Poster Presentation - SOMANZ ASM Society of Obstetric Medicine of Australia and New Zealand ASM 2023

A pilot study exploring barriers and facilitators to attendance at the six-week postpartum check (#73)

Naomi CA Whyler 1 , Sushena Krishnaswamy 1 2 , Sarah Price 3 4 5 , Michelle L Giles 1 3 6
  1. Department of Obstetrics & Gynaecology, Monash University, Melbourne, Victoria, Australia
  2. Department of Infectious Diseases,, Monash Health, Melbourne, Victoria, Australia
  3. Department of Obstetric Medicine, Royal Women's Hospital, Melbourne, Victoria, Australia
  4. Department of Obstetric Medicine, Frances Perry House, Melbourne, VIC, Australia
  5. Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
  6. Department of Infectious Diseases, University of Melbourne, Melbourne, VIC, Australia

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 populations3. Attendance rates among Australian women are not well-documented.

Methods:

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.

Results:

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:

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.

  1. 1. Milroy T & Frayne J. Postnatal care: The general practitioner’s visit. Australian Journal of General Practice. 2022; 51(3): 105-110.
  2. 2. Bryant AS, Haas JS, McElrath TF & McCormick MC. Predictors of compliance with the postpartum visit among women living in Healthy Start project areas. Matern Child Health J. 2006; 10: 511-516.
  3. 3. Thiel de Bocanegra H, Braughton M, Bradsberry M, Howell M, Logan J & Schwarz EM. Racial and ethnic disparities in postpartum care and contraception in California’s Medicaid program. Am J Obstet Gynecol. 2017; 217: 47.e1-e7.