Women Veterans' Experiences with Department of Veterans Affairs Maternity Care: Current Successes and Targets for Improvement

Introduction: Little is known about women veterans' experiences accessing and using Department of Veterans Affairs (VA) maternity care, which is nearly all purchased from non-VA providers. Objective: To understand women veterans' experiences, preferences, and challenges using VA maternity care. Methods: We conducted 27 semistructured interviews with women veterans who used VA maternity care during fiscal year 2016. To capture a wide variety of experiences, we randomly sampled veterans from urban and rural VA facilities with higher and lower volumes of VA paid deliveries. All interviews were recorded and transcribed verbatim. Transcripts were analyzed using inductive and deductive content analysis. Results: Themes included experiences initiating prenatal care, obtaining prenatal and lactation classes, the role of maternity care coordinators, mental health care, and satisfaction with care. Women described challenges obtaining authorization for care and establishing care with non-VA providers. First-time mothers appreciated the availability of prenatal and lactation classes. VA maternity care coordinators helped women veterans to navigate the challenges related to VA maternity care, ranging from finding non-VA providers to billing. The majority of participants were engaged with mental health care before pregnancy and continued this care during pregnancy. Women's satisfaction with VA maternity care was impacted by access to supportive, knowledgeable providers; care coordinators; womancentered labor and delivery experiences; and billing issues. Conclusions: Our findings provide a portrait of the current state of VA maternity care from the perspectives of women veterans and highlight areas, such as care coordination and woman-centered models for labor and delivery, that can improve satisfaction with care. Published by Elsevier Inc. on behalf of Jacobs Institute of Women's Health.