DOES AN EARLY POSTNATAL CHECK-UP IMPROVE MATERNAL HEALTH - RESULTS FROM A RANDOMIZED TRIAL IN AUSTRALIAN GENERAL-PRACTICE

Objectives To investigate whether a visit to a general practitioner on e week after discharge results in less depression, increased breastfee ding rates, improved patient wellbeing, fewer physical problems and gr eater satisfaction with general practice care than the traditional six week postnatal check-up. Design A randomised controlled trial. Settin g 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 appoi ntment date to see a general practitioner for a check-up: the interven tion group for one week after hospital discharge, the control group fo r 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 pa rticipating hospitals were eligible for the trial: 683 (67.2%) gave in formed consent. The average response rate to postal follow up at three and six months was 67.5%. No significant differences were found betwe en the groups in: Edinburgh Postnatal Depression and Short Form 36 sco res; number of problems; breastfeeding rates; or satisfaction with gen eral practitioner care. Women in the intervention group were less like ly to attend for their check-up (76.4% vs 88.4%; P = 0.001), more like ly 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; 9 5% 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 a bout 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). Conclusion s To make clinically important improvements in maternal health more is required than early postnatal review.