A UK study in this weeks issue of THE LANCET highlights how a new model of postnatal care led by midwives and tailored to meet individual needs could reduce the risk of mental illness among women in the first four months after childbirth. A Commentary article also published this week concludes that the study has implications for the delivery of postnatal care in the USA.
Much physical and psychological illness after childbirth is not addressed by present postnatal care, which is based on routine examinations. Christine MacArthur and colleagues from the University of Birmingham, UK, assessed a new model of community postnatal care that was based on results of research and maternity care recommendations, and compared the effects of such care on womens subsequent health with women given conventional care.
Of 36 general practices in the West Midlands health region of the UK, 1087 women (53%) were recruited from 19 practices randomly allocated to intervention, and 977 women (47%) from 17 practices allocated to control. The new model of community-based postnatal care (given to women in the intervention group) meant that care could be tailored flexibly to individual needs. Care was led by midwives, including home visits and the final discharge consultation, and contact with general practitioners was based on referral. To ensure that specific needs could be identified, a symptom checklist was used at the first visit, at days 10 and 28, and at the discharge consultation at 10-12 weeks. The Edinburgh postnatal depression scale (EPDS) was also used to screen for depression at day 28 and at the discharge consultation. Care plans were made and visits scheduled on the basis of these results rather than on a predetermined schedule. Women in the control group were given conventional postnatal care (s
Contact: Richard Lane