Melbourne School of Population and Global Health - Theses
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ItemThe role of the general practitioner in postnatal care: an early intervention study( 1997)This thesis deals with the role of the general practitioner (GP) in postnatal care, especially the provision of and the most appropriate timing for the traditional postnatal check-up. Chapter 1 discusses the origins of postnatal care, the common morbidities, the lack of formal research in the area and the opportunity that the routine postnatal check-up presents to general practitioners. Chapter 2 shows, by the analysis of routinely collected Medicare data, that a mother and baby will have 7.7 visits (on average) to a GP in the six months after birth and many women will attend a GP for their routine postnatal check-up. Given the frequent contacts that GPs have with mothers and babies a Statewide postal survey of 1104 general practitioners was used to obtain their views towards postnatal care. The main findings are presented in Chapter 3. Most GPs are involved in postnatal care. Female GPs have different views from male GPs as to what should take place at the routine postnatal check-up. Overall, GPs are placing too much emphasis on routine examination and neglecting many of the common problems, both physical and emotional. Many GPs lack confidence to deal with common postnatal problems. GPs provide many visits in the early weeks prior to the traditional check-up. Some GPs believed that an earlier timing for the traditional postnatal check-up might improve maternal health. Chapter 4 reports on a randomised controlled trial designed to test whether a visit to a GP one week after discharge resulted in improved maternal health, as measured by the Edinburgh Postnatal Depression Scale (EPDS), the Short Form 36 (SF 36) subscales, self-report items about physical and emotional health and items about satisfaction with the check-up. Whilst the change in timing of the check-up resulted in less routine examination and more time to talk there were no differences in maternal health between the groups. The survey of general practitioners and the randomised controlled trial of an early postnatal check-up revealed a number of problems with the current postnatal check-up. To explore these problems further the findings of the GP survey are compared with the experiences of women in the standard care group of the trial. These findings are reported in Chapter 5 and indicate that many women experience problems after childbirth and some may consult a GP about the problems. However, only the minority of women will rate the GP as 'very helpful'. Many women are dissatisfied with their postnatal check-up and the current postnatal check-up is not focussed on the common problems. Whilst the traditional postnatal check-up provides an opportunity for the general practitioner to improve maternal health, this is not likely at present. If GPs are to have a role in improving maternal health a new approach to the postnatal check-up is needed. Chapter 6 provides a framework for a postnatal check-up in general practice, which might make that difference.