Postpartum care 2.0: the effect of flexible postpartum care hours on the success rate of breastfeeding, experienced empowerment and quality of care by the mother during and after postpartum period.

The Dutch maternity care model with in-home postpartum care is unique. This uniqueness results in little to no scientific knowledge on the effectiveness and efficiency of in-home postpartum care. Filling the knowledge gap and
following the trend of personalized care are prerequisites in preserving this form of maternity care. Therefore this study researches the possibility of flexible distribution and intermission of postpartum care hours. It concerns a practice based innovative research model which, without extension of postpartum hours, analyses whether distribution and intermission of postpartum care hours benefits the health of mother and child.

It is expected that this planning flexibility of postpartum care hours will have a positive effect on the health of mother and newborn (in terms of successful breastfeeding, experienced quality and self-reliance by the client and her partner),
a better and more efficient cooperation between different health institutes and a smoother start for youth care organisations. Scientific evidence of essential and effective postpartum care can contribute to an improved maternity care system and its goal to give all mothers and newborns a perfect kick-off of life. To a greater extent, this new generated knowlegde can reduce maternal and perinatal mortality and morbidity in the long run.

The Dutch maternity care model with in-home postpartum care is unique. This uniqueness results in little to no
scientific knowledge on the effectiveness and efficiency of in-home postpartum care. Filling the knowledge gap and
following the trend of personalized care are prerequisites in preserving this form of maternity care. Therefore this study
researches the effect of flexible distribution and intermission of postpartum care hours on the health of mother and child.

Primary outcome:

Measured at day 1 after birth, at the end of the postpartum care period and at 4 weeks postpartum



Secondary outcomes:

- experienced quality; measured 4 weeks after childbirth by means of QCLiK questionnaire;

- experienced self-reliance; measured 4 weeks after childbirth by means of CLiK questionnaire;

- experience of intervention by caregivers; measured during 2 year intervention by means of focus group discussions and questionnaires, focus on the barriers and possibilities of intervention;

- cost-effectives; measured 4 weeks after birth by comparing the actual postpartum care hours and healthcare needs of client after postpartum care period. By adding the following question to the questionnaire (sent 4 week postpartum)- How often and which healthcare provider did you contact after the postpartum caregiver was gone?

Intervention group:

Clients are offered the opportunity for flexible planning of their postpartum care hours (i.e. distribution and/or intermission), without making any additional health care costs. This means that the indicated 24-49 postpartum care hours may be distributed throughout the whole day and on noncontiguous days (to a maximum of 14 days). Additional indicated postpartum care (up to 80hrs) may also be distributed throughout the whole day and noncontiguous days (to
a maximum of 14 days). Furthermore, a decrease of the number of postpartum care hours is also possible. In this case, the guarantee of continuity of care is a vital condition.

(Re)distribution of postpartum care hours is always done in consultation with the client, the healthcare provider (who accompanies and is medically responsible during parturition and childbed) and postpartum caregiver; in a similar
manner as is done in the current situation using the LIP.



Control group:

Clients receive the current package of postpartum care hours (i.e. 24-49 hours in 8 continguous days), possibly followed by an additional indication of hours (up to 80hrs) within 10 contiguous days (i.e. 2 extra days).