Attendance, content and relevance of the six week postnatal examination.

OBJECTIVE: to describe the attendance and content of the six week postnatal examination, and associate the examinations performed with relevant delivery factors and postpartum symptoms.
DESIGN: survey of 1278 women who responded to a postal questionnaire sent 6-7 months after delivery, as part of a wider study investigating the severity, effect and extent of long-term health problems after childbirth. Questions about attendance and content of the postnatal examination were included. Data obtained from the women were linked to the obstetric case notes.
SETTING: a large maternity hospital in Birmingham. PARTICIPANTS: all women who had delivered between April and September 1992, except for those who had had a neonatal death and, due to lack of funding for translators, Asian women.
FINDINGS: the majority of women (91%) attended for their postnatal examination and 93% of these had an abdominal and 70% a vaginal examination. Women who had a vaginal delivery and perineal trauma were significantly more likely to have a vaginal examination but still over two-thirds of those with an intact perineum and almost half delivered by elective caesarean section also had this. Only 16% of women had a blood test. Those who had a PPH, a low third day Hb or reported a new postpartum onset of fatigue were more likely to have a blood test, but three-quarters of the women with these risk factors did not have blood taken. DISCUSSION AND
CONCLUSION: women are prepared to attend for postnatal assessment but many have examinations without obvious reason, whilst other tests which might be helpful for certain conditions are infrequently used. Substantial postpartum morbidity is known to exist and this is not routinely assessed at the postnatal assessment. IMPLICATIONS FOR PRACTICE: the present six week postnatal examination does not appear to meet the health needs of women after childbirth: its content and timing should be reviewed.