Assessing Access to Care in a Postpartum Pelvic Floor Healing Clinic

Anya Singh-Varma ^1* Li Wang ² Rachel Durst ³ Pamela A. Moalli ^1,3,4 Lauren Giugale ^1,3*

• ¹ School of Medicine, University of Pittsburgh, Pittsburgh, United States
• ² Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
• ³ Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
• ⁴ Magee-Womens Research Institute, Pittsburgh, Pennsylvania, United States

Introduction: Disparities in pregnancy care exist in the United States, with limited data on access to specialized postpartum care for patients with complicated perineal lacerations. Our objective was to assess for disparities in access to a Postpartum Pelvic Floor Healing Clinic following vaginal delivery. We hypothesized underrepresentation of patients from more resource-deprived neighborhoods and those with longer travel times in the specialized clinic.Methods: Retrospective cohort study comparing sociodemographic variables from a historical cohort of patients with third- and fourth-degree lacerations following vaginal delivery to a cohort of patients evaluated in a Postpartum Pelvic Floor Healing Clinic. The primary outcome was neighborhood area deprivation index compared between groups. Secondary outcomes included median household income, driving time and distance to the hospital. Results: Patients seen in the Postpartum Pelvic Floor Healing Clinic were older (31.3 vs 29.9 years, p<0.01) and more likely multiparous (20.3% vs 13.1%, p=0.04). Race, ethnicity, and operative vaginal delivery were similar between groups. Postpartum Pelvic Floor Healing Clinic patients had more postpartum visits [3 (IQR 2-4) vs. 2 (IQR 1-2) visits, p<0.01]. There was no significant difference in median neighborhood area deprivation indices [4 (IQR 2-7) vs. 5 (IQR 3-7), p=0.06]. Fewer patients from the most resource-deprived neighborhoods were seen in the Postpartum Pelvic Floor Healing Clinic, though this was not statically significant (4.5% vs 8.9%, p=0.06). There were no significant differences in median household income or driving distance to the hospital between groups. Conclusions: Access to a specialized postpartum pelvic floor healing clinic at our institution appears equitable across several sociodemographic factors.