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

i think for me the biggest thing that should be done is to make training as a midwife/hca easier to access. when i had my dc (1999,2001,2005,2006) i noticed a very distinct lack of midwife and other professionals who were parents themselves. i think by making it easier/cheaper to train for these roles, more parents would be willing/able to do it after completing their own families, and this would lead to much more empathy being given, and the standard of care rising because the staff know whats happening and have been through it themselves. i will use myself as an example here, i had my children young, i was almost 18 when my first son was born, and have had 3 more since. now, i am a sahm with 4 children all out of primary school (almost, the youngest leaves primary this year), i am about to turn 36 so realistically i could be working for another 30 odd years. i would love to train as a midwife but cant afford to, but having been through giving birth several times (and inductions, post natal wards etc), i will be more able to sympathise what new parents are going through, and help in a caring and efficient manner. i think this would make a massive difference to be honest.

I didn't even get the tea and toast that everyone on MN had raved about after having DS! Didn't occur to me as unusual at the time, I've never been in hospital before and had brought snacks and everything I would need anyway. The food lady did come round to take orders for meals but they took ages and just skipped you if you were asleep, didn't come back or anything.
But the other people on the ward were so inconsiderate, literally talking on the phone all night so odd. You don't really want to use earplugs in case you don't hear your own baby!

I had the last three babies at home but in my final pregnancy there was a complication and I had some time in a teaching hospital whilst pregnant, in an ante-natal bay surrounded by post-natal bays. Here were my observations.

1. The UK midwives were pretty indifferent and unhelpful, largely parking themselves behind a reception desk and moving from it as little as possible. The overseas midwives on the other hand were much more competent and compassionate, and anxious to make sure everyone was comfortable, rested and properly fed. They also smiled more. The UK nurses lost my notes and scan pictures. This didn't seem to be an issue to them.

1. There was a 24h fridge with a choice of sandwiches, fruit and yoghurts, cartons of juice, and a kettle and toaster with supplies, so you could make snacks whenever you like. This was a good thing, although many of the sandwiches included things you are not supposed to eat in pregnancy like pate and soft cheese. The trolley meals during the day were a bit limited and 1950s-style, elderly pensioner food. Salad was strictly rationed, difficult if you come from a culture like me where you practically live off it and have one with every meal as a side order (this was disapproved of heavily by the NHS salad police and each salad box had a warning sticker prohibiting such outrageous indulgence).

1. There were several women in labour on the ante-natal ward every night and they groaned and mooed behind curtains for hours. Their menfolk came and went throughout the night. It all seemed pretty undignified. I did feel there should be more single rooms for early labour. Someone started having a more dramatic labour at about 11pm one night, making noises and movements that sounded (to me) like she was building up to transition, and I had to step in as birth attendant as there were no midwives to be found. Luckily I didn't have to deliver her baby as one of the other mums managed to hunt a midwife down in the end and they whisked the mum off somewhere rapidly. I expressed disquiet at this but was fobbed off. Eventually one of the overseas midwives apologised and said it never should have happened.

1. There was a fabulous breastfeeding-friendly day room with rocking chairs and drinks and TV/magazines and it was a very popular place to hang out as it was so nice. I am sure this will have got feeding rates up.

1. The ward was too hot for absolutely everyone. There were no duvets like in German hospitals and the sheets had shrunk and didn't fit the beds properly, so you fought with bedding all night. There was an official pillow shortage.

1. I thought the ward was nicely decorated and they had made an effort, but there really wasn't enough privacy or provision for family members to be with people in difficulty without disturbing other women.

1. DH said it felt very 'pink', the entire hospital, and an alien space where men were tolerated but not really supposed to be. I told him to get over himself. I see his point, but then again it should be bloody pink as we are the people having to do the deed with them getting all of the benefits with none of the pain.

Overall my time in hospital was great, and the pn ward not as bad as I was expecting. But I was surprised by just how crap the food was having just been told by MW about how I must eat plenty of fibre. Partner went straight out to supermarket.

Nursing care skills and philosophy MUST be brought back into midwifery. Women are not getting nursing care when that is what they need.
OR, as with St Michael's hospital in Bristol, employ registered general nurses to manage and deliver the mothers' care needs (pain relief, washing, eating, constipation problems, catheter care, wound care, physiological observation to detect infection, DVT etc) thereby freeing up midwives to concentrate on supporting breastfeeding.
Midwives have no professional interest in postnatal care apart from when there are 'interesting' complications such as postpartum psychosis. They are not trained or culturally shaped to be nurses.
I speak as an ex nurse who until four years ago worked as part of an obstetric theatre team so had lots of close contact with midwives, pre and post natal women.

To address @SexualFlexual's point about the burns risk from a food trolley - there is a middle ground. When I was on the post natal ward with ds1 (who turns 24 this year, so quite a long time ago, I accept), there was a day room where all the women who were up and about, went to get their meals - the trolley could be parked outside such a room, and meals served from it. And women who couldn't get out of bed could have their tray taken up the ward to them.

This relies on communication - we all knew when the meals were served, and were called down to the day room for them. It also relies on the nursing staff accepting that, if a woman cannot get out of her bed, for whatever reason, it is part of the nursing care to ensure that she gets her meal.

Or you could have a system similar to the one I observed in use at the Queen Elizabeth University Hospital in Glasgow, when a friend was on one of the adult wards. The trolley came onto the ward, but to a safe area away from the patients' rooms, and an assistant dished up each meal from the heated trolley, then trays were taken to each patient. It is not beyond the wit of mortal man to find a safe place for a heated trolley, where no mums or newborns will be at risk of harm.

From accounts I have read on here, one big issue seems to be that many midwifery staff do not consider themselves to be nurses. I have read accounts of the lack of care women who have had C-sections receive, on some wards. The mantra of 'childbirth is not an illness' being trotted out (if I recall correctly) - completely ignoring the fact that a C-section is major, abdominal surgery, and that a woman who has had such surgery NEEDS certain care - and if the midwives are not going to give it, who is?

I may be considered old-fashioned, but I would like to see a return to the days when I trained - when visiting hours were limited, and where Sisters/Charge Nurses/Ward Managers had the clout and the courage to deal with too many visitors, visitors who stayed too late and visitors who were making life miserable for other patients on the ward. Tablets and smart phones exist - we can't change that - but people visiting any ward need to remember that the patients are there for a reason, and need rest and peace, in order to recover - and if they can't realise that on their own, someone needs to remind them - and needs to throw them off the ward if they can't or won't have a bit of consideration for others!

I trained in the last days of the battle-axe Sisters. It was quite scary working for these women, because you knew they had high standards and if you didn't live up to them, you were going to get a bollocking - but the care their patients got was second to none.

Of course, it helped that, in those days there were more staff on the wards - partly because the student nurses did most of their training on the wards, so there was a bigger workforce, and partly because this was before the worst of the healthcare cuts. Nurses and midwives now have the double whammy of having a much bigger professional role - more responsibilities than nurses in my day had - whilst having fewer of them to do all these extra jobs.

So staffing is a definite issue - at the very least, there need to be more HCAs on maternity wards, who can help women with caring for themselves and their babies.

I had an emergency c-section at 31-weeks and so was on a post-natal ward whilst my son was on SCBU.
I remember a nurse and a health visitor coming round and demanding to know "where's your baby?". I was otherwise ignored because I didn't have a child with me, whilst the rest of the bay was packed with celebratingnew Mums and their extended families. I'm ashamed to say that with hormones raging I hated them all at that time!
I complained to the hospital and had a meeting with the matron a few weeks later about allocation of SCBU bays or private rooms for people in this situation.i couldn't let anyone else go through that.

I think the care between generations has changed massively. I was admitted the night before my c section, given a sleeping tablet after a warm bath, slept like a brick and woken at 6am to get ready for theatre. After baby was born, I had a bed on a 4 bed ward with massive amounts of space. Partners were allowed 9am to 9pm, all other visitors were 3 -4 pm and 7 - 8 pm and it was very strictly adhered to. HCAs were on hand to help with babies and mums - meals and drinks were brought to you, and the midwives happily took babies off mums at 10pm so mum could get some sleep. Bathrooms were constantly being cleaned, there was a full time cleaner on the ward. It sounds blissful looking back.
When my DD had her last baby, it was horrific. She had to wait in a corridor for 14 hours for a bed, was induced at 4am, had the baby at 7am (she did rapid labours) and discharged by 9am. She was shaking like a leaf, could barely stand and was wheeled out to the door for us to take care of. She didn't even get a cup of tea; she was supposed to have an anti D injection (she's rhesus negative) and had to go back in 2 days later for after persistent follow up by her DH. Baby wasn't checked by a Paed, and was only given her first proper check up at 6 weeks by DDs GP. What a system . Mums don't even get the most basic of medical care anymore, let alone help and support.

I'd also like to see midwives doing training exercises where they go through the patient's experience - actually see how it feels to be in a gown on a labour ward confined to bed, dependant on others to help you. Listening to mobile phone calls in the middle of the night instead of sleeping. Listening to the midwives giggling over cake at 2am at the desk, bitching about previous patients.

After a long labour and then an emcs, I got 3 meals in 3 and half days postnatally (one of those was the tea and toast in recovery). Ds was in NICU and time just flew down there.

Having some food kept on one side for me would have been amazing or the option to order in advance.

I also managed to miss all the drug rounds, mostly because I didn't know they were at set times. Luckily I didn't need anything but I'm pretty sure I'm an outlier in that regard.

Also asking me if I'm a victim of domestic violence in front of my MiL and DH is totally unacceptable regardless of how supportive they seem.

I'd have liked a card which explained the rules and what to do.
And have one for if your baby is in NICU/SCBU - and a bit of compassion for not having your baby with you. I'll never forget wobbling up the corridor, holding onto the handrail in the middle of the night to get to SCBU so I could take the milk I'd expressed to ds - I'd lost a lot of blood, hadn't eaten for 48 hours (no gluten free food unless you went 4 hours before every meal) and no one would take me to see him, or put my milk in a fridge for me.

I'm going to go slightly against the grain and give a huge well done to the RLI at Lancaster. I had DS 12 weeks ago, everything that could go wrong did go wrong during labour and I ended up with a crash section BUT at every stage the care was fantastic.

DS was on neonatal for a week and I was offered a private room so I wouldn't be upset by mums with their babies. Pain relief brought regularly and topped up if needed. Always someone around to wheel me down to neonatal - the midwives banned me from walking down by myself for 3 days. If I didn't show up collect food from the day room someone came to find me and see if I needed anything. Water jugs brought round every morning and topped up after lunch. Breastfeeding support was consistent and easily accessible. Everything clean. I just couldn't fault it, so perhaps looking at places like Lancaster and sharing best practice would help - a sort of gold standard framework?

My daughter was born via a lovely and straightforward waterbirth last year. Well equipped shiny ward. I stayed an extra night as they wanted to be sure that there was no group B strep (I had tested positive earlier in pregnancy but there was no time for antibiotics at birth). I had a private room, a button to call midwives and I had food brought to me. It was lovely and chilled. I am based in Wales.

Staffing ratios on the ward need to be calculated by considering both mother and baby as patients. So if mother is not well enough to care for baby or (shock!) needs to just rest after giving birth, midwives have capacity to care for baby.

That is a good idea daisygirl , it sounds like a fantastic experience! Since they are all NHS it would be lovely if they could discuss with other hospitals that have low ratings and try and help change procedures. The standard of care should be higher across the board and although it's different, I do think as have seen another poster say on a thead about childbirth, that with midwifery you are so much more at the whim of what your particular midwife thinks and what her standards are in regards to care, and this should not be the case.

The culture of post natal care has changed.

Before, to become a midwife you had to do your nurse training, then midwifery training. So all midwives had worked on general wards and knew how to look after sick patients.

Now with direct entry training midwives are not nurses. Midwifery training is emphasises pregnancy/childbirth is a natural process. So post-natal mothers are not ill.

I was old school (am retired now) and believed that new mothers needed mothering/caring/nurturing themselves.

Staffing levels are also appalling now, one midwife for 24 mothers and new babies. How on earth can good care be given? How on earth can any care be given?

@JaneEyre70 your daughters experience sounds totally shit and certainly not uncommon. However it's not universally bad out there either and as Justine says the majority rate their experience as good or ok.

I'd have massive issues with being given sleeping tablets and babies being removed to a nursery at 10pm though! Glad things have moved on a bit since you had your DD.

I too think the staff need to put themselves in new mothers' situation. With my first I was dumped on the ward in the middle of the night, my husband had to leave, and then I was left alone with a baby with really no idea of what to do with her! Just a 'your priority is to get the baby to eat something' would've done.

There was nowhere to change a baby's nappy. Seriously. You did it on your bed, which by the time you left was covered in blood, baby poo, baby sick, and whatever crumbs of food you were allowed.

Also having to ring a bell and wait to be brought stuff like water is insane. I was so thirsty post birth but I was also completely able-bodied and wasn't allowed to fetch my own water!

Cleanliness is a real issue. The place is never really cleaned, just wiped over with a damp mop. Gross.

They should get teenage girls to volunteer/ get pocket money to fetch and carry for new mothers on post natal wards. It would bring teenage birth rates right down.

I was in an extra day because there was another woman on the ward with the same (common) surname as me and they accidentally discharged her instead. I understand these wards are busy and priorities ever-changing, but someone else could've had that bed. Extreme lack of organisation.

Being able to make a phone call at any time of the day or night to tell your DH that you've given birth. I gave birth at 1am and wanted to phone DH to tell him we had a son, my mum had said she would ring but I wanted to do it so told her not to, as the midwife had said when I get to the ward I could use the phone. When I was taken to the ward, the nurses there wouldn't bring me the phone and I couldn't get up, so he didn't know until much later that DS had been born. (This was before I had a mobile phone). However, being given the opportunity to make the call wouldn't have taken any staff off whatever they were doing, but would have made a huge difference to us.

Also forgot to add that my baby was taken to the SCBU and I couldn't even tell DH that, or spend my time on the ward before the phone call enjoying my new baby because he was poorly. So that phone call was really important- looking back I should have just let my mum go ahead and call him.

Bringing new mothers breakfast.
I had had nothing to eat in over 24 hours after having dd. I couldn't feel my legs when breakfast was served and you had to go to the other end of the ward for it.
The midwives just told me to go get it when I could. I couldn't. I got nothing to eat until that evening as there weren't enough lunches to round and I was supposed to be going home. I didn't get discharged until 6pm as there wasn't anyone around to do the checks until then. My DH had brought some snacks in the vending machine but I wanted food.
The midwives made jokey 'you're not eating for two anymore' comments and if I hadn't been so pain filled, traumatised, exhausted etc I'd have seriously lost it.
I went home and ate for the first time in over 36 hours and I don't think I'd have felt as bad as I did if I had been given something to eat.

Noise management would be amazing. The amount of loud phones and family members making a racket was awful and kept waking my baby up.

Also, someone to offer general support. I spent almost 2 days non stop crying as I was exhausted, struggling to breastfeed and generally overwhelmed and I was offered zero support. I would rather labour ten times over than spend 1 day in a postnatal ward again.

All the call buttons and bed side lights should work. My only option was to move beds in the middle of the night (had a cs so that was difficult). Then none of the nurses and doctors could find me in the morning. It's surely basic maintenance.

We do get food and water delivered to our beds in my hospital (great). I don't think I could have eaten otherwise, I was bedbound. But there's nothing after 5pm until 8am, which I'd find a struggle anytime, not least when I'm trying to breastfeed an enormous newborn every two hours through the night. Glad I brought snacks.

I had a catheter and obviously no experience of this before. I was told I had to get up and moving and get to the toilet so I dragged myself out of bed, catheter and blood came out. I buzzed for help and was scolded for getting out bed without getting them to remove this first. How was I supposed to know this? I was already vulnerable and could barely walk. This added unpleasantness wasn't necessary.

None of the staff told any of the women where any of the baby supplies were - cotton wool, little foil tins for water for cleaning baby etc. I saw each woman arrive and be confused and mildly distressed until the other women on the ward advised them.

You had to leave your baby unattended to go get meals. It went against all of your developing motherly instincts. And most mothers had mobility issues: it was like the Walking Dead!