Researchers from the University of Michigan teamed up with colleagues from Brandeis University’s Lurie Institute for Disability Policy to examine the differences in postpartum hospitalizations between women who are deaf and hard of hearing (DHH) and other delivering women. They also compared the leading reasons for those hospitalizations between the two groups immediately after birth and up to one year postpartum.
Results from the study “Postpartum hospital readmissions among Massachusetts women who are deaf or hard of hearing,” were published online first in the Journal of Women's Health. Kimberly S. McKee, Ph.D., MPH, assistant professor in the Department of Family Medicine at the University of Michigan, served as the paper’s first author.
The team used data from the Massachusetts Pregnancy to Early Life Longitudinal (PELL) Data System, a statewide, all payer database that links to the hospital discharge records of mothers’ delivery and children’s birth, to identify women who had given birth between 1998-2017 in Massachusetts. They identified 3,546 women who were deaf or hard of hearing who gave birth to one child (i.e. single-birth) and 1,381,439 single-birth deliveries to non-DHH women.
They found that women who were deaf and hard of hearing had a higher risk of any hospital admission across all postpartum periods compared with non-DHH women — and were more likely to experience a wide range of conditions with serious, lifelong implications for both mother and child.
Women who were deaf and hard of hearing had an almost seven-times higher risk for repeated hospital admissions in the three months after delivery — and a nearly four-times higher risk of hospitalization in the year after delivery, as compared to non-DHH women. In prior work, the team documented that DHH mothers are also more likely to experience longer hospital delivery stays, to deliver by cesarean section, and to deliver infants pre-term and small for their gestational age.
While there was some overlap in the leading postpartum hospital readmissions at 42 or fewer days, DHH women experienced health challenges leading to hospital readmissions in greater numbers. Those reasons included hypertension (pre-existing, gestational, and preeclampsia). Beyond six weeks postpartum, the leading postpartum reasons for readmissions were distinct from that of other postpartum women. They included disorders of the soft tissue, gall stones, pneumonia, carcinoma of the breast and genitourinary system, abdominal and pelvic pain, asthma, hereditary hemolytic anemias, affective psychoses, and alcohol dependence syndrome.
One possible explanation for the findings is that DHH women may be less likely to receive timely and adequate prenatal care, which may be the result of barriers to accessing American Sign Language interpreters within the healthcare setting and lack of provider training for individuals with disabilities. These barriers underscore the need for tailored surveillance and interventions among this population of women, including early identification and documentation of a disability to ensure accommodations, as examples. These actions can facilitate provider-patient communication. Adopting an integrated care model may also be helpful.
“In light of the maternal morbidity and mortality crisis in the U.S., we hope that these study results underscore the fact that DHH women may require additional care in the first year postpartum, including the coverage of additional postpartum visits,” lead author McKee said. “Our study results highlight a need for evidence-based practices to support these vulnerable subpopulations of women and address disparities.
“All women should expect to deliver babies in a safe manner, one that negates the need for hospital readmissions, regardless of whether or not they live with a disability,” she added.
Article Citation: McKee, K. S., Akobirshoev, I., McKee, M., Li, F. S., &; Mitra, M. (2022). Postpartum hospital readmissions among Massachusetts women who are deaf or hard of hearing. Journal of Women's Health. https://doi.org/10.1089/jwh.2022.0068
