Background In high-income countries delivery usually takes place in a short-stay hospital setting and includes limited specific care after discharge. Perinatal system performance is therefore predominantly expressed in direct terms of delivery outcomes such as preterm birth (PTB), small for gestational age (SGA) or, in case of the mother, perineal rupture. Complications during the subsequent postpartum period may further modify outcomes, but postpartum complication rates are largely unknown. The Dutch obstetric system includes an 8-10 day episode of professional postpartum home maternity care. We investigated the prevalence of a set of 67 predefined complications during the first 8-10 days postpartum as routinely recorded during this episode.

Methods Prospective cohort of all clients of one large maternity care organization receiving home maternity care in November 2014. We combined maternal background and intra- and postpartum characteristics with complication data, routinely recorded by home maternity care assistants. Complication prevalence rates per postpartum day were calculated. Univariate and multivariable logistic regression were used to predict the presence of postpartum complications.

Results Complications occurred throughout the entire episode of home maternity care and prevalence was high, with 55% of all mother-baby pairs experiencing at least one complication (e.g. cracked nipples, >10% weight loss of the baby) and 5% at least one major complication (e.g. mastitis, cyanosis of the baby). Predictive ability of maternal background and intra- and postpartum variables on presence of complications was moderate (max. 62.9%), even when an accumulative risk score was used.

Conclusions The prevalence rate of maternal and neonatal postpartum complications was higher than expected. Professional postpartum follow-up is to be considered to observe and manage emerging complications, to provide opportunities for interventions, and minimize treatment delay. Opportunities for risk-guided care should be investigated further.