Costs and effectiveness of community postnatal support workers: randomised controlled trial.

OBJECTIVES To establish the relative cost effectiveness of postnatal support in the community in addition to the usual care provided by community midwives. DESIGN Randomised controlled trial with six month follow up. SETTING Recruitment in a university teaching hospital and care provided in women's homes. PARTICIPANTS 623 postnatal women allocated at random to intervention (311) or control (312) group. INTERVENTION Up to 10 home visits in the first postnatal month of up to three hours duration by a community postnatal support worker. MAIN OUTCOME MEASURE General health status as measured by the SF-36 and risk of postnatal depression. Breast feeding rates, satisfaction with care, use of services, and personal costs. RESULTS At six weeks there was no significant improvement in health status among the women in the intervention group. At six weeks the mean total NHS costs were pound 635 for the intervention group and pound 456 for the control group (P=0.001). At six months figures were pound 815 and pound 639 (P=0.001). There were no differences between the groups in use of social services or personal costs. The women in the intervention group were very satisfied with the support worker visits. CONCLUSIONS There was no health benefit of additional home visits by community postnatal support workers compared with traditional community midwifery visiting as measured by the SF-36. There were no savings to the NHS over six months after the introduction of the community postnatal support worker service.