To explain why postnatal care is so bad

[mwunderground]

Dear New Parents

Please don’t think I haven’t noticed you, sitting there patiently on your bed, pacing the corridors looking for me, pressing the call bell. I’ve seen you and I know what you want; to go home, some help with breastfeeding, some painkillers.
Your requests aren’t unreasonable, your expectations are not too high, this is the care you deserve and the care I want to give but let me explain why you won’t get it.

I work an 11 1/2 hour shift, pretty standard for most midwives, actually it’s 12 1/2 hours if you include the hour unpaid break. A lot of my colleagues don’t take it. I try to, you never get those hours back but when your needs are acute; your baby is sick, you are very upset and need to talk. I’ll skip it too.

In that shift I will look after 8 women and a varying number of babies. Some babies are in special care, some women have twins.
The ward is almost always full.

In that shift I will
-check all 8 women and record those checks. At 20 minutes each (and that’s very quick if the midwife is slow with computers or a woman is very complex) 2 hours and 40 minutes of my day is gone.

• do three drug rounds taking 25 minutes each time. If I’m lucky nobody needs IV medication or a medication I need to hunt for and I can make up some time here

• I’ll have 4 babies needing observations and blood sugars. 10 minutes each time, 3 times a day each, there goes another 2 hours. Let’s hope none of those observations are out of range and the blood sugar isn’t low. I don’t have time.....

-one woman with complications will need me to take her blood pressure, 5 minutes a time, 3 times a shift. 15 minutes not much but it adds up

• four women will want to go home. Sorting out their discharge, the paperwork, medication etc will take 30 minutes each, 2 more hours

-four more women will fill those beds, each of them will need 15 minutes for a quick check and for me to write up their admission

Nine hours gone, add another hour for hand overs, 30 minutes at each end of the day and that’s if we take just over one minute per woman (try explaining complex social or medical issues in one minute) and I have just 90 minutes per shift left

90 minutes for
-helping you with breastfeeding

• managing your pain when the standard painkillers aren’t working
• managing the baby who has a low blood sugar, is cold or sick
• getting help for the mother having a mental health crisis

And for the mundane, calling a porter, using the loo, dealing with the broken computer and other equipment....

It’s crap, I’m sorry, Its not the care I want to give, it’s not the care you deserve. I go home feeling guilty and knowing that it is surely just a matter of time before something goes wrong.

This isn’t a call to arms although maybe it should be. It isn’t even a request for sympathy or to stop asking for what you need because you should ask and you shouldn’t be giving me sympathy. It is simply an explanation. So when you see me rushing past and telling you I’ll be back in a minute, you know; I don’t want this, you don’t want this and I’m honestly really really sorry it’s that way.

Yes to what you described.
I was a midwife, and it's one of the reasons I gave up-it felt like I just couldn't give even basic care!

I've recently had my first DC and it's horrible from this side too. Even with my past and experience there were things I needed help with. I ended up self discharging!

In our area its not midwives on postnatal wards. Is it the best use of your time to be doing BP and pain relief? Maybe you could get your area to see if they are deploying resources to best effect. I'm really surprised by your post, but then I suppose we never know really outside our own experience.

From a parent, I completely understand - I thought my postnatal care really wasn’t great but not for a second did I think the people working on the ward were at fault. It’s clear to see how busy you all are and that there’s just too much to keep on top of. You’re doing an amazing job with the time and resources you have, it’s definitely appreciated

I work on a paeds ward and it's the same. I will have up to 10 children to look after. Some need IV's, some need tube feeds, at least 2 will be for theatre, obs will have to be done hourly, 2 hourly or 4 hourly. Inhalers and nebs will need to be given 1 hourly, 2 hourly or 3 hourly or 4 hourly. Ward round takes 30-90 minutes depending on which consultant is on and how complex the children are.
Take home meds need to be ordered. Ward meds need to be given.
Fluid charts needs to be updated.
Blood tests need to be done.
Discharges to be done, new admissions to be completed.

There are simply not enough hours in the day to give the care we want with the staff that we have.

I’m so sad midwifery has come to this. I had my first dc 13 years ago and the ward seemed understaffed at that point, both the labour ward and the post natal ward. The midwives has no-time to sit with me and help with breastfeeding and the whole experience wasn’t great. When I had dc 2 and then 3, I had home births. The midwives were great and because I had no expectations of post natal care ‘on tap’ I got what I expected.
I feel so sorry for midwives who are doing their very best but are being let down by a lack of funding. NHS staff are hero’s, working long shifts, often with no breaks and with understaffed wards. I don’t know how you keep going, I really don’t. But thank you for each shift that you do, you are doing the best you can in a really bad situation.

Yes it is an utterly rubbish, about to go through it for the third time and dreading the postnatal bit more than the birth, and that is at one of the best rated hospitals in the country.

I find it interesting that the most commonly used areas of the NHS are those that seem to be the worse resourced, ie maternity units, emergency care, and GPs. All are appalling really. The people who seem more pro NHS tend to be the ones with more serious issues, those who have survived cancer etc.

But as pp say I don't blame me the individuals who work in maternity wards, they generally seem very busy. However, I agree that midwives shouldn't be doing everything, much less qualified nurses can do alot of the tasks listed above, so that particular hospital is making poor use of midwife skills.

Can I just say thank you, thank you for what you do, for the kindness and the unwavering smiles you give your patients, for not letting us sat on the ward know how stressed you are, how much tail chasing you're doing, how hectic the days are.
I had my son in July and the midwives were amazing, clearly busy, definitely friendly and never rushed or were brisk.
So thank you.

Thanks for this, i could tell how hard the midwives worked on the pn ward. Thankfully i didn't need much extra help, and the only time i did was in the middle of the night and a truly amazing midwife stayed with me (while i was crying and baby was losing it) to calm my baby and get her feeding for absolutely ages and I'll never forget it. Truly incredible.

The thing is, I dont think anyone doubts how difficult being a MW is. We all know the NHS is struggling.
My DS was prem, and was whisked away from me within minutes. No one explained what was wrong with him. I thought he was dying and no one was there to tell me he was 'just' jaundice and the reason he was on the red ward in SCBU where the really ill babies were was because there were no beds in the blue ward for him.
When I asked to be taken to him, the nurse asked me where he was. I had no idea. I burst into tears. What sort of mother loses her 2 hour old baby?!
When I finally got to see him, I tried to reach into the incubator to touch his hand and was shouted at. Only parents can touch. I was the parent. Oh, go one then.
I was too scared to touch him after that. I didnt for 2 days. I sat by his bed while he was surrounded by lights for his jaundice, too scared to touch him and convinced he was dying. When he was finally moved out of SCBU and on the normal ward, no one explained how I was supposed to tube feed him. I had been milking myself silly for him but apparently no one knew so he'd been on formula since birth.
Nearly 3 years on and I have no idea why he was prem. I'm too scared to have another baby.

Most of the midwives were amazing, and you could tell that although they were frazzled they did everything they could for me and baby. A few though were horrible, they were probably shattered and stressed, but so was I, but it's a travesty the government has let it get this bad, for the sake of MWs and patients.

It is outrageous though, what do you think word help? Is it really as simple as they need to put more money in for staff to decrease the demands on individual midwives? Maybe broaden the entries to midwifery so people who are capable, dedicated and passionate can afford to do an access course etc? More MA's to do obs etc as well as the fantastic work they do now? Reimagination of places to give birth etc?

Sorry you feel this way, must be tough and frustrating.

My baby was born last year on what was the busiest week of their year so far (end of November so a lot to choose from!). The staff were busy, the queue for the delivery suites was ridiculous (people were giving birth on the induction ward, I personally waited 3 days for a space and only then was queue jumped because my waters had broken 24 hours before) and the post natal ward was jam packed.

But the care I received was absolutely amazing. From the midwives monitoring my unproductive induction, to the midwives (I had a couple of shift changes!), obstetricians and paediatricians who dealt with me during labour and birth and the midwives, MCAs and volunteers who helped on the post natal ward.

Every single person we encountered provided impeccable care, and the little bits didn't go unnoticed, in fact they meant the most. They really went above and beyond. I was stuck in hospital for a while and towards the end of my stay, having had zero sleep I was on the brink of falling apart. The midwives fought my corner (another department monitoring me due to an existing condition was holding up my discharge), they rearranged the entire ward in an attempt to enable me to get some sleep, they looked after my baby so my husband and I could go for a coffee together in an attempt for me to regain a small amount of sanity, and I regularly had a cup of tea delivered with a chat in the early hours of the morning.

The postnatal ward in particular was hell on earth for me, but the staff were incredible.

My DM is a midwife and feels much the same as you. She keeps going and cares so deeply about every woman she meets but it’s clear that there are not enough staff to do all the jobs that need doing and also that the amount of paperwork now involved is ridiculous. The paperwork aspect sounds like the same mostly pointless paperwork I see teachers on here complaining about.

Meanwhile, due to my DH’s job opportunities and one earlier than planned labour, I ended up having each of my 4 DC in 4 different hospitals. 3 in England and one in Scotland. By far and above the best post natal care I experienced was in Scotland. This was about ten years ago so I’m not sure if it is still the same now but on the Scottish post natal ward where I had to stay a week due to complications, they had midwives, nursery nurses and really great hca’s who were good at making sure I had all of my meals and that everything was tidied away really quickly. The nursery nurses walked around helping with breastfeeding and bathing and the midwives were seemingly free to do all the health and pain relief jobs.

I often think it’s a shame that model isn’t available everywhere.

@Biancadelrioisback what an awful experience, sorry you went through that I don’t think I’d have coped well in a situation like that.

I hear you OP. You have listed many of the reasons why I hated my postnatal placement when I was a Student MW and eventually gave up the profession shortly after qualifying (some of the reasons, not all).

To posters above who also think that registered MWs needn't be doing tasks such as BP; I disagree. These observations are the bread and butter of anyone who works in healthcare and our physical evidence of how a person is from a haemodynamic POV. At the very least these results will need to be escalated to to a qualified nurse or midwife; however it can be argued that being physically in front of a person can also give us information that observations can't- a subtle change in respiratory rate/depth/ pattern for example can be the first signs that someone is becoming unwell. Also, not taking anything away from our wonderful healthcare support staff the qualified staff members will have professional responsibility for that person and whose registration will be at risk should anything go wrong. Lack of recognition of acute illness has been shown to be a factor in maternal mortality and morbidity in the UK. So yes, I would argue that at least 1 set of observations each day needs to be done by the registered midwife overseeing their care.

I was so lucky with my 2 baby's- I feel I received exceptional care throughout my whole maternity journey, or it could be because I'm mostly on the other side I had more realistic expectations. Yes, its frustrating when you just want to get home and you're being delayed by paper work, medication delivery etc but as most people do seem to acknowledge people are generally, for the most part working really hard and are as just as frustrated with the current situation in the NHS as anyone else.

Postnatal care is rubbish because midwives are so stretched and there isn't enough staff/money and the NHS is on it's arse.

Every MW/HCP I saw in the time I was in absolutely cared and really tried for me but they didn't have the time to be able to dedicate to making it pleasant.

Postnatal care is a conveyor belt and something to endure.

Thank you OP and all other MW/HCP who are doing an awesome job.

It doesn’t sound like a good system at all, for women or for health care professionals.

I had only the vaguest of ideas that post natal care was even a thing when I had my first baby. I didn’t know to ask for it, so in the event I ended up with zero postnatal care. It’s odd to think that that can happen in 21st century Britain, especially when I look back now as a much more experienced parent.

I think part of the reason post natal care is bad is because it affects women. If it affected men I honestly believe it would be different.

I looked after myself post natally in hospital but I dread to think what would have happened if I was unable to. The midwife who did my stitches was awful. I was unable to speak due to being overwhelmed and was shaking. She kept saying "ugh I hate doing these" and it made me feel inhuman.

This time round I'll be taking pain killers, food and drink with me because there's no chance of getting them there.

I manage a care setting so understand it isn't the staffs fault at all. However if we treated service users in that way we would be (rightly) safeguarded and possibly shut down.

Thank you OP for being a good, caring midwife. It's a shame a few midwives don't have the same empathy and kindness. But us patients know it isn't your fault. I'm sure there are some who are unpleasant to you though! for you

Yeah post natal care is really poor. Next time I'm self discharging straight after.

When I had DC1 I was very impressed with all the medical staff I saw. They are obviously all run off their feet but genuinely seemed to care and I never felt fobbed off or dismissed by any of them. I take my hat off to midwives/nurses etc who work such long shifts with so much stress and so little thanks. They do an amazing job.

Bianca I'm so sorry that's awful, the whole thing.

I'm really surprised that midwives are on post natal wards in so many areas. I had mine 12 years ago and lost natal was health care assistants and nurses (maybe specialised I don't know). I mean probably the midwives came sometimes to see people but generally they weren't providing the care.

I mean it was still terrible though.

As much as I agree with the midwives being stretched. I know they are tired and I know how hard they work but some. Not all. Are just so damn rude and miserable.

I have been lucky with all 4 of my births and not really needed any after care. Only with my 4th i asked for ibuprofen before I started feeding because the after cramps were like labour and I just wanted something to help even if it was a placebo like effect. She rolled her eyes. Sighed, tutted and then left me for 30 minutes then came back and gave me the ibuprofen. By then I had already fed and was in awful pain. If it was rammed i would understand. There was only 3 of us there! And they had partners with them. I was alone as dh was with the other dc. Not their problem I know. But I felt like an inconvenience. I wanted to go home straight away but they stopped me coming in. My waters broke and my contractions stopped for 32 hours I had no water. My own midwife called me and said I've told them they must induce you now.

Well that was also an inconvenience for the midwife on the ward. Lots of eye rolling. I didn't complain. Didn't ask for help during labour etc tried to be a good a d easy patient but no.

She also didn't believe me baby was coming and sighed let me go to delivery. Baby cake 10 minutes later as I walked into the delivery suite

I have met some bloody amazing midwives and some that just shouldn't be in that line of work

I agree that is a lot of work but perhaps the issue is that perfectly healthy mums and babies are on the ward at all? I certainly did not need that noisy, chaotic postnatal ward experience, I asked to go home and was told it was hospital practice for first time mums to stay at least one night. The following morning I self discharged despite being told to stay a further night - my community midwife came to my house to establish breastfeeding etc whereas in the hospital the midwife suggested a bottle if I was struggling !

Hospital beds should be for sick people/recovery from surgery not what we were built to do, keep the postnatal beds for complications

As much as I feel for midwifes, I am terrified of giving birth again because of the post natal ward experience. After my c section I got rushed into a ward where we weren't taken care of at all. A ward where 5 minutes turned into 4 hours, lights were on all day and all night so we couldn't sleep, and a midwife who asked us why we hadn't given birth (emergency c section because of waters having been broken for too long). We weren't fed for the 24 hours we were there because they kept forgetting to order our food, and not allowed to bring in outside food due to allergens of the other patients.
In fact when we got discharged we didn't even know what painkillers to take but had been given liquid morphine with no instructions and hadn't even been given it at the ward.
It made me regret having my son, and I love him so much, and led to a pretty miserable few months and depression that will hopefully get better at some point.