Facilitating postpartum care with a doula and certified nurse midwife in the neonatal intensive care unit: A qualitative analysis of maternal experiences

Abstract

Abstract Introduction Mothers of infants in the Neonatal Intensive Care Unit (NICU) are at higher risk of postpartum complications than mothers of well infants. The Postpartum Care in the NICU (PeliCaN) study was an unblinded, randomized controlled trial of doula-supported, certified nurse midwife?delivered postpartum care for NICU mothers that reduced time to postpartum care for intervention participants. To establish acceptability and identify the most valuable core components of this care model, we conducted a qualitative study to understand the following: (1) the perspective and experience of NICU mothers in the intervention and control groups, (2) their receipt of and associated facilitators and barriers to postpartum care, and (3) the relative contributions of the doula and certified nurse midwife in accessing postpartum care. Methods Semi-structured interviews were completed with 20 participants (10 intervention and 10 control) who were NICU mothers of infants born <34 weeks? gestation, admitted to the NICU, and <2 weeks old. We utilized template analysis, a form of thematic analysis, and an inductive approach to examine, interpret, and identify themes in the data. Results We identified seven primary themes capturing the positive influence and care facilitated by the doula and certified nurse midwife. Four themes were specific to the doula: care coordination, prioritization of NICU mothers? own postpartum care, resource coordination, and guidance by the doula. Three themes were specific to the certified nurse midwife: efficient, timely care at the bedside; removing travel and scheduling barriers; and personalized care from the midwife. Conclusions We identified a variety of ways in which embedding a doula and certified nurse midwife in the NICU to support postpartum care contributed to timely access to postpartum care and improved the postpartum experience for these high-risk obstetric patients. The synergy of doula-facilitated care, resource coordination, emotional support, and guidance with personalized certified nurse midwife?delivered essential bedside care that minimized logistical barriers was well received and appreciated by intervention participants. These maternal perspectives support embedding postpartum care in NICUs via policies and integrated healthcare delivery models.