Current Approaches to Following Up Women and Newborns After Discharge From Childbirth Facilities: A Scoping Review

Abstract

This review found that follow-up after childbirth can be implemented using a variety of methods after discharge with high response rates in most studies and have the potential to be integrated into routine health care approaches.

Abstract

Key Findings

• Intensified post-childbirth follow-up creates opportunities to detect childbirth-related complications and to offer support. This scoping review describes current approaches to following women and newborns up to 1 year after they leave childbirth facilities.

• Follow-up was conducted via in-person visits, telephone calls, self-administered questionnaires, or a combination—with high response rates in most studies.

• The included studies illustrated the range of methods available and demonstrated that post-discharge follow-up of women and newborns was feasible, well received, and important for identifying cases of postpartum illness or complication that would otherwise be missed.

Key Implications

• Those using follow-up methods should report information on the cost of and resources needed for follow-up. More robust evaluations should examine outcomes beyond infection and assess validity and cost-effectiveness.

• With a variety of methods to choose from, health care facilities and public health authorities should consider integrating post-discharge follow-up into routine health care approaches. Recognizing the need for further testing and local prioritization, the follow-up methods identified could potentially become an essential component of fostering a continuum of care and measuring and addressing postpartum morbidity.

ABSTRACT

Introduction:

The postpartum period is critical for the health and well-being of women and newborns, but there is limited research on the most effective methods of post-childbirth follow-up. This scoping review synthesizes evidence from high-, middle-, and low-income countries on approaches to following up individuals after discharge from childbirth facilities.

Methods:

Using a systematic search in Ovid MEDLINE, we identified quantitative studies describing post-discharge follow-up methods deployed up to 12 months postpartum. We searched for English-language, peer-reviewed articles published between January 1, 2007 and November 2, 2022, with search terms covering 2 broad areas: “postpartum/postnatal period” and “surveillance.” We single-screened titles and abstracts and double-extracted all included articles, recording study design and location, population, health outcome, method, timing and frequency of data collection, and percentage of study participants reached.

Results:

We identified 1,654 records, of which 31 studies were included. Eight studies used in-person visits to follow up participants, 10 used telephone calls, 7 used self-administered questionnaires, and 6 used multiple methods. Across studies, the minimum length of follow-up was 1 week after delivery, and up to 4 contacts were made within the first year after delivery. Follow-up (response) rates ranged from 23% to100%. Postpartum infection was the most common outcome investigated. Other outcomes included maternal (ill-)health, neonatal (ill-)health and growth, maternal mental health and well-being, care-giving/-seeking behaviors, and knowledge and intentions.

Conclusion:

Our scoping review identified multiple follow-up methods after discharge, ranging from home visits to self-administered electronic questionnaires, which could be implemented with high response rates. The studies demonstrated that post-discharge follow-up of women and newborns was feasible, well received, and important for identifying postpartum illness or complications that would otherwise be missed. Therefore, the identified methods have the potential to become an important component of fostering a continuum of care and measuring and addressing postpartum morbidity.