Posted on Nov. 21: Researchers examine policy changes for new moms

The community care component of the Healthy Babies, Healthy Children (HBHC) Postpartum Enhancement program is reaching most postpartum women, according to the results of a study released at the Ontario Public Health Association Conference in Toronto.

Nursing professor Wendy Sword and social work professor Susan Watt, of McMaster University, presented the initial findings from a survey of 1,250 women at five hospitals in southern and central Ontario, conducted last winter and spring. This study, called Maternal and Newborn Infant Health Outcomes and Community-Based Service Utilization in Ontario Following Policy Change, is funded by the Canadian Institutes of Health Research.

The expanded HBHC program, announced by the Ontario Ministry of Health and Long-Term Care in 1999, responded to concerns about the health and well-being of mothers and their newborn infants. The changes were intended to provide women with the option of staying in hospital for up to 60 hours after a normal birth, a follow-up telephone assessment by a public health nurse within 48 hours of discharge and the offer of a home visit.

Twelve to 81 per cent of women, depending upon the hospital, reported that the 60-hour stay option was offered to them. When a 60-hour stay was offered, the acceptance rate varied from 21 to 39 per cent. Hospital providers cited lack of resources as the major reason for not extending the offer to all women. Neither the offer nor acceptance of the offer was associated with any of the health outcomes for mothers or infants, measured at four weeks after discharge.

The second part of the initiative, mandating a telephone assessment and an offer of a home visit from a public health nurse, had higher implementation rates across all sites. Sixty-three to 78 per cent of women reported receiving a telephone call from a public health nurse within the first 48 hours after discharge. Almost all women reported receiving a phone call post partum (88 to per cent), but not necessarily within the mandated 48 hours of discharge. Community care providers cited lack of resources to provide weekend service as a reason that not all women were contacted within the specified timeframe.

Ninety-two to 97 per cent of women reported receiving the offer of a home visit; 41 to 76 per cent of these women reported accepting the offer. Respondents stated that the visits were useful and that public health nurses provided helpful information about infant care and breastfeeding. In terms of health outcomes at four weeks post discharge, the researchers found an association between reported acceptance of the offer of a home visit and higher scores on the Edinburgh Postnatal Depression Scale, which measures risk for postpartum depression.