In a new study, Christine Agdestein has surveyed several aspects of the postnatal check-up. Agdestein is a specialist in general practice and a general practitioner, and is currently a PhD candidate at the Norwegian University of Science and Technology (NTNU). The research project is part of her PhD.
"An important finding is that the majority are satisfied with the 6-week check-up with their GP. This is an important offer for those who have recently given birth. GPs have an important role in postnatal care," says Christine Agdestein.
"Not much research has been done on the postnatal check-up before, and therefore it is extra rewarding that we can offer new knowledge. These are findings that can quickly be used in improvement work related to postnatal care," she says.
The study was conducted together with four other researchers from NTNU and Nord-Trøndelag Regional Health Authority.
Women's feedback
The study shows that satisfaction was strongly linked to being able to talk about the birth experience, that many relevant topics were raised during the consultation and that a gynaecological examination was included.
The topics that were most often considered important or very important:
- the birth experience (61 per cent)
- Contraception (55 percent)
- Breastfeeding (53 percent)
- birth-related pelvic injuries (52 per cent)
- mental health (40 per cent)
The most important topics were also discussed most frequently.
One in four do not show up
Although the offer is perceived as positive and important, many women do not take advantage of the opportunity. The researchers found four main reasons:
- Lack of a GP
- did not feel that it was necessary to have a postnatal check-up
- Was not satisfied with previous visits
- Didn't know about the offer
Women who did not show up for the follow-up check-up after childbirth thus missed out on an important opportunity for support and health-promoting measures.
"Women with chronic diseases, high-risk pregnancies and complications during childbirth did not participate more often in the follow-up check-up than women with good health and uncomplicated births. This is worrying considering that these women have an increased risk of disease and mortality," says Christine Agdestein.
The consultation is free of charge
It is important to provide information about the postnatal check-up. In principle, the women should receive information both during pregnancy and from the maternity ward. Only 44 per cent stated that they had received information from the maternity ward.
52 per cent had received information about the service from a midwife in the municipality, and some had received information from their GP. 18 per cent received information from friends and 11 per cent from social media.
"We definitely see room for improvement here," says Agdestein. She also takes into account that some of those who have just given birth do not remember all the information that is given. Therefore, it can be important to design written information for the women, Agdestein believes.
It also emerged that 32 per cent of the women did not know that the service is free, which is important to make clear in the information provided.
"The odds of attending increase if you know that the consultation is free," the study shows.
Wants a gynecological examination
A gynaecological examination was high on the list of what the women wanted during the postnatal check-up. Not everyone was offered this. The study shows a strong correlation between satisfaction with the postnatal check-up and having a gynaecological examination.
The women recommended that GPs should offer gynaecological examinations to a greater extent proactively.
"The study showed that some women find it difficult to ask to have their genitals examined. The findings show that it is important that they are offered a gynaecological examination, and then the women can decide for themselves whether they want and need it. Many people may have pain and tears after childbirth, and experience incontinence, so it is important that they are offered a gynaecological examination," says Agdestein.
Mental health and increased postpartum depression
40 per cent of the women responded that talking about mental health is important, and the topic was brought up in as many as 60 per cent of the consultations.
"This may indicate that GPs are focusing on mental health, and that is good. We see from other studies that the prevalence of postpartum depression has increased in Norway in recent years, so mental health is an important topic to talk about at the postnatal check-up," Agdestein emphasizes.
Improvement work is already underway
Based on the study, Christine Agdestein is working on a follow-up project, together with several of those who worked on the first study. The follow-up is specifically about tools to improve postnatal control.
"We have developed a tool and a prototype that is ready for testing. It is a tool that will be used by GPs and women in collaboration," says Christine Agdestein.
It will provide good information to the women about which topics can be addressed during the 6-week check-up and help the woman to prioritise what is most important to her. In this way, the GP can adapt the check-up to each individual.
"With this measure, we hope to improve both information and quality, which in turn can contribute to increased attendance and better benefit from the postnatal check-up.
"I started looking into this because, as a GP, I have followed up many women throughout pregnancy and the postnatal period. Then I saw that there was a great need for knowledge about postnatal care in the primary health service. I have gone from clinical practice, to research and now to improving practice," says Christine Agdestein.
How the study was conducted
The study was conducted as a questionnaire survey where the target group was all women who gave birth in Nord-Trøndelag Regional Health Authority for one year. 1119 women were in the target group, and 351 responded.
"The age, education and number of births for those who responded are comparable to women who gave birth in Norway in the same year. Thus, the results are also relevant in the rest of the country," says Agdestein.
She summarises that the most important findings are that one in four do not show up, that there is a need for better information, that it is important that the consultation covers many and relevant topics, including the experience of childbirth, and that the women should be offered a gynaecological examination.
"Our survey includes insight into the content of the consultations, and an analysis of the factors that affect whether the women are satisfied or not. This means that professionals can quickly address the findings to improve the service," concludes Christine Agdestein.