My hope is that by highlighting the importance of the maternal postnatal check, we can reverse our national trend of worsening maternal mortality.
Dr Dhiviya Tharan
Dr Dhiviya Tharan
General Practitioner
Background on maternal postnatal care
Since the COVID-19 pandemic, maternal mortality rates have worsened, as highlighted by the MBRRACE-UK study. This trend reflects a broader lack of attention and investment in maternal health. Even before the pandemic, an estimated 20–40% of women in England did not have a postpartum maternal check recorded in primary care- a pattern mirrored globally. Despite additional funding introduced through the General Medical Services contract in 2020/21, there was an assumption of universal provision of the six-week maternal postnatal check, which was not reflected in practice.
The pandemic disrupted routine healthcare delivery, especially in general practice. Policy interventions focused on a ‘supply-focussed’ model of access, often without comprehensive equality impact assessments. These changes exacerbated existing health inequalities. Concerned that local appointment access changes were contributing to inequitable postnatal care, Dr Dhiviya sought to evaluate and redesign the access model to ensure equity and improve maternal postnatal care delivery.
Solution
Dhiviya and her team introduced a new practice protocol in April 2023, centred on:
- Protected weekly sessions with 15-minute slots for combined mother-and-baby face-to-face appointments.
- Proactive patient invitations using Accurx SMS.
- Dedicated clinician oversight, with backup from other practitioners as needed.
- Flexible rescheduling, offering up to two additional appointments for missed sessions.
Appointment data analysis revealed gaps in equitable access. Dhiviya aimed to rapidly deploy a patient-centred model that prioritised equity, efficiency, and sustainability by adapting existing clinical processes.
Having the chance to ask ‘is it normal..?’ questions in a safe, nonjudgmental space- I found this appointment very useful and really reassuring, which is helpful to me as a new mum.
Patient
Implementing the new protocol for postnatal care
Key Steps
- Developed a new protocol for postnatal care.
- Upon receiving a maternity discharge letter or baby registration, patients were contacted via SMS with a pre-booked appointment.
- SMS allowed open-text responses for confirmation or rescheduling.
- Protected postnatal appointments were reserved exclusively for this purpose and managed by a dedicated administrator.
- Unused slots were released for other clinical activity only on the day of the clinic.
Challenges & Mitigation
- Digital exclusion: SMS communication posed barriers for some patients.
- Solution: Direct phone calls and collaboration with health visitors ensured inclusive communication.
Discussion of baby’s health and contraceptive options- I felt at ease and comfortable discussing everything. I liked that I didn’t feel rushed.
Patient
Results of the postnatal checks
- Maternal postnatal checks offered: 112/114 (98%)
- Uptake improved: from 58% to 89% (101/114)
- Checks within 6–8 weeks: improved from 60% to 76% (77/101)
- Newborn checks uptake: improved from 86% to 91% (106/116)
- Newborn checks within 6–8 weeks: improved from 46% to 75% (80/106)
Conclusion & Key Takeaways
The success of this project was driven by the freedom to creatively redesign access models, the prioritisation of both maternal and infant health within a single appointment, and the use of proactive and inclusive communication strategies. For other practices, key lessons include the importance of evaluating current maternal postnatal care delivery, ensuring access models are equitable and avoid digital exclusion, and considering an opt-out approach to improve appointment uptake. Looking ahead, the next steps involve advocating for improved maternal postnatal care in primary care settings, encouraging the widespread adoption of equity-focused access models, and continuing to evaluate service delivery while sharing best practices across the sector.
