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

@Oneiroi - genuine question. Speaking from your own experience, what would help women like you if their partner could not be with them - if they had to care for other children, were unavailable due to work (Forces etc), illness etc?

I absolutely understand that, for many women, this would be their worst nightmare - but it must happen sometimes, so what else could hospitals do, to try to make things a bit better?

Apologies Gin, I got confused because you joined halfway through a conversation. I have gone back to check and it was Three who, because I said women should have the choice to have their partners with them for support when they feel vulnerable, said I should "have some compassion" for rape victims, having clearly not read the thread and realised that I am one. I responded to Three pointing out how ridiculous that was and that her comment was absolutely lacking in compassion to me and many others like me. You then told me I was "mistaking a lack of compassion for an ability to see that with care free at the point of need some tough decisions about what one person wants and what the majority need have to be made." Which, as I said, is dismissive of some people's needs and characterising them as mere 'wants', thereby implying these needs can be overridden by other needs. All women's needs must be met as the basic standard of care. This is the minimum we should expect. Anything less is unacceptable.

SDT that situation is so terrifying to me that I would do anything to avoid it. I would never have a partner in the forces because I need my partner with me for support, not away for months on end and unavailable for key life events like this. We had our baby a few weeks ago so if we have another we'll have to find a way to make sure my husband can be with me again. We have no family around who could look after him so will have to rely on friends for childcare I suppose so that my husband can be with me, and hope I can get back home with 24 hours again. There is mo way I could stay in hospital surrounded by strangers alone when I'm that vulnerable, with a newborn to look after as well. The talk of banning partners terrifies me. I also found it hard there being so many people around but I needed my husband there.

The obvious answer seems to be bringing postnatal services up to an acceptable standard for a developed country, with private rooms as a minimum and ideally the 'maternity hotel' model operated across most of Europe, where the whole family can stay if they wish, in privacy, but with medical and nursing help available as needed. There is no reason we should accept substandard care and the unworkable compromises that posters are suggesting when they can be so damaging to mothers, babies and partners, and cost far more in the long run.

I hope my question didn't upset you, @Oneiroi.

But people are trying to suggest compromises, One, and compromises that would mean women like you who need their partner there have that need met. But other women's needs for privacy and dignity and feeling safe by not sharing a ward with blokes they don't know at a vulnerable time need to be met, too - as they would be on any other ward that is not postnatal.

I think everyone would agree that individual rooms would be the best solution here, but we also need something that'll work on shared wards in the meantime. And for a lot of women - not you! But a lot of women - they would feel much better about not having their partner there as long as the hospital was providing adequate care and support. So many people on this thread and others have said "women need partners there because the care is inadequate". The solution to that is to fix the terrible care in the first place, so nobody's left unable to reach her own baby and care for herself.

SDT no, you didn't upset me. It's a valid question. But for me and many others there is no alternative that would be ok. In that vulnerable state I need the only person I trust by my side. The medical staff are strangers just as much as other patients and their visitors, I would not feel safe with them regardless of their sex if he was not there. I also think fathers should have some consideration. To deprive all of them whose partner needs to be in hospital of the first hours of their child's life seems utterly cruel to me, when there are obvious solutions that give everyone what they want without the need for this.

53 yes I agree, fixing the appalling lack of basic nursing and medical care will improve the experience for all mothers. My very first post on this thread raised exactly these points, as have many others. My objection was purely to the posters suggesting partners be prevented from staying overnight.

I've also, repeatedly, recognised that many women need a space without other people's partners, and that this need should be met too. But neither should be viewed as an exception. Both are perfectly normal. I would also rather have only my own partner and medical staff around and not have to be near to other people I don't know. The answer is so obvious, hence why it is standard practice is pretty much all other developed countries: private rooms. Some people have implied this is some crazy dream of utopia. It isn't. It's basic, decent care and instead of arguing we should all be working together to demand it.

I don't think anyone believes that no partners should ever stay under any circumstances, no matter what the situation is (and if they do then they shouldn't). Just that partners shouldn't be staying overnight as standard blanket policy, because on shared wards that means they'd be sharing rooms with women who don't want that.

Also agree that it's sad for new fathers to be sent away when they would have wanted to stay - I know my DH found that difficult. But they aren't the patients, the women are, and we need to get care right for the patients first.

Apologies if this is a bit stream-of-consciousness, but bear with me, it's late and I have spent the last hour rtft...
Presumably you'd generally have access to your own TV on most post-natal wards? My recent hospital experiences are limited to children’s wards and elderly care, but there’s almost always a TV and there’s usually some free hospital-specific content of some sort and sometimes fancy software for paid-for extra TV etc. Surely someone with a decent understanding of the technology could organise a way of accessing free videos via your TV specifically tailored to postnatal wards. If you’d just delivered DC3 and therefore didn’t need to be taught to suck proverbial eggs, well no one would force you to watch them. But more importantly you could watch what you wanted when you wanted to (obvs with headphones, if it was the middle of the night!!)
If you were struggling to breastfeed, or wanted a video showing how to bath/top and tail baby, or needed some tips on perineum care post-birth (a friend who recently gave birth and had a fairly shocking post-natal experience said no-one explained about jugs of warm water for when you go for a wee, and she’d never even heard of a valley cushion) then there could be videos for all the above. Get someone decent to make one good video for each subject (e.g. I’m sure La Leche League or NCT could do a better ‘breastfeeding tips’ video than a lot of midwives could, with suitable mums & babies to 'demo' possible problems and solutions) and you could roll said videos out to every ward in the UK with presumably minimal expense. I’m sure the hive mind of MN could come up with a good list of useful topics. I bet you could all offer constructive criticism on pilot videos too! A bf video could mention things like tongue-tie, which I imagine most young mums not on MN and struggling to feed won’t ever have heard of.
Anyway you get the idea. Taking it a step further (ok this would be trickier as it would be hospital-specific) you could do your ‘intro-to-the-ward’ as a video too, actually show people where clean sheets, feeding/changing etc. equipment is, have people modelling the different staff uniforms, explain what time meals are and what particular esoteric food rules that particular hospital has, blah blah.
Anyone else think it's worth exploring in a bit more detail? There is so much amazingly useful stuff for new mums on here that if it could be distilled into some cheerful, reassuring, caring videos it would be better than nothing. Goes without saying that more cheerful, reassuring, caring staff wouldn't go amiss, but that's kind of been covered here already.

bearfrills I like your idea of streaming for postnatal recovery. A lot of people just want to get out ASAP and are physically capable of it too.

I just worry given the lack of understanding, screening and recognition of mental health as important, that the straight forward simple FACT that the same birth can be shrugged off by one person, and be utterly mentally devastating to another, will be missed.....

perhaps a self-assessed streaming could work.

No TVs on my postnatal!

No telly on the PN ward I was on. Are the televisions charged for? It also strikes me that they'd need different videos for each hospital which would probably end up being produced by expensive promotional companies...

More substantial meals- I was offered tea and toast after giving birth and again the following morning!

More input from midwives not just monitoring but discussing how to care for baby and more feeding support.

more aligned care.
I missed a couple of meals because I was actually giving birth when the forms for lunch&dinner where given out. so when I was wheeled to post ward lunch was served to everyone but me - same thing for dinner.

@Oneiroi apology accepted.
I would never write something like that.

However I disagree that I was being dismissive of women who need their partner there, as I say if you'd read my previous posts I had said that accommodation needs to be metaphorically and literally made for them, but that not at the cost of having communal wards overflowing with random strange men. My comment about the wants and basic needs of the majority prevailing is inevitably a feature of care free at the point of need. Hence the saying "you pay your money you make your choice". The NHS can't please everybody all of the time so it needs to focus on getting the basics right for everyone. The basics right for everyone in terms of postnatal care is a safe, clean, peaceful, caring and clinically competent environment. The capacity and capability to accommodate every single women's birth partner 24/7 is not as essential for everyone so ergo more people will think this is currently a bridge too far given the state of things.

I still maintain that if postnatal care was as it should be then the need for partners 24/7 would be largely mitigated for in the majority of women's cases.

The thing is Gin I don't hold the NHS up on a pedestal like that. I think the system is inefficient, badly managed and generally provides pretty poor care in a much less timely manner than the systems operated across most of Europe, including the systems in many countries that are significantly poorer than this one. I have experienced some other healthcare systems first hand and have friends and family in a number of different countries and the care they provide (for maternity/ postnatal and in general) seems to be far superior. The argument that we should accept such poor treatment and be grateful for it is nonsense to me.

@Oneiroi I worked for the NHS for quite some time, and trust me I don't hold it up on a pedestal. It is failing. So when I write that they need to get the basics right, it's because they are not currently doing this. They used to, and the reasons behind this derailing are complex and complicated.

I am not suggesting for a minute we accept substandard care, far from it. The NHS might be free at the point of need but most of us on this discussion have paid considerable amounts of tax over the years to support it, so I'm not grateful. I'm often very disappointed and bewildered with it. Your experience of other healthcare systems will not have operated on an exact platform, model of scale etc that the NHS does, because in terms of size, composition, tumultuous change and delivery there is no model like it anywhere in the world, so I don't think compositions like that are helpful.

What I am saying is that we need to start with the fundamental aspects of postnatal care, and whether or not partners can be accommodated 24/7 is just not that.

@CommonScentsandNoAbility's idea of videos could work even where there are no TVs on the post natal wards, simply by making them available online, so women could watch them at home, before they have their baby - like an online version of the antenatal hospital tour, with added content about basic baby care, breast feeding, perineum care etc.

Actually - maybe MN could do the videos on baby care, breastfeeding etc, in conjunction with other organisations like the NCT and La Leche League - because all of that would be universally applicable.

Then all the local hospital would have to do is to add their own 'Tour of the Post Natal Ward' video, showing people where to get their meals, where the loo and shower are, and giving specific information about meal times, drug rounds, post natal checks etc - the stuff that is specific to individual units.

Quite a few hospitals already do those online video tours of labour ward. Adding one for postnatal would be doable surely. (Would need to be supplemented with info you can read/see when actually on the ward though - can't really expect women who've just given birth to remember what colour uniform is a midwife vs a HCA, etc.)

I like the universal cooperative videos online especially if they were accessible over hospitals WiFi. Technically a guest WiFi connection with a list of accessible sites is easy. And the supplemental laminated local info sheets to go with it.

Wow those of you dismissing direct entry midwives have you actually completed the direct entry course?

I trained as a direct entry midwife about 15yrs ago. There certainly was nursing experience as well as midwifery skills. We completed placements on icu, and general wards to cover the nursing skills. We also had placements on scbu and nicu to learn how to care for babies with additional needs as well as to see how the 'other' side works and the effects on the families with babies there.

Food certainly was provided for women visiting babies on special care wards. There is also a small kitchen with the facilities to make toast and tea and coffee. Not great as ideally a better range of foods would be avalaible but the crux of it is things like sandwiches and yogurts are placed in the open access kitchens they would be taken. If placed in staff only access kitchens that then required an already overworked staff member to be able to get the food for you.

There are such a diverse range of women on postnatal wards now. Women who have had normal no complication vaginal deliveries to women who have had crash sections, diabetes, pph the list goes on.

Midwives certainly are trained in how to take observations on women and babies. How to take bloods (lots of nursing counterparts weren't trained to take blood until late in training or even after qualification)

A large part of the problem I see is that people can't identify who does what. Especially in a culture of scrub wearing so all in light blue scrubs with Id badges not clearly visible. The wards are staffed by a large number of different workers, on the ante and post natal wards we had a nurse for drug rounds and to give care when needed, maternity care assistants, where even some of them had trained to take blood or remove catheters etc but others in the same uniform could only change sheets, help women to the loo, change baby etc. Then the level of the midwife. And then the dr/consultants who are in and out of the ward.

Perhaps I was lucky and the hospital I worked in and birthed my three children in whilst busy and understaffed the vast majority of the staff were kind and patient and capable and very hard working.

Food was available and water jugs given as someone else said it's very difficult to get an ice machine on a ward due to infection control, most meals except for breakfast served bedside.

Breakfast usually gave the care assistants chance to change beds and clean the bed area while women ate breakfast and also got people up and out of bed. Those that were bed bound breakfast is brought to them.

Re bathrooms I know they can appear to be gross but we're cleaned wife a day by the cleaner, but people/women need to take responsibility for themselves and whilst yes it's normal that women bleed after giving birth but it's a shared bathroom leave it clean after use. If you were home after and bled in the shower tray you'd clean up and not leave it for someone else?

Oh and having stayed on a non maternity ward just over a week ago I'd say the staff shortage was universal.

I received a blood transfusion and should have been home in 48 hours but due to staff shortages and the nurse having so many other patients to care for that often required more urgent care than my unit of blood needing changing I was in much longer.

The bathrooms had the same issues, people not cleaning up after themselves, small poo smear near the toilet roll etc. Which is gross, by should have been cleaned by the person who did it!

Also lack of access to food other than set meal times. Unlike the maternity wards there was no patient kitchen so no access to toast etc. I saw overworked health care assistants rushing around trying to get food brought up from the kitchen for newly admitted from a&e patients but without success or being brought up with the next meal trolley hours later.

It's the whole of the NHS that needs looking at and better funding and access to training. They've taken away the free uni fees now and charging £9000 a year to train. So they will leave with a lot of debt and a career that ultimately isn't going to pay overly well so that will put a lot More off of training.

Also the places for training are limited. There were 20 in each intake when I trained split between two hospitals I believe that's increased to 12 a hospital now. Due to the hours and lack of money while training the drop out figures are high. The people that I came across that quit training all said it was due to money and that was when you automatically received a small bursary for training and could apply for childcare funding as well.

"Re bathrooms I know they can appear to be gross but we're cleaned wife a day by the cleaner, but people/women need to take responsibility for themselves and whilst yes it's normal that women bleed after giving birth but it's a shared bathroom leave it clean after use. If you were home after and bled in the shower tray you'd clean up and not leave it for someone else?"

Maybe one of the reasons I'm still in hospital is that I can't clean up after myself.