title: Systematic review of the literature on postpartum care: effectiveness of postpartum support to improve maternal parenting, mental health, quality of life, and physical health.
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.
authors.affiliation: Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Shaw
authors.forename: Cheryl
authors.initials: C
authors.lastname: Levitt
authors.forename: Sharon
authors.initials: S
authors.lastname: Wong
authors.forename: Janusz
authors.initials: J
authors.lastname: Kaczorowski
mesh_terms: D000328:Adult; D005260:Female; D006304:Health Status; D006801:Humans; D008425:Maternal Behavior / Q000523:psychology*; D008429:Maternal Welfare; D008603:Mental Health; D009034:Mother-Child Relations; D016487:Parenting / Q000523:psychology*; D010353:Patient Education as Topic; D011181:Postnatal Care / Q000592:standards*; D049590:Postpartum Period; D011788:Quality of Life; D012307:Risk Factors; D016387:Women's Health