Abstract
ObjectiveTo evaluate the efficacy, safety, and maternal satisfaction of a newly established integrative postpartum community-based clinic providing comprehensive support for mothers during the first month after discharge from the hospital. Our primary interests were breastfeeding rates, readmission and patient satisfaction.MethodsA randomized controlled trial was conducted in Ottawa, Canada, where 472 mothers were randomized via a 1:2 ratio to either receive standard of care (n = 157) or to attend the postpartum breastfeeding clinic (n = 315). Outcome data were captured through questionnaires completed by the participants at 2, 4, 12 and 24 weeks postpartum. Unadjusted and adjusted logistic regression models were conducted to determine the effect of the intervention on exclusive breastfeeding at 12 weeks (primary outcome). Secondary outcomes included breastfeeding rate at 2, 4 and 24 weeks, breastfeeding self-efficacy scale, readmission rate, and satisfaction score.ResultsMore mothers in the intervention group (n = 195, 66.1%) were exclusively breastfeeding at 12 weeks compared to mothers in the control group (n = 81, 60.5%), however no statistically significant difference was observed (OR = 1.28; 95% CI:0.84–1.95)). The rate of emergency room visits at 2 weeks for the intervention group was 11.4% compared to the standard of care group (15.2%) (OR = 0.69; 95% CI: 0.39–1.23). The intervention group was significantly more satisfied with the overall care they received for breastfeeding compared to the control group (OR = 1.96; 95% CI: 3.50–6.88)).ConclusionThis new model of care did not significantly increase exclusive breastfeeding at 12 weeks. However, there were clinically meaningful improvements in the rate of postnatal problems and satisfaction that support this new service delivery model for postpartum care. A community-based multidisciplinary postpartum clinic is feasible to implement and can provide appropriate and highly satisfactory care to mother-baby dyads. This model of care may be more beneficial in a population that is not already predisposed to breastfeed.Trial RegistrationClinicalTrials.gov NCT02043119
Highlights
Postnatal care is of the utmost importance for women and newborns as it assures a smooth transition from hospital to home and improves patient health outcomes [1,2]
The primary outcome of this study was exclusive breastfeeding at 12 weeks post-birth because health benefits of breastfeeding have been shown after as little as 3 months of exclusive breastfeeding [21,22]
Based on an estimated 50% rate of exclusive breastfeeding at 12 weeks in the control group (Infant Care Survey 2005, City of Ottawa, Public Health Unit [28] and the pilot study we conducted prior to the RCT), using an equal sample comparison of proportions we estimate that 200 patients per group are needed to detect a 15% relative difference in the intervention group (α = 0.05, β = 0.9, one-sided test)
Summary
Postnatal care is of the utmost importance for women and newborns as it assures a smooth transition from hospital to home and improves patient health outcomes [1,2]. Among them, breastfeeding difficulties can cause neonatal jaundice, dehydration and poor weight gain, resulting in emergency room visits, longer hospital stays, early hospital readmissions and breastfeeding cessation [3,4]. In jurisdictions such as New Zealand, Australia, Canada and the UK, home-visits done by nurses, midwives and peers are available for mother-baby dyads and have been studied thoroughly in the past decade [5,6,7,8]. Postpartum home-visits may decrease newborn hospital admissions [11] These visits are costly, and not always universally accessible [9]. They are not necessary in order to identify mothers needing additional postpartum support: other methods, such as telephone calls may be as effective [12,13,14]
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