Background:
Studies have shown that quality of care impacts health outcomes (Riedl et al. 2017, Stewart 1995) and emotional health (Stewart et al. 2000). Specifically, prenatal care is associated with birth outcomes such as birth weight (Cox et al. 2011, Ruiz et al. 2014), preterm birth (Willems Van Dijk et al. 2011; Cox et al. 2011), and infant mortality (Cox et al. 2011, Ruiz et al. 2014), and negative perceptions of care are associated with poor birth outcomes (Reichman and Keney 1998; Ruiz et al. 2014). The link between poor prenatal care and poor birth outcomes emphasizes the need to improve the quality of such care to improve maternal and infant health. Yet, more studies are needed to examine the influence of quality of care measures such as communication and the perceptions of quality of care to birth outcomes. Few if not any studies examine the relationship between quality of care to postpartum depression (PPD). Prior work suggests that there is a connection between women’s perceived birth experience and PPD (Bell and Andersson (2016).

Methods/Design:
In this study, we examine whether perceived quality of prenatal care contributes to birth outcomes (preterm birth, normal birthweight, vaginal delivery), and postpartum depression. We use data from the 3rd wave of the Listening to Mothers (LTM) dataset (2013), which is the only national dataset to examine maternity experiences among US women (n = 2400). Through linear and logistic regression analysis, we test the following hypotheses: 1) perceived quality of prenatal care will have a positive association with a) vaginal delivery, b) term pregnancy, and c) birthweight and 2) perceived quality of prenatal care will have a negative association with PPD risk. Quality of prenatal care items asked participants: if their prenatal care providers: 1) spent enough time with them (time spent), 2) answered questions to their satisfaction, and 3) encouraged them to ask questions. Medical jargon was also examined and indicated whether or not their prenatal care providers used medical words they did not understand (yes=1, no=0).

Findings:
This study supports the association between quality of care measures and birth outcomes and PPD risk. Women reporting a better interaction quality with their healthcare providers are significantly less likely to have a preterm birth relative to women who report lower quality of interaction. Also, women who report medical jargon during their prenatal visits are less likely to have a normal birthweight baby. These findings suggest that negative experiences like medical jargon can have a negative impact on birth outcomes while positive experiences like better quality of interactions can be protective. In addition, quality of care measures were highly associated with PPD risk. Women who report medical jargon, a lower quality of interaction, and a lower perceived quality of maternity care in the U. S. were more likely to be in the depression risk cutoff group. Although there were inconsistent findings between quality of care measures and birth outcomes, the quality of care measures were a consistent predictor of PPD risk.

Conclusion:
These findings demonstrate the importance of quality of care especially relating to postpartum mental health. Studying each of these components of quality of care can lead to strategies to improve both birth
outcomes and postpartum experiences.

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