In a new study, Christine Agdestein has investigated several aspects of postnatal control. Agdestein is a specialist in general medicine and general practitioner and is currently a PhD candidate at the Norwegian University of Science and Technology (NTNU). The research project is part of her Ph.D.
“An important finding is that the majority are satisfied with the 6-week check-up with their doctor. This is an important offer for those who have recently given birth. Doctors have an important role in postnatal care,” says Christine Agdestein.
Not much research has been done on postnatal control in the past, so it is particularly rewarding to be able to offer new insights. These are findings that can quickly be used in improvement work related to postnatal care.”
Christine Agdestein, Norwegian University of Science and Technology
The study was conducted together with four other researchers from NTNU and the regional health authority of Nord-Trøndelag.
Women feedback
The study shows that satisfaction was closely related to being able to talk about the birth experience, that many related topics were raised during the consultation, and that a gynecological examination was included.
The most frequently discussed topics great or very important:
- the experience of childbirth (61 percent)
- Contraception (55 percent)
- Breastfeeding (53 percent)
- birth-related pelvic injuries (52 percent)
- mental health (40 percent)
The most important topics were also discussed more often.
One in four does not appear
Although the offer is perceived as positive and important, many women do not take advantage of the opportunity. The researchers found four main reasons:
- Lack of general practitioner
- she did not feel it was necessary to undergo postnatal screening
- He was not satisfied with previous visits
- I didn’t know about the offer
Women who did not show up for their postpartum follow-up check thus missed an important opportunity for health support and promotion measures.
“Women with chronic diseases, high-risk pregnancies and complications during delivery did not participate in follow-up screening more often than women in good health and uncomplicated deliveries. This is worrying since these women have an increased risk of morbidity and mortality,” says Christine Agdestein.
The consultation is free
It is important to provide information about postnatal testing. In principle, women should receive information both during pregnancy and from the maternity ward. Only 44 percent stated that they had received information from the maternity hospital.
52 per cent had received information about the service from a midwife in the municipality and some had received information from their GP. 18 percent received information from friends and 11 percent from social media.
“We definitely see room for improvement here,” says Agdestein. She also takes into account that some of those who have just given birth do not remember all the information given. Therefore, it may be important to design written information for women, Agdestein believes.
It also found that 32 percent of women did not know that the service is free, which is important to make clear in the information provided.
“The chances of participation increase if you know that the consultation is free,” the study shows.
She wants a gynecological exam
A gynecological examination was high on the list of what women wanted during their postnatal check-up. Not everyone was offered this. The study shows a strong correlation between satisfaction with postnatal screening and gynecological examination.
The women recommended that GPs offer more preventive gynecological examinations.
“The study showed that some women find it difficult to ask for a genital examination. The findings show that it is important to be offered a gynecological examination and then women can decide for themselves if they want it and if they need it. Many people may have pain and tears after childbirth and experience incontinence, so it is important to be offered a gynecological examination,” says Agdeste.
Mental health and increased postpartum depression
40 per cent of women said talking about mental health is important and the topic was mentioned in 60 per cent of consultations.
“This may indicate that doctors are focusing on mental health, and that is a good thing. We see from other studies that the prevalence of postpartum depression has increased in Norway in recent years, so mental health is an important topic to talk about in the postnatal checkup,” stresses Agdestein.
Improvement work is already underway
Based on the study, Christine Agdestein is working on a follow-up project, along with several of those who worked on the first study. Monitoring is about specific tools to improve postnatal control.
“We have developed a tool and a prototype that is ready for testing. It is a tool that will be used by doctors and women in collaboration,” says Christine Agdestein.
It will provide good information to women about the topics that can be considered during the 6 week check and help the woman to prioritize what is most important to her. In this way, the general practitioner can tailor the screening to each individual.
“With this measure, we hope to improve both information and quality, which in turn can help increase attendance and better benefit from postnatal screening.
“I started looking into this because, as a general practitioner, I saw many women during pregnancy and the postnatal period. Then I saw that there was a great need for knowledge about postnatal care in the primary health service. I have moved from clinical practice, to research and now to improving practice,” says Christine Agdestein.
How the study was conducted
The study was conducted as a questionnaire survey where the target group was all women who gave birth in the Nord-Trøndelag Regional Health Authority in one year. 1119 women were in the target group and 351 responded.
“The age, education and number of births for those who responded are comparable to women who gave birth in Norway in the same year. So the results are also relevant in the rest of the country,” says Agdestein.
She summarizes that the most important findings are that one in four do not show up, that there is a need for better information, that it is important that the consultation covers many and relevant topics, including the birth experience, and that women should have a gynecological examination.
“Our research includes information on the content of the consultations and analysis of the factors that influence whether women are satisfied or not. This means that professionals can quickly address the findings to improve the service,” concludes Christine Agdestein.
