title: Enhancing early postnatal care: findings from a major reform of maternity care in three Australian hospitals.
abstract: BACKGROUND
  four hospitals comprising a health network in Melbourne, Australia, implemented a range of initiatives aimed at enhancing women's experiences of postnatal maternity care.
  
  
  OBJECTIVE
  to compare women's views and experiences of early postnatal care before and after implementation of maternity enhancement initiatives.
  
  
  METHODS
  'before and after' study design incorporating two postal surveys of recent mothers (baseline and post-implementation).
  
  
  METHODS
  four hospitals in Melbourne, Australia. Analysis of postnatal outcomes was confined to three hospitals where the initiatives were fully operational.
  
  
  METHODS
  1256 women participated in the baseline survey in 1999 (before implementing the initiative) and 1050 women responded to the post-implementation survey in 2001.
  
  
  RESULTS
  the response to the 1999 baseline survey was 65.3% (1256/1922) and to the 2001 post-implementation survey 57.4% (1050/1829). Comparative analysis revealed a statistically significant improvement in overall ratings of hospital postnatal care; the level of advice and support received in relation to discharge and going home; the sensitivity of caregivers; and the proportion of women receiving domiciliary care after discharge. There was little change in the time women spent in hospital after birth between the two survey time-points. Over 90% of women reported one or more health problems in the first 3 months postpartum. The proportion of women reporting physical or emotional health problems between the two surveys did not change.
  
  
  CONCLUSIONS
  mainstream maternity care can be restructured to improve women's experiences of early postnatal care.
  
  
  CONCLUSIONS
  maternity service providers should consider a multi-faceted approach to reorienting postnatal services and improving women's experiences of care. Approaches worthy of consideration include attempts to ensure consistency and continuity of care through staffing arrangements, guidelines and protocols; an emphasis on planning for postnatal care during pregnancy; the use of evidence to inform both consumer information and advice and in the practice of caring; and skill-enhancement opportunities for care providers in managing postnatal issues and in effective communication.
authors.affiliation: Mother and Child Health Research, La Trobe University, 324-328 Little Lonsdale Street, Melbourne 3000, Melbourne, Australia.
authors.forename: Jane
authors.initials: J
authors.lastname: Yelland
authors.forename: Ann
authors.initials: A
authors.lastname: Krastev
authors.forename: Stephanie
authors.initials: S
authors.lastname: Brown
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D005260:Female; D018166:Health Care Reform / Q000379:methods / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008880:Midwifery / Q000379:methods; D009775:Obstetrics and Gynecology Department, Hospital / Q000458:organization & administration*; D010353:Patient Education as Topic; D017060:Patient Satisfaction; D011181:Postnatal Care / Q000379:methods / Q000458:organization & administration* / Q000706:statistics & numerical data*; D011247:Pregnancy; D011369:Professional-Patient Relations; D014739:Victoria; D055815:Young Adult