Individualised, flexible postnatal care: a feasibility study for a randomised controlled trial

Abstract

BackgroundPostnatal care in hospital is often provided using defined care pathways, with limited opportunity for more refined and individualised care. We explored whether a tertiary maternity service could provide flexible, individualised early postnatal care for women in a dynamic and timely manner, and if this approach was acceptable to women.MethodsA feasibility study was designed to inform a future randomised controlled trial to evaluate an alternative approach to postnatal care. English-speaking women at low risk of medical complications were recruited around 26 weeks gestation to explore their willingness to participate in a study of a new, flexible model of care that involved antenatal planning for early postpartum discharge with additional home-based postnatal care. The earlier women were discharged from hospital, the more home-based visits they were eligible to receive. Program uptake was measured, women’s views obtained by a postal survey sent at eight weeks postpartum and clinical data collected from medical records.ResultsStudy uptake was 39% (109/277 approached). Most women (n=103) completed a postnatal care plan during pregnancy; 17% planned to leave hospital within 12 hours of giving birth and 36% planned to stay 48 hours. At eight weeks postpartum most women (90%) were positive about the concept and 88% would opt for the same program again. Of the 28% who stayed in hospital for the length they had planned, less than half (43%) received the appropriate number of home visits, and only 41% were given an option for the timing of the visit. Most (62%) stayed in hospital longer than planned (probably due to clinical complications); 11% stayed shorter than planned.ConclusionsWomen were very positive about individualised postnatal care planning that commenced during pregnancy. Given the hospital stay may be impacted by clinical factors, individualised care planning needs to continue into the postnatal period to take into account circumstances which cannot be planned for during pregnancy. However, individualised care planning during the postnatal period which incorporates a high level of flexibility may be challenging for organisations to manage and implement, and a randomised controlled trial of such an approach may not be feasible.

Policy, evidence and practice for post-birth care plans: a scoping review

“…Although both the Victorian guidelines on post-birth care [34] and NICE guidelines on the routine care of postnatal women and their babies [7] suggest all care should be individualised there is a lack of evidence regarding the efficacy of a personalised approach to post-birth care and whether this would be feasible from an organisational perspective [11]. However, contemporary policy continually reiterates that all women should have a personalised care plan for the whole maternity journey [38].…”

“…The NHS resource pack for implementing Better Births, suggests that post-birth planning is considered before birth and continually revisited in the postnatal period [38]. Although Forster et al shows the importance of flexible and individualised care and how planning care antenatally is crucial for post-birth care, they only focussed on early discharge planning from hospital and did not emphasise the potential impact of relational continuity on such planning [11].…”

“…For example, in 1975, it was commonplace for women in UK hospitals to stay for at least 1 week after their baby’s birth, now 60% are home within 1 day of giving birth [10]. These shortened hospital stays are attributed to an increase in birth rates and a lack of resources in terms of midwives and hospital space [11]. Indeed, the Royal College of Midwives has estimated a current deficit of 3000 midwives in England [9].…”

MyHEART: A Non Randomized Feasibility Study of a Young Adult Hypertension Intervention

“…Coded responses on the abstraction form were analyzed using descriptive statistics and Microsoft Excel. Insights into young adults’ experiences of the MyHEART program emerged from the comments of the acceptability survey completed at 3-months and direct quotes are provided in the Results [ 32 , 33 ].…”

La prise en charge des parturientes : une expérience suédoise

“…Certains auteurs ont observé que les taux d'allaitement et de dépression du post-partum étaient comparables à ceux observés après une sortie standard [5]. Du point de vue des patientes, cette flexibilité possible en termes de séjour en post-partum semble par ailleurs les satisfaire [6].…”