A recent study led by Christine Agdestein, a general practitioner and PhD candidate at the Norwegian University of Science and Technology (NTNU), has found that one in four women in Norway do not attend their postpartum check-up. The research, conducted with colleagues from NTNU and Nord-Trøndelag Regional Health Authority, surveyed 1,119 women who gave birth within the Nord-Trøndelag region over one year; 351 responded to the questionnaire.
"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 Christine Agdestein.
The study revealed satisfaction was closely tied to discussing the birth experience, covering several relevant topics during consultation, and including a gynecological examination. While most participants valued these elements, not all were offered a gynecological exam despite strong demand.
"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 gynecological 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 gynecological examination," Agdestein stated.
Forty percent of respondents considered mental health discussions essential during their check-up; this topic was addressed 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," said Agdestein.
Despite positive perceptions of postnatal care services among attendees, many women did not participate in follow-up appointments after childbirth. Four main reasons were identified for non-attendance: lack of information about the service or its importance; logistical challenges such as scheduling or travel; feeling healthy enough not to need a follow-up; or having negative previous experiences.
The survey also highlighted gaps in communication about available services: only 44 percent reported receiving information from maternity wards about postnatal check-ups; 52 percent received information from municipal midwives; some heard from their GP; while others learned through friends (18 percent) or social media (11 percent). Furthermore, nearly one-third of respondents were unaware these consultations are free.
"We definitely see room for improvement here," Agdestein commented regarding communication shortcomings. She suggested written materials could help address forgetfulness common after childbirth. According to her research: "The odds of attending increase if you know that the consultation is free."
Based on these findings, Agdestein and her team are developing new tools designed for use by both GPs and patients to improve information flow before six-week check-ups. These resources aim to clarify which topics can be discussed during visits so each woman can prioritize what matters most.
"It will provide good information to the women about which topics can be addressed during the 6-week check-up and help the woman to prioritise what is most important to her. In this way, the GP can adapt the check-up to each individual," she explained.
Agdestein concluded: "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 added: "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."
According to Agdestein’s summary: One-quarter of new mothers miss out on postpartum appointments; there remains significant need for better outreach efforts regarding available services; comprehensive consultations—covering physical recovery as well as emotional wellbeing—are valued by patients; proactive offers of gynecological exams could further enhance patient satisfaction.
