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Systematic Review of the Literature on Postpartum Care: Effectiveness of Postpartum Support to Improve Maternal Parenting, Mental Health, Quality of Life, and Physical Health

Authors

  • Elizabeth Shaw MD, CCFP, FCFP,

    Corresponding author
    1. 1Elizabeth Shaw is Associate Professor, 2Cheryl Levitt is Professor, 3Janusz Kaczorowski is Associate Professor in the Department of Family Medicine, McMaster University, Hamilton, and 4Sharon Wong is Assistant Professor, School of Nutrition, Ryerson University, Toronto, Ontario, Canada.
      Dr. Elizabeth Shaw, Department of Family Medicine, McMaster University, 1200 Main Street West, Room 2V4, Hamilton, Ontario, L8N 3Z5, Canada.
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  • 1 Cheryl Levitt MBBCh, CCFP, FCFP,

    1. 1Elizabeth Shaw is Associate Professor, 2Cheryl Levitt is Professor, 3Janusz Kaczorowski is Associate Professor in the Department of Family Medicine, McMaster University, Hamilton, and 4Sharon Wong is Assistant Professor, School of Nutrition, Ryerson University, Toronto, Ontario, Canada.
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  • 2 Sharon Wong PhD, RD,

    1. 1Elizabeth Shaw is Associate Professor, 2Cheryl Levitt is Professor, 3Janusz Kaczorowski is Associate Professor in the Department of Family Medicine, McMaster University, Hamilton, and 4Sharon Wong is Assistant Professor, School of Nutrition, Ryerson University, Toronto, Ontario, Canada.
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  • 4 Janusz Kaczorowski PhD,

    1. 1Elizabeth Shaw is Associate Professor, 2Cheryl Levitt is Professor, 3Janusz Kaczorowski is Associate Professor in the Department of Family Medicine, McMaster University, Hamilton, and 4Sharon Wong is Assistant Professor, School of Nutrition, Ryerson University, Toronto, Ontario, Canada.
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  • and 3 The McMaster University Postpartum Research Group

    1. 1Elizabeth Shaw is Associate Professor, 2Cheryl Levitt is Professor, 3Janusz Kaczorowski is Associate Professor in the Department of Family Medicine, McMaster University, Hamilton, and 4Sharon Wong is Assistant Professor, School of Nutrition, Ryerson University, Toronto, Ontario, Canada.
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  • *

    The McMaster University Postpartum Research Group is in the Department of Family Medicine at McMaster University (www.postpartumresearchgroup.ca).

  • This study was funded by a grant from the Bureau of Reproductive and Child Health, Health Canada, Ottawa, Canada.

Dr. Elizabeth Shaw, Department of Family Medicine, McMaster University, 1200 Main Street West, Room 2V4, Hamilton, Ontario, L8N 3Z5, Canada.

Abstract

Abstract: Background: Postpartum support is recommended to prevent infant and maternal morbidity. This review examined the published evidence of the effectiveness of postpartum support programs to improve maternal knowledge, attitudes, and skills related to parenting, maternal mental health, maternal quality of life, and maternal physical health. Methods: MEDLINE, Cinahl, PsycINFO, and the Cochrane Library were searched for randomized controlled trials of interventions initiated from immediately after birth to 1 year in postnatal women. The initial literature search was done in 1999 and was enhanced in 2003 and 2005. Studies were categorized based on the the above outcomes. Data were extracted in a systematic manner, and the quality of each study was reviewed. Results: In the 1999 search, 9 studies met the inclusion criteria. The 2003 and 2005 searches identified 13 additional trials for a total of 22 trials. Universal postpartum support to unselected women at low risk did not result in statistically significant improvements for any outcomes examined. Educational visits to a pediatrician showed statistically significant improvements in maternal-infant parenting skills in low-income primiparous women. In women at high risk for family dysfunction and child abuse, nurse home visits combined with case conferencing produced a statistically significant improvement in home environment quality using the HOME (Home Observation for Measurement of the Environment) program. Similarly, in women at high risk for either family dysfunction or postpartum depression, home visitation or peer support, respectively, produced a statistically significant reduction in Edinburgh Postnatal Depression Scale scores (difference - 2.23, 95% CI –3.72 to –0.74, p= 0.004; and 15.0% vs 52.4%, OR 6.23, 95% CI 1.40 to 27.84, p= 0.01, respectively). Educational programs reduced repeat unplanned pregnancies (12.0% vs 28.3%, p= 0.003) and increased effective contraceptive use (RR 1.35, 95% CI 1.09 to 1.68, p= 0.007). Maternal satisfaction was higher with home visitation programs. Conclusions: No randomized controlled trial evidence was found to endorse universal provision of postpartum support to improve parenting, maternal mental health, maternal quality of life, or maternal physical health. There is some evidence that high-risk populations may benefit from postpartum support. (BIRTH 33:3 September 2006)

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