Falling through the cracks: the impact of COVID-19 on postnatal care in primary care

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POSTNATAL CAREPostnatal care has always been the 'Cinderella' of maternity services, both in primary and secondary care.1,2 One illustration of this is that until the most recent GP contract there was no requirement for a GP practice to provide a maternal postnatal check.Prior to the COVID-19 pandemic the provision of services to postnatal women showed wide variation across the country. 1 With a paucity of more recent research to establish what best postnatal care looks like, it is difficult to provide evidencebased practice.In 2014 the annual Chief Medical Officer for England's report came to the conclusion that postnatal care in England was 'not fit for purpose'.2 Since then community postnatal services, such as health visitor provision, have seen funding cut and services have become increasingly fragmented.3 The Royal College of General Practitioners (RCGP) issued a statement in 2017 recognising that GP training is not adequate when it comes to the provision of maternity care in the community, while also acknowledging that GPs are best placed to coordinate joined-up care across services.4 Successive confidential inquires into maternal deaths have also repeatedly highlighted the need for joined-up care to prevent women 'falling through the cracks'.5 COVID-19 has disproportionately affected people from black, Asian, and ethnic minority (BAME) backgrounds, as well as those in the most deprived areas.We know that these groups of women are most at risk of maternal death, with maternal death rates twice as high in Asian women, and five times higher in black women compared with women of white ethnicity.5 Although we tend to think of maternal deaths occurring during pregnancy and at the time of delivery, the single biggest period of risk is the postnatal period.The current maternal death rate is 9.16 per 100 000 maternities, with 45% of

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