News at UI Health

An innovative clinical model to provide new moms with primary care during their baby’s first pediatric visits successfully connected more moms with the medical care they needed, according to research from the University of Illinois Chicago (UIC).

Mothers seen at the UI Health Two-Generation Clinic were more than five times as likely to see a primary care doctor in the year after delivery compared with mothers in standard postpartum care, the study found. Mothers treated at the clinic were also more likely to get lactation support and psychiatric services for behavioral health issues.

Dr. Sam Wainwright, UI Health pediatrician and
internist, talks with a patient and her mother.
(Photo: Hossein Fatemi/UI Health)

“The study shows that the two-generation model of care leads to more timely and more frequent health care for moms during the postpartum period,” said Dr. Rachel Caskey, a pediatric primary care provider and head of the Department of Medicine at UI Health. “This is especially important for moms at risk of adverse outcomes related to pregnancy.”

In 2020, a multidisciplinary team of health care providers started the Two-Generation Clinic at UI Health, the University of Illinois Chicago’s academic health enterprise. In the clinic, physicians specialized in both adult medicine and pediatrics treat new babies and their mothers in the same visit.

Physicians assess the mother’s health and whether she needs care for common postpartum conditions such as cardiovascular and mental health issues, or help managing chronic medical concerns, such as obesity or diabetes, that may have predated the pregnancy. By co-locating social work, lactation support, care navigation and other services, the clinic can quickly connect patients with necessary care at their appointment.

“Many of the challenges facing new moms are primary care issues; they aren’t gynecological issues,” UI Health pediatrician and internist Dr. Sam Wainwright said. “But most young women, especially after they’ve moved through obstetrical care, are not seeing primary care. Our clinic came out of the idea of, if moms are coming in for their babies, how can we meet their needs where they are?”

The new Journal of General Internal Medicine study is the first to assess the impact of the Two-Generation Clinic model. Researchers compared 98 mothers who received care in the clinic with 149 mothers who received standard postpartum care.

In the year after delivery, mothers in both groups made at least one obstetrics/gynecologist visit at similar rates. But 97% of mothers seen in the Two-Generation Clinic also received care from primary care professionals at least once in that time, compared with only 19% of patients receiving standard care. Two-Generation Clinic patients had far more primary care clinic visits: an average of 5.9 visits versus an average of 0.4 visits in the first year after delivery for patients receiving traditional postpartum care.

UI Health physicians Dr. Sam Wainwright and
Dr. Erin Hickey provide care for mothers and their
babies at the Two-Generation Clinic.
(Photo: Hossein Fatemi/UI Health)

“We know that a lot of young women go to obstetrics for their physical health, and that’s their medical home,” Wainwright said. “We’re not replacing obstetrics, but we think that primary care can provide a better longitudinal home to treat mothers’ chronic conditions over time, after the pregnancy is over.”

Mothers seen in the Two-Generation Clinic also received more specialty care in the year following the birth of their child. Two-thirds of patients received consultations for breastfeeding, compared with 15% of mothers in standard care. And while patients in both clinics were equally screened for depression, 50% of the mothers in the Two-Generation Clinic received at least one therapy session during the postpartum one-year period, compared with 6% of mothers in typical care.

“We develop relationships with these moms, so when things do arise, they feel comfortable calling us,” said Anne Elizabeth Glassgow, medical director of the Two-Generation Clinic. “We can intervene early. There’s not a waiting list. You can come and reach out to us at any time. I think that has been the key to our success, because we’re very flexible in provision of care.”

Additional research is needed to assess the long-term health impact of the Two-Generation Clinic. But the current study is strong evidence that a comprehensive, family-based model reduces barriers to the care that mothers need, the authors said. The clinic will continue at UI Health as part of UIC’s commitment to reducing maternal mortality, alongside efforts such as the Maternal Health Research Center of Excellence.

“We think the clinic is a sustainable, powerful intervention that empowers new moms and supports their children,” Wainwright said. “And it empowers the providers — the doctors and the social workers and the nurses and the care managers — to let us all work at the top of our license to the best of our ability to move the needle on maternal mortality.”

Author: Rob Mitchum — Director, Research & Science Communications