care of pregnant and postpartum people in Wisconsin. The MMRT makes recommendations for each pregnancy-related, preventable death. These recommendations are intended to prevent future similar deaths. MMRT recommendations address several topics, including postpartum care.

Several recommendations addressed topics of education that postpartum visits should provide.

• Prenatal care providers should screen all patients for depression at prenatal and postpartum visits and educate patients about symptoms for postpartum depression and how/when to seek care.
• Providers should educate patients during pregnancy and the postpartum period on the risks of substance use following decreased use which may lead to decreased tolerance.
• Providers should counsel postpartum women with obesity on nutrition, refer to weight management, and provide education on risks of obesity as well as risks in future pregnancies.

Several recommendations addressed removing barriers to postpartum care, including increasing community-based and home care.

• Healthcare organizations should support family dyad visits to increase access to postpartum care whenever limited resources are available.
• Health systems should pay for and incorporate nurse home visits as part of the postpartum follow up program.
• Payers should utilize community-based postpartum visits with community health workers or doulas to address key postpartum screenings and other issues, including mental health, social support, and isolation.

Data definitions

Postpartum visit

Postpartum refers to the period after delivery, but there is no standard definition for the duration of the postpartum period. The data in this dashboard come from the Wisconsin Pregnancy Risk Assessment Monitoring System (PRAMS), which defines a postpartum visit as a regular health checkup someone has up to 12 weeks after giving birth.

Regions and urban vs rural counties

The maps in the dashboard show data based on where an individual lived at the time of their delivery. Urban versus rural counties are defined by the Wisconsin Office of Rural Health. Regions are defined by the Division of Public Health to align with the division’s regional offices.

Insurance

Insurance during the postpartum period is reported by Wisconsin Pregnancy Risk Assessment Monitoring System (PRAMS) survey participants anywhere from 2–6 months after delivery. Private insurance includes any private insurance paid for by the individual, someone else, through a job. This includes TRICARE or other military health care. If an individual says they are covered by both private insurance and public insurance [Medicaid, BadgerCare Plus (ForwardHealth), Indian Health Service, or other tribal health care], then they are included within the private insurance group.

Race and ethnicity

The race and ethnicity groupings used in the dashboard are not mutually exclusive, meaning that a person may be included in multiple groups. American Indian or Alaska Native includes everyone who identified as American Indian or Alaska Native, including those who also identified as Hispanic or another race. Hispanic includes everyone who identified as Hispanic.

Household income

Household income group is based on three factors: 1) an individual and their spouse or partner’s total income before taxes during the 12 months before their new baby was born, 2) the total number of individuals who depended on the income, and 3) Federal Poverty Level guidelines during the birth year, as released by the U.S. Department of Health and Human Services. Individuals in the group “< 100% federal poverty level” had a household income below the federal poverty level, as adjusted for the number of household members. Individuals in the group “100–199% federal poverty level” had a household income at or just above the federal poverty level. Individuals in the group “200%+ federal poverty level” had a household income that was over two times the federal poverty level.

Other data concepts

Percentages

The data in this dashboard are shown as percentages. A percentage represents a fraction of a whole where the whole equals 100. As an example, this dashboard tells us that 91.4% of Wisconsin mothers had a postpartum visit in 2023. The population of all Wisconsin mothers or people who gave birth represents the whole. If the population of all Wisconsin mothers was 100 people, then 91.4 people would have had a postpartum visit.

While it is commonly understood that percentages add up to 100, the percentages shown within each graph in this dashboard do not add up to 100. This is because the dashboard is only showing one of two possible scenarios: the percentage of mothers who had a postpartum visit. If the percentage of mothers who did not have a postpartum visit was also shown, then those two numbers would add up to 100 as there are only two possible scenarios: having a visit or not having a visit.

Confidence intervals

Hovering over a data point within the dashboard gives a pop-up box with an interpretation of that data point. The pop-up box also gives two numbers that represent the 95% confidence interval. While a data point is the best estimate of the truth based on the information available, we cannot know with certainty that it is the true value for the entire population. A confidence interval is a range of numbers that likely contain the true value. The range of a confidence interval is impacted by the number of people included in the data, how much each person’s data differs from others, and the level of certainty that the range contains the true value (in this case, 95% certain).

Health care access, use, and experiences may differ across populations due to differences in several factors, including social and environmental factors. The University of Wisconsin Population Health Institute’s Model of Health shows how community conditions impact health. It important to remember that blame for adverse health outcomes, including health care experiences, should not be placed on the individuals or populations who experience them.

Age and education level are important factors impacting access to health care. Individuals who are younger or with fewer years of education may have limited connections with health systems and services or may experience additional barriers to care.

A person’s insurance coverage can impact their access to health care and their experiences while receiving care, ultimately impacting health outcomes. Insurance coverage and type can determine when, where, and with whom a person is able to receive care, greatest impacting communities with health care service shortages or other barriers to quality care. Additionally, medical procedures not covered fully by health insurance can prevent people from getting the medical attention they need. Confusion around insurance policies may contribute to delayed care and interrupted care coordination.

While race or ethnicity does not have any impact on the biology of a person, it can shed light on how different populations experience health care as well as social and economic conditions. Some populations may experience systemic barriers to quality care, safe housing, economic opportunities, and more—both historically and currently—that impact care access and health outcomes. It is also important to understand why people may distrust health care systems and to foster feelings of trust and safety within health care settings. When we see differences between racial and ethnic groups we can better understand where to place resources to improve the conditions populations are living in and increase access to health care inside and outside the hospital.

Data sources, including the ones used to create this data dashboard, may be limited in their ability to show data for all populations or for smaller geographies. Additional maternal health data may be also available that is not shown on the data dashboard.

If you have any questions around maternal health data or would like to request data, email DHSFHSData@dhs.wisconsin.gov.

Additional data and information related to maternal, infant, child, and adolescent health can be found on the Family Health Data page. This webpage contains resources that are freely available from state and national data sources. You will also find a guide for using WISH (Wisconsin Interactive Statistics on Health) to show you how to do your own data queries on a wide-range of health indicators in our state and communities.