Schedule home visits in the early postpartum period

Naoki Yonemoto, Satoshi Nagai, and Ryo Mori. Schedule of home visits in the early postpartum period. Cochrane Database of Systematic Reviews 2021, No. 7. Art. No.: CD009326. doi: 10.1002 /14651858.CD009326.pub4. accessed on July 28, 2021.

Commentary

This study was conducted to assess the impact of different home visit schedules on maternal and neonatal mortality in the early postpartum period. The review focused on the frequency, timing, duration, and intensity of home visits.

The main results included 16 randomized trials with data from 12,080 women, conducted in countries around the world in both high- and low-resource settings. It should be noted that in low-resource settings, women receiving usual care may not have received additional postpartum care after early discharge.

Interventions and management varied considerably across studies, and the trial focused on three broad types of comparisons.

・Increases and decreases in home visits (5 studies, 2102 women)

The evidence on whether home visits have any effect on maternal or neonatal mortality is very uncertain. Mean postpartum depression scores, as measured by the Edinburgh Postpartum Depression Scale (EPDS), may be slightly worse with more home visits, but the difference in scores was not clinically meaningful.

Two separate analyses showed conflicting results on maternal satisfaction.

Infant health care utilization may decrease with increased home visits and may increase only with breastfeeding at 6 weeks Serious neonatal morbidity up to 6 months was not reported in any of the trials.

・Different models of postnatal care (3 studies, 4394 women)

Cluster RCTs comparing usual care with individualized care by midwives, extending to 3 months of age, may make little difference in neonatal mortality; the proportion of women with an EPDS score of 13 or higher at 4 months is probably reduced by individualized care.

One study suggested that there may be no difference between home visits and telephone screening in newborn morbidity up to 28 days, and another study found no difference between breastfeeding promotion and regular visits in breastfeeding rates at 6 months.

・Home versus facility-based postpartum care (8 studies, 5179 women)

Suggests that there may be little or no difference in postpartum depression rates as measured by the EPDS scale at 42 and 60 days postpartum. Mothers' satisfaction with postpartum care may be better with home visits.

The authors conclude that

The evidence on the effect of home visits on maternal and neonatal mortality is very uncertain. Individualized care as a package of home visits probably improves depression scores at 4 months, and it is possible that increasing the frequency of home visits may improve breastfeeding rates and infant health care utilization.

Mothers' satisfaction may be better with home visits than with hospital visits. However, the overall evidence was less certain and findings were not consistent across studies and comparisons.