Many mothers do not show up for postnatal check-ups

In a recent study, Christine Agdestein has mapped several aspects of the postnatal check-up. 

“An important finding is that the majority are satisfied with the 6-week check-up with their general practitioner (GP). This is an important offer for those who have recently given birth. GPs have an important role in postnatal care,” she says.

Agdestein is a specialist in general medicine and a GP.

“Not much research has been done on the postnatal check-up before, and therefore it's extra rewarding that we can offer new knowledge. These are findings that can quickly be used in improvement work related to postnatal care,” she says.

What the women wanted to talk about

The study shows that satisfaction was strongly linked to being able to talk about the birth experience, that many relevant topics were raised during the consultation, and that a gynaecological examination was included.

The topics that were most often considered important or very important:

• The birth experience (61 per cent)
• Contraception (55 per cent)
• Breastfeeding (53 per cent)
• Birth-related pelvic injuries (52 per cent)
• Mental health (40 per cent)

The most important topics were also discussed most frequently.

One in four do not show up

Although the offer is perceived as positive and important, many women do not take advantage of the opportunity. The researchers found four main reasons:

• Did not have a GP
• Did not feel a postnatal check-up was necessary
• Were not satisfied with previous visits
• Did not know about the service

Women who did not show up for the follow-up check-up after childbirth therefore missed out on an important opportunity for support and health-promoting measures.

“Women with chronic diseases, high-risk pregnancies, and complications during childbirth did not participate more often in the follow-up check-up than women with good health and uncomplicated births. This is worrying considering that these women have an increased risk of disease and mortality,” says Agdestein.

Many were not informed of the service

It's important to provide information about the postnatal check-up. 

In principle, women should receive information both during pregnancy and from the maternity ward. 

Only 44 per cent stated that they had received information from the maternity ward.

52 per cent had received information about the service from a midwife in the municipality, and some had received information from their GP. 18 per cent received information from friends and 11 per cent from social media.

The service is free

“We definitely see room for improvement here,” says Agdestein. 

She also points out that some of those who have just given birth do not remember all the information they are given. It may therefore be useful to provide written information to the women.

It also emerged that 32 per cent of the women did not know that the service is free, which is important to make clear in the information provided.

The odds of attending increase if women know that the consultation is free, the study shows.

Want a gynaecological examination

A gynaecological examination was high on the list of what the women wanted during the postnatal check-up. Not everyone was offered this. 

The study shows a strong correlation between satisfaction with the postnatal check-up and having a gynaecological examination.

The women recommended that GPs should be more proactive in offering gynaecological exams.

The study showed that some women find it difficult to ask to have their genital area examined. The findings show that it's important that they are offered a gynaecological exam, and then the women can decide for themselves whether they want or need it. 

"Many may have pain and tears after childbirth, and experience incontinence, so it's important that they're offered a gynaecological examination,” says Agdestein.

Mental health and increased postpartum depression

40 per cent of the women responded that talking about mental health is important, and the topic was brought up in as many as 60 per cent of the consultations.

“This may indicate that GPs are focusing on mental health, and that's good. We see from other studies that the prevalence of postpartum depression has increased in Norway in recent years, so mental health is an important topic to talk about at the postnatal check-up,” the researcher stresses.

Improvement work is already underway

“We have developed a tool and a prototype that's ready for testing. It's a tool that will be used by GPs and women in collaboration,” says Christine Agdestein.

It will provide good information to women about which topics they can bring up at the 6-week check-up, and help the woman prioritise what is most important to her. 

In this way, the GP can tailor the check-up to each individual.

With this measure, the researchers hope to improve both information and quality, which in turn may contribute to higher attendance and better benefit from the postnatal check-up.

“I started looking into this because, as a GP, I have followed many women through pregnancy and the postnatal period. Then I saw that there was a great need for knowledge about postnatal care in the primary health service," she says.

Agdestein has therefore moved from clinical practice to research and now to improving practice.

How the study was conducted

The study was conducted using a questionnaire. The target group was all women who gave birth in Nord-Trøndelag Regional Health Authority over one year. 1,119 women were in the target group, and 351 responded.

“The age, education, and number of births for those who responded are comparable to women who gave birth in Norway in the same year. Thus, the results are also relevant in the rest of the country,” says Agdestein.

She summarises that the most important findings are that one in four do not show up, and that there is a need for better information. Furthermore, it's important that the consultation covers many relevant topics, including the birth experience, and that the women should be offered a gynaecological exam.

“Our survey includes insight into the content of the consultations, and an analysis of the factors that affect whether the women are satisfied or not. This means that professionals can quickly address the findings to improve the service,” she says.

Reference: 

Agdestein et al. Postpartum check-ups with general practitioners in Norway: a cross-sectional survey of attendance, content and patient satisfaction, BMC Primary Care, 2025. DOI: 10.1186/s12875-025-02992-x

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Read the Norwegian version of this article on forskning.no

About the research

The study was conducted together with four other researchers from NTNU and Nord-Trøndelag Regional Health Authority.

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