title: Individualised, flexible postnatal care: a feasibility study for a randomised controlled trial.
abstract: BACKGROUND
  Postnatal care in hospital is often provided using defined care pathways, with limited opportunity for more refined and individualised care. We explored whether a tertiary maternity service could provide flexible, individualised early postnatal care for women in a dynamic and timely manner, and if this approach was acceptable to women.
  
  
  METHODS
  A feasibility study was designed to inform a future randomised controlled trial to evaluate an alternative approach to postnatal care. English-speaking women at low risk of medical complications were recruited around 26 weeks gestation to explore their willingness to participate in a study of a new, flexible model of care that involved antenatal planning for early postpartum discharge with additional home-based postnatal care. The earlier women were discharged from hospital, the more home-based visits they were eligible to receive. Program uptake was measured, women's views obtained by a postal survey sent at eight weeks postpartum and clinical data collected from medical records.
  
  
  RESULTS
  Study uptake was 39% (109/277 approached). Most women (n=103) completed a postnatal care plan during pregnancy; 17% planned to leave hospital within 12 hours of giving birth and 36% planned to stay 48 hours. At eight weeks postpartum most women (90%) were positive about the concept and 88% would opt for the same program again. Of the 28% who stayed in hospital for the length they had planned, less than half (43%) received the appropriate number of home visits, and only 41% were given an option for the timing of the visit. Most (62%) stayed in hospital longer than planned (probably due to clinical complications); 11% stayed shorter than planned.
  
  
  CONCLUSIONS
  Women were very positive about individualised postnatal care planning that commenced during pregnancy. Given the hospital stay may be impacted by clinical factors, individualised care planning needs to continue into the postnatal period to take into account circumstances which cannot be planned for during pregnancy. However, individualised care planning during the postnatal period which incorporates a high level of flexibility may be challenging for organisations to manage and implement, and a randomised controlled trial of such an approach may not be feasible.
authors.affiliation: Judith Lumely Centre, La Trobe University, 215 Franklin St, Melbourne, 3000, Australia. d.forster@latrobe.edu.au.|The Royal Women's Hospital, Locked Bag 300, Cnr Grattan St and Flemington Rd, Parkville, 3052, Australia. d.forster@latrobe.edu.au.
authors.forename: Della A
authors.initials: DA
authors.lastname: Forster
authors.affiliation: Judith Lumely Centre, La Trobe University, 215 Franklin St, Melbourne, 3000, Australia. tracey.savage@ynhh.org.|The Royal Women's Hospital, Locked Bag 300, Cnr Grattan St and Flemington Rd, Parkville, 3052, Australia. tracey.savage@ynhh.org.|Yale New Haven Hospital, 20 York Street, New Haven, CT, 06510, USA. tracey.savage@ynhh.org.
authors.forename: Tracey L
authors.initials: TL
authors.lastname: Savage
authors.affiliation: Judith Lumely Centre, La Trobe University, 215 Franklin St, Melbourne, 3000, Australia. h.mclachlan@latrobe.edu.au.|School of Nursing and Midwifery, La Trobe University, Melbourne Campus, Kingsbury Drive, Bundoora, Vic, 3086, Australia. h.mclachlan@latrobe.edu.au.
authors.forename: Helen L
authors.initials: HL
authors.lastname: McLachlan
authors.affiliation: Deakin Health Economics, Deakin University, 221 Burwood Highway, Burwood, 3125, Australia. Lisa.gold@deakin.edu.au.
authors.forename: Lisa
authors.initials: L
authors.lastname: Gold
authors.affiliation: The Royal Women's Hospital, Locked Bag 300, Cnr Grattan St and Flemington Rd, Parkville, 3052, Australia. Tanya.farrell@thewomens.org.au.
authors.forename: Tanya
authors.initials: T
authors.lastname: Farrell
authors.affiliation: School of Nursing and Midwifery, La Trobe University, Melbourne Campus, Kingsbury Drive, Bundoora, Vic, 3086, Australia. j.rayner@latrobe.edu.au.
authors.forename: Jo
authors.initials: J
authors.lastname: Rayner
authors.affiliation: Healthy Mothers Healthy Families Research Group, Murdoch Childrens Research Institute, 50 Flemington Road, Parkville, Victoria, 3052, Australia. jane.yelland@mcri.edu.au.
authors.forename: Jane
authors.initials: J
authors.lastname: Yelland
authors.affiliation: Drug Strategy Analysis Unit, Population 846 Health Division, Department of Health and Ageing, Canberra, Australia. breerankin@yahoo.com.au.
authors.forename: Bree
authors.initials: B
authors.lastname: Rankin
authors.affiliation: The Royal Women's Hospital, Locked Bag 300, Cnr Grattan St and Flemington Rd, Parkville, 3052, Australia. b.naturalbeginnings@gmail.com.
authors.forename: Belinda
authors.initials: B
authors.lastname: Lovell
mesh_terms: D000328:Adult; D001315:Australia; D005240:Feasibility Studies; D005260:Female; D006771:Hospitals, Maternity / Q000458:organization & administration*; D006801:Humans; D010347:Patient Care Planning / Q000458:organization & administration*; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D018802:Patient-Centered Care / Q000458:organization & administration*; D011181:Postnatal Care / Q000458:organization & administration* / Q000706:statistics & numerical data; D011247:Pregnancy; D016032:Randomized Controlled Trials as Topic; D013222:State Medicine / Q000458:organization & administration*; D011795:Surveys and Questionnaires; D062606:Tertiary Care Centers / Q000458:organization & administration*; D055815:Young Adult