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.

Not a midwife, but a mum who had postnatal mental health problems that started while still in hospital. I just want to say thank you for what you COULD do, I saw how rushed those midwives were, one lady was in from 7am until midnight one day because someone called in sick. But she still sat with me while I cried hysterically. I don't know her name but I damn well remember her face and if I ever see her I will give her the biggest hug that is allowed from a basic stranger and thank her. You do an amazing job, you should be proud. I'm about to train as an LD nurse, reading threads like this half make me anxious and half make me feel like I'm defo needed and should go and do.

Thank you
To answer some things

• I totally agree the hospital could deploy staff better and hospitals that have MSWs or nursery nurses to help with baby observations really free up midwives. Sadly there’s nothing I can do about that

🙄 what about the support workers who do the majority of your job for you whilst you can have a cup to tea and a chat whilst writing in your notes 🙄

Don’t make out all midwives are really hardworking and can’t give the care they really want to... for most, it’s a job and they can no longer be arsed.

Sorry posted too soon. The reality is in my current hospital we currently run on bank staff and they won’t fill vacancies, let alone create more posts for support staff

I completely agree some midwives are rude, burned out and over it. We too come on shift and sigh when we’re working with some colleagues. I’m sure that’s the same in every job.

We rarely have low risk women on the ward here. No compulsory one night stays here. If you want to leave and can, they’ll rush you out the door

This was written simply because I’ve come back from maternity leave and wondered why I couldn’t do the basics and when I sat and worked out the times I spent on just essential tasks I realised I had no time

As for obs, HCAs do most of our obs but there is always one woman who needs a manual blood pressure which they can’t do.

Zebraa in my trust, support staff can’t do any of the things I’ve listed. I’m aware some trysts have MSWs who can do loads

I’ve had a cup of tea indeed while writing notes but the support staff are often less busy than is. I acknowledge my trust doesn’t use support staff well.

It's so ridiculous when university courses are so heavily subscribed that even people who have exceeded the entry requirements get turned away, yet I guess there's no jobs for them as they won't create the vacancies even though there's evidently a need! It will be ridiculous to have children soon, you won't have any midwives and there won't be any teachers to teach them. Not because there aren't plenty of passionate, talented people (amid the crap ones as any profession), but because the government has dismantled the professions sufficiently that no one wants to do them. It's scary that more isn't done to change things. I agree @Zebraaa they were absolutely fantastic. It was an MCA who noticed I was losing too much blood after birth as my pad was saturating too quickly, the midwife I had spoken to previously had said of course bleeding is normal afterwards, it's not my job to change the pads- maybe true but I would have been extremely poorly otherwise! They're the only ones who helped me try to BF too.

And it is just a job. I’m not a saint. I do it for the money. If they didn’t pay me I wouldn’t be there. I’ve done my time focused on midwifery and working hundreds of unpaid hours. Now I work to feed my kids. I just wouldn’t mind being able to do it to a reasonable standard while I'm there

In a way I'm glad that I was ill enough to spend 36 hours on HDU after DS1 as it gave some rest and care that were totally absent on the postnatal ward.

It was one of the peak weeks of the year (DS had come naturally, but a lot of inductions and ELCSs were arranged to avoid a certain date later in the week). By day 4, the atmosphere was calming down and the MW I'd seen days before had time to talk to me. They were down to 1:8 from 1:14. That last day, I did feel treated like a human.

There was no point in pressing the buzzer.
Sympathy for problems like having been physically unable to walk as far as the dining area/ out of the hospital for months due to SPD before the long labour/ major surgery/ additional complications was minimal. I was too weak to make a fuss if I needed anything, even stupid things like being unable to work out how to deactivate the TV above my head to get rid of the constant blue light in my face day and night. Or knowing what to do with baby when having a shower. There wasn't the space to wheel him in the cubical. No one to look after him. It seemed utterly wrong to just abandon him by the bed which was the only functional option.
It didn't help with the trauma from the actual birth. By the time I got home, I was in a mental state to match my stitched up abdomen.

Second time was better, partly because it was quieter, I was far less ill, had minimal expectations and was prepared with things like an adequate supply of food and not relying on the inadequate geriatic portions that served about 50% of the needs for a healing woman trying to establish a milk supply.

I don't blame the individual staff. Constant under resourcing will never bring out the best care. I was a teacher and left after I reached the stage where it felt like teaching, the actual point of the job was getting in the way of the oh-so-critical admin. I know it's rife through the public sector, and the private sector not immune either.

I do think there is a specific issue with areas like maternal health as it is "routine" and a "natural process" which dismisses the impacts of complications. Things like the referral/ physio process for SPD are so long winded that you are close to due date by the time you can access aids like crutches. Would a broken leg be left for 6+ weeks before getting a plaster cast and crutches to aid healing and function? Poor maternal care can tip the balance into PND.
I had my two a few years back before austerity really hit, so presumably the critical weeks are much more normal now than they were then.

It is a massive shock realising how you're seen by the NHS as a new mum. Pre-natal and the birth was great and my post-natal care was excellent after I transferred, for my second night, to a local birthing centre for feeding support. I was the only one on the post natal ward there so I had my own 1 to 1 midwife. However from the moment I had had my post-birth bath, the midwives were desperately trying to kick me out of the delivery suite. I had to call one into the bathroom and ask exactly how I was meant to get dressed while hooked up to a drip stand. She didn't get it, so the nurse who overheard had to come in and cap it off for me. I really struggled on the ward for the next 24 hours because DS was sicky and wouldn't latch, I had to walk and get my own food from the canteen with said drip stand and after stitches... it really feels like such a fuck-you, this is self-inflicted attitude from the NHS. I'm so glad I don't want another baby!

Dear OP

I understand the constraints on your time.
BUT
Does this mean you don't have to tell me your name or ever introduce yourself?
Does this mean you have to "forget" I am on the ward and let me go into labour alone behind a curtain?
Does this mean I have to be spoken to roughly and told I am being stupid for being in pain?

I get it, believe me, I do. I am an NHS employee too.
But there is such a thing as human kindness.

Postnatal Care at my local hospital was shocking. Sadly I never went into spontaneous labour so never got a home birth.

When I had only slept 30 mins in 48 hours and was on my knees they argued you against me self discharging, they had a while extra ward open due to a birth boom and no empty beds. It was loud noisy chaos.

No information on how to get your blood soaked sheets changed or how/where to get breakfast or food from.

The staff were so stretched.

With the last 2 I refused to go into the postnatal ward after the first 2 horrific experiences. Forever grateful I was well enough to go home and they weren't that concerned about my non feeding baby

Part of the problem is that women are too vulnerable then too busy/knackered to kick up a stink about poor care.

Also that poor postnatal care outcomes are maybe hard to measure - obviously there are infections etc but mostly it's misery, which doesn't lend itself to targets very well!

With DC1 I spent a week on a postnatal ward, it was horrendous. If someone had taken the time to explain what was going on clearly it would have saved staff time overall.

16 years ago I had no post natal care at all. Dd was born in the evening, we were transferred to a ward around 9pm and basically left to it. I did get shown how to feed her, then left till the morning.
The next morning I was asked how often I had changed her nappy. I just cried and said I didn't know how often it needed to be done, or how to do it. Which was true, I had no idea. The HCP (no idea of she was a midwife or not) said she would come and show me soon.
After waiting an hour or so, the kind lady in the next bed showed me.
Then the HCP came back, and told me off for making the other women get up, as she was supposed to be resting after a c section. I didn't know that!
Then i asked to go home. However, it was a Sunday before a bank holiday, and was told that there would be no-one there to check and discharge DD until the Tuesday after the bank holiday.
So I asked for some food. Got told that because we had got to the ward after orders had been taken last night, I would not get anything until lunch.

I was an emotional wreck, and just wanted to go home. I cried a lot, DH kicked up a fuss, and someone miraculously was found to check and discharge us.
The care was not bad as much as non existent, I'd have been more comfortable in the hotel next door and the care level would have been the same.

I was in for 6 days post op and was treated like a piece of shit.
Needless to say , I have only one child.

"As much as I feel for midwifes, I am terrified of giving birth again because of the post natal ward experience"

, grisen. I feel exactly the same. One of the midwives admitted to me, towards the end of my stay on the ward, that my postnatal care in the first 24 hours after my c-section was actually dangerously sub-standard. They were so understaffed that, by her own admission, they'd forgotten about me. I have every sympathy for individual midwives because I know what it's like to be in a profession where the system grinds you down and sets you up to fail. I'll carry on making a noise about postnatal care in the UK though because I believe that mothers and babies are being put at risk.

My postnatal ward experience was mixed but the hospital was making excellent use of student midwives who did, at the very least, all of the observations. I was also helped a lot by a nursery nurse, particularly with breastfeeding. A couple of maternity care assistants were involved as well in administering phototherapy. Nonetheless my postnatal mental health issues began on that ward during our week long stay. The best thing anyone could have done for us would have probably been to get us home! Though we were dealing with sepsis and jaundice, that could have been possible if the phototherapy technology was up to date. Then we also wouldn't have been a burden on the ward for as long.

Both myself and my baby nearly died due to failings in postnatal care. I'm terrified of having my baby on October.

I don't blame the midwives though. I blame the people in charge for letting it get so bad.

@AhoyDelBoy and @Fraggling thank you.

DS is absolutely fine now, you'd never know he was prem so I've largely been able to put it behind me.

On the 4th or 5th night I remember being in my bed and the nurse came to wake me up and asked me to go to SCBU. I was utterly convinced he had died. I was trembling as I walked there, I couldn't look when I got to his ward, I stood outside feeling everything and nothing. He just needed a feed and they knew I was keen to try breastfeeding. That was all. I did actually meet the most amazing hospital worker that day. I dont know her name or her job title. All I know is she was covering the ward that night because they were short staffed and she didnt normally work in SCBU. She saw me trying to unhook DS from the phototherapy lights but I didn't know what I was supposed to unplug etc. She helped me get settled and showed me some different positions to feed in and he did it! Sort of. I think that was the first time I had smiled in nearly a week. She sat with me, laughed with me, showed me some breast pump tricks and then I fell asleep in the chair next to DS. She popped a blanket on me and let me rest. Then I never saw her again so I'm partially convinced she was a ghost or something... DH thinks I made her up

I’m not a mum but there is definitely something to the lack of advocacy. Reading threads here birth partners/fathers sometimes take a lead to get basics, but a they leave/there is no-one and new mother is less able just exhausted or busy with newborn.

I’ve been in A&E a few times and really got through due to DM advocacy. Most recent was a broken dislocated ankle. Thankfully I took some paracetamol before I left my house. It was only with a lot of pushing that I got any more pain relief 5 hours in. (One hour till triage then four for actual treatment.) Again all staff very busy, doing their best.

Talking of hotels, it would be really astoundingly helpful if there was a booklet explaining how the post natal ward works, like they have in hotels. And if it was available online BEFORE you go into labour. We get our bags packed and that’s it, no-one tells you anything about what is expected of you once you’re in there.

So, details about what to do if baby is struggling to latch or even wake up enough to feed? Is there someone who isn’t rushed off their feet who you can contact to come and teach you to breastfeed? Can you ask for an outside agency to visit you to do this? What are you supposed to do if you decide to bottle feed while you’re there but haven’t brought any equipment with you? Are you expected to bring your own milk and bottles in? Where do you sterilise stuff? What about pumping? How do you clean equipment? What happens if you miss the meal orders because you’ve had to leave the ward to go and get tests/ultrasound done? What happens if a midwife disappears to an emergency in the middle of stitching you up and doesn’t come back for nearly an hour? And you can’t reach a call button and don’t know if you’ve been forgotten about? If you shout for help will you be seen as neurotic? ARE you neurotic, you wonder?? Should you be bleeding out on the bed while you wait, while your legs are in stirrups and you can’t move, or is that normal? What do you do if you want to go to the coffee shop with your husband because you were left off the tea round? Are you allowed to take the baby with you? What happens if you’re starving and have no food - can you leave to go to the shop? What happens if you need a shower? Do you just leave the baby on it’s own?! What happens if the baby pees all over the sheets, or you leak all over them? ( There is no-one around to ask for clean ones). If the only painkillers you’re allowed are paracetamol, can you just get DH yo bring them and self administer or do they want to know what you’re having when? (Because they don’t bring paracetamol when you need it)

Are you allowed to nap while in sole charge of your baby or are you expected to stay awake all the time? How long are you supposed to wait to be discharged before you assume they’ve forgotten? Can visitors bring hot meals in for you? What is “normal” behaviour for a newborn? If they projectile vomit after feeding when is it a worry? Will someone show you how to bath a baby before you go home or not?

On and on and on and on. None of us have ever experienced any of that before. We have no idea what to do. No-one knows what the expectations are and there is no-one to tell you. It’s stressful not to know any of this stuff and you feel like you should just somehow know it so you also feel incompetent.

My postnatal care was woeful too. Barely saw a midwife from one hour to the next. I'd had an emergency section. DD had to go off twice a day for IV antibiotics. Had to stay in for 3 days after delivery. Limited pain relief. Zero help trying to breast feed (as it was I didn't produce any milk anyway). Just no help at all. The woman in the next bed was a godsend. She already had a child so helped with anything I needed or wasn't sure about.

I'm a HCP too, so understand about the nhs and staffing levels, but it was a horrible experience. So pleased I stuck at one child. Particularly as my obstetrician informed me any subsequent pregnancies I'd need an elective section

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.

Your shift sounds exhausting OP and I know I couldn't do it.

What checks do you do that take 20 minutes per patient. After both my children a midwife never spent more than a few minutes with me.

Yes, advocacy. Most fathers are useless. They don’t know what is expected either and don’t like to cause a fuss. Volunteers would be amazing on a post natal ward. Do any hospitals have them?

Yes I don’t know what checks midwives do either. I had hardly any. Temp taken I think, that was it. Lots of checks in labour, nothing afterwards. I was just a woman in a room left floundering, it felt like. I do think it would have helped everyone if I could have just gone home earlier! I was waiting for hours for someone to discharge me once they said I had passed the minimum time limit. I do wonder if it was because it was one less woman to have to see to. I was just left in the room, causing no one any bother, with DS2. No checks. Maybe if the room had become vacant it meant more work with the next woman who may have needed closer monitoring.

The postnatal checks probably don’t feel like the midwife is competing a check if you’re physically not having your observations taken (blood pressure, pulse, temp ect) as it’s done as part of a conversation unless a physical check is needed such as checking your bleeding, cesarean scar ect.

You’ll be asked things like how are you feeling?, how is your bleeding? have you passed urine/had a bowl movement? How do your breasts feel? Have you got any pain? Do you have swelling or any pain in your ankles? This is done to assess your wellbeing. Your baby will also be assessed through asking questions about how they are feeding/when they last fed/how much, have they had wet and dirty nappies, do you have any concerns ect