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Meta-Analysis
. 2017 Aug 2;8(8):CD009326.
doi: 10.1002/14651858.CD009326.pub3.

Schedules for home visits in the early postpartum period

Naohiro Yonemoto  1 , Therese Dowswell, Shuko Nagai, Rintaro Mori
Affiliations
Meta-Analysis

Schedules for home visits in the early postpartum period

Naohiro Yonemoto et al. Cochrane Database Syst Rev. .

Update in

Abstract

Background: Maternal complications including psychological and mental health problems and neonatal morbidity have been commonly observed in the postpartum period. Home visits by health professionals or lay supporters in the weeks following the birth may prevent health problems from becoming chronic with long-term effects on women, their babies, and their families.

Objectives: To assess outcomes for women and babies of different home-visiting schedules during the early postpartum period. The review focuses on the frequency of home visits, the duration (when visits ended) and intensity, and on different types of home-visiting interventions.

Search methods: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (28 January 2013) and reference lists of retrieved articles.

Selection criteria: Randomised controlled trials (RCTs) (including cluster-RCTs) comparing different types of home-visiting interventions enrolling participants in the early postpartum period (up to 42 days after birth). We excluded studies in which women were enrolled and received an intervention during the antenatal period (even if the intervention continued into the postnatal period) and studies recruiting only women from specific high-risk groups. (e.g. women with alcohol or drug problems).

Data collection and analysis: Study eligibility was assessed by at least two review authors. Data extraction and assessment of risk of bias were carried out independently by at least two review authors. Data were entered into Review Manager software.

Main results: We included data from 12 randomised trials with data for more than 11,000 women. The trials were carried out in countries across the world, and in both high- and low-resource settings. In low-resource settings women receiving usual care may have received no additional postnatal care after early hospital discharge.The interventions and control conditions varied considerably across studies with trials focusing on three broad types of comparisons: schedules involving more versus fewer postnatal home visits (five studies), schedules involving different models of care (three studies), and home versus hospital clinic postnatal check-ups (four studies). In all but two of the included studies, postnatal care at home was delivered by healthcare professionals. The aim of all interventions was broadly to assess the wellbeing of mothers and babies, and to provide education and support, although some interventions had more specific aims such as to encourage breastfeeding, or to provide practical support.For most of our outcomes only one or two studies provided data, and overall results were inconsistent.There was no evidence that home visits were associated with improvements in maternal and neonatal mortality, and no consistent evidence that more postnatal visits at home were associated with improvements in maternal health. More intensive schedules of home visits did not appear to improve maternal psychological health and results from two studies suggested that women receiving more visits had higher mean depression scores. The reason for this finding was not clear. In a cluster randomised trial comparing usual care with individualised care by midwives extended up to three months after the birth, the proportions of women with Edinburgh postnatal depression scale (EPDS) scores ≥ 13 at four months was reduced in the individualised care group (RR 0.68, 95% CI 0.53 to 0.86). There was some evidence that postnatal care at home may reduce infant health service utilisation in the weeks following the birth, and that more home visits may encourage more women to exclusively breastfeed their babies. There was some evidence that home visits are associated with increased maternal satisfaction with postnatal care.

Authors' conclusions: Increasing the number of postnatal home visits may promote infant health and maternal satisfaction and more individualised care may improve outcomes for women, although overall findings in different studies were not consistent. The frequency, timing, duration and intensity of such postnatal care visits should be based upon local and individual needs. Further well designed RCTs evaluating this complex intervention will be required to formulate the optimal package.

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Conflict of interest statement

None known.

Figures

1
1
'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
2
2
'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1 Schedules involving more vs fewer postpartum visits, Outcome 1 Maternal mortality within 42 days post birth.
1.2
1.2. Analysis
Comparison 1 Schedules involving more vs fewer postpartum visits, Outcome 2 Neonatal mortality.
1.3
1.3. Analysis
Comparison 1 Schedules involving more vs fewer postpartum visits, Outcome 3 Severe maternal morbidity.
1.4
1.4. Analysis
Comparison 1 Schedules involving more vs fewer postpartum visits, Outcome 4 Secondary postpartum haemorrhage.
1.5
1.5. Analysis
Comparison 1 Schedules involving more vs fewer postpartum visits, Outcome 5 Abdominal pain up to 42 days postpartum.
1.6
1.6. Analysis
Comparison 1 Schedules involving more vs fewer postpartum visits, Outcome 6 Back pain up to 42 days postpartum.
1.9
1.9. Analysis
Comparison 1 Schedules involving more vs fewer postpartum visits, Outcome 9 Urinary tract complications up to 42 days postpartum.
1.10
1.10. Analysis
Comparison 1 Schedules involving more vs fewer postpartum visits, Outcome 10 Maternal fever up to 42 days postpartum.
1.11
1.11. Analysis
Comparison 1 Schedules involving more vs fewer postpartum visits, Outcome 11 Dyspareunia.
1.12
1.12. Analysis
Comparison 1 Schedules involving more vs fewer postpartum visits, Outcome 12 Maternal perception of general health at 6 weeks (mean SF36).
1.14
1.14. Analysis
Comparison 1 Schedules involving more vs fewer postpartum visits, Outcome 14 Mean postnatal depression score (last assessment up to 42 days postpartum).
1.16
1.16. Analysis
Comparison 1 Schedules involving more vs fewer postpartum visits, Outcome 16 Mean maternal anxiety score (last assessment up to 42 days postpartum).
1.17
1.17. Analysis
Comparison 1 Schedules involving more vs fewer postpartum visits, Outcome 17 Maternal satisfaction with postnatal care.
1.18
1.18. Analysis
Comparison 1 Schedules involving more vs fewer postpartum visits, Outcome 18 Mean satisfaction score with postnatal care.
1.19
1.19. Analysis
Comparison 1 Schedules involving more vs fewer postpartum visits, Outcome 19 Serious neonatal morbidity up to 6 months.
1.20
1.20. Analysis
Comparison 1 Schedules involving more vs fewer postpartum visits, Outcome 20 Exclusive breastfeeding (last assessment up to 6 weeks).
1.21
1.21. Analysis
Comparison 1 Schedules involving more vs fewer postpartum visits, Outcome 21 Exclusive breastfeeding (last assessment up to 6 months).
1.22
1.22. Analysis
Comparison 1 Schedules involving more vs fewer postpartum visits, Outcome 22 Any breastfeeding (up to 6 weeks).
1.23
1.23. Analysis
Comparison 1 Schedules involving more vs fewer postpartum visits, Outcome 23 Any breastfeeding (last assessment up to 6 months).
1.24
1.24. Analysis
Comparison 1 Schedules involving more vs fewer postpartum visits, Outcome 24 Mean duration of any breastfeeding (months).
1.25
1.25. Analysis
Comparison 1 Schedules involving more vs fewer postpartum visits, Outcome 25 Infant respiratory tract infection within 42 days.
1.26
1.26. Analysis
Comparison 1 Schedules involving more vs fewer postpartum visits, Outcome 26 Infant jaundice.
1.27
1.27. Analysis
Comparison 1 Schedules involving more vs fewer postpartum visits, Outcome 27 Infant diarrhoea up to 42 days postpartum.
1.28
1.28. Analysis
Comparison 1 Schedules involving more vs fewer postpartum visits, Outcome 28 Infant immunisation took place.
1.29
1.29. Analysis
Comparison 1 Schedules involving more vs fewer postpartum visits, Outcome 29 Non prespecified ‐ Contraceptive use.
2.2
2.2. Analysis
Comparison 2 Studies comparing different ways of offering postnatal care at home, Outcome 2 Neonatal mortality.
2.9
2.9. Analysis
Comparison 2 Studies comparing different ways of offering postnatal care at home, Outcome 9 Postnatal depression (EPDS ≥ 13 at 4 months postpartum).
2.15
2.15. Analysis
Comparison 2 Studies comparing different ways of offering postnatal care at home, Outcome 15 Neonatal morbidity up to 28 days.
2.16
2.16. Analysis
Comparison 2 Studies comparing different ways of offering postnatal care at home, Outcome 16 Stopped exclusive breastfeeding (last assessment up to 6 weeks).
2.17
2.17. Analysis
Comparison 2 Studies comparing different ways of offering postnatal care at home, Outcome 17 Exclusive breastfeeding (last assessment up to 6 months).
2.18
2.18. Analysis
Comparison 2 Studies comparing different ways of offering postnatal care at home, Outcome 18 Any breastfeeding (up to 6 weeks).
3.3
3.3. Analysis
Comparison 3 Postnatal visit at home vs hospital clinic visit, Outcome 3 Severe maternal morbidity.
3.10
3.10. Analysis
Comparison 3 Postnatal visit at home vs hospital clinic visit, Outcome 10 Postnatal depression (last assessment up to 42 days postpartum).
3.13
3.13. Analysis
Comparison 3 Postnatal visit at home vs hospital clinic visit, Outcome 13 Mean maternal anxiety score (last assessment up to 42 days postpartum).
3.14
3.14. Analysis
Comparison 3 Postnatal visit at home vs hospital clinic visit, Outcome 14 Maternal satisfaction with postnatal care.
3.15
3.15. Analysis
Comparison 3 Postnatal visit at home vs hospital clinic visit, Outcome 15 Mean satisfaction score with postnatal care.
3.16
3.16. Analysis
Comparison 3 Postnatal visit at home vs hospital clinic visit, Outcome 16 Exclusive breastfeeding (last assessment up to 6 weeks).
3.18
3.18. Analysis
Comparison 3 Postnatal visit at home vs hospital clinic visit, Outcome 18 Discontinued breastfeeding (up to 6 weeks).
3.19
3.19. Analysis
Comparison 3 Postnatal visit at home vs hospital clinic visit, Outcome 19 Any breastfeeding (last assessment up to 6 months).
3.21
3.21. Analysis
Comparison 3 Postnatal visit at home vs hospital clinic visit, Outcome 21 Severe infant morbidity up to 6 weeks.
See this image and copyright information in PMC

Update of

References

References to studies included in this review

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References to other published versions of this review

Yonemoto 2011
    1. Yonemoto N, Nagai S, Mori R. Schedules for home visits in the early postpartum period. Cochrane Database of Systematic Reviews 2011, Issue 9. [DOI: 10.1002/14651858.CD009326] - DOI - PMC - PubMed

Publication types