Bartels, Helena C. and Fox, Karin A. and Aryananda, Rozi Aditya and Terlizzi, Kristen and Cooney, Naomi and Nieto-Calvache, Albaro José and Lalor, Joan G. and Brennan, Donal J. (2026) Patient centered care for placenta accreta spectrum: Exploring implementation of recommendations based on reported patient and healthcare provider experiences. International Journal of Gynecology and Obstetrics, 172 (1). 467 - 481.

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Abstract

Objective: Previously, we made recommendations for “family-centered care” for patients with placenta accreta spectrum (PAS). This study explored patients' experience of their care and how often these recommendations are utilized. Furthermore, we explored whether these recommendations are valued by healthcare providers and identify barriers to implementation. Methods: This study consists of two surveys; one for patients with a history of PAS and a second survey for healthcare providers involved in PAS care. Surveys were circulated over an 8-week period between September and October 2024. Four overarching recommendations were investigated as follows; preparation for birth, supportive care, education of healthcare providers and postpartum care. Quantitative and qualitative data were obtained; content analysis was performed to identify themes from the patient and healthcare provider experiences. Results: A total of 155 patients responded to the online survey. While some felt well prepared for the birth (96/155, 63%), most felt frustrated by the lack of treatment options and preparatory resources (n = 122/155, 78%). Less than half of patients were offered mental health referrals (n = 69/155, 44%), although when offered they were positively received. Only 40% (n = 62/155) of patients were offered specialist postpartum care. From the healthcare provider survey, which had 89 responses, possible barriers identified by healthcare providers to offer such support were cost, lack of insurance coverage and geographical distance. Qualitative content analysis revealed that patients strongly expressed a need for counseling, physical health support, and specialist postpartum care. Conclusion: Previously published recommendations are strongly desired by patients, with positive experiences where these are offered. Healthcare providers acknowledge and value the need for supportive care, with barriers to implementation including cost and limited resources. We suggest practical, low-cost measures to overcome these gaps.

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