New Mothers’ Perspectives on Maternal Health Care Access and Quality in Genesee County, Michigan

1. New Mothers’ Perspectives on Maternal Health Care Access and Quality in Genesee County, Michigan Thomas M. Reischl, PhD Susan Franzen, BS Prevention Research Center University of Michigan FR-11D1A Primary Data Report No. 1 www.sph.umich.edu/prc Funded by the Ruth Mott Foundation, Flint, MI

2. Acknowledgements • Lawton and Rhea Chiles Center for Healthy Mothers and Babies at the University of South Florida • Lori Kunkel and staff at Greater Flint Health Coalition • Yvonne Lewis and staff at Faith Access to Community Economic Development (FACED) • Deborah Cummings and staff at McLaren Regional Medical Center • Andy Kruse and staff at Genesys Regional Medical Center • Vicki McKinney and staff at Hurley Medical Center • Members of the Flint/Genesee County Friendly Access Project Leadership Team and Steering Committee

3. Study of New Mothers’ Ratings of Prenatal and Perinatal Health Care • Sample: • 358 new mothers whose birth was paid for by Medicaid or by self-pay at three hospitals • Quota sampling strategy • Based on population counts of Medicaid-paid & self-paid births at three hospitals in Genesee County: Hurley (n=198), Genesys (n=130), McLaren (n=30) • Interview procedures • Interviews 12-24 hours after giving birth (after 36 hrs for C-section births) • 45 minutes structured interview protocol • $15 gift certificate incentive

4. Mother’s average age: 25.4 years Average number of children: 2.4 Mother’s education: 23.7% with no HS Diploma 34.6% with HS Diploma 41.6% beyond HS Mother’s race Hispanic or Latino: 7.3% African American: 39.8% European American: 54.5% Other: 5.7% Marital status 24.6% married 66.5% never married 8.9% divorced or separated New Mothers Sample Characteristics

5. New Mothers Sample Characteristics Compared to population data (from birth records), our sample was: • Slightly older • Had 1 more child (on average) • More likely to have education beyond HS • Less likely to be African American • More likely to be married • More likely to have had a C-section

6. Most Frequent Life Events

7. Birth Control & Becoming Pregnant • Using birth control at time of conception: 25.5% • Feelings about becoming pregnant: • Wanted to become pregnant later: 33.5% • Didn’t want to be pregnant then or in future: 31.5%

8. Finding a Prenatal Provider • How many mothers did not have a prenatal provider: 6 (2%) • How did you find your provider? • Friend or Family Recommendation: 27.2% • Doctor Recommendation: 21.8% • Same provider as last pregnancy: 19.0% • Type of Provider • Doctor: 70.9% • Group practice: 24.2% • Midwife or Nurse: 2.9% • More than 1 Provider:19.1%→ Ave. # of Providers:3.44

9. Appointments with Prenatal Provider • Average wait to see provider: 20.4 minutes • Average 5-point ratings of provider (1=never; 5=always) • Provider understood what mother said or asked: 4.68 • Mother felt comfortable telling the provider worries: 4.67 • Provider gave mother enough time to talk about worries: 4.66 • Provider spent enough time with mother: 4.53 • Provider reviewed lab test results with mother: 4.52 • Provider discussed beliefs and religious practices: 1.59 • Average time provider spent with mother: 18.1 minutes

10. Ratings of Prenatal Providers • Average 5-point ratings of providers (1=poor; 5=excellent) • Respect shown by the provider: 4.24 • Technical skills of the provider: 4.20 • How well the provider explained procedures: 4.15 • Concern shown by the provider: 4.09 • Comfort the mother felt with provider: 4.08 • Respect the receptionist (office staff) showed: 4.11 • Comfort the mother felt with nurses or receptionist: 3.95 • Concern shown by the nurses or receptionist: 3.82

11. Prenatal Care • Month when prenatal care began (ave.): 2.56 • Did not receive prenatal care as early as desired: 31.2% • Number of prenatal care visits • 1 to 3 visits: 2.0% • 4 to 7 visits: 7.7% • 8 to 10 visits: 24.1% • 11 or more visits: 66.2% • Race of provider different than mother’s: 50.9% • Race of provider made a difference in care: 4.0%

12. More Ratings of Prenatal Care • Prenatal care was… • Better than expected: 48.7% • About what expected: 43.3% • Worse than expected: 7.4% • Quality ratings (0=low, 10=high) • Ave. rating of prenatal provider: 8.75 • Ave. rating of prenatal care: 8.97 • Would recommend provider to friend/relative: 91.2% • Would change providers if it was easy to do:18.1%

13. Labor and Delivery Experience • Mother decided when family members were present: 86.7% • Mother had some control over what happened during labor and delivery: 72.8% • Labor and delivery staff… • Respected mother’s wishes during labor and delivery: 92.7% • Asked what the mother wanted during labor and delivery: 75.6% • Provider who delivered baby… • Was as helpful as she/he could be: 92.7% • Treated mother with courtesy and respect: 95.5%

14. Ratings of Hospital Experience • 5-point ratings of health care professionals (1=never, 5=always): • Treated mother with courtesy & respect: 4.69 • As helpful as mother thought they should be: 4.59 • 5-point ratings of hospital support staff (1=never, 5=always): • Treated mother with courtesy & respect: 4.68 • As helpful as mother thought they should be: 4.57 • Ratings of hospital (0=low, 10=high) • Overall rating of delivery care: 8.49 • Overall rating of hospital: 8.93 • Care at the hospital was… • Better than expected: 45.2% • About what expected: 49.4% • Worse than expected: 4.8%

15. Post-Delivery Care • Mother decided amount of contact with baby: 79.3% • Mother decided how they wanted to feed the baby: 95.8% • Feeding method chosen: • Formula only 49.6% • Breastfeed only: 25.5% • Both formula and breastfeed: 23.8% • Undecided: 1.1% • Hospital staff offered to teach breastfeeding: 68.0% • Mother had chosen a health care provider for baby: 74.1%

16. Health Insurance, Payments, Benefits • On Medicaid before pregnancy: 44.1% • On other health insurance before pregnancy: 22.5% • Entire pregnancy covered by any insurance: 92.7% • Had trouble paying for prenatal care: 2.0% • Received WIC during pregnancy: 72.7% • May have trouble paying for birth: 3.1%

17. Summary of Results • Most of the new mothers reported high ratings of the prenatal and perinatal care they received. • Across many of the rating questions, about 10% of the new mothers were unhappy with their care. • The new mothers also report some areas of concern: • Many have experienced life changing stressful circumstances • Most of the mothers did not want to get pregnant • 31% of mothers said they initiated prenatal care later than they wished. • Wait times to see provider averaged 20 minutes • Nearly all mothers were insured during pregnancy, but only 67% were insured before pregnancy.