Multiple barriers prevent delivery of optimal primary postpartum care in Singapore

Various factors such as prior training, childcare experience, and access to resource materials affect the primary care physicians’ (PCP) ability to deliver optimal postpartum care, according to a recent Singapore study.

“This study reveals multiple barriers relating to physician, maternal, and healthcare systems and identifies facilitators which potentially enable PCPs to improve their provision of postpartum care,” the researchers said. “The results allude to the possibility of a multipronged intervention to address the barriers, so that PCPs can deliver quality postpartum care.”

Through focus group discussions and in-depth interviews, they aimed to explore the experiences of 29 PCPs in managing mothers during the postpartum period. Qualitative data were audited, independently coded by two investigators, and subjected to primary content analysis.

Use of The Generalists’ Wheel of Knowledge, Understanding, and Inquiry as the conceptual framework led to the emergence of four main domains: personal attributes in relation to postpartum care, information mastery, professional relationship with the mothers, and interaction with healthcare systems and policies. [BMC Farm Pract 2021;22:139]

PCPs said that their own personal attributes immediately impacted the quality of care they were able to provide patients. Men, for example, said that they were less likely to be consulted by postpartum mothers due to the sensitive nature of the examinations. In cases where a male provider would attend to the mothers, they felt that the patient might still not bring up related issues.

Background knowledge and personal experience were also important factors to consider. Those who had raised children of their own were able to provide more confident and direct advice as regards breastfeeding and other parenting issues to postpartum mothers. In contrast, PCPs with no children or with sparse professional obstetric background were less confident.

Indeed, information mastery was a factor important enough to warrant its own domain. While most PCPs claimed to know the basics of postpartum care, some still felt that they were not well-trained in other aspects, especially in newborn care. The general lack of local postpartum care guidelines also emerged as a barrier.

The interpersonal and professional relationship between the PCP and their patients also affected the quality of care. For fear of souring these relations, PCPs are often less inclined to debunk myths or nonmedical practices that their patients believe in. Language barriers and the mothers’ engagement with other healthcare providers (formal or informal) also interfered with PCP postpartum care.

Gaps and cracks in the healthcare system impacted primary postpartum care, too. PCPs pointed to short consultation times, lack of lactation support services in the community, and poor transfer from specialist to primary care as notable barriers.

To improve postpartum care, “PCPs have suggested team-based care to address multiple barriers faced by postpartum mothers,” the researchers said. “Clinician diversity in a team allows postpartum mothers to select their preferred PCPs to discuss gender-specific issues. The nurses in the team can also be trained to be midwives and lactation consultants.”

“Further research involving postpartum mothers and a survey to measure the magnitude of the barriers will triangulate with the findings in this study,” they added.