Authors' objectives:

This study aimed to develop, implement and test the cost-effectiveness of a new model of postnatal care compared with current care on women's physical and psychological health.

Authors' results and conclusions: At 4 months postpartum the mean Mental Component Scores (MCS) and Edinburgh Postnatal Depression Scale (EPDS) scores were significantly better in the intervention group and the proportion of women with an EPDS score of 13+ (indicative of probable depression) was lower relative to controls. Mean Physical Component Scores (PCS) did not differ. Assessments of women's views about care were either more positive in the intervention group or did not differ. At 12 months, MCS and EPDS scores remained significantly better among intervention group women. Fewer women in the intervention group reported depression, fatigue and haemorrhoids as present at 12 months in the intervention group, with no differences for other reported morbidities. GP consultation rates during the year were reduced in the intervention group. Secondary care referrals to medical and surgical specialities did not differ. There were more secondary care contacts with professions allied to medicine (PAMs) in the intervention group but more PAM primary care contacts in the control group. Breastfeeding continuation, contraceptive advice and child immunisation did not differ. The intervention midwives were more satisfied with redesigned care than control midwives were with standard care. The GPs and health visitors views about postnatal care did not differ. Intervention care was cost-effective since outcomes were better and costs did not differ substantially.

Authors' recommendations: The redesigned community postnatal care led by midwives and delivered over a longer period resulted in an improvement in womens mental health at 4 months postpartum, which persisted at 12 months and at equivalent overall cost. Subject to consideration and evaluation of local issues of implementation, the evidence would, in the authors opinion, justify this form of care as standard for postnatal women.

Authors' methods: Randomised controlled trial

Project Status: Completed

URL for project: http://www.hta.ac.uk/968

Year Published: 2003

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: England, United Kingdom

Organisation Name: NIHR Health Technology Assessment programme

Contact Address: NIHR Journals Library, National Institute for Health and Care Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK

Contact Name: journals.library@nihr.ac.uk

Contact Email: journals.library@nihr.ac.uk

Copyright: 2009 Queen's Printer and Controller of HMSO