Guest post: improved support for new and expectant mothers

[MumsnetGuestPosts]

Last week we launched the NHS Long Term Plan, a landmark moment that sets out how we will secure the health service now and for generations to come.

Along with the £20.5 billion in extra funding this government has pledged for the NHS - the largest cash increase in NHS funding in history - we asked the health service to produce a plan to make sure every penny of that extra money is well spent, and will help it meet the challenges of the future.

The plan covers cradle-to-grave healthcare, with one of our aims being to provide the best maternity care in the world - not only to ensure every baby gets the best start in life, but also to ensure new parents are better supported before and after birth. From Mumsnet’s campaign for Better Postnatal Care we know that much of the provision in the UK is good, but for a significant minority of new mums their experiences could have been better.

The fact is that around one in four new mums experience mental health problems during pregnancy and after giving birth, while up to one in 10 dads also experience problems.
Having a baby is meant to be a time of great joy, but it can also be a time of great stress. Whether it’s sleepless nights, huge hormonal changes or just the pressures of having a newborn totally reliant on you, we should recognise this is a time in which new parents can struggle to cope. And it is not always easy to speak up and ask for help with something we are told should come naturally.

For that reason, the NHS Long Term Plan has given particular attention to perinatal care. We are doubling the period in which women can access specialist perinatal mental health care from one year to two years, as well as ensuring partners also have access to mental health support. Mums will now have access to mental health services and care from preconception to 24 months after birth. And outreach clinics will integrate maternity, reproductive health and mental health services for women experiencing mental illness as a direct result of their pregnancy.

Access to evidence-based psychological therapies within specialist perinatal mental health services will be expanded to include effective therapies such as parent-infant, couple, co-parenting and family interventions. Dads and partners will also be offered evidence-based assessments for their mental health, leading to referrals to specialist support as required.

As well as focusing on mental health, we also want to focus on physical health – not least because around 90% of women will sustain an injury or tear while giving birth. Physiotherapy can be key to preventing and treating incontinence and prolapse symptoms which could otherwise last for years, so we will improve access to postnatal physiotherapy at multidisciplinary pelvic health clinics. These clinics will also provide training and support for GPs and midwives to help them better understand the needs of women recovering from birth. We also want to ensure pregnant women develop a good relationship with their caring team, with the aim that, by March 2021, the majority of women have the same midwife caring for them throughout their pregnancy, during birth, and beyond.

The numbers speak for themselves: women who experience this continuity are 16% less likely to lose their baby, 19% less likely to lose their baby before 24 weeks, and 24% less likely to give birth prematurely.

Bringing a baby into the world brings with it a rollercoaster of emotions – from fear, doubt, and stress, to love, joy, and excitement. With this new support, we hope to better help parents through this transformational time.

Jackie Doyle-Price will be able to respond to some comments on Tuesday, 5-6pm (22/01/2019) [Date edited by MNHQ]

[Snog]

Mental health support really needs to be available to everyone. Men, women adults and children alike.

[MadeForThis]

Those are fantastic numbers. Would be great to see it implemented.

[Helpmemyhairisterrible]

Two babies here and both times the experience was ruined by midwives forgetting that what I really needed on the second night after giving birth was basic nursing care- to be checked on, supported, encouraged and maybe offered a cup of tea while sobbing through excruciating breastfeeding pain. I'm really grateful that midwives are so highly skilled, but it does frequently seen to come at the expense of kindness, compassion and the ability to overcome their own qualifications to just nurse when it's most needed. I've heard this described by doctors, anaesthetists etc also. In my case, I've been so put off by the prospect of midwife care that we will stop at two and not have a much wanted third baby. It's sad, because I'll never forget the kindness, attentiveness and care I received from the two student midwives from RGU who attended the birth of my son. They were a credit to the profession. I can only hope that CPD covers basic nursing and compassion and not purely the medical aspects of midwifery in the future.

[Itssosunnyout]

Having the team read notes before any appointments would be helpful especially during handover.

I found that to be the most frustrating part of care. I have a rainbow child and it was traumatising having to go through the reasons why again and again even though there was a rainbow sticker on my handheld notes.
I also had to go through every detail during booking such as date of delivery weight health issue of child. It was so upsetting especially as it was the same trust.

Currently I have been referred to gynecology due to issues with tearing. The hospital and GP were fantastic. However I had an appointment at the beginning of December being advised i would have further scan but it still hasn't been arranged. This is for an issue that involves me having to limit when I can be out of my home.

I do have to credit breastfeeding support though. The midwife were excellent on the hospital and I referred myself to a team who visit at home home who can check the latch and answer all questions.

[AgentCooper]

Having the same midwife throughout would be amazing. I started out with a really good one, then had a different one who basically told me I had tested positive for slapped cheek (I was about 20 weeks at this point), she didn't know why I'd been tested and she wasn't sure what the ramifications were. She let me leave in floods of tears. She wasn't horrible, just useless - she had to Google to work out that human parvovirus was slapped cheek. The next one basically berated me for not having had the whooping cough vaccine, when nobody had told me about it - again left in tears and put in a complaint.

The head midwife at the hospital then took me on and she was amazing. Seeing her for the rest of my pregnancy and getting to speak to her on the phone when I was then in hospital after DS was born made me feel I was in safe hands.

[Verbena87]

Routine pelvic floor physio post partum would be amazing. I had a difficult birth resulting in pelvic organ prolapse and had to wait months for urogynae and then physio referrals. Actually getting physio has transformed my quality of life and mental health.

[TravellinTeacher]

I was told I’d have the same midwife the whole way through, then was told I’d have the same health visitor for the first year - these things didn’t happen, much to our detriment.
Midwives did not read my notes and having to explain everything verbally, to then not be believed so they read the notes anyway was a waste of everybody’s time (apparently having a bp of 80/60 and not fainting is impossible.... it’s not and my notes explained it!).
During birth, a failure to read my notes had catastrophic consequences that mean both myself and my daughter have spent the first year of her life at weekly hospital appointments.
The hospital have admitted fault but unfortunately that doesn’t undo the damage that was done by someone not reading notes properly.
If we’d had the same midwife and if proper handovers had been done, all of our problems wouldn’t have been problems!

[ElyElyOy]

My son was born via csection as an emergency and I had to have a general anaesthetic. I was then dumped on a mother and baby ward unable to move with no water (having been unable to drink for over 12 hours) and no pain relief listening to crying babies. I also was unable to reach a call bell. No one came to me for 5 hours and when they did they were rude and annoyed that I hadn’t expressed any milk for my baby. I tried to explain I could move and didn’t know what expressing was and tried to ask how my sick baby was doing. The response was “I don’t know, I just want to know if they can give him formula then unless you are going to go down there yourself”. I again pointed out I could move and yes I suppose formula was the only option to be then again abandoned for a further 3 hours, missing breakfast because I was unable to go and fetch any, and still without fluids or pain relief.

I had no support and despite being identified as having PND was offered no help or advice. The midwives and transitional support workers were mostly very good, but they were often not there or not enough staff, and some overworked staff seemed to take it out on the mothers who needed more help or who had complications.

I also had an horrific pregnancy (lost my sons twin) and was given a poor prognosis for my son who was eventually born prematurely and quite sick. It would have been useful to have had support during the pregnancy. I know funds are limited but volunteer-led peer support would have prevented a lot of the problems I experienced. Midwives and GPs in the community know their patients and would be able to lead support groups etc if they had more funding. Even antenatal classes are barley available and offer little in the way of support for new parents.

[WhyTheLongFace]

Where are the midwives going to come from to enable continuity of carer throughout pregnancy, birth and postnatal?
With current staffing levels this simply isn’t possible with the ratios and caseloads.

To start with a firm definition of what ‘continuity of carer’ actually is could clarify what is wanted and needed by women. This could go a long way towards trusts trying to change their services rather than a tick box exercise.

[Daisy2990]

@ElyElyOy Sorry to hear this. What hospital was this? Because your experience sounds eerily similar to mine (Leeds General Infirmary). I was also left without water or call button, had no pain relief after section so couldn't move - when I sobbed quietly in my bed a passing midwife tutted at me and rolled her eyes.
This was followed by PND which I'm still dealing with 6 years on.

Am pregnant again at the moment and the quality of care has been dire. There is just a very basic lack of personal consultation. I was throwing up bloody mucus daily at the beginning of pregnancy and nobody would discuss taking me off aspirin. I was so patronised and scared by the fuss made over my BMI that I eventually admitted to my husband I was not eating about 12 weeks in. Depressed and lethargic after that and at 20 weeks someone finally realised I was anaemic. Nobody had even mentioned it as they were utterly obsessed with the fact I would have GD, which i dont!

I think it is actually kind of patronising for the Minister to label these things as 'new mum problems' along with lack of sleep. It shouldn't be lumped together. Poor hospital care during and after birth comes down to a fundamental lack of funding in the NHS, and maternity services seem to bear the brunt because women don't complain as much as they should.

PS. Can we use this as an opportunity to GET BOUNTY SALES REPS OFF POST NATAL WARDS please!!

[Racecardriver]

Well not causing the mental health problems by traumatising women during labour might be a better place to start. The contempt with which women on labour wards are treated is horrendous.

[anderjoe]

Yeah, NHS Long Term Plan has been going pretty good for most of us living here at Utah.

[April2020mom]

I was told inaccurate information by a MFM doctor. When I was pregnant with the twins one boy one girl I had a completely different experience. I know services and funding are limited and controlled but I would have appreciated it if I had access to a health visitor post birth.
I had to rely on a online support group post diagnosis for advice and support.

[JackieDoylePriceMP]

Hello, thank you for your questions. It is very helpful to get your feedback so that we properly reflect the actual experience of maternity and postnatal care. I am genuinely committed to getting the best possible experience for everyone

[JackieDoylePriceMP]

I agree that we need to improve mental health provision across the board. Within that we have specific plans to improve support for children and young people. However we do need to develop specialist perinatal services, recognising that this is the time that women are most vulnerable to mental ill-heath.

[JackieDoylePriceMP]

Childbirth is a vulnerable time and for some the experience is less than it should be as evidenced by some posts on this thread. Continuity of carer will enable families to build a relationship with their care team. Health visitors are vitally important in supporting families in the early months. We recognise that to deliver our ambition we will need to recruit more midwives and we re taking steps to do that