One in three women miss check-ups after giving birth

One in three women miss check-ups after giving birth

New research from Norway highlights a missed opportunity in aftercare, showing that women's satisfaction increases dramatically when checkups with family doctors are more comprehensive and convenient.

Study: Follow-up visits among general practitioners in Norway: a cross-sectional survey of attendance, content and patient satisfaction. Photo credit: Dorde Krstic/Shutterstock.com

A recent study inBMC Primary Careexamined general practitioners' (GPs') postpartum check-up attendance and patient satisfaction in Norway.

Aftercare: Meaning and Guidelines

Postpartum care for mothers is critical to their well-being and the healthy development of their babies. Effective aftercare helps women recover, adapt to the demands of parenthood, and ensure newborns receive nourishing support.

Leading health organizations such as the World Health Organization (WHO) and the National Institute for Health and Care Excellence (NICE) emphasize the importance of regular check-ups after delivery.

Recommendations for timing of follow-up visits vary. For example, the WHO recommends a six-week check-up tailored to individual needs, while NICE suggests a period of six to eight weeks. The American College of Obstetrics and Gynecology (ACOG) recommends initial contact within 3 weeks and a complete examination after 12 weeks.

Most women in high-income countries participate in postpartum screening, but participation may be influenced by socioeconomic status. The content of these visits varies; Women are more likely to receive information about contraception than sexual health.

Midwives tend to focus on contraception, while GPs deal with a wider range of topics including mental health, nutrition and sexual health. Obstetricians are less likely to cover these areas.

In England, general practitioners usually carry out postpartum examinations, and in the USA, obstetricians. In Norway, care is provided by a mix of professionals, but family doctors have traditionally overseen postpartum check-ups. Therefore, general practice is an important source of postpartum care for women and families.

Women in England and Australia want to talk to GPs about a wide range of topics, including physical recovery, mental health, infant feeding, contraception, health promotion and personal concerns. The period after birth offers an important opportunity for health promotion by family doctors.

Assessment of postpartum healthcare in Norway

Residents of Norway can choose a regular family doctor to ensure continuity of care during pregnancy and the postpartum period. National guidelines recommend a home visit from the midwife soon after discharge, a visit from the nurse within ten days and a follow-up visit after four to six weeks, with earlier visits for patients with complications or chronic illnesses. Preventive examinations after birth are free and usually take place at the family doctor.

The current study included all women who gave birth to one or more live-born children between July 1, 2021 and June 20, 2022 in the two hospitals of Nord-Trøndelag Health Trust. A total of 1,119 women were eligible for this study and had received an invitation letter and a link to the digital questionnaire, which was only available in Norwegian.

The questionnaire included demographic data, information about postpartum checkups, attendance and reasons for missing checkups with the primary care physician. Details of GP visits were also provided and important topics such as examination content and satisfaction were addressed.

Patient experience was measured using a five-point Likert scale, with overall satisfaction as the primary outcome. Responses were grouped as “Satisfied” or “Not Satisfied.” Participants were also asked to submit suggestions for improvements.

Significant non-participation with generally positive experiences

Of the 1,119 women invited, 351 responded (a response rate of just over 30%), and the majority were between 25 and 29 years old. The study cohort included approximately 41% primiparous women and 36% had experienced birth complications.

Women who consulted midwives were more likely to be younger, first-time mothers or from smaller communities. The authors note that despite broadly representative demographic data, the response rate introduces potential selection bias.

Most women found out about postpartum check-ups from midwives or maternity wards, while few found out about them from GPs, friends or social media. Only 68% knew that the examination was free.

The majority of women thought six weeks postpartum was the right time to visit, although some said it was too late or too early.

Of those surveyed, 254 attended a follow-up visit, either with a family doctor, a midwife or in a hospital. The most common reasons for not participating were not having a regular family doctor, believing the visit was unnecessary, not knowing about the examination, or being dissatisfied with previous experiences.

Participation rates were similar across most groups, with women with higher education being more likely to participate. Knowing that the screening was free increased the likelihood of taking part.

Notably, women with underlying medical conditions or adverse pregnancy outcomes did not attend follow-up visits more frequently than healthier women, despite their potentially greater need for follow-up care.

22 percent of women contacted their primary care doctor for reasons other than a scheduled follow-up visit, mostly through in-person visits but also by phone, email, video or home visits.

Only women who visited a primary care doctor for postpartum checkups answered questions about key issues and satisfaction. The most commonly discussed topics were contraception, breastfeeding, labor, mental health and birth injuries.

Typically, female general practitioners dealt with more issues and performed more gynecological examinations than male general practitioners.

Women rated primary care physicians highly in terms of communication, medical skills, and care. However, overall satisfaction was moderate rather than general, with just over half of women reporting high overall satisfaction with the primary care examination.

Satisfaction was strongly related to discussing labor and performing a pelvic exam. Satisfied women had more topics covered during prenatal visits than dissatisfied women, highlighting the importance of scope and depth in postpartum consultations.

Strategies for increasing postpartum attendance

A significant minority of women miss postpartum check-ups, representing a missed opportunity for support and long-term health promotion. Participation was not higher among women with chronic illnesses or adverse pregnancy outcomes, raising concerns about whether current systems are adequately reaching those most at risk.

Ensuring regular access to a general practitioner, improving the quality and structure of check-ups, and better communication about the purpose and free availability of postpartum visits could help increase participation.

While many women report positive experiences with home health care after childbirth, satisfaction depends closely on how comprehensive the visit is, including whether sensitive but important topics are discussed and whether a gynecological exam is offered. The study also points to structural constraints such as: B. the limited consultation hours in general practice, which can limit the scope of postpartum preventive examinations.

Ultimately, postpartum care should be individualized and include sufficient time and attention to address each woman's individual needs and support not only short-term recovery, but also long-term health and well-being.

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