Abstract
BackgroundThe postpartum period is an important period for preventive strategies as common maternal and child health risks may become manifest. Women with a lower socioeconomic status tend to have lower maternal empowerment. Increasing their risks of adverse maternal and child health outcomes. This study aims to assess the effectiveness of a primary care level intervention. Delivered to maternity care assistants, aiming to increase maternal empowerment postpartum.MethodsThis study is part of the Dutch nationwide “Healthy Pregnancy 4 All-2” (HP4All-2) program, which aims to identify vulnerable mothers and young children at risk of adverse health outcomes, and subsequently improve their care. This program targets women from deprived neighborhoods.A pragmatic cluster randomized controlled trial will be undertaken in 12 maternity care organizations. Maternity care organizations in urban municipalities (i.e. the clusters) will be randomized to either a systematic risk assessment during pregnancy with emphasis on identification of non-medical risk factors for adverse maternal and neonatal health outcomes, and subsequent adaptation of care towards a client-tailored approach during pregnancy and the postpartum period, or solely the systematic risk assessment. The primary outcome is the prevalence of a low maternal empowerment score postpartum. Secondary maternal outcomes cover health-related quality of life, postnatal depression, smoking, alcohol consumption, illicit drug use. Finally, maternal and neonatal health care utilization postpartum are recorded. All outcomes will be analyzed according to the intention-to-treat principle, using multi-level mixed effects models.DiscussionThe study will contribute to evidence regarding the effectiveness of client-tailored, risk-based maternity care to increase maternal empowerment postpartum.Trial registrationNetherlands Trial Registry (NTR) 6311, registered 03-27-2017.
Highlights
The postpartum period, defined by the World Health Organization (WHO) as the period from childbirth to the 42nd day following delivery, is an important period for preventive strategies as common maternal and child health problems become apparent
The intervention under study consists of a systematic risk assessment during pregnancy, with emphasis on identifying non-medical risk factors for adverse maternal and neonatal health outcomes, in conjunction with client-tailored care during pregnancy and the postpartum period based on the obtained risk profile
The funding source has no role in the design of the study, and neither in the collection and management of the data. With this Cluster Randomized Controlled Trial (C-RCT) we aim to systematically increase the identification of non-medical risk factors during pregnancy, and use the obtained risk profile for improved client-tailored care during the postpartum period. We envisage that this intervention creates an additional opportunity for Maternity Care Assistants (MCA) to empower women during the postpartum period
Summary
The postpartum period, defined by the World Health Organization (WHO) as the period from childbirth to the 42nd day following delivery, is an important period for preventive strategies as common maternal and child health problems become apparent. Women with a lower socioeconomic status (SES) are more at risk of developing adverse maternal and child health outcomes within both western and non-western countries. Maternal empowerment is a valuable outcome per se, and an important predictor of maternal and child health and increased health care utilization [10–13]. The postpartum period is an important period for preventive strategies as common maternal and child health risks may become manifest. Women with a lower socioeconomic status tend to have lower maternal empowerment. Increasing their risks of adverse maternal and child health outcomes. Delivered to maternity care assistants, aiming to increase maternal empowerment postpartum
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