ArticlesEffects of redesigned community postnatal care on womens' health 4 months after birth: a cluster randomised controlled trial
Introduction
Results of studies1, 2, 3, 4 have shown that many women have, but do not report, physical and emotional disorders after childbirth, some of which are persistent. At present, postnatal care does not adequately address these needs, but continues to devote much time and resources to routine examinations that screen for morbidities that are no longer the major health burden for women.5, 6, 7, 8 UK Government reports and other national bodies have clearly stated the need for wide-ranging changes to maternity services, emphasising poor assessment and frequently inappropriate delivery of postnatal care.9, 10, 11, 12 A service led by midwives, with continuity of care and involvement of women, which is supportive and sensitive to individual needs and preferences is at the centre of the maternity care recommendations.10
We aimed to develop and implement a new model of community postnatal care, that was based on results of research and maternity care recommendations, and to compare the effects of such care on women's subsequent health with those of present care.
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Recruitment and randomisation
The unit of randomisation was the general practice. Since the intervention included midwife education, and midwives could not be expected to deliver two models of care without contamination, randomisation of individual women was not possible. Midwives could also not be randomly assigned because of contamination from crossover in care by midwives in the same practice. General practices were randomly selected from all those in the West Midlands health region. Women were eligible if they had had
Results
From a randomly selected list of 125 general practitioners, we identified 120 practices to approach (five were selected twice through two partners), from which 40 (33%) took part. In three cases, midwives also gave care in another recruited practice, but each practice pair was included as one cluster. We thus had 37 general practice clusters which were allocated either to intervention (n=18) or to control (19). One practice was excluded after allocation but before recruitment of women, because
Discussion
Our results show that the redesigned community postnatal care was associated with positive psychological health outcomes in women at 4 months' postpartum, although physical health measures did not differ. For the SF36 mental component score there was a 3·03 point improvement and for the EPDS the odds of a score suggestive of depression relative to controls was 0·57. The effects were across clusters and not attributable to a few clusters with atypical scores. Some of this improvement in
References (37)
- et al.
Postnatal home visiting by midwives
Midwifery
(1994) - et al.
Factors affecting the duration of postnatal visits
Midwifery
(1991) - et al.
Health after childbirth
(1991) - et al.
Postnatal maternal morbidity: extent, causes, prevention and treatment
Br J Obstet Gynaecol
(1995) - et al.
Maternal health after childbirth: results of an Australian population based survey
Br J Obstet Gynaecol
(1998) - et al.
Women's health after childbirth: a longitudinal study in France and Italy
BJOG
(2000) - et al.
Routine 6-week postnatal vaginal examination: to do or not to do?
J Obstet Gynaecol
(1993) - et al.
What are we doing in the postnatal check?
Br J Midwif
(1995) House of Commons select committee. V1
(1992)The expert maternity group. Changing childbirth
(1993)