MATERNAL AND EARLY CHILD HEALTH

Health Evidence Bulletins - Wales

Date of Completion: 10.1.98

The contents of this bulletin are likely to be valid for approximately one year, by which time significantly new research evidence may become available


18. Maternal support during the puerperium and bereavement

(Users are advised to consult the supporting evidence for a consideration of all the implications of a recommendation)

The Puerperium  
The Statements The Evidence
18.1a. Mothers should be given consistent advice after birth and continuity of care is advantageous(i,ii,iii).

(Health gain notation - 2 "likely to be beneficial")

i. Chalmers I, Enkin M, Keirse MJNC. Effective care in pregnancy and childbirth. Oxford: Oxford University Press, 1989 p. 1341
(Type V evidence - expert opinion. Summary in Enkin M, Keirse MJNC, Renfrew M, Neilson J. A guide to effective care in pregnancy and childbirth. 2nd ed. Oxford: Oxford University Press. 1995. pp. 344-345);
ii. Joint working group of the Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives. Communication standards - Obstetrics. London: Royal College of Obstetricians and Gynaecologists, June 1995
(Type V evidence - expert opinion);
iii. National Audit Commission. First class delivery. Improving maternity services in London: Audit Commission, 1997.
(Type IV evidence - observational studies)
18.1b. Postnatal support programs have no known risks and may have important benefits for socially disadvantaged mothers and their children. Further research is recommended(i).
(Health gain notation - 2 "likely to be beneficial")
i. Hodnett ED. Home based social support for socially disadvantaged mothers. Cochrane database of systematic reviews. Cochrane Library 1997 Issue 4.
(Type I evidence - systematic review)
18.1c. It is likely to be beneficial to allow women choice of length of postpartum stay in hospital. Both randomised trials and observational studies have shown that few women or babies are readmitted to hospital after early discharge. Midwifery care continues in the home and this policy does not represent a saving in cost; Thus the woman should be allowed to choose (i).
(Health gain notation - 2 "likely to be beneficial")
i. Chalmers I, Enkin M, Keirse MJNC. Effective care in pregnancy and childbirth. Oxford: Oxford University Press, 1989 pp. 1341-1344
(Type I evidence - systematic review. Summary in Enkin M, Keirse MJNC, Renfrew M, Neilson J. A guide to effective care in pregnancy and childbirth. 2nd ed. Oxford: Oxford University Press. 1995. pp. 345-346)

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18.1d. Women who are depressed after childbirth should be provided with appropriate psychological support by professionals involved in their care, who have the time to listen and to talk(i).
(Health gain notation - 2 "likely to be beneficial")
i. Chalmers I, Enkin M, Keirse MJNC. Effective care in pregnancy and childbirth. Oxford: Oxford University Press, 1989 pp. 1433-1443
(Type V evidence - expert opinion. Summary in Enkin M, Keirse MJNC, Renfrew M, Neilson J. A guide to effective care in pregnancy and childbirth. 2nd ed. Oxford: Oxford University Press. 1995. pp. 345-347)
18.2 BEREAVEMENT  
The Statements The Evidence
18.2a. All those suffering bereavement subsequent to perinatal loss, miscarriage or termination of a pregnancy (for example after identification of a major fetal anomaly) require particular care and support from their caregivers. Guidelines for all staff and training should be an important aspect of local agreed policy and include the many aspects of grieving, burial or cremation arrangements, postmortem, good communication and appropriate referral for advice in future pregnancies, or with contraception (i).
(Health gain notation - 2 "likely to be beneficial")
i. Internal Review Group (See Contributors)

(Type V evidence - expert opinion)

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Health Evidence Bulletins: Wales, Duthie Library, UWCM, Cardiff CF14 4XN. e-mail: weightmanal@cardiff.ac.uk