A recent study led by Christine Agdestein, a general practitioner and PhD candidate at the Norwegian University of Science and Technology (NTNU), has identified gaps in both information provision and attendance rates for postnatal check-ups among women in Norway. The research, conducted with four other researchers from NTNU and Nord-Trøndelag Regional Health Authority, surveyed women who gave birth within the health authority over one year.
"An important finding is that the majority are satisfied with the 6-week check-up with their GP. This is an important offer for those who have recently given birth. GPs have an important role in postnatal care," said Agdestein.
The study found that satisfaction was closely linked to being able to discuss the birth experience, covering many relevant topics during the consultation, and including a gynaecological examination. However, despite positive perceptions of the service, a significant number of women did not attend their follow-up appointment.
Four main reasons were identified for non-attendance: lack of information about the check-up, not knowing it was free, logistical challenges such as time constraints or childcare issues, and perceiving no need due to good health or uncomplicated births. Notably, women with chronic diseases or high-risk pregnancies did not attend more frequently than others—a point Agdestein described as concerning given their higher risk profiles.
"It is important to provide information about the postnatal check-up. In principle, the 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," she said.
Additional findings showed that 52 percent learned about postnatal services from municipal midwives, some from their GP, while others relied on friends (18 percent) or social media (11 percent). "We definitely see room for improvement here," Agdestein noted. She suggested written materials may help ensure new mothers retain key details.
The study also revealed that nearly one-third of respondents were unaware that postnatal consultations are free. "The odds of attending increase if you know that the consultation is free," according to Agdestein.
A gynaecological examination emerged as a priority for many women but was not universally offered. Satisfaction with postnatal care was strongly associated with receiving this examination. Women recommended GPs take a more proactive approach in offering it: "The study showed that some women find it difficult to ask to have their genitals examined. The findings show that it is important that they are offered a gynaecological examination, and then the women can decide for themselves whether they want and need it. Many people may have pain and tears after childbirth, and experience incontinence, so it is important that they are offered a gynaecological examination," said Agdestein.
Mental health was another focus area; 40 percent considered discussing mental health important, and this topic arose in 60 percent of consultations. "This may indicate that GPs are focusing on mental health, and that is 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," she added.
To address these issues, Agdestein’s team has developed a tool designed for use by GPs and patients together during consultations: "We have developed a tool and a prototype that is ready for testing. It is a tool that will be used by GPs and women in collaboration." The aim is to improve communication around available topics at check-ups and help tailor appointments to individual needs: "With this measure, we hope to improve both information and quality, which in turn can contribute to increased attendance and better benefit from the postnatal check-up."
Agdestein emphasized her motivation stemmed from clinical experience: "I started looking into this because, as a GP, I have followed up many women throughout pregnancy and the postnatal period. Then I saw that there was a great need for knowledge about postnatal care in the primary health service. I have gone from clinical practice, to research and now to improving practice."
Of 1,119 eligible participants invited across Nord-Trøndelag Regional Health Authority during one year, 351 responded—representing similar demographics (age, education level, number of births) as national averages among new mothers.
"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," said Agdestein.
She summarized key findings: approximately one-quarter do not attend follow-ups; there is demand for better information; comprehensive consultations—including discussion of childbirth experiences—are valued; proactive offers of gynaecological examinations matter; insight into what influences satisfaction can guide improvements quickly: "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," concluded Christine Agdestein.
