 POSTNATAL CARE: EVIDENCE AND GUIDELINES FOR MANAGEMENT by Debra Bick
England 2002
Review by Margaret Barnes
This book is a recent addition to the midwifery literature and adds to resources in the area of postnatal care. The guidelines were developed as part of a research trial testing a new model of midwifery-led postnatal care, the aim of which was to improve physical and psychological postnatal health.
The title of the text is somewhat misleading and suggests that the volume considers all aspects of postnatal care. The text is designed to be problem focused and deals with a range of specific postnatal problems; endometritis and abnormal bleeding; backache; fatigue; headache; caesarean wound care and pain relief; urinary and bowel problems; breastfeeding issues and depression..
The guidelines are research based and well set out in three sections. The first section provides a review of the literature in the area and concludes with a summary of the evidence. The second section is an action-oriented "What to do" which provides clinical practice guidelines. The third section is a summary guideline and the book provides a leaflet form of the guidelines for ease of use.
The search strategy used is outlined in the appendix and is based on the hierarchy of evidence framework. While expert opinion is included as 'evidence' the focus is on quantitative studies. Less emphasis is given to qualitative studies, which is unfortunate as qualitative work provides depth of understanding, contextual information and experiential accounts, important adjuncts to quantitative data.
The topics chosen are appropriate and reflect the range of common postnatal problems. The text suggests that women should be asked specifically if they are experiencing any of these problems and a symptom checklist is provided. Midwives caring for postnatal women could adopt this practice, but with the short length of stay, midwives do not have the opportunity for continuing postnatal care in order to identify many of the issues discussed, for example, urinary and bowel problems. This highlights the differences in the UK and Australian health systems; in the UK a midwife provides postnatal care for at least 10 days postpartum. Notwithstanding this situation, screening for postnatal problems by a health professional (child health nurse, community nurse or midwife or GP) would enable early identification of problems.
As a UK text there is reference to the NHS and UK data (for example, breastfeeding rates) which can be irritating for Australian readers as many of the recommendations can be UK specific,. However, the overall layout and content of the volume makes it a useful addition. Research in the area of postnatal care has been neglected and the text provides a good overview of postnatal problems, research evidence and clinical guidelines.
Margaret Barnes
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