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LETTERS:
Jane Barlow, Sarah Stewart-Brown, C Jane Morrell, and Helen Spiby
Costs and effectiveness of community postnatal support workers
BMJ 2001; 322: 301 [Full text]
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[Read Rapid Response] Postnatal care - towards more effective provision
Emma Kenyon, Jenny Hewison   (15 February 2001)

Postnatal care - towards more effective provision 15 February 2001
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Emma Kenyon,
Research Psychologist, Professor
School of PSychology, The University of Leeds,
Jenny Hewison

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Re: Postnatal care - towards more effective provision

RESPONSE TO "COSTS AND EFFECTIVENESS OF COMMUNITY POSTNATAL SUPPORT WORKERS"

EDITOR - Health Service initiatives over the last decade have pursued increased efficiency. One of the outcomes for the maternity sector has been a reduction in the length of postnatal stay women are offered. It is increasingly common for women to go home within 24 hours of delivery.1

Our research2 tested the hypothesis that women who were dissatisfied with the support available to them at home would stay in hospital for longer after the birth of their baby. Women filled in questionnaires antenatally about their support, and information on length of stay (LOS) was collected from hospital records after discharge. Few women in the study stayed in hospital beyond the third day, but within that narrow time range, a small but significant positive correlation was found between dissatisfaction with practical support and LOS (r = .165, p = .032). The relationship between LOS and dissatisfaction with emotional support was weaker and failed to reach statistical significance (r = .127, p = 0.1). In a multiple regression analysis, significant predictors of LOS were found to be, first, the number of children a woman already had (fewer children being associated with longer stay, reflecting both parity and domestic obligations), and second, her dissatisfaction with practical support.

These associations between support and length of stay have implications both for targeting and also for the kind of support that is being offered. The urgent need for re-consideration of postnatal hospital provision has already been highlighted3 , but the need to coordinate hospital and community postnatal support has not yet been addressed . It is in this complex domain, amidst the competing drives for efficiency, where we feel there is the potential for substantial gains in postnatal support to be made.

1Jackson, K. (1996) Postnatal care in hospital. British Journal of Midwifery 4,1 p40-41 2 Kenyon E. current PhD thesis, Supervised by Hewison, J , School of Psychology, the University of Leeds. 3 Audit Commission for Local Authorities and the National Health Service in England and Wales (1997) "First Class Delivery - Improving Maternity services in England and Wales" Audit Commission p53

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