What would you ideal maternity unit be like?(35 Posts)
Reposting this from the men on ward thread, as I thought it was a really interesting discussion.
If you were planning a new maternity unit and pre-and postnatal wards what, within some reason and how the NHS works, would it be like?
I'd like a prenatal ward that wasn't just beds, but was more relaxing and had sofas and chairs for women who don't need continuous monitoring.
A midwife and consultant led birth unit that was together, so you can chose and transfer between them if you want to - so if you do decide after two days you want an epidural, you can transfer to the CLU quite easily. (Our new maternity unit is like this and it was great, I think it gives confidence to women who might want to start out in an MLU and aim for a natural birth but are worried they aren't close enough to more medical support if they do need it, which would have been me if our unit wasn't mixed).
Enough rooms that women can stay in the room where they gave birth that first night, with their partner if they want. This is also working on the assumption that a lot of women only need to stay that first night, and so a transfer to a busy ward isn't ideal.
I think a postnatal ward is probably still needed as women who need ongoing medical care presumably need to be in a ward setting, as the NHS isn't like a private hospital with enough staff to monitor everyone in a private room. But the bays need to be bigger, so you've got room to actually fit the incubator/cot in it and still move! Comfy chairs for partners as well.
Possibly some of the 4-bed sidewards are for men to stay as well, and some aren't, so catering for choice of whether you mind other men being around as well or not. But here I'm working on another assumption, that women who have to stay in for 3-5 nights might not want their partner with them every night.
More midwife/maternity staff on hand to help with the baby if you're immobile, maybe get you a cup of tea if you're feeding at night.
More lactacion advisors on hand, day and night.
More accessible kitchen areas for preparing bottles, rather than being stuck miles away from the beds (bloody nightmare in the middle of the night!)
And really importantly, more provision for women who don't have their baby with them and when it really isn't very nice to put them on a side-ward with mums with their babies.
One had a little lounge area with tea /coffee tv and sofas.
I was lucky enough to have my own room when the Dts were in NICU and the midwives said they always try to do that for Mothers who haven't got their babies with them.
I would say more rooms in the NICU, SCBU area. It wouldn't have helped me so much but more for parents whose babies only spend a couple of nights in Scbu and for parents who have been transferred.
More Breast feeding advisors in NICU/ Scbu
It's nice to think about what we would all like in an ideal world but considering the limited funds the NHS has, I was very pleased with the unit I gave birth in
Enough staff. 6 of the 8 rooms in my lovely birthing centre were empty and I still went through transition in the corridor because there were no free midwives. When I did get seen the midwives were great - am not criticising them at all - but sod the decor and fuck the lighting: MORE MIDWIVES.
Windows - that's just asking for the moon on a stick
I know all of this would require so much money and as I said on the other thread, if you asked me to chose there are many other NHS services I'd rather spend the money. Still, it's nice to dream.
Ralph yes, I'd rather have been able to find a midwife on the pre-labour ward than have a carefully consulted pink wall in the delivery room...
I would say my experience in a state funded Swedish hospital was near perfect. We had a huge delivery room, it had panoramic windows, a corner sofa and all the birth props you could imagine ( birthing balls, walking frames, rocking chair, a huge leather corner sofa to support yourself on
or for dp to have a little nap on birthing stool) they brought us yummy food and drinks throughout. I had my own toilet and shower.
We stayed in that room for a few hours (4/5) after the birth and we then went the "patient hotel" which was also free. We had our own room with a large double bedwith a little nest thing for ds to sleep in with us as it was assumed we would co-sleep. There was a really nice communal room with a kitchen and tv and comfy sofa so the new mums and dads could hang out and chat.
It is advised that you stay in the patient hotel until your milk comes in.
When dc2 is born ds1 will also stay in the patient hotel with us.
Oh my god IKEA, a patient hotel!!! Sounds amazing. We have such low expectations here, people stop feeling entitled to decent basic care, it is only when you see how it could be done, and is in other places, that you realise how complacent we have got about poor levels of public service. Don't get me me wrong, the NHS is amazing in a crisis, but as funding gets stripped back we are seeing the effects in non-emergency and community care.
I gave birth to my second in an NHS hospital that only has single rooms. After the hell of the antenatal and postnatal ward at kings that was near perfect.
I really think that birth and postnatal care are vital areas for the NHS to spend money on, I think bonding ( especially between the father and baby) is so important and if the father doesn't spend the child's first few hours and days with his child there is a risk that he won't feel needed or important. In Sweden when relationships breakdown the father nearly always has 50/50 access, fathers also take out parental leave and are just as likely as mothers to stay at home with ill children. I believe those first few days makes a huge difference. My dp spent the first days of my ds's life having skin to skin with ds, those special moments could never be recaptured.
The other positive is breastfeeding, if mothers are supported, relaxed and comfortable there is a much higher chance that breastfeeding will work.
I think that decent care of newborns, new mothers and fathers is not just important for the individual families but important for society.
A full complement of a competent, caring staff would be a good starting-point.
I was really pleased with my care during the 3 deliveries. The only thing I hated was the someone in their infinite wisdom had decided (between having DC2 and DC3) that they would have a waiting room on the fucking delivery ward for relatives and women arriving on the ward from home.
When I got to the hospital, contractions only a couple of minutes apart, I was asked to wait in this waiting room until the midwife came for me (they were snowed under that night), which was full with one family's Aunts, Uncles, Grannies, neighbours and neighbours dog (well, not the dog obv...). It was utterly humiliating having contractions in front of complete strangers - and completely unnecessary for the whole, extended family to be at the hospital.
I'd get rid of that straight away, but everything else was great.
I spent a couple of days in a "transitional care unit" which is a little ward for babies coming out of SCBU and their mothers. The idea is you spend some time with your baby there, before you take them home to get to know each other and learn how to feed, bath them, if necessary how to deal with oxygen, tube feeding etc..
Everyone had private rooms and there was a little kitchen and a common room. Food was provided but you could also bring your own stuff and keep it in the kitchen.
If I had to design an ideal maternity ward it would have elements of the transitional care unit.
If Sweden can afford it... the simple question is why can't we.
The answer is not simply a question of how much we are taxed and what spending per head is.
Its down to how budgets are drawn up and the dots are not connected past the doors of maternity. Combined with a cultural problem, to which women themselves contribute simply by saying that we shouldn't expect x, y or z.
Or course we bloody should. We are being taken for fucking fools to be blunt about it.
It's not as simple, no - but it's a key feature. The NHS as it stands at present (and that's across the UK, not just in one part) is unsustainable in its current form with the level of revenue it receives.
The NHS may not be sustainable as it is, but some of it comes down to attitudes, or procedures. Staffing is a key issue; it's seen as an overhead- making one midwife cover three labouring women is seen as 'efficient' because the time spent just sitting and reassuring one woman without bustling around doing something isn't quantifiable.
Similarly expensive equipment may be bought, forgetting that this is only as good as the person operating it, or with something like continuous monitoring equipment, little use if no one acts on the information given.
Redtoothbrush brilliantly put. The other thread really sums up the low expectations we've been suckered into accepting. All this 'there is no money we should be grateful for what we get, just suck it up', without considering that there is a whole set of cultural and misogynist expectations which lead to the underfunding of postnatal care. It's not as simple as just budgets.
The other thread really sums up the low expectations we've been suckered into accepting.
Damn straight it did. It was all about how this job is more important than this one and how we must cater for the masses and not give a toss about others.
Everyone was going on about how disgusting it was, but couldn't see how they are contributing to it and allowing it to continue.
It was a far cry from feminism as it just pandered to the cultural bollocks that there is no alternative.
Of course there fucking is!
If there was greater knowledge of how maternity care was organised on the continent, there'd be more outrage. A friend of mine has just given birth in the Netherlands and you get something like 30 hours of individual home help from a maternity nurse in the week after birth!! Ikea's description of patient hotels in Sweden is another example of the different universe of expectations in other countries. No system is perfect, i know there are different issues, but all the same!
You have to see how the maternity care sits in the context of health & social care provision when looking at other countries.
My experience of the Netherlands was that they had a generally robust stance. Treatment is given on the basis of need rather than a looser 'want'. I know that some of my colleagues from non NL countries were shocked to not get antibiotics on request. We had to pay a small amount (to us) of a few euros to see anyone at the doctor's surgery.
They have a far higher home birth rate but the family is expected to do a lot of preparation for that. The midwife arrives with nothing. The 'kit' has to be requested in advance including needle & thread and gas & air.
The home care sits in the context of that.
A separate postnatal ward for mums of babies in scbu close to scbu. Our hospital has something a bit like the flats in halls of residence for the parents of babies in scbu after the mum doesn't need care herself. It was lovely but only 3 rooms (plus shared kitchen and bathroom) so mainly used by parents whose babies were about to go home. You could bring your baby to the flat if he/she was well enough.
More tlc in general. Someone to acknowledge what an awful time I was having, to take me down to scbu in a wheelchair, bring me back, help me back into bed and get me a drink would have been lovely.
A bounty lady repelling device at the entrance .
Volunteers to come and chat to mums who don't have visitors but want them.
I would have liked my community midwife to have come and admired my baby in scbu. I know it's trivial but scbu mums get their postnatal checks in hospital instead of at home by the community midwives. I think this is good but I felt like I'd missed out on that first home visit when the community midwife visits you and tells you that your baby is so gorgeous even though they look like a garden gnome
Also ice on the wards would have been nice, it was boiling in there.
It's got less to do with misogyny and and a hell of a lot to do with allocation of resources within the current funding structure. Birthing has become a medical procedure - in some cases, that's the correct approach, obviously, but in many more it's not. While we continue to treat it as that one size fits all medical procedure we don't have the flexibility to allocate on the basis of need.
The maternity nurse in the NL is paid for by insurance iirc, and it's not always free for more than the minimum 3(?) hours.
I think I prefer this thread to the other one, it was depressing beyond words.
even if it is just fantasy
ikea the swedish hotel sounds AMAZING.
Love all your ideas too Thurlow.
I was trying to make a nicer thread
The only thing that I keep going back to, as I said on the other thread, is that as much as I would love all this stuff - I don't think I rank it above a lot of other things the NHS could spend extra money on. If it comes down to a choice between a nicer birth experience and more money for children with serious illnesses, that's no contest for me.
As much as some people were very nice, I had a absolutely shitty time in hospital having DD, but honestly most of that could have fixed if people had just seemed kind and appreciated that while it was all run of the mill for them, it certainly wasn't for me, a first-time mum. Kindness doesn't cost money...
Though I might have had a particularly bad hospital because whenever I watch OBEM, that's nothing like the experience I had!
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