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Observational Study
. 2024 Jan-Dec:20:17455057241274897.
doi: 10.1177/17455057241274897.

Postpartum menstrual equity: Video and audio analysis of vaginal bleeding counseling during postpartum inpatient care at a southeastern US tertiary hospital

Shilpa M Darivemula  1 , Kelley Ec Massengale  2   3   4 , Catalina Montiel  5 , Alison M Stuebe  6   7   8 , Kristin P Tully  6   7
Affiliations
Observational Study

Postpartum menstrual equity: Video and audio analysis of vaginal bleeding counseling during postpartum inpatient care at a southeastern US tertiary hospital

Shilpa M Darivemula et al. Womens Health (Lond). 2024 Jan-Dec.

Abstract

Background: Despite the universal nature of postpartum vaginal bleeding after childbirth and the importance of managing vaginal bleeding in the postpartum period to monitor health status, little is known about the information or products that birthing individuals are provided. Investigating current practices may offer insights to enacting more supportive and equitable postpartum care.

Objective: To evaluate the patterns and content of vaginal bleeding counseling provided to birthing parents while on a postnatal inpatient unit.

Design: Observational study of inpatient postpartum care. Birthing parents and their companions consented to video and audio recording of themselves, their infants, and healthcare team members during their postnatal unit stay.

Methods: Following IRB approval and in coordination with clinicians at a tertiary hospital in the southeastern United States, data were collected with 15 families from August to December 2020. A multidisciplinary team coded video and audio data from each family from 12 h before hospital discharge. This analysis evaluates patterns of vaginal bleeding counseling timing, content, and language concordance and thematic content of this communication.

Results: Birthing parent participants were self-identified Hispanic White (n = 6), non-Hispanic Black (n = 5), non-Hispanic White (n = 3), and non-Hispanic multi-race (n = 1). Six were Spanish-speaking and eight had cesarean section births. The timing, content, and language concordance of vaginal bleeding communication varied, with these topics mainly addressed in the hour preceding discharge. Twelve of the 15 birthing parents had communication on these topics between 2 and 5 times, 2 had one exchange, and 1 had no counseling on postpartum bleeding observed. Four of the six Spanish-speaking birthing parents had counseling on these topics that was not language concordant. Postpartum vaginal bleeding management involved the themes of access to products, patient safety, and meaningful counseling. There was a lack of adequate access, variation in accurate and respectful care, and a busy clinical environment with differences in information provided.

Conclusion: Findings suggest that there are opportunities to strengthen clinical practices for more consistent, proactive, and language concordant vaginal bleeding and subsequent menstrual care postpartum. Menstrual equity is an important part of dignified and safe care.

Keywords: counseling; language concordance; menstrual equity; patient safety; postpartum.

Plain language summary

Video analysis of when and what information on vaginal bleeding was shared between people who just gave birth and their healthcare team at the hospital.Why did we do the study? After birth, people must take care of vaginal bleeding. It is important for people in the hospital to recognize warning signs for too much bleeding, have access to pads, and feel supported by their healthcare team before discharging to home. There has been little research on experiences with inpatient counseling on postpartum vaginal bleeding—a part of the reproductive life cycle—for new parents. We wanted to watch and listen in hospital rooms so we could think about the best ways for healthcare providers to talk about vaginal bleeding. What did we do? We asked 15 people who just gave birth, people staying with them at the hospital, and their healthcare team if we could video and sound record in their hospital rooms. They could start and stop recording anytime. We only recorded people who agreed to be in the study. What did we learn? We watched recordings of the last 12 hours at the hospital before each family went home. We found that most of the time, the healthcare workers did not talk about vaginal bleeding. People who spoke Spanish did not always have someone interpreting into their language. Sometimes family members had to translate and ask for pads. Some people did not have enough pads or underwear and had to wait after asking for more. What does it mean? We found ways to improve teaching about vaginal bleeding after birth. We recommend always having an interpreter when needed, giving people enough pads and underwear in their rooms, including companions in the teaching, and having enough healthcare workers to answer requests. These ideas would improve the counseling and give everyone the support needed after giving birth.

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Conflict of interest statement

The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Drs. Tully and Stuebe are inventors of a patented medical device. The University of North Carolina at Chapel Hill intellectual property is licensed. The device is not referenced or otherwise related to the content of this manuscript. The other authors report no conflicts of interest.

Figures

Figure 1.
Figure 1.
The timing, content, and language concordance of vaginal bleeding verbal communication among healthcare team members, birthing parents and companions as filmed during the 12 h of inpatient postpartum care prior to hospital discharge. *Spanish-speaking birthing parents.
Figure 2.
Figure 2.
Recommendations for improving postpartum menstrual equity.
See this image and copyright information in PMC

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