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Investigating postnatal care for mothers

Published on Thursday, 27 January 2022

Postnatal care always generates a lot of conversation when talking to parents and organisations about maternity research. There's general concern that what is currently provided isn't meeting the needs of mothers, but there's also a need for timely research to guide improvements to care.

A single piece of research rarely triggers widespread changes in any area of health care. It's usually the case that a picture is built up from different projects focusing on various elements of an area of health and using different methods to answer similar questions. That body of evidence then informs changes to care.

Two recent studies published by researchers at the Policy Research Unit in Maternal and Neonatal Health and Care (PRU-MNHC) show how research works in tandem with the Department of Health and Social Care, to build a fuller picture of health and care, what needs to be improved and how to measure whether those improvements are actually taking place.

The first study looked at whether GPs are delivering postnatal checks for mothers and the second collected women's experiences of postnatal care as part of the National Maternity Survey.

The first study came about because in early 2019 NHS England asked us to carry out research to inform a discussion around the policy and funding of a GP health check for mothers 6-8 weeks after giving birth. While this health check was included in NICE guidance, it was not classed as an essential service under the GP contract at the time. NHS England wanted to know what the provision was like under the existing contract, to help them decide what to do next.

The research team, led by Claire Carson and working with PRU researcher Yangmei Li , used health records from primary care to address this question. These records included over 34,000 women who gave birth between 2015 and 2018.

The researchers found that 62% of women had a postnatal check within 12 weeks of their baby's birth but only 40% had a check at the recommended time of 6-8 weeks. Women were more likely to have had a late check, or no check at all, if they were in their teens or early 20s, had a premature baby or were registered with a GP practice in a more deprived area. This snapshot of practice informed the discussions of the new GP contract, and in February 2020 it was announced that a maternal six week check would now be an essential service, with an additional £12million in funding for postpartum care.

However, the Covid-19 pandemic was rapidly changing the way that women accessed and received care during and after they had their babies. The second project was the 2020 Maternity Survey, led by Fiona Alderdice and Maria Quigley working with PRU researcher Sian Harrison , which provides a picture of what happened during the early pandemic.

This survey takes place every 3 years or so and asks similar questions each time so that researchers can get a picture of women's experience of care over time – whether they are improving or getting worse. This last survey invited women who gave birth in May that year to take part, capturing the voices of 6,000 women in the middle of the first UK lockdown for the COVID-19 pandemic.

The survey found there was a huge drop in satisfaction with postnatal care during lockdown, with only 53% of women satisfied with their care after the birth of their baby, compared with 77% in the 2014 survey. On average, women had fewer postnatal home visits from a midwife (most women had 1 visit, versus 3 in the 2018 NMS) and more women expressed a need for additional professional breastfeeding support (46% versus 30% in the 2018 NMS). While women praised the efforts of their midwives, GPs and health visitors, their accounts of their postnatal care, both in hospital and when at home, described intense loneliness, anxiety and emotional strain, and feeling forgotten or abandoned.

The two pieces of research use very different methods but give us insights from different perspectives about the care that women are receiving. Working in this way produces timely research which can then quickly contribute to policy changes in improving postnatal care for women.

Updated: Monday, 02 October 2023 11:49 (v8)