Every year more than 350,000 women in the UK may be missing out on key formal health and wellbeing check-ups following the birth of a child, reveals the largest study of its kind, published in the online journal BMJ Open.
Teen mums and those living in the most deprived areas of the country are least likely to get these check-ups, which offer timely opportunities for health promotion and for important postnatal health needs to be picked up, say the researchers.
In the UK women have automatic access to midwives and health visitors for the first few days after a birth. They should then be invited by their family doctor for a formal check-up 6-8 weeks later in line with national (NICE) and World Health Organization guidance.
These postnatal check-ups are crucial for picking up any physical and mental health issues and for assessing how well women are recovering after pregnancy and birth. They also provide an opportunity to discuss breastfeeding, contraception, smoking cessation, return to physical activity, and diet.
While it is thought that most new mothers do attend these check-ups, there are no official published data on patterns of primary care use for women following childbirth.
To try and plug this knowledge gap, the researchers drew on entries to The Health Improvement Network (THIN) database which contains anonymised health records for 16 million patients from 730 general practices across the UK.
They extracted information on postnatal check-ups in person or by phone and use of primary care in the 12 months following a birth by 15-49 year olds who gave birth between 2006 and 2015. In all, 309,573 births to 241,662 women were included in their analysis.
A third (32%) of the women were aged 30-34 at the time of the birth. Around 1 in 5 (21%) lived in areas of least deprivation while around 1 in 6 (16%) lived in the most deprived.
Three out of four women (76%) had a vaginal delivery; the rest had a caesarean birth. Nearly half the births (48%) were to first time mums; 22% were second births. Nearly half the women didn’t smoke (46%); 11% were current smokers.
Only just over half the women (56%) had a structured postnatal check-up; for four in 10 there was no record of this within the first 10 weeks of giving birth. Younger women and those living in the most deprived areas were least likely to get a check-up.
After excluding those women with fewer than 5 weeks of follow-up information and missing information on deprivation, 275,577 women were included in further analysis.
This showed that 15-19 year olds were 12% less likely to get a postnatal check-up between weeks 5 and 10 than were 30-35 year olds. Similarly, women from the most deprived areas were 10% less likely to get a postnatal check than were those from the least deprived.
Yet in the 12 months following childbirth, most of the total sample (95%) had at least one appointment with a clinician, averaging around 5, rising to around 6 for smokers, and to around 8 for those who had had a C-section delivery.
Based on their findings, and the fact that around 800,000 women give birth in the UK every year, the researchers estimate that up to 350 400 new mothers may be missing out on formal postnatal check-ups within 10 weeks of giving birth each year.
There are several possible explanations for their findings, say the researchers.
“It is possible that women do not want or feel they need advice from GPs; or invitations from the GP are not taken up either because women do not respond to them, or may find it difficult to access appointments. Alternatively, a lack of recording in electronic health records may explain the apparently low rate,” they suggest.
But this matters, they insist. “The postnatal period is a potentially vulnerable time for women and there could be serious consequences to not identifying [those] at risk of poor health or harm after childbirth.
“The postnatal check has been shown to be a key contact to identify serious health needs such as postnatal depression, which affects one in six women after childbirth.”
They continue: “Our findings suggest practices may need to implement systems for follow-up of women who have declined or missed a postnatal check. There is a need for better promotion of the benefits of attending the postnatal check at other times in the maternity pathway.
“Additionally, there are currently no known financial or quality based incentives to document primary care activity in the postnatal period.”