A pilot study exploring barriers and facilitators to attendance at the six-week postpartum check.

Abstract

Background: The postpartum period marks an important time for the mother-baby dyad. Early maternal review by a medical practitioner is advised to address various topics1 including contraception, breastfeeding, perinatal mental health, and post-delivery care. Individual recommendations may include oral glucose tolerance test after gestational diabetes, and blood pressure check after hypertensive disorders in pregnancy. International data suggests non-Attendance at postpartum check ranges from 15%2 to 49% in certain populations.3 Attendance rates among Australian women are not well-documented. Method(s): We conducted an exploratory study to evaluate barriers to attendance at postpartum appointments to inform a future randomised controlled trial. Women were recruited after birth, but before discharge, and underwent telephone survey at eight weeks' postpartum to discuss attendance and barriers to attending the six-week check. Result(s): We recruited 72 women who delivered between 12/04/2023 and 27/06/2023 across three sites. Mean age was 32 years, with 35/72 (49%) birthing for the first time. All pregnancies were singleton. Most were born overseas (45/72, 63%) with 39/72 (54%) of culturally/linguistically diverse background. Most (41/72, 57%) received public hospital-based antenatal care; 17/72 (24%) received private antenatal care and 14/72 (19%) public/GP shared care. Similar numbers underwent vaginal delivery (39/72, 54%) versus Caesarean section (33/72, 46%; with 21/33 elective). Sixteen (22%) had an antenatal diagnosis of gestational diabetes, and 9/72 (13%) had a hypertensive disorder of pregnancy. For this interim report, 48/72 participants were 8+ weeks' postpartum; 39 responses were completed, and four withdrawn. Nearly all (33/39, 85%) had attended a six-week check, and organised their own appointments (30/39, 77%). Only 1/12 (8%) women with gestational diabetes reported having had the postpartum oral glucose tolerance test at the time of the survey; 3/4 (75%) of those with hypertension in pregnancy had undertaken a blood pressure measurement. Barriers to attendance were discussed; six participants reported difficulty booking a convenient time. Suggestions to improve the postpartum transition included assistance with booking postnatal checks prior to hospital discharge; and access to a postpartum specialist clinic. Conclusion(s): A high proportion of women in our study attended the recommended six-week postpartum check, but there was suboptimal compliance with recommended postpartum tests for those with higher risk pregnancies. Increased assistance with making the transition from hospital-based perinatal care back to community care was reported as desirable. The results of this pilot study will inform postnatal interventions in our future randomised controlled trial to improve post-partum follow-up in women with antenatal complications.