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Teens and deprived mothers missing postnatal checks

Tuesday November 24th 2020

More than 350,000 women in the UK are likely to be missing key postnatal check-ups, according to the largest study of its kind published today.

The report, published in BMJ Open, warns that teenage mothers and women living in the most deprived areas of the country are least likely to receive the checks.

This is despite the fact that GPs invite new mothers for a formal postnatal check-up at six-eight weeks, in line with NICE and World Health Organization guidance.

This check helps to identify any physical and mental health issues and doctors can also assess the mothers to see how they are recovering after pregnancy and birth, as well as go over breastfeeding, contraception, smoking cessation, return to physical activity, and diet, where necessary.

But because there are no official published data on patterns of primary care use for women following childbirth, researchers from University College London and Imperial College London analysed The Health Improvement Network (THIN) database, extracting information on 241,662 women, aged 15 to 49, who gave birth to 309,573 infants between 2006 and 2015.

They found that 32% of the women were aged 30-34 at the time of the birth and about one in five lived in areas of least deprivation while around 16% lived in the most deprived.

Three out of four women had a vaginal delivery, with the remaining having a caesarean birth, and 48% of births were to first time mothers. Nearly half the women didn’t smoke (46%) and 11% were current smokers.

The research team found that 56% took up the structured postnatal check-up but could not find evidence of this happening for four in 10 new mothers in the first 10 weeks after giving birth.

They found that younger women and those living in the most deprived areas were least likely to attend the check-up appointment.

When the research team excluded women with fewer than five weeks of follow-up information and missing information on deprivation, 275,577 women were included in additional analysis that revealed 15-19 year olds were 12% less likely to get a postnatal check-up between weeks five and 10 than were 30–35 year olds.

Women from the most deprived areas were 10% less likely to get a postnatal check than were those from the least deprived.

The researchers write: “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.

“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 say that their findings suggest GP surgeries may need to implement systems for follow-up of women who have declined or missed a postnatal check.

Smith HC, Saxena S, Petersen I. Postnatal checks and primary care consultations in the year following childbirth: an observational cohort study of 309573 women in the UK, 2006–2016. BMJ Open 24 November 2020; doi: 10.1136/ bmjopen-2020-036835

[abstract]

Tags: Childbirth and Pregnancy | UK News | Women's Health & Gynaecology

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