Original article Women Veterans’ Experiences with Department of Veterans Affairs Maternity Care: Current Successes and Targets for Improvement Jodie G. Katon, PhD, MS a,b, * , Erica W. Ma, BA a , George Sayre, PsyD a,b , Laurie C. Zephyrin, MD, MBA, MPH c , Kristina M. Cordasco, MD, MPH, MSPH d,e , Elizabeth M. Yano, PhD, MSPH d,f , John C. Fortney, PhD a,g a U.S. Department of Veterans Affairs (VA) Health Services Research and Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Healthcare System, Seattle, Washington b Department of Health Services, University of Washington School of Public Health, Seattle, Washington c VA Office of Patient Care Services, Women’s Health Services, Washington, DC d VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, North Hills, California e Department of Medicine, University of California Los Angeles (UCLA) David Geffen School of Medicine, Los Angeles, California f Department of Health Policy and Management, UCLA Jonathan and Karin Fielding School of Public Health, Los Angeles, California g Department of Psychiatry and Behavioral Medicine, University of Washington School of Medicine, Seattle, Washington Article history: Received 11 May 2018; Received in revised form 16 August 2018; Accepted 21 August 2018 abstract 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. Tran- scripts 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; woman- centered 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. Women veterans are the fastest growing group of new Department of Veterans Affairs (VA) users. Approximately 41% of women veterans who use VA care are of childbearing age (18– 45 years; Women Veterans Enrollment Cube, 2013). The VA has had to rapidly adapt services to ensure that these younger women veterans receive the reproductive health care they need, including maternity care, as part of the VA comprehensive health benefits package (VHA Handbook 1330.01, 2010) VA maternity Dr. Katon was supported by the VA Puget Sound HSR&D Center of Innovation (COIN) for Veteran-Centered and Value Driven Care, and by a HSR&D Career Development Award (VA HSRD CDA 13–266). Dr. Yano was supported by a VA HSR&D Senior Research Career Scientist Award (VA HSRD RCS 05–195). * Correspondence to: Jodie G. Katon, PhD, MS, VA Puget Sound Health Care System, 1660 South Columbian Way S-152, Seattle, WA 98108. Phone: þ206- 277-1843; fax: þ206-763-5490. E-mail address: jodie.katon@va.gov (J.G. Katon). www.whijournal.com 1049-3867/$ - see front matter Published by Elsevier Inc. on behalf of Jacobs Institute of Women's Health. https://doi.org/10.1016/j.whi.2018.08.006 Women's Health Issues xxx-xx (2018) 1–7