Postpartum counseling perceptions and practices: what's new?

BACKGROUND

The in-hospital postpartum period is a critical opportunity for health care providers to enhance maternal understanding of newborn care, yet few studies have determined whether health care providers' educational priorities match those of new mothers.

OBJECTIVE

To document how well pediatricians' perceptions of educational priorities for counseling about care of the newborn match those of new mothers during the postpartum hospitalization, and to determine whether pediatricians' actual counseling practices reflected maternal priorities.

DESIGN

Cross-sectional study of perceived educational needs with direct observation of pediatrician counseling practices.

SETTING

A suburban Washington, DC, community hospital.

PARTICIPANTS AND INTERVENTION: All pediatricians on staff and a convenience sample of postpartum mothers were asked to rate the importance of newborn counseling issues using lists generated from focus groups and interviews. Pediatricians were observed while counseling mothers, and their postpartum counseling practices were scored using a template derived from the rating procedure.

MAIN OUTCOME MEASURES: Comparison of pediatricians' and mothers' perceptions of educational priorities and the description of pediatricians' actual counseling practice.

RESULTS

Mothers listed 9 issues as "very important" and expected the pediatrician to address health problems, especially jaundice, feeding, testing, pain medications for circumcision, behavior, and when to call the pediatrician for concerns or to schedule well-child care. Pediatricians and mothers agreed on 6 out of 11 very important issues. Pediatricians were observed to discuss an average of 8 issues per session, especially those they rated as very important, but they frequently failed to mention safety, sleep position, when to call for advice, testing, infant behavior, or circumcision issues.

CONCLUSION

Mothers desire to learn a significant amount of information regarding the care of their newborn before hospital discharge. Although pediatricians discussed more issues than in a previously reported study of postpartum counseling, they still fell short of maternal expectations. Pediatricians must ensure that other sources of information, such as nurses, media, and reinforcement at postpartum well-child visits, supplement the information they provide in their in-hospital counseling sessions.