Uptake of postnatal services for mothers of newborn babies up to eight weeks of age

AIM: Significant changes have occurred in the way postnatal care is funded in New Zealand since July 1996. This study investigated three aspects of postnatal care: the uptake of the six-week check, the six-week immunisation and breast feeding rates. METHOD: A prospective prevalence survey of 504 mothers of newborn babies recruited from birthing centres in urban Auckland over the period November 1997 to February 1998. A postal questionnaire was sent at ten weeks postnatal, covering issues concerning the six-week check, six-week immunisation and breast feeding. RESULTS: Four hundred and four completed questionnaires were obtained (82%); 98% of respondents had obtained a six-week check and 90% a six-week immunisation for their infant. Infants who received their six-week check from a general practitioner were more likely to be immunised. Younger mothers (15-19 years) and older mothers (35 years plus) were less likely to have immunised children. Of reasons given for not immunising, 43% were concerns over immaturity of the baby and 27% because the child was not well. At birth, 88% of mothers were fully breast feeding and 62% at six-weeks postnatal. Of the reasons given for stopping feeding, 41% stated insufficient milk or poor weight gain and 15% stated failure to establish feeding. CONCLUSIONS: Removing the six- week check from a general practitioner check and splitting it from the immunisation, has a deleterious effect on immunisation uptake. Mothers, particularly under 20 years, but also 35 years plus, are less likely to have immunised infants. A significant number of unimmunised babies arose from concerns that the baby may be too immature. The rate of breast feeding in New Zealand is continuing to drop. Actual rates fall well below mothers' desires to breast feed. Reasons given for stopping breast feeding point to a general need for greater postnatal support. The high rate of failure to establish feeding raises concerns over lack of early postnatal support. In July 1996 significant changes in payment of the maternity services benefit were introduced in New Zealand. In particular, postnatal services previously paid on a 'fee-for-service' basis were altered to a set capped amount for the 'postnatal module'. This led to concerns that care in the postnatal period had become more limited. In particular, there were anecdotal reports of the six-week check not being given, or being given by a range of providers who did not necessarily offer the opportunity for immunisation at the time of the check. Recent concerns have also been expressed about the apparent dropping immunisation rates in New Zealand, and the dropping breast feeding rates. The present study, developed in response to these concerns investigated three aspects of postnatal care: (a) The incidence of the uptake of the six-week check and whether mothers perceived any barriers to access. (b) The incidence of the uptake of the six-week immunisation and whether mothers perceived any barriers to access. (c) The rate of breast feeding and what barriers mothers perceived to continuing to breast feed.