Evaluation of a midwifery network to guarantee outpatient postpartum care: a mixed methods study

Abstract

Background: The necessity of outpatient postpartum care has increased due to shorter hospital stays. In a health care system, where postpartum care after hospital discharge must be arranged by families themselves, this can be challenging for those experiencing psychosocial disadvantages. Therefore, we compared characteristics of users of a midwifery network which referred women to outpatient postpartum care providers with those of women organising care themselves. Additionally, we investigated benefits of the network for women and health professionals. Methods: Evaluation of the services of a midwifery network in Switzerland. We combined quantitative secondary analysis of routine data of independent midwives with qualitative telephone interviews with users and a focus group with midwives and nurses. Descriptive statistics and logistic regression modelling were done using Stata 13. Content analysis was applied for qualitative data.Results: Users of the network were more likely to be: primiparas (OR 1.52, 95% CI [1.31-1.75, p < 0.001]); of foreign nationality (OR 2.36, 95% CI [2.04-2.73], p < 0.001); without professional education (OR 1.89, 95% CI [1.56-2.29] p < 0.001); unemployed (OR 1.28, 95% CI [1.09-1.51], p = 0.002) and have given birth by caesarean section (OR 1.38, 95% CI [1.20-1.59], p < 0.001) compared to women organising care themselves. Furthermore, users had cumulative risk factors for vulnerable transition into parenthood more often (≥ three risk factors: 4.2% vs. 1.5%, p < 0.001). Women appreciate the services provided. The collaboration within the network facilitated work scheduling and the better use of resources for health professionals. Conclusions: The network enabled midwives and nurses to reach families who might have struggled to organise postpartum care themselves. It also facilitated the work organisation of health professionals. Networks therefore provide benefits for families and health professionals.

Support during the postnatal period: Evaluating new mothers' and midwives' experiences of a new, coordinated postnatal care model in a midwifery clinic in Sweden

“…The effective transfer of care and continuity from pregnancy to the postnatal period was what women desired [2]. Our findings are consistent with other studies showing that accessibility has a great impact on women after childbirth [18,43].…”

“But at home, with the midwife, you are a person”: experiences and impact of a new early postpartum home-based midwifery care model in the view of women in vulnerable family situations

“…Women included in the study used metaphors such as “angel” or even “God” to describe the midwives. Similar expressions by postpartum women have also been documented in a recent study in Zurich involving socially disadvantaged women [ 16 ]. These expressions may reflect, on the one hand, the hardships experienced in vulnerable situations and, on the other hand highlighted that support in such situations was perceived as particularly helpful.…”

“…Relational continuity has also been described as a crucial part of midwifery care in the review of Dahlberg [ 22 ], and it was linked to improved outcomes [ 23 ]. The high accessibility and reliability of the midwife appeared very central also in the other recent Swiss study [ 16 , 38 ]. The building of trust probably occurred fully only if midwives could be immediately present in the homes of new mothers, recognize situations of psychosocial and emotional emergency, and act as first professional responders.…”

“…These expressions may reflect, on the one hand, the hardships experienced in vulnerable situations and, on the other hand highlighted that support in such situations was perceived as particularly helpful. According to the Swiss study by Grylka-Baeschlin et al, midwives who provided postpartum care evolved into important support persons, and, among women with migration history, in that the midwives became cultural mediators [ 16 ]. Relational continuity has also been described as a crucial part of midwifery care in the review of Dahlberg [ 22 ], and it was linked to improved outcomes [ 23 ].…”

“…They assure that all women who give birth in the collaborating hospitals receive standardized care in that a midwife comes to their homes after hospital discharge and ensures further care. A first evaluation study in Switzerland suggested a great value of organized, guaranteed postpartum outpatient care by a midwifery network, especially for socially disadvantaged families [ 16 ]. It appeared that the accessibility and reliability of the midwives were crucial to women.…”