Post-natal home care must target at-risk women

Tuesday, December 4, 2012


Australia’s first population-based survey to investigate the factors associated with receiving postnatal home visits has found that women most in need of this care are often missing out.

This study is reported in the most recent edition of the Australian Health Review, the peer reviewed journal of the Australian Healthcare and Hospitals Association.

“Postnatal domiciliary (home) care is designed to provide care for women who have been discharged from hospital after having a baby.  Women generally receive one or perhaps two midwifery visits to assess maternal health and issues related to infant care,” study leader, Dr Mary Anne Biro from Monash University said today.

“Postnatal home services have expanded dramatically over the past decade as the postpartum hospital stay has shortened.  Government policy and funding arrangements in relation to home service provision for women giving birth in the public sector vary by state.

“Despite the widespread introduction of postnatal home visiting, there are no mechanisms in place to monitor or evaluate whether this service is meeting women’s expectations. We know little about the women who receive home visits in the first week after discharge from hospital, and how they regard their experience of care.

Over 4000 women took part in the survey undertaken by Murdoch Children’s Research Institute. The study examined (1) the proportion of women admitted to hospital as public patients receiving postnatal home visits; (2) a range of sociodemographic, obstetric and organisational factors associated with women receiving postnatal home visits and (3) women’s overall rating of postnatal home care; with comparisons made within and between the two states.

“We found that the majority of women in public maternity care in Victoria and South Australia received at least one domiciliary midwifery visit in the first week after they left hospital and the majority of these rated their care positively. However, there were significant state differences both in the groups of women who received care, and in their experiences. Victorian women were less likely to receive a visit and to rate their care positively.

“Of particular concern is the finding that in both states younger women, women on a lower income, those holding a healthcare concession card or women who had not completed secondary education were less likely to receive a home visit in their first weeks at home. Whilst the majority of women received home care and rated it positively, an inverse care law seems to apply: women who were more likely to need and derive benefit from home care were less likely to receive it. However, these women may also have chosen not to receive home postnatal visits, perhaps seeing them as inappropriate in their circumstances.

“Regardless of the explanation, maternity services and state governments need to re-examine the structure and content of traditional home postnatal care in order to develop innovative early postnatal programs that may be more likely to meet the needs of our most vulnerable groups of childbearing women.

“There is a need to further explore the purpose, aims and content of domiciliary care at individual and state-wide levels.  As suggested recently by the Victorian Auditor-General, postnatal care should be underpinned by a robust policy and service guidelines with a focus on vulnerable women in the early postnatal period and beyond,” Dr Biro said.

For more information and comment:  Dr Mary Anne Biro (03) 99054838 or 0400 802 566