Canadian Women's Experience of Postnatal Care: A Mixed Method Study

Postpartum Emergency Department Use Following Midwifery-Model vs Obstetrics-Model Care

Importance

Emergency department (ED) use postpartum is a common and often-preventable event. Unlike traditional obstetrics models, the Ontario midwifery model offers early care postpartum.

Objective

To assess whether postpartum ED use differs between women who received perinatal care in midwifery-model care vs in traditional obstetrics-model care.

Design, Setting, and Participants

This retrospective population-based cohort study took place in Ontario, Canada, where public health care is universally funded. Participants included women who were low risk and primiparous and gave birth to a live baby in an Ontario hospital between 2012 and 2018. Data were collected from April 2012 to March 2018 and analyzed from June 2022 to April 2023.

Exposures

Perinatal care clinician, namely, a midwife or obstetrician.

Main Outcome and Measures

: Any unscheduled ED visit 42 days postpartum or less. Poisson regression models compared ED use between women with midwifery-model care vs obstetrics-model care, weighting by propensity score-based overlap weights.

Results

Among 104 995 primiparous women aged 11 to 50 years, those in midwifery-model care received a median (IQR) of 7 (6-8) postpartum visits, compared with 0 (0-1) visits among those receiving obstetrics-model care. Unscheduled ED visits 42 days or less postpartum occurred for 1549 of 23 124 women (6.7%) with midwifery-model care compared with 6902 of 81 871 women (8.4%) with traditional obstetrics-model care (adjusted relative risks [aRR], 0.78; 95% CI, 0.73-0.83). Similar aRRs were seen in women with a spontaneous vaginal birth (aRR, 0.71; 95% CI, 0.65-0.78) or assisted vaginal birth (aRR, 0.70; 95% CI, 0.59-0.82) but not those with a cesarean birth (aRR, 0.94; 95% CI, 0.86-1.03) or those with intrapartum transfer of care between a midwife and obstetrician (aRR, 0.94; 95% CI, 0.87-1.04). ED use 7 days or less postpartum was also lower among women receiving midwifery model care (aRR, 0.70; 95% CI, 0.65-0.77).

Conclusions and Relevance

In this cohort study, midwifery-model care was associated with less postpartum ED use than traditional obstetrics-model care among women who had low risk and were primiparous, which may be due to early access to postpartum care provided by Ontario midwives.

Navigating return to sex: A qualitative Reddit analysis of parents' perceptions about the timing of resuming sex after a birth

OBJECTIVE

Given the many transitions that occur in the postpartum period as men and women navigate the return to sex after a birth, this study aimed to explore parents' experiences of resuming sexual activity.

METHODS

This was a qualitative study that used posts from both men and women from the online public forum Reddit. Data were analysed using constructivist grounded theory.

RESULTS

This study found that the discourse surrounding sexual activity in the postpartum period was dominated by an understanding that medical guidelines prohibited sex prior to six weeks after giving birth. Although some parents disagreed, many Reddit users perceived a high degree of risk in resuming sex prior to six weeks and medical expertise was highly valued as parents negotiated the return to sex. While Reddit users were largely in agreement that penetrative vaginal sex prior to six weeks was a risky activity, there was less consensus as to the risk involved in other sexual activities.

CONCLUSION

This study recommends that medical practitioners initiate conversations with men and women about returning to sexual activity after a birth, and that these conversations should consider parents' emotional well-being as they resume sex. Further research is needed to establish evidence-based and comprehensive guidelines to facilitate these conversations.

Effectiveness of the "Essential Coaching for Every Mother" postpartum text message program on maternal psychosocial outcomes: A randomized controlled trial

Objective

To determine the effectiveness of the Essential Coaching for Every Mother program on maternal self-efficacy, perceived social support, postpartum anxiety, and postpartum depression at six-weeks postpartum.

Methods

Participants from Nova Scotia were randomized, stratified by parity, to receive either the Essential Coaching for Every Mother postpartum text-message program or usual care, from birth to six-weeks postpartum. Participants completed surveys at enrollment (after birth) and at 6 weeks. Differences between groups were analyzed using analysis of covariance, considering parity and group allocation.

Results

Of the 171 participants recruited (53% primiparous), 150 completed the baseline survey (intervention n = 78, control n = 72). At baseline, newborns were on average 4.4 days old (SD: 3.9) and mothers 31.4 years old (SD: 4.5). Controlling for maternal age, primiparous women in the intervention group had a greater increase in maternal self-efficacy than primiparous women in the control group (mean difference [MD] = 4.84 (standard error [SE] = 0.75) vs. MD = 2.13 (SE = 0.81), p = 0.034). Women allocated to the intervention group had a greater reduction in postpartum anxiety symptoms than women in the control group for both multiparous and primiparous women (MD = -3.91 (SE = 1.82) vs. 2.81 (SE = 1.86), p = 0.011). There was no significant change in postpartum depression scores or perceived social support for either group.

Discussion

This study presents the results of the first Canadian postpartum text message program, which found improved psychosocial outcomes for postpartum women. Given the potential to reach numerous women at a low cost across geographical locations, the scalability of this intervention can improve maternal self-efficacy and reduce postpartum anxiety.