Midwifery 30 (2014) 571–574

Contents lists available at ScienceDirect

Midwifery journal homepage: www.elsevier.com/midw

Commentary

Postnatal care – Current issues and future challenges Virginia Schmied ((Professor of Midwifery), RM, RN, BA, MA, (Hons), PhD)b,n, Debra Bick, RM, BA, MMedSci, PhD (Professor of Evidence Based Midwifery Practice)a a Kings College London Florence Nightingale School of Nursing and Midwifery, Division of Women's Health, Room 4.32, James Clerk Maxwell Building, 57 Waterloo Road, London SE1 8WA, UK b School of Nursing and Midwifery, University of Western Sydney, Building EBLG Room 33, Parramatta South Campus, Sydney, Australia

Introduction Internationally postnatal care varies in terms of who provides it, how long women receive care for, whether it is in hospital, the community or at home, the content and quality of care provided (National Audit Office, 2013). What is clear from the papers included in this issue, and our own experiences as researchers, is that women the world over report similar concerns and issues about their postnatal health, infant feeding needs and expectations. Certainly priorities will differ, depending on where women give birth and the model of care available to them. It is clearly not appropriate to compare needs of women giving birth in a country in Western Europe with those of a woman giving birth in a country in subSaharan Africa, or women giving birth in health systems with no routine midwifery care compared with systems where all women see a midwife. Nevertheless, we have been struck by the similarity of issues facing women and their families. In this commentary we draw on policy and research on postnatal care in the UK and Australia to highlight current issues and future challenges. Women's health after birth Maternal health problems following birth in Western countries appear to be increasing due a range of complex, but sometimes interrelated factors. More women are becoming pregnant with existing chronic health problems including obesity or cardiac disease (Centre for Maternal and Child Enquiries, 2011), caesarean section rates are increasing, as is the incidence of major post partum haemorrhage (Callaghan et al., 2010) and eclampsia (Thornton et al., 2013); and more women are sustaining third degree perienal tears (Dahlen et al., 2013). Observational studies continue to report widespread and persistent maternal morbidity including extreme tiredness, back pain, breast problems, painful perineum, and urinary incontinence (Brown et al., 2005; Woolhouse et al., 2014). Physical health issues are exacerbated for some women by co-morbidities including mental health problems and social issues (Schmied et al., 2013; Woolhouse n Correspondence to: School of Nursling and Midwifery, Parramatta Campus, University of Western Sydney, Locked Bag 1797 Penrith South DC, Penrith NSW 2751 Australia. E-mail address: [email protected] (V. Schmied).

http://dx.doi.org/10.1016/j.midw.2014.05.001 0266-6138/& 2014 Published by Elsevier Ltd.

et al., 2014), with inequalities in access to services experienced by women from indigenous, migrant and refugee populations (Ou et al., 2010a; Ou et al., 2010b). Furthermore, women continue to report receiving insufficient or inconsistent information on infant feeding, particularly if they had given birth to their first baby (Care Quality Commission, 2013), which impacts on duration of breast feeding. Even in countries like Australia, with a high initiation rate of breast feeding (96%), by four months only 39% of infants were exclusively breast fed and at six months of age 15% were exclusively breast fed (Australian Institute of Health and Welfare, 2011). The policy context In the UK and Australia, policy support for midwifery and postnatal care is relatively strong, an indication of the recognition that if public and child health goals are to be achieved, optimal care in the weeks and months after birth and investment in the early years are crucial (Royal College of Obstetricians and Gynaecologists, 2012). ‘Maternity Matters’ (Department of Health/Partnerships for Children and Families and Maternity, 2007) outlined the need for women to be offered a choice of their lead maternity professional and choice of place of care, including care post-birth. In Australia, most State and Territory maternity policies identify woman-centered care and continuity of care as core principles advocating that women be linked to a known care provider, typically a midwife (Schmied et al., 2011b). It is fair to say however that postnatal care has not been a key priority. More recently in New South Wales (NSW) in Australia, the ‘Towards Normal Birth’ policy included as a key performance measure: ‘All women receive midwifery support at home for at least two weeks after the baby is born’ (NSW Health, 2010, p. 11). However in most instances services are yet to consider how this will be achieved. Guidelines published in the last decade in the UK include NICE guidelines for routine postnatal care (National Institute for Health and Clinical Excellence (NICE), 2006), antenatal and postnatal mental health (National Institute for Health and Clinical Excellence (NICE), 2007) and caesarean section (NICE, 2008). These should inform the core care offered to all women giving birth in the UK NHS (around 98% of all births), although the extent to which recommendations are translated into practice is unknown. Currently, Victoria is

572

V. Schmied, D. Bick / Midwifery 30 (2014) 571–574

the only Australian State to have guidelines on postnatal care (State of Victoria Department of Health, 2012) and a number of other policies refer to the UK NICE guidelines.

did not find an increase in readmissions despite decreasing lengths of in-patient postnatal stay (Lain et al., 2013). What women want from postnatal care?

Has the quality of postnatal care declined? A large survey of UK women who gave birth to their first babies in 2010, which compared findings with a survey a decade earlier, concluded that despite NICE postnatal guidance (National Institute for Health and Clinical Excellence (NICE), 2006), women-centred care quality standards appeared to have declined (Singh and Newburn, 2000; Bhavnani and Newburn, 2010). In 2010, women reported poor co-ordination and planning of care and too few midwives to provide them with the level of care they needed (Bhavnani and Newburn, 2010). Reviews of postnatal care in Australia (Brown et al., 2005; Fenwick et al., 2010; Biro et al., 2012) have consistently found women are less satisfied with postnatal care, particularly if they give birth in a metropolitan hospital, a public hospital, had a short (less than 48 hours) stay in hospital, were younger or of non-English speaking background. Continuity of midwifery care, that is, having met a midwife during pregnancy, labour or birth who then provided postnatal care, significantly reduced the likelihood of women giving a negative rating of their postnatal care (Brown et al., 2005). Postnatal care is provided to all women in the UK as part of universal service provision. National Institute for Health and Clinical Excellence (NICE) (2006) recommends a minimum of three home contacts post-birth by a health professional with the appropriate skills and competencies. Most contacts will be made by a midwife, although more women are being visited by maternity support workers who may or may not have had training. The number of contacts varies across the UK, with some women now asked to attend postnatal clinics to see their midwives. Many Australian women receive at least one visit from a midwife in their home after birth but this service is not available to all women. In States or Territories that provide a home visit by midwives, younger women, women on a lower income, health care concession card or who had not completed secondary education are less likely to receive a visit (Biro et al., 2012). This limited home-based postnatal care contrasts with midwifery care in New Zealand where midwives are funded to provide a minimum of five and up to 10 home visits in the six week period following birth. Most recently in Australia, midwives who have gained accreditation as an ‘eligible midwife’ and have a Medicare provider number are able to offer women a Medicare rebate for short and long postnatal visits up to six weeks after birth, but at this point there is no set minimum or maximum number of visits. Midwives report many barriers to providing high quality postnatal care particularly in hospital including busyness of postnatal units, inadequacy of midwife to woman ratios, priority given to other episodes of care and lack of opportunity for women to rest (McLachlan et al., 2008; Schmied et al., 2008; Bick et al., 2011). Significant resource constraints and recent increases in the birth rate in the UK are undoubtedly affecting service provision for women post-birth (Bhavnani and Newburn, 2010; Care Quality Commission, 2013), but it is hard to say how (or if) reduction in postnatal services or lower quality postnatal care is impacting on maternal and infant health. Unfortunately much maternal morbidity still remains invisible or does not become apparent until months after birth. For example, more women experience depressive symptoms from six to 12 months after birth than in the first six months (Schmied et al., 2013). In the UK, whilst there is some anecdotal evidence of an increase in readmissions for women and infants post birth, with maternal infection and infant feeding problems cited as reasons, a recent analysis of hospital admission data in the last decade in NSW

In one synthesis of qualitative studies examining breast feeding support in the early postnatal period (Schmied et al., 2011a), the most important aspect of care was that the midwife or other caregiver demonstrated an ‘authentic presence’ characterised by a trusting relationship with a care provider, who was empathetic, non-judgmental, affirming of the woman's abilities to breast feed, took time to listen to her, observed a feed, shared experiences and offered realistic and accurate information, practical help and tips. Most importantly women wanted to have their individual needs addressed. This is reflected in a quote from a woman in a study by Burns (2010, p. 175): She (midwife) was the only one that seemed to be interested in me and the relationship I was having with the baby… she actually respected that I had my own ideas about how I wanted to work with my baby...she could see that we were a unit, not just individual people… she also respected my husband and his views as well… She wanted to know the story. She asked the story. So how did the birth go? She was the first person who asked who really listened to that story. Yet, this care is far from realised in institutions where a women can see up to 11 midwives (Fenwick et al., 2010) during their postnatal stay in hospital. Some women have high levels of fear and anxiety about taking their newborn infant home (Forster et al., 2008). In one Australian study (Forster et al., 2008) women wanted a longer stay in hospital to develop confidence in infant care and infant feeding. Same day discharge or only having a 24 hours stay following birth was seen as ‘too scary’ by first time mothers (Forster et al., 2008). This is despite evidence indicating that women who have access to postnatal midwifery care at home are happier with care received (Brown et al., 2005; Fenwick et al., 2010). We have also observed an overemphasis when caring for new mothers on measuring, weighing infants, a dependency on biomedical technology, and using monitoring equipment such as apnoea blankets. It is important to consider if health professionals fuel some of these ideas. A recent study of interactions between midwives and women around breast feeding found that midwives focused on procedures and technology to ensure that breast milk is ‘delivered’ to infants by whatever possible means (Burns et al., 2013). Are we providing the right type of care, for the right length of time? Length of inpatient stay following birth has decreased over the past two decades with little evidence to inform the optimum length of in-patient stay or type of support required at home following early discharge (Brown et al., 2004). Since the late 1990s Australian researchers have raised concerns about the decreasing length of stay and called for rigorous trials to assess the ‘safety’ of ‘early’ discharge from hospital. However, is a shorter in-patient stay necessarily a bad thing? Rather than being primarily focused on length of stay it would seem more appropriate to concentrate on the level of support women need in the days and weeks following birth. NICE guidance (National Institute for Health and Clinical Excellence (NICE), 2006) supported by available evidence of birth recovery and support needs recommended what contacts should include for women and their infants from the first 24 hours until eight weeks post-birth, however there is limited evidence that these recommendations are being implemented (Bhavnani and Newburn, 2010; Royal College of Midwives (RCM), 2014).

V. Schmied, D. Bick / Midwifery 30 (2014) 571–574

One of the issues service providers face is how to ‘measure’ if effective care has been provided, as it is likely that aspects of care women feel they have benefited from (such as a chance to talk to their midwife and feel reassured about their postnatal recovery), are difficult to assess and measure. This means that although outcomes such as method of infant feeding on hospital discharge and at 6–8 weeks postnatal can be captured as a ‘hard’ measure, more qualitative elements of contacts such as time to talk which could also impact on a woman's health and well-being are less likely to be recorded or used as an indicator of care quality. Attempts to improve current in-hospital postnatal care A range of strategies have been introduced and evaluated in the UK and Australia to improve the quality of in-hospital postnatal care. These included providing opportunities for women to plan for the postnatal period in discussion with midwives in pregnancy (Yelland et al., 2009; Bick et al., 2011, 2012); the development of consumer written information on maternal health, infant care, sources of support and advice after discharge (McKellar et al., 2009; Yelland et al., 2009) and introduction of new handheld records to prompt evidence based individualised care, with emphasis on undertaking routine physical observations and examinations after the first postnatal contact based on individual needs (Schmied et al., 2009; Bick et al., 2011). At some study sites, mentoring and professional development were also offered to support implementation of strategies (Schmied et al., 2009; Bick et al., 2011). Organisational and environmental changes were introduced to encourage midwives to offer each woman an uninterrupted period of time to listen to her concerns or needs. Initiatives developed with a ‘whole of organisation’ focus rather than as a participatory initiative with midwives on the postnatal units, demonstrated improvements in outcomes for women (Schmied et al., 2009; Yelland et al., 2009; Bick et al., 2011). Transition of care to other services In countries with a system of universal child health services (e. g. health visitors in the UK; child health nurses in Sweden and child and family health (CFH) nurses in Australia), the care and support for women and families is transitioned from midwifery/ maternity services to child health services at some point between 10 days and 4–6 weeks after birth. Recent research in Australia and Scandinavia shows that communication problems in the transition of care processes results in some women ‘falling through the gap’. Furthermore CFH nurses and or general practitioners do not always get the information they need on the discharge summaries to make an assessment of the families' needs (Psaila et al., 2014). Progressive universalism There is increasing recognition of need to ‘invest in the early years’ to improve ‘life-chances’ of women and their infants. Preconception and pregnancy health and health behaviours, fetal environment, events during birth and the postnatal period can affect infant, child and later adult health. Postnatal care needs to be viewed as contributing to the critical foundation for the life course of the woman and her infant, in the same way that antenatal care is prioritised. In the UK and Australia increasing attention is being given to the concept of progressive universalism (Oberklaid et al., 2013). In this model, universal services are the essential base to promote a continuum of effective care prepregnancy to birth and beyond. Progressive universalism is based on the understanding that all women and infants need a basic level of care and support, that some will need additional services

573

some of the time, and a smaller group of women and their families will need sustained support.

Theory of change It is concerning that there is limited evidence of the benefit of routine postnatal care provided by midwives. This may be due to a mismatch between the theory of change that informs postnatal care and the measures used to evaluate outcomes. The question arises as to whether we are measuring the right outcomes. For example, most midwives would agree that the aims or focus of postnatal care in the first 10 days post-birth is to facilitate rest and recovery from birth; to identify any health problems with mother or infant; to ensure that the mother is aware of any signs or symptoms of health issues; to support initiation of breast feeding and provide information on infant care and other health promotion topics as required by the woman and family. To effectively evaluate postnatal care we may then want to ask women with in one month of birth for example, whether they received the information on signs and symptoms of health issues and knew how to act on any concerns; if they were breast feeding at six weeks; their level of tiredness. Yet most studies evaluating postnatal care and interventions focus on measuring parenting confidence, breast feeding and depression at a more distal point - three or six months postnatal when many other events or care may have taken place. This issue of the ‘theory of change’ and measuring appropriate outcomes is partly reflected in a recent Cochrane review of schedules for home visits in the postnatal period (Yonemoto et al., 2013) which included data from low and high income resource settings provided by a range of different health professionals in different health systems. The reviewers found impact on maternal and infant outcomes to be inconsistent, but concluded that the frequency, timing, duration and intensity of home visits should be based on local needs. Clearly, studies need to be context and service provision specific however, where evidence of benefit is found, implementation into practice needs to be prioritised.

Quality standards NICE Quality Standards describe high-priority areas for quality improvement in a defined care or service area, each standard comprising a set of specific, precise and measureable statements, based on existing guidance. Standards aim to support improvements in health in England included in the NHS Outcomes Framework 2013/14 and Public Health Outcomes Framework 2013/16. Eleven Quality Standards for Postnatal Care were published (National Institute for Health and Care Excellence, 2013), including breast feeding (Quality Standard 5) and maternal mental well-being (Quality Standard 10). NHS trusts in England are expected to measure quality of care against standards using ‘local data’ collection. The Quality Standards for Postnatal Care (National Institute for Health and Care Excellence, 2013) recognised that for some women and infants, the postnatal period should be extended in order to better meet their needs. This was highlighted as important for women or their infants who develop complications and are more vulnerable to adverse outcome. This could include women who have poor support networks, those who developed a postnatal infection or other health problem which continued to impact on their daily lives, or women at risk of mental health problems or infant attachment problems (National Institute for Health and Care Excellence, 2013). Although policy is acknowledging that for some women a longer period of contact is appropriate, it is unclear how the UK maternity services will implement this or if local evaluations of the extent to which quality standards are achieved will be published.

574

V. Schmied, D. Bick / Midwifery 30 (2014) 571–574

Future challenges Despite evidence from large observational studies from the UK, Australia and other countries of the extent maternal morbidity, there have been few revisions to models of routine care post-birth, other than increasingly shorter lengths of in-patient stay, a reduction in the number of home contacts, an increase in use of unqualified care assistants and establishment of postnatal clinics, all based on little evidence and driven by service providers, not by women's needs or priorities. Evidence that implementation of a new model of extended midwifery-led community care in one region of England was effective in terms of maternal mental health outcomes and use of NHS resources (MacArthur et al., 2002), did not lead to support from policy makers or maternity service funders to revise the content or duration of routine midwifery care. In contrast, services have been cut back. Postnatal care is a campaign priority for the Royal College of Midwives in 2014 which could help to raise the importance of what has been termed the ‘Cinderella’ service, but is it too little too late? A recent report on the extent to which a sample of UK women who used an online user website (NetMums) were offered information on signs and symptoms of potentially life threatening health problems in the first 24 hours postnatal (based on National Institute for Health and Clinical Excellence (NICE) (2006) guidance) found that just under half (47%) did not receive any information. Maternal mortality in the UK is low, however two-thirds of maternal deaths occurred after the birth (Centre for Maternal and Child Enquiries, 2011). This alone should reiterate why postnatal care needs to be addressed as a priority. We also know that women, their partners and families need support in their transition to parenthood, including support for infant feeding. The challenges facing postnatal care are significant – choosing to ignore them will not make the problems will disappear. Just ask the women and their families. References Australian Institute of Health and Welfare, 2011. 2010 Australian National Infant Feeding Survey: Indicator Results. AIHW, Canberra. Bick, D.E., Murrells, T., Weavers, A., Rose, V., Wray, J., Beake, S., 2012. Revising acute care systems and processes to improve breastfeeding and maternal postnatal health: a pre and post intervention study in one English maternity unit. BMC Pregnancy Childbirth 12, 41. Bick, D.E., Rose, V., Weavers, A., Wray, J., Beake, S., 2011. Improving inpatient postnatal services: midwives views and perspectives of engagement in a quality improvement initiative. BMC Health Serv. Res. 11, 293. Biro, M.A., Yelland, J.S., Sutherland, G.A., Brown, S.J., 2012. Women's experience of domiciliary postnatal care in Victoria and South Australia: a population-based survey. Aust. Health Rev. 36, 448–456. Bhavnani, V., Newburn, M., 2010. Left to Your Own Devices. The Postnatal Experiences of 1260 First-Time Mothers. NCT, Alexandra House, Oldham Terrace, London. Brown, S., Bruinsma, F., Darcy, M.-A., Small, R., Lumley, J., 2004. Early discharge: No evidence of adverse outcomes in three consecutive population-based Australian surveys of recent mothers, conducted in 1989, 1994 and 2000. Paediatric and Perinatal Epidemiology 18, 202–213. Brown, S.J., Davey, M.-A., Bruinsma, F.J., 2005. Women's views and experiences of postnatal hospital care in the Victorian Survey of Recent Mothers 2000. Midwifery 21, 109–126. Burns, E., Fenwick, J., Sheehan, A., Schmied, V., 2013. Mining for liquid gold: midwifery language and practices associated with early breastfeeding support. Matern. Child Nutr. 9, 57–73. Burns, E., 2010. Mining for Liquid Gold: An Analysis of the Language and Practices of Midwives When Interacting with Women who are Establishing Breastfeeding (Doctoral Dissertation). University of Western Sydney, Sydney, Australia 〈http:// arrow.uws.edu.au:8080/vital/access/manager/Repository/uws:19828〉. Callaghan, W.M., Kuklina, E.V., Breg, C.J., 2010. Trends in Postpartum haemorrhage: United States 1994–2006. American Journal of Obstetrics and Gynaecology 202 (353), e1–e6. Care Quality Commission, 2013. National Findings from the 2013 Survey of Women's Experiences of Maternity Care. Care Quality Commission, London. Centre for Maternal and Child Enquiries, 2011. Saving mothers' lives: reviewing maternal deaths to make motherhood safer: 2006–08. The eighth report on confidential enquiries into maternal deaths in the United Kingdom. BJOG 118, 1–203. Dahlen, H., Priddis, H., Schmied, V., et al., 2013. Trends and risk factors for severe perineal trauma during childbirth in New South Wales between 2000 and

2008: a population-based data study. BMJ Open 3, e002824, http://dx.doi.org/ 10.1136/bmjopen-2013-002824. Department of Health/Partnerships for Children and Families and Maternity, 2007. Maternity Matters: Choice, Access and Continuity of Care in a Safe Service. Department of Health/Partnerships for Children and Families and Maternity, London. Fenwick, J., Butt, J., Dhaliwal, S., Hauck, Y., Schmied, V., 2010. Western Australian women's perceptions of the style and quality of midwifery postnatal care in hospital and at home. Women Birth 23, 10–21. Forster, D.A., McLachlan, H.L., Rayner, J., Yelland, J., Gold, L., Rayner, S., 2008. The early postnatal period: exploring women's views, expectations and experiences of care using focus groups in Victoria, Australia. BMC Pregnancy Childbirth 8, 27. Lain, S.J., Nassar, N., Bowen, J.R., Roberts, C.L., 2013. Risk factors and costs of hospital admissions in first year of life: a population-based study. J. Pediatr. 163, 1014–1019. MacArthur, C., Winter, H.R., Bick, D.E., et al., 2002. Effects of redesigned community postnatal care on women's health 4 months after birth: a cluster randomised controlled trial. Lancet 359, 378–385. McKellar, L., Pincombe, J., Henderson, A., 2009. Encountering the culture of midwifery practice on the postnatal ward during Action Research: an impediment to change. Women Birth 22, 112–118, http://dx.doi.org/10.1016/j.wombi.2009.08.003. McLachlan, H.L., Forster, Della A., Yelland, J., Rayner, J., Lumley, J., 2008. Is the organisation and structure of hospital postnatal care a barrier to quality care? Findings from a state-wide review in Victoria, Australia. Midwifery 24, 358–370. National Audit Office, 2013. Maternity Services in England. Report by the Comptroller and Auditor General. The Stationery Office, London. National Institute for Health and Clinical Excellence (NICE), 2006. Routine Postnatal Care of Woman and Their Babies, Clinical Guideline CG37. National Institute for Health and Clinical Excellence, London. National Institute for Health and Clinical Excellence (NICE), 2007. Antenatal and Postnatal Mental Health, Clinical Guideline CG45. National Institute for Health and Clinical Excellence, London. National Institute for Health and Clinical Excellence (NICE), 2008. Caesarean section, Clinical Guideline, 132. National Institute for Health and Clinical Excellence, London. National Institute for Health and Care Excellence, 2013. QS 37 Postnatal Care. Downloaded from: 〈http://publications.nice.org.uk/postnatal-care-qs37〉 (last accessed 28 April 2014). NSW Health, 2010. Towards normal birth in NSW. The NSW Department of Health. 〈http://www0.health.nsw.gov.au/policies/pd/2010/pdf/PD2010_045.pdf〉 (last accessed 1 April 2014). Oberklaid, F., Baird, G., Blair, M., Melhuish, E., Hall, D., 2013. Children's health and development: approaches to early identification and intervention. Arch. Dis. Child. 22, 1008–1011. Ou, L., Chen, J., Hillman, K., 2010a. Health services utilisation disparities between English speaking and non-English speaking background Australian infants. BMC Public Health 10, 182. Ou, L., Chen, J., Hillman, K., Eastwood, J., 2010b. The comparison of health status and health services utilisation between Indigenous and non-Indigenous infants in Australia. Aust. N. Z. J. Public Health 34, 50–56. Psaila, K., Schmied, V., Fowler, C., Kruske, S., 2014. Discontinuities between maternity and child and family health services: health professional's perceptions. BMC Health Serv. Res. 14, 4. Royal College of Obstetricians and Gynaecologists, 2012. High Quality Women's Health Care: A Proposal for Change. RCOG, London. Royal College of Midwives (2014). Pressure Points. 24 hours signs and symptoms. Advising on the potentially life-threatening signs in postnatal care, RCM, London. Schmied, V., Cooke, M., Gutwein, R., Steinlein, E., Homer, C., 2009. An evaluation of strategies to improve the quality and content of hospital-based postnatal care in a metropolitan Australian hospital. JCN 18, 1850–1861. Schmied, V., Beake, S., Sheehan, A., McCourt, C., Dykes, F., 2011a. Women's perceptions and experiences of breastfeeding support: a metasynthesis. Birth 38, 49–60. Schmied, V., Cooke, M., Gutwein, R., Steinlein, E., Homer, C., 2008. Time to listen: strategies to improve hospital-based postnatal care. Women Birth 21, 99–105. Schmied, V., Donovan, J., Kruske, S., Kemp, L., Homer, C., Fowler, C., 2011b. Commonalities and challenges: a review of Australian state and territory maternity and child health policies. Contemp. Nurse 40, 106–117. Schmied, V., Johnson, M., Naidoo, N., Austin, M-P., Matthey, S., Kemp, L., Mills, A., Meade, T., Yeo, T., 2013. Maternal Mental Health in Australia and New Zealand: A review of longitudinal studies: Women and Birth 26, 167–178. Singh, D., Newburn, M., 2000. Access to Maternity Information and Support: the Needs of Women Before and After Giving Birth. National Childbirth Trust, London. State of Victoria Department of Health, 2012. Postnatal care program guidelines for Victorian Health Services. Retrieved 1 June 2012, from: 〈www.health.vic.gov.au/ maternitycare〉. Thornton, C., Dahlen, H., Korda, A., Hennessy, A., 2013. The incidence of preeclampsia and eclampsia and associated maternal mortality in Australia from populationlinked datasets: 2000–2008. Am. J. Obstet. Gynecol. 208, 476.e471–476.e475. Woolhouse, H., Gartland, D., Perlen, S., Donath, S., Brown, S.J., 2014. Physical health after childbirth and maternal depression in the first 12 months post partum: results of an Australian nulliparous pregnancy cohort study. Midwifery 30, 378–384. Yelland, J., Krastev, A., Brown, S., 2009. Enhancing early postnatal care: findings from a major reform of maternity care in three Australian hospitals. Midwifery 25, 392–402. Yonemoto, N., Dowswell, T., Nagai, S., Mori, R., 2013. Schedules for home visits in the early postpartum period. The Cochrane database of systematic reviews, 7.

Postnatal care - current issues and future challenges.

Postnatal care - current issues and future challenges. - PDF Download Free
242KB Sizes 0 Downloads 0 Views