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Guidelines and Interventions Related to the Postpartum Visit for Low-Risk Postpartum Women in High and Upper Middle Income Countries

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Abstract

Objectives A two-part review was undertaken to: (1) summarize current guidelines on the timing and frequency of postpartum follow-up care for generally healthy, non-high risk postpartum women and to delineate the evidence on which these guidelines are based; and, (2) summarize the results of intervention studies focused on increasing utilization of the postpartum visit for generally healthy, non-high risk postpartum women. Methods A review of guidelines from high and upper middle income countries published between 2000 and 2016 in English related to non-high risk postpartum follow-up visits was conducted in 2014–2016 using four databases and additional sources. In addition, articles published between 1990 and 2016 which evaluated interventions from high to upper middle income countries related to increasing attendance at the postpartum visit were gathered using three databases. Results This review located eight guidelines, all of which relied on expert opinion/group consensus as the evidence for their recommendations regarding the timing of the postpartum visit. The review located 19 intervention studies focused on increasing use of the postpartum visit; in 12 there was statistically significant evidence that these approaches improved utilization. However, no intervention strategy was evaluated more than a few times and many of the evaluations were relatively dated. Conclusions Guidelines for the timing of the postpartum visit are variable and are typically based on weak evidence; however, there is support for increased flexibility to meet women’s needs. Additionally, while there is a diverse set of promising interventions to increase utilization of the postpartum visit, there is limited evaluative information. Future initiatives should focus on more rigorous evaluation.

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Notes

  1. Postpartum guidelines not found through the review methodology outlined above but provided by a reviewer, the "Postnatal Care Program Guidelines for Victorian Health Services” from the Australia's State of Victoria's Department of Health in 2012 [37], also support providing "women-centered" postnatal care that focuses on the needs and expectations of the woman and allows her to help drive the plan for postnatal care. These guidelines recommend that postnatal care planning begin during the prenatal period and should include the woman’s preferred location and timing of care.

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Acknowledgments

The authors would like to thank Gwen Smith and Linda Wheal of the Illinois Department of Healthcare and Family Services for their support for the project on which this paper is based. The authors would also like to thank Tierra Williams for her work collecting articles for this review. This document was developed under grant CFDA 93.767 from the U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services. However these contents do not necessarily represent the policy of the U.S. Department of Health and Human Services, and you should not assume endorsement by the Federal Government.

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Authors and Affiliations

  1. UIC College of Medicine, 808 S Wood, Chicago, IL, 60612, USA

    Katrina Stumbras

  2. Department of Epidemiology and Biostatistics, UIC School of Public Health, 1603 W. Taylor, Chicago, IL, 60612, USA

    Kristin Rankin

  3. Department of Pediatrics, UIC College of Medicine, 840 South Wood Street, Clinical Science North 440, MC 718, Chicago, IL, 60612, USA

    Rachel Caskey

  4. Department of Obstetrics and Gynecology, UIC College of Medicine, 840 South Wood Street, Clinical Science North 440, MC 718, Chicago, IL, 60612, USA

    Sadia Haider

  5. Department of Community Health Sciences, UIC School of Public Health, 1603 W. Taylor, Chicago, IL, 60612, USA

    Arden Handler

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Correspondence to Katrina Stumbras.

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Stumbras, K., Rankin, K., Caskey, R. et al. Guidelines and Interventions Related to the Postpartum Visit for Low-Risk Postpartum Women in High and Upper Middle Income Countries. Matern Child Health J 20 (Suppl 1), 103–116 (2016). https://doi.org/10.1007/s10995-016-2053-6

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