New research from Norway reveals a missed opportunity in postpartum care, and shows that when GP check-ups are more comprehensive and hands-on, women’s satisfaction rises dramatically.
Study: Postpartum check-ups with general practitioners in Norway: a cross-sectional survey of attendance, content and patient satisfaction. Image credit: Dorde Krstic/Shutterstock.com
A recent study in BMC Primary Care investigated attendance in postpartum check-ups with General Practitioners (GPs) and patient satisfaction in Norway.
Postpartum care: Importance and guidelines
Caring for mothers after childbirth is essential for their well-being and for the healthy development of their babies. Effective postpartum care helps women recover, adapt to the demands of parenthood, and ensures newborns receive nurturing support.
Leading health organizations, such as the World Health Organization (WHO) and the National Institute for Health and Care Excellence (NICE), emphasize the importance of regular follow-up visits after delivery.
Recommendations for postpartum check-up timing vary. For instance, the WHO recommends a six-week check-up tailored to individual needs, while NICE suggests a period of six to eight weeks. The American College of Obstetrics and Gynecology (ACOG) recommends initial contact within 3 weeks and a full check-up by 12 weeks.
Most women in high-income countries attend postpartum check-ups, though attendance can be influenced by socioeconomic status. The content of these visits varies; women are more likely to receive information on birth control than on sexual health.
Midwives tend to focus on contraception, while family physicians address a broader range of topics, including mental health, nutrition, and sexual health. Obstetricians are less likely to cover these areas.
GPs usually conduct postpartum check-ups in England, and obstetricians in the U.S. In Norway, care is provided by a mix of professionals, but GPs have traditionally overseen the postpartum check-up. Therefore, general practice is a key source of postpartum care for women and families.
Women in England and Australia seek to discuss a wide range of topics with GPs, such as physical recovery, mental health, infant feeding, contraception, health promotion, and personal concerns. The postpartum period presents an important opportunity for health promotion by GPs.
Assessing Norwegian postpartum health care
Norwegian residents can choose a regular GP to provide continuity of care throughout pregnancy and the postpartum period. National guidelines recommend a midwife home visit soon after discharge, a nurse visit within 10 days, and a postpartum check-up at four to six weeks, with earlier visits for those with complications or chronic conditions. Postpartum check-ups are free and usually take place with the GP.
The current study included all women who gave birth to one or more liveborn children in the two hospitals of Nord-Trøndelag Health Trust between 1st July 2021 to 20th June 2022. A total of 1,119 women were eligible for this study and had received an invitation letter and a link to the digital questionnaire, which was available in Norwegian only.
The questionnaire included demographic data, information about postpartum check-ups, attendance, and reasons for missing GP check-ups. It also provided details on GP visits, covering key topics, such as check-up content and satisfaction.
Patient experience was measured using a five-point Likert scale, with overall satisfaction as the main outcome. Responses were grouped into “Satisfied” or “Not satisfied.” Participants were also asked to provide suggestions for improvement.
Substantial non-attendance alongside generally positive experiences
Of the 1,119 invited women, 351 responded (a response rate of just over 30 %), and the majority were aged 25–29 years. The study cohort comprised approximately 41 % first-time mothers, and 36 % had experienced labour complications.
Women who consulted midwives were more likely to be younger, first-time mothers, or from smaller communities. The authors note that, despite broadly representative demographics, the response rate introduces potential selection bias.
Most women learned about postpartum check-ups from community midwives or maternity wards, while fewer heard from GPs, friends, or social media. Only 68 % knew the check-up was free.
The majority of women considered six weeks postpartum the right time for the visit, though some felt it was too late or too early.
Of the respondents, 254 attended a postpartum check-up, either with a GP, a midwife, or at a hospital. The most common reasons for not attending were not having a regular GP, feeling the visit was unnecessary, being unaware of the check-up, or dissatisfaction with prior experiences.
Attendance rates were similar across most groups, though women with higher education were more likely to attend. Knowing the check-up was free increased the likelihood of attending.
Notably, women with pre-existing conditions or adverse pregnancy outcomes did not attend postpartum check-ups more frequently than healthier women, despite their potentially greater need for follow-up care.
Twenty-two percent of women contacted their GP for reasons other than a scheduled postpartum check-up, most often through in-person visits, but also by phone, electronic messages, video, or home visits.
Only women who saw GPs for postpartum check-ups answered questions about key topics and satisfaction. The most discussed topics were contraception, breastfeeding, labour, mental health, and birth injuries.
Typically, female GPs addressed more topics and conducted more gynecological exams than male GPs.
Women rated GPs highly for communication, medical skills, and care. Overall satisfaction, however, was moderate rather than universal, with just over half of women reporting high overall satisfaction with the GP check-up.
Satisfaction was strongly linked to discussing labour and having a gynecological exam. Satisfied women had more topics covered during their check-up than those who were not satisfied, highlighting the importance of breadth and depth in postpartum consultations.
Strategies to boost postpartum attendance
A substantial minority of women miss postpartum check-ups, representing a lost opportunity for support and long-term health promotion. Attendance was not higher among women with chronic conditions or adverse pregnancy outcomes, raising concerns about whether current systems adequately reach those at greatest risk.
Ensuring regular access to a GP, improving the quality and structure of check-ups, and better communication about the purpose and free availability of postpartum visits could help increase attendance.
While many women report positive experiences with GP-led postpartum care, satisfaction is closely tied to how comprehensive the visit is, including whether sensitive but important topics are discussed and whether a gynecological examination is offered. The study also highlights structural constraints, such as limited consultation time in general practice, which may restrict how comprehensive postpartum check-ups can be.
Ultimately, postpartum care should be individualized, with sufficient time and attention to address each woman's unique needs and to support not only short-term recovery, but also long-term health and well-being.
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