Effects of redesigned community postnatal care on womens' health 4 months after birth: a cluster randomised controlled trial

C. MacArthur, H. R. Winter, D. E. Bick, H. Knowles, R. Lilford, C. Henderson, R. J. Lancashire, David Alexander Braunholtz, H. Gee

Research output: Contribution to journalArticle

174 Citations (Scopus)

Abstract

Background Much postpartum physical and psychological morbidity is not addressed by present care, which tends to focus on routine examinations. We undertook a cluster randomised controlled trial to assess community postnatal care that has been redesigned to identify and manage individual needs.

Methods We randomly allocated 36 general practice clusters from the West Midlands health region of the UK to intervention (n=17) or control (19) care. Midwives from the practices recruited women and provided care. 1087 (53%) of 2064 women were in practices randomly assigned to the intervention group, with 977 (47%) women in practices assigned to the control group. Care was led by midwives, with no routine contact with general practitioners, and was extended to 3 months. Midwives used symptom checklists and the Edinburgh postnatal depression scale (EPDS) to identify health needs and guidelines for the management of these needs. Primary outcomes at 4 months were obtained by postal questionnaire and included the women's short form 36 physical (PCS) and mental (MCS) component summary scores and the EPDS. Secondary outcomes were women's views about care. Multilevel analysis accounted for possible cluster effects.

Findings 801 (77%) of 1087 women in the intervention group and 702 (76%) of 977 controls responded at 4 months. Women's mental health measures were significantly better in the intervention group (MCS, 3.03 [95% CI 1.53-4.52]; EPDS -1.92 [-2.55 to -1.29]; EPDS 13+ odds ratio 0.57 [0.43-0.76]) than in controls, but the physical health score did not differ.

Interpretation Redesign of care so that it is midwife-led, flexible, and tailored to needs, could help to improve women's mental health and reduce probable depression at 4 months' postpartum.

Original languageEnglish
Pages (from-to)378-385
Number of pages7
JournalThe Lancet
Volume359
Issue number9304
DOIs
Publication statusPublished - Feb 2002

Keywords

  • MATERNAL HEALTH
  • DEPRESSION
  • CHILDBIRTH
  • PREVENTION
  • SUPPORT

Cite this

MacArthur, C., Winter, H. R., Bick, D. E., Knowles, H., Lilford, R., Henderson, C., ... Gee, H. (2002). Effects of redesigned community postnatal care on womens' health 4 months after birth: a cluster randomised controlled trial. The Lancet, 359(9304), 378-385. https://doi.org/10.1016/S0140-6736(02)07596-7

Effects of redesigned community postnatal care on womens' health 4 months after birth: a cluster randomised controlled trial. / MacArthur, C.; Winter, H. R.; Bick, D. E.; Knowles, H.; Lilford, R.; Henderson, C.; Lancashire, R. J.; Braunholtz, David Alexander; Gee, H.

In: The Lancet, Vol. 359, No. 9304, 02.2002, p. 378-385.

Research output: Contribution to journalArticle

MacArthur, C, Winter, HR, Bick, DE, Knowles, H, Lilford, R, Henderson, C, Lancashire, RJ, Braunholtz, DA & Gee, H 2002, 'Effects of redesigned community postnatal care on womens' health 4 months after birth: a cluster randomised controlled trial', The Lancet, vol. 359, no. 9304, pp. 378-385. https://doi.org/10.1016/S0140-6736(02)07596-7
MacArthur, C. ; Winter, H. R. ; Bick, D. E. ; Knowles, H. ; Lilford, R. ; Henderson, C. ; Lancashire, R. J. ; Braunholtz, David Alexander ; Gee, H. / Effects of redesigned community postnatal care on womens' health 4 months after birth: a cluster randomised controlled trial. In: The Lancet. 2002 ; Vol. 359, No. 9304. pp. 378-385.
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abstract = "Background Much postpartum physical and psychological morbidity is not addressed by present care, which tends to focus on routine examinations. We undertook a cluster randomised controlled trial to assess community postnatal care that has been redesigned to identify and manage individual needs.Methods We randomly allocated 36 general practice clusters from the West Midlands health region of the UK to intervention (n=17) or control (19) care. Midwives from the practices recruited women and provided care. 1087 (53{\%}) of 2064 women were in practices randomly assigned to the intervention group, with 977 (47{\%}) women in practices assigned to the control group. Care was led by midwives, with no routine contact with general practitioners, and was extended to 3 months. Midwives used symptom checklists and the Edinburgh postnatal depression scale (EPDS) to identify health needs and guidelines for the management of these needs. Primary outcomes at 4 months were obtained by postal questionnaire and included the women's short form 36 physical (PCS) and mental (MCS) component summary scores and the EPDS. Secondary outcomes were women's views about care. Multilevel analysis accounted for possible cluster effects.Findings 801 (77{\%}) of 1087 women in the intervention group and 702 (76{\%}) of 977 controls responded at 4 months. Women's mental health measures were significantly better in the intervention group (MCS, 3.03 [95{\%} CI 1.53-4.52]; EPDS -1.92 [-2.55 to -1.29]; EPDS 13+ odds ratio 0.57 [0.43-0.76]) than in controls, but the physical health score did not differ.Interpretation Redesign of care so that it is midwife-led, flexible, and tailored to needs, could help to improve women's mental health and reduce probable depression at 4 months' postpartum.",
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T1 - Effects of redesigned community postnatal care on womens' health 4 months after birth: a cluster randomised controlled trial

AU - MacArthur, C.

AU - Winter, H. R.

AU - Bick, D. E.

AU - Knowles, H.

AU - Lilford, R.

AU - Henderson, C.

AU - Lancashire, R. J.

AU - Braunholtz, David Alexander

AU - Gee, H.

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N2 - Background Much postpartum physical and psychological morbidity is not addressed by present care, which tends to focus on routine examinations. We undertook a cluster randomised controlled trial to assess community postnatal care that has been redesigned to identify and manage individual needs.Methods We randomly allocated 36 general practice clusters from the West Midlands health region of the UK to intervention (n=17) or control (19) care. Midwives from the practices recruited women and provided care. 1087 (53%) of 2064 women were in practices randomly assigned to the intervention group, with 977 (47%) women in practices assigned to the control group. Care was led by midwives, with no routine contact with general practitioners, and was extended to 3 months. Midwives used symptom checklists and the Edinburgh postnatal depression scale (EPDS) to identify health needs and guidelines for the management of these needs. Primary outcomes at 4 months were obtained by postal questionnaire and included the women's short form 36 physical (PCS) and mental (MCS) component summary scores and the EPDS. Secondary outcomes were women's views about care. Multilevel analysis accounted for possible cluster effects.Findings 801 (77%) of 1087 women in the intervention group and 702 (76%) of 977 controls responded at 4 months. Women's mental health measures were significantly better in the intervention group (MCS, 3.03 [95% CI 1.53-4.52]; EPDS -1.92 [-2.55 to -1.29]; EPDS 13+ odds ratio 0.57 [0.43-0.76]) than in controls, but the physical health score did not differ.Interpretation Redesign of care so that it is midwife-led, flexible, and tailored to needs, could help to improve women's mental health and reduce probable depression at 4 months' postpartum.

AB - Background Much postpartum physical and psychological morbidity is not addressed by present care, which tends to focus on routine examinations. We undertook a cluster randomised controlled trial to assess community postnatal care that has been redesigned to identify and manage individual needs.Methods We randomly allocated 36 general practice clusters from the West Midlands health region of the UK to intervention (n=17) or control (19) care. Midwives from the practices recruited women and provided care. 1087 (53%) of 2064 women were in practices randomly assigned to the intervention group, with 977 (47%) women in practices assigned to the control group. Care was led by midwives, with no routine contact with general practitioners, and was extended to 3 months. Midwives used symptom checklists and the Edinburgh postnatal depression scale (EPDS) to identify health needs and guidelines for the management of these needs. Primary outcomes at 4 months were obtained by postal questionnaire and included the women's short form 36 physical (PCS) and mental (MCS) component summary scores and the EPDS. Secondary outcomes were women's views about care. Multilevel analysis accounted for possible cluster effects.Findings 801 (77%) of 1087 women in the intervention group and 702 (76%) of 977 controls responded at 4 months. Women's mental health measures were significantly better in the intervention group (MCS, 3.03 [95% CI 1.53-4.52]; EPDS -1.92 [-2.55 to -1.29]; EPDS 13+ odds ratio 0.57 [0.43-0.76]) than in controls, but the physical health score did not differ.Interpretation Redesign of care so that it is midwife-led, flexible, and tailored to needs, could help to improve women's mental health and reduce probable depression at 4 months' postpartum.

KW - MATERNAL HEALTH

KW - DEPRESSION

KW - CHILDBIRTH

KW - PREVENTION

KW - SUPPORT

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DO - 10.1016/S0140-6736(02)07596-7

M3 - Article

VL - 359

SP - 378

EP - 385

JO - The Lancet

JF - The Lancet

SN - 0140-6736

IS - 9304

ER -