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Does an early postnatal check-up improve maternal health: results from a randomised trial in Australian general
1Department of General Practice and Public Health, University of Melbourne, Carlton, Australia.
Objectives:
To investigate whether a visit to a general practitioner one week after discharge results in less depression, increased breastfeeding rates, improved patient wellbeing, fewer physical problems and greater satisfaction with general practice care than the traditional six week postnatal check-up.
Design:
A randomised controlled trial.
Setting:
Rural and metropolitan Victoria, Australia. Population Women giving birth at one rural and one metropolitan hospital between February and December 1995 inclusive.
Methods:
All women received a letter and appointment date to see a general practitioner for a check-up: the intervention group for one week after hospital discharge, the control group for six weeks after birth. A mail-out survey was conducted at three and six months after birth, including Edinburgh Postnatal Depression Scale and Short Form 36.
Results:
1017/1407 (72.3%) women giving birth at participating hospitals were eligible for the trial: 683 (67.2%) gave informed consent. The average response rate to postal follow up at three and six months was 67.5%. No significant differences were found between the groups in: Edinburgh Postnatal Depression and Short Form 36 scores; number of problems; breastfeeding rates; or satisfaction with general practitioner care. Women in the intervention group were less likely to attend for their check-up (76.4% vs 88.4%; P = 0.001), more likely to discuss labour and birth at their check-up (OR= 1.77, 95% CI 1.17-2.68), less likely to have a vaginal examination (OR = 0.51; 95%, CI 0.34-0.77) or pap smear (OR = 0.34; 95% CI = 0.22-0.52) at their check; more likely to report difficulties with low milk supply (OR= 1.72; 95% CI = 1.12-2.66) and adjusting to the demands of a new baby (OR = 1.76; 95% CI 1.13 2.74), more likely to talk to a general practitioner about their baby (68.2% vs 58.0%; P=0.02) and less likely to consult a hospital doctor about their baby (7.3% vs 14.0%, P = 0.02).
Conclusions:
To make clinically important improvements in maternal health more is required than early postnatal review.