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Postnatal care - outcomes of various care options in Sweden
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
2008 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: In high-income countries, hospital length of stay after a normal birth has gradually decreased correspondingly to length of stay in care of other patients. A short stay provides a greater opportunity for autonomy and an increased sense of participation, but it may involve great challenges satisfying parental guidance as well as on the possibility of preventing, discovering, and treating neonatal medical conditions.

Aim: This study evaluates postnatal care based on cost calculations, risk assessments, and parents’ satisfaction with care.

Methods: Questionnaires were sent to 1 122 new mothers and her partner during 1998-1999. For the summary of utilization of health care services during the first 28 days postdelivery, the participants were linked with registry data from the hospital administration system for mothers and newborns (n= 773). The answers were also used to describe new parents’ experiences with postnatal care (n = 1 479). The costs for five postnatal care models were estimated, including three care options: Maternity Ward, Family Suite, and Early Discharge. Data about neonatal readmissions and death within 28 days was retrieved from the Swedish Medical Birth Register, the Swedish Hospital Discharge Registry, and the Swedish Cause-of-Death Register between 1999 and 2002 (n = 197 898). This data was related to data about postnatal follow-up practices from all 48 Swedish delivery wards.

Results: The readmission rate for the mothers was similar among the various care options, and there was no difference in utilization of health care or breastfeeding outcome due to type of maternity care. As a proxy for morbidity, the readmission rate for the newborns was influenced by postdelivery follow-up routines as routine neonatal examination timing. Depending on the proportion of mothers receiving care at the Maternity Ward, the costs differed significantly between the various care models, while parents’ preferences complied with the cost-minimizing option Family Suite. Most mothers and fathers (70%) were satisfied with the overall impression of the postnatal care, but 72% were dissatisfied with at least one particular topic. A main finding was that the parents experienced a close emotional attachment, an affinity that was not always supported by the staff. The father was not treated as a principal character even though the parents wanted the father’s to be involved and recognized.

Conclusions: Since the postnatal care options are not always the most cost minimizing and postnatal routines influence neonatal morbidity and parental satisfaction, the postnatal services need to be improved. Without increasing risks or costs, every postnatal care option ought to meet the families’ need for support, security, autonomy, and attachment with each other.

Place, publisher, year, edition, pages
Umeå: Klinisk vetenskap , 2008. , 62 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1202
Keyword [en]
Health economics, infant newborn, length of stay, maternal health services, midwife, patient satisfaction, patient readmission, postnatal care, postpartum
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
URN: urn:nbn:se:umu:diva-1818ISBN: 978-91-7264-597-4 (print)OAI: oai:DiVA.org:umu-1818DiVA: diva2:142099
Public defence
2008-09-26, Sal B, 9 tr, By 1D, Tandläkarhögskolan, Norrlands universitetssjukhus, Umeå, 09:00 (English)
Opponent
Supervisors
Available from: 2008-09-09 Created: 2008-09-09 Last updated: 2011-04-07Bibliographically approved
List of papers
1. Comparison of health care utilization of postnatal programs in Sweden
Open this publication in new window or tab >>Comparison of health care utilization of postnatal programs in Sweden
2005 (English)In: Journal of obstetric, gynecologic, and neonatal nursing, ISSN 0884-2175, Vol. 34, no 1, 55-62 p.Article in journal (Refereed) Published
Identifiers
urn:nbn:se:umu:diva-3413 (URN)
Available from: 2008-09-09 Created: 2008-09-09 Last updated: 2011-03-31Bibliographically approved
2. Satisfying parents' preferences with regard to various models of postnatal care is cost-minimizing
Open this publication in new window or tab >>Satisfying parents' preferences with regard to various models of postnatal care is cost-minimizing
2006 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 85, no 2, 175-181 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: This study describes three options for postnatal care in Sweden and contains a cost analysis of the options in various combinations. The aim of the study was to calculate the cost of a postnatal care model according to new parents' preferences.

METHODS: Staff costs were calculated for various models of postnatal care, comprising the maternity ward, the family suite, and/or the early discharge program. One of the models was based on answers from 342 parents who specified their preferences with regard to postnatal care in the event of another birth.

RESULTS: Comparing costs for five different models of postnatal care showed that the proportion of mothers receiving care at the maternity ward crucially influences the total costs. The staff costs differed significantly between the models, ranging from US$448 000 to US$778 000 per 1500 mother-child dyads. MAIN OUTCOME

MEASURES: Cost calculation of various care models and parents' preferences for postnatal care.

CONCLUSIONS: Because the parents' preferences with regard to postnatal care created one of the most cost-minimizing care models in the study, it would be possible to better meet parent's desires and, at the same time, reduce costs, without increasing risks in comparison with the early discharge program.

Keyword
costs and cost analysis, infant newborn, length of stay, maternal health services, postnatal care economics
Identifiers
urn:nbn:se:umu:diva-37066 (URN)10.1080/00016340500486784 (DOI)16532911 (PubMedID)
Available from: 2010-10-19 Created: 2010-10-19 Last updated: 2017-12-12Bibliographically approved
3. “We feel like one, they see us as two”: new parents' discontent with postnatal care
Open this publication in new window or tab >>“We feel like one, they see us as two”: new parents' discontent with postnatal care
2010 (English)In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 26, no 4, 463-468 p.Article in journal (Refereed) Published
Abstract [en]

Objective postnatal care has gone through remarkable changes, such as reducing the length of hospital stay and increasing the parents’ responsibility. Focusing on dissatisfaction, this study describes how new parents experience postpartum care.

Design cross-sectional, population-based study, based on questionnaires.

Participants 1474 parents.

Measurements and findings the questionnaires, posted six months after childbirth, addressed how parents experienced postnatal care. The data were analysed with descriptive statistics and content analysis.

Key conclusions a main finding was that the close emotional attachment between the parents was not always supported by staff. The father was treated as an outsider and the care was described as ‘a woman's world’. The asymmetric encounter between parents and staff was pronounced with respect to decision-making, and some designated this as ‘paternalism’. A great deal of the discontent with health care may be due to organisational failure, and the postnatal care should be more prioritised in the health-care organisation.

Implications for practice midwives should acknowledge that parents, irrespective of gender, should have equal opportunities as parents during postpartum care as parenting is a joint project.

Keyword
Maternal health services, midwife, patient satisfaction, postnatal care, postpartum
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-3415 (URN)10.1016/j.midw.2008.10.006 (DOI)000279742400014 ()19084301 (PubMedID)
Available from: 2008-09-09 Created: 2008-09-09 Last updated: 2017-12-14Bibliographically approved
4. Maternity care options influences readmission of newborns
Open this publication in new window or tab >>Maternity care options influences readmission of newborns
Show others...
2008 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 97, no 5, 579-583 p.Article in journal (Refereed) Published
Abstract [en]

Aim: To analyse morbidity and mortality in healthy newborn infants in relation to various routines of post-natal follow-up. Design: cross-sectional study. Setting: maternity care in Sweden. Population: healthy infants born at term between 1999 and 2002 (n = 197 898).

Methods: Assessment of post-natal follow-up routines after uncomplicated childbirth in 48 hospitals and data collected from the Swedish Medical Birth Register, Hospital Discharge Register and Cause-of-Death Register. Main outcome measure: neonatal mortality and readmission as proxy for morbidity.

Results: During the first 28 days, 2.1% of the infants were readmitted generally because of infections, jaundice and feeding-related problems. Infants born in hospitals with a routine neonatal examination before 48 h and a home care programme had a readmission rate [OR, 1.3 (95% CI, 1.16–1.48)] higher than infants born in hospitals with routine neonatal examination after 48 h and 24-h care. There were 26 neonatal deaths.

Conclusion: Post-delivery care options and routines influence neonatal morbidity as measured by hospital readmission rate. A final infant examination at 49–72 h and an active follow-up programme may reduce the risk of readmission.

Keyword
Infant, length of stay, morbidity, mortality, post-natal
National Category
Nursing Pediatrics Obstetrics, Gynecology and Reproductive Medicine Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-3416 (URN)10.1111/j.1651-2227.2008.00714.x (DOI)
Available from: 2008-09-09 Created: 2008-09-09 Last updated: 2017-12-14Bibliographically approved

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