AIBU to think that all mothers should have food and water on postnatal wards?

[JustineMumsnet]

Hello,

Today, we at MNHQ are launching a new campaign called Better Postnatal Care: Aftercare, not Afterthought.

Over the years, we’ve been struck by how many MNers have related pretty horrible experiences on postnatal wards. We’ve also seen lots of discussions about longer term aspects of postnatal care: help with breast or bottle feeding, mental health care for new mothers, wound care after difficult births, and physio for women who feel they need it (but rarely feel able to ask for it) - among other things.

So, towards the end of last year we decided to see if we could do something about it. We ran a big survey of Mumsnet users’ experiences of postnatal care, and some of the results were striking. (You can see more here.) Among those who stayed in hospital after giving birth - which was most new mums - many reported that it was sometimes difficult to access food, pain relief, drinking water and washing facilities. 61% had been unable to access food when they needed it; 45% had been unable to access pain relief when they needed it; 22% had been unable to access water when they needed it; and 19% had been unable to access washing facilities when they needed them.

So today, we are asking the major UK political parties to commit, in their manifestos for the general election, to making sure that women on postnatal wards always have access to the absolute basics: food, water, pain relief and washing facilities.

We’re also asking everyone (this means you!) to contribute ideas about how we can make postnatal wards ‘fit for purpose’. More midwives? A fridge full of sandwiches, fruit and water on every ward? Asking all visitors and patients to turn off noises on their phones and personal devices? Maternity support assistants? Welcome cards by every bed explaining how the ward works? Making sure that inpatients and their visitors use headphones if they’re watching TV? We’re after all your suggestions, no matter how small. We’ll also be asking for input from healthcare workers with frontline experience - so if you’re one of those, please do chip in.

This isn’t about going into battle with people who work in maternity services in the NHS. Most of you feel that overall, over the year or so post-birth, standards of postnatal care are good or OK. When asked what needs to change, many of you say you think there should be more staff. Some of you had very good experiences: if you look at the ‘Good Stuff’ heading on this page you’ll see some shout-outs to hospitals and services that MNers say are getting things right. So we know that it can be done. What we want to do is find out how these hospitals are managing to get it right, and see if the lessons can be transferred.

In the months to come, the campaign will look in more detail at things like infant feeding, traumatic births, postnatal mental health, and follow-up care for birth injuries.

Please get involved with the campaign. Here are some ways you can help.

And as ever - do let us know what you think!

Thanks

Why should the world's fourth richest nation "need to be realistic" about maternity services? The UK manages to find the money for all sorts of nonsense, why not maternity services?

Are you seriously suggesting that non-medical "helpers" start taking on maternity work that should be done by medically trained professionals, just because the UK would rather spend its money elsewhere?

Crazy. Plenty of other, poorer, countries manage decent post natal care. There's no excuse.

A request for sensible discharge times and common sense. DS2 needed 24hrs of monitoring when he got to the ward which started at 11pm. I asked all of the next day would we be discharged at 11pm if all was ok - was told constantly no, so stood DH down (and care for 2 yr old DS1). Lo and behold at 11pm they told I was being discharged and to call DH to pick me up - I refused and stayed in the bed all night (the ward was not full) and was disturbed constantly by midwives who were pissed off at my attitude. I left at 7am the next morning.

Other than that - food delivered to bedsides would be an improvement as would welcome cards that explained how the ward worked (was shouted at for changing DS on the bed - I had no idea that would be a problem and in any case wouldn't have managed to carry him far) and a more understanding attitude from midwives that women are vulnerable, don't always know what to expect, and a need support not criticism after giving birth.

And a big no to extending visiting hours or allowing partners to stay overnight.

Why should the world's fourth richest nation "need to be realistic" about maternity services?

Any changes need to be realistic based on the current budget and staffing level. If any increase in budget and staffing levels can be achieved from this campaign, then great! But that is unlikely as the NHS are cutting costs.

Are you seriously suggesting that non-medical "helpers" start taking on maternity work that should be done by medically trained professionals, just because the UK would rather spend its money elsewhere?

Absolutely not! The idea about having relatives/friends on the ward is to help support the woman such as helping her get her meals, help care for the baby, not to provide her or the baby with healthcare.

Ohh @AgentCooper really try not to worry

A lot of our bad experiences centre around not having the basics. The best thing you can do (or IMHO as this is what I'll be doing with my second in November) is to just come really prepared with things you might need.

Obviously you don't want to over encumber yourself as the post wards are often quite short of space, but we will be bringing one bag with my essentialsand baby's, and then our second bag will be a cool bag stocked with cold drinks (some frozen), with packaged ready to eat food and easy to carry snacks (nuts, Naked bars, sweets etc). Make sure you bring an eye mask and ear plugs (as mentioned wards are bright and for some reason they begrudge you lowering lights), some extra pillows if you can manage (useful for breastfeeding) and some over the counter painkillers. This should at least ensure that neither you or your birth partner are going ages without some decent food and a nice cold drink.

You might also want to bring and old blanket for changing baby on - mats are a little bulky for hospital but as PP said you only really have the hospital bed to change baby on, so will help avoid any mess (meconium gets everywhere quite quickly!)

Best of luck

Of course maternal death have improved that's really not what this thread is about. That should be a given now in 2017!

Everyone here is mentioning the basic care issues of water jugs, empathy. Food issues, visitor numbers and midwifes attitude.

I think as a nurse this thread is shameful and if so called HCP today Are too important to fill up a bloody water jug then something has gone badly wrong with nurse training.

The thing is passthewine is that a lot of the things that leave women feeling there care was lacking are very basic things that could be simply done a different way. How much money would it really take to realise that women give birth ato all times of day and so might not have access to food for hours? How hard would it be to have an info card explaining where basic facilities such as water coolers and toilets are, or how the meal system works? Not a lot, and even small things like things that would make a huge difference even if midwives are too understaffed to help out themselves. I mean even supplying a vending machine would make a world of difference to a woman with no food and drink if the alternative is going hours before they next have something. If some NHS hospitals can get it right and have the majority of women having a positive birth experonce, why can all of them?

'It's also worth bearing in mind that any recommendations need to be realistic. Maternity services are already under resourced and overstretched.

The idea about some postnatal wards permitting a relative/friend to stay, is for them to help provide support to both mum and baby. This includes things like getting the woman's meals/water, watching the baby whilst mum gets a wash ect.'

It's unrealistic to assume that every woman has a relative/friend who can provide care (it's not 'support' to safely get a patient who is just hours post-op from major abdominal surgery up and washed, that's actual nursing care) 24/7. The wards are not designed for such double occupancy, it's also a huge infection risk and it doesn't happen in any other adult care unit in hospital

Oh yeah I forgot to mention that but expat is right not everyone will have someone there - especially for an extendedicated stay or if they already have older children. And this is the problem - the attitude for patient's on a post natal ward should be the same from a healthcare provider''s perspective - if you wouldn't expect people on a ward recovering from surgery to rely on visitors to meet their basic needs, then you shouldn't assume this is possible for mothers on the post natal ward.

This is it cherries all basic stuff really and again I still believe and always did that the switch of nurse training from nursing schools and a more apprenticeship type training to uni based study was disasterous.

I also feel direct midwife training was wrong. Midwives are far better for being qualified general nurses first and as in my day have to have 18 months post qualification before starting midwife/district nurse courses.

The basics arnt being met.

Having 'hcp' taking blood and citing drops is not the pinnacle of nursing.

Nursing is about getting all the basics right and if you don't do that then complications set in.

passthewine re: "support" what you're talking about is care that should be provided by people who know what they're doing. Either that, or the woman in question shouldn't be in hospital.

Re: funding, it is blindingly obvious that the NHS as a whole needs more funding. Like other posters have said upthread, the problems on postnatal wards are the result of them being lowest in the chain of maternity services i.e. Staffed by the worst and left understaffed first if there aren't enough staff to go round maternity services as a whole. So the problems caused by lack of funding are felt there first and particularly. More staff are needed. This requires more money. I don't see how you can expect anything to improve without more money.

Even complaints about rude staff and dirty facilities which on the face of it could be solved by better training/ better staff discipline and more cleaning are actually symptomatic of the low pay and understaffing work environment.

All I can say is this: I was one of the lucky ones who went onto the postnatal ward with a healthy newborn, able-bodied and fine in myself. I left two days later distinctly worse for wear. I am totally convinced that had I had to stay any longer I would have become seriously ill, both physically and mentally. That is not right.

No-one ever answered the buzzer, ever. Fortunately I could get my arse to the nurses station and ask, where there were invariably three people all doing something or other who brushed me off with 'just coming'. Someone would come 30 to 90 minutes later, if I was lucky. To be fair food was brought to my bed and was more or less edible, but it was not nearly enough and I mostly lived off what DH brought in. I was told absolutely nothing, have no idea if there was a day room or any resources for longer stays, or what to do with my baby if I walked around. I probably wouldn't have used a day room anyway, as all I wanted was to sleep and go home, not necessarily in that order. And the general contempt from staff was pervasive.

Also, can someone please explain why hospitals are invariably hotter than the surface of the sun? I gave birth in winter and the ward was a sauna.

food, water, and PRIVACY!!!

Reading this has made me ask my sister to book time off and be my own nurse for when im in. I know I'm going to have an extended stay due to GD. I'm due in the next week or two and hate hospitals as it is.

Any changes need to be realistic based on the current budget and staffing level. If any increase in budget and staffing levels can be achieved from this campaign, then great! But that is unlikely as the NHS are cutting costs.

The cost of maternal mental health issues is £8billion per year to the country in terms of health costs, benefits and drops in productivity.

It would cost an extra £350million per year to raise standards to the basic minimum level of care that is recommended by NICE.

But yes, be realistic and talk about cuts

SORRY BUT BOLLOCKS TO THAT CRAP.

Recognise the impact and cost of cuts and that they are false economy that are harming our society and our economy.

Its why austerity doesn't work. Too people think of public finances as being the same as your bank balance and managing personal debt and think they have to do that so society should work in the same way.

Except it doesn't because humans aren't that straightforward and follow the 'Law of Unintended Consequences'.

We need to see health care as an investment that will produce savings on a medium to long term basis rather than acting in a short term mindset.

We SHOULD be aiming high, because inevitably there will be a crap excuse for any change. The more you press, the most likely you are to actually achieve something.

If Theresa May can do negotiations with an attitude that demands cake and unicorns, why the fuck shouldn't women do that for basic requirements to match basic health care standards and recommendations.

Expecting to have food and water is not being 'demanding'. Expecting to have appropriate mental healthcare is not being 'demanding'. Did you know that under the NHS charter you have a RIGHT to the most appropriate care for your healthcare needs.

A Right that seems to be being forgotten, ignored and generally actively suppressed. A Right that politicians don't want you to know about, much less exercise.

Posts that say 'be realistic' and 'think of the money' boil my piss as they are inherently soulless and inhumane, as they have no regard for what 'be realistic' means in reality for women on the receiving end of unacceptable provision of services.

Get angry at that. Don't be an accountant who just stares at balance sheets without any idea of what those numbers reflect.

YY RedToothbrush!

Absolutely agree with RedToothbrush!

In the same spirit, until we can afford to have decent private rooms with private bathrooms (the way they exist in other public hospitals in various countries, and some hospitals here), respect women's privacy!

keep the goddamn curtains closed, which allow them to have a partner, at least someone fit enough to go and grab water/ food and lift the baby when the mum can't even do that.

The fact that having water and food is considered a "luxury" is unbelievable.

Great post redtoothbrush.

I agree with others saying that wards should be appropriately staffed and managed so that it isn't necessary to rely on partners for nursing however, even if the staffing issues are resolved some of the most vulnerable and traumatised women in particular need their partners there with them for emotional support. My husband being allowed to stay was the only good thing about how the postnatal ward we were sent to was managed, I would not have coped without him.

Completely agree with the people who are saying that postnatal wards need to return to a nursing philosophy. Postnatal women have experienced some manner of physical trauma, some amount of blood loss, many of them are recovering from anaesthetic. Few of them are completely fit and well, so they need nursing support to meet their basic activities of living.

I've talked to a lot of midwives/student midwives about the difference between nursing and midwifery. They tell me: midwives don't look after people who are unwell (it's a huge faux pas to refer to mothers as "patients"), and midwives have more autonomy than nurses.

There was a long political struggle to create direct-entry midwifery. They're very keen to maintain the distinction, so constantly repeat that nursing and midwifery are completely, totally, 100% different careers. Which is all fine, until a previously self-caring woman experiences childbirth, and then needs nursing support to meet her nutrition needs, or elimination needs, or to maintain her skin integrity after anaesthetic.

And, of course, postnatal wards are gravely understaffed. With the best will in the world, unsafe staffing ratios will always compromise patient (sorry, mother-infant dyad) care.

I can't really wrap that up into a neat suggestion for service improvement. The main thing is probably appropriate staffing for the acuity of the patients -- and recognising that acuity.

Red yes yes great post

But again all the issues here are not difficult or cost millions...

What does it cost to have a full water jug with ice in by every bed?

What does it cost for a nurse to help a patient to the loo or bring a cuppa? Or make toast?

What does it cost to empathise, listen, support?

What does it cost to know when a woman delivered and let her sleep on?

What does it cost to produce a ward guide?

What does it cost to ensure visitor numbers are strictly controlled to allow women to rest and have privacy?

Nothing! As s nurse in the 80s this was generally provided and trust me there were no where near the amount of staff I saw on my dils post natal ward.

The problem is training and not staffing or money.

clock honestly I saw far more staff on the ward my dil was in and my mother was on this year than I ever had on my ward back in the 80s.

I totally totally agree that direct midwife training is disasterous. By default a midwife in the 80s was a trained general nurse in all areas with st least 18 months experience before being accepted for midwife training.

Patients can become very unwell following even a straightforward birth and need very careful management and care

@RowanMumsnet - it seems that there is an issue emerging here, that needs to be stressed in the campaign - the necessity for nursing care on post-natal wards, and the fact that midwives no longer get any nurse training either before or during their midwifery training.

If a woman arrives on the post natal ward healthy, after an uneventful labour with no need for intervention or anaesthetic (epidural or general), she may well be able to care for her own hygiene, nutrition and hydration needs.

But many women will arrive on the post natal ward needing proper nursing care - after a C-section, is the single biggest one - it is major, abdominal surgery, and anyone who says that someone does not NEED proper post-operative nursing care after a C-section is an idiot!

A woman who has had an epidural will also need additional care whilst it is wearing off. If she stays in one position too long, she will develop pressure sores. She won't be able to get out of bed to go to the loo, fetch a drink or a meal, or go to her baby.

Any woman with stitches, be they in her abdomen after a section or her perineum after a tear or episiotomy, will need proper wound care.

At the most basic level, every woman on the post natal ward will need proper nutrition, hydration and rest - and it should be the responsibility of the midwives to ensure they all get them.

What does it cost to have a full water jug with ice in by every bed?
What does it cost for a nurse to help a patient to the loo or bring a cuppa? Or make toast?
Toast and water are not free. Yes they add up to quite a lot over the course of a year.

What does it cost to empathise, listen, support?
What does it cost to know when a woman delivered and let her sleep on?
Staffing levels need to be better to enable an environment where staff have the time to check notes properly and not be stressed out to the point that staff are suffering themselves.

What does it cost to produce a ward guide?
Having worked in printing and done work for the NHS. Quite a bit. Each hospital has a different policy. That means someone to write up a policy, get it approved, liase with someone to get the message across to the public (web or print alike), design that medium, then get that medium up and running and then promoted and distributed within the hospital to patients. For each hospital.

What does it cost to ensure visitor numbers are strictly controlled to allow women to rest and have privacy?
Some women need visitors for their emotional wellbeing. Not as simple as strictly enforcing a visitor policy. Mainly because they easily become draconian as not all families are straightforward. I still have issues with Bounty being allowed under any circumstances as I don't think it consistent with NHS objectives. There is a danger that the likes of them would end up with more access to patients than relatives might.

This is where we are at. Most issues would be much better simply with more staff. There is a real fudging on how numbers of staff are being reported trust by trust to the CQC too. Many Trusts are applying their own way of measuring this to make them look a lot more favourable. This means that midwife staffing levels are not transparent or properly accountable.

In addition to this, the formulas for calculating the number of staff a maternity ward needs, doesn't always reflect the level of need of the patients. Some hospitals have much higher need patients which has a knock on effect to other patients. Just saying there is X midwife ratio doesn't rate the level of demand and whether the two match each other.

I've seen some really dubious reporting by Trusts on CQC reports. But the CQC is itself under pressure, under resourced and lacks the teeth to really get to the bottom of issues.

Bottom line always comes back to political will and the lack of political pressure for reform and improvement for maternity service to reach BASIC levels. Women are their own worst enemy in this by trotting out the 'no money' shit in defence of poor attitudes to maternity. Women have to 'suck it up' because they are almost conditioned that this is acceptable.

Until maternity is not treated as somewhere where women are demanding and the rights we already have are taken seriously by various politicians and health care groups and has a serious lobbying power behind it, nothing will change. (Thank you MN for trying to step into this void).

Things that don't cost must, actually need more money than you think to enact and as I say, are connected to wider issues over crap provision of services.

Toast and water are not free. Yes they add up to quite a lot over the course of a year.

then maybe we shouldn't provide "free" medication either, and ask the patient to pay for them in advance. Or maybe we should just scrap hospitals all together, what a huge saving that would be.

I don't want you to feel I am having a go at you, but at the way things currently are. Patients are made to feel they are a burden. How did we end up in such a situation?

When I was on postnatal, I saw two qualified midwives and one support worker to manage a 28-bedded ward, which obviously gives a total of 56 patients if there are no multiple births, no babies in SCBU, etc. And presumably quite a few of those were on regular obs, regular IV antibiotics and other time-intensive therapies . . . not to mention the genuinely daunting amount of paperwork required in healthcare today, particularly in obstetrics, since it's such a high-risk area for litigation. There may have been other staff lurking in the sluice or something, but I never encountered them (oh, one other lady did come around with a tea trolley. I don't think she was wearing a uniform, so she might have been a volunteer).

I don't know loads about staffing metrics, but to me, that was not adequate.