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.

Also to those of you who have received poor care, I’m sorry that this has happened. I’d urge anyone who has received poor care to complain to the hospital. I’d also urge anyone who had a traumatic experience to request a debrief.

OP, thank you for this post. I was very fortunate that I had wonderful midwives for the birth of dc2, and because she was an uncomplicated pregnancy and birth, I didn't have a medical need for anyone to do anything but the very basic checks on baby and me.
I think you, and others in the profession are amazing, and it pains me to think that you are so understaffed and undervalued. I wish I could remember the names of the two lovely midwives who were with me when my daughter was born; they were so caring and calming. Please keep doing the work that you do, and know that some of us are grateful for what you give.

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.

I had both of mine in Scotland. 4 years and 1 year ago and both my postnatal experiences were pretty rubbish. The best thing about the 2nd was that my consultant swung me a private room because they knew I wouldn't stay on the ward given that partners can now stay overnight. I had zero help with anything and it's just lucky that I didn't need any despite having 2 emergency sections.

With my 1st, dc1 went to NICU. The midwife let me carry on believing that he was in the child's hospital not downstairs so I spent 9 hours not knowing where or how he was becoming increasingly distressed. Then because I was in NICU despite having an emcs after a long labour, pushing and failed forceps I missed every drugs round and every meal because no one told me it was all done at set times. In the 3 nights/4 days I spent in the hospital postnatally I had the tea and toast post delivery, 1 cold mouthful of cauliflower cheese and a sandwich the woman in the bed next to me grabbed off the trolley for me. I was convinced I was sitting by the bedside of a doll, not really understanding why (the lack of sleep/no food really not helping) but my midwife notes say "baby blues". They "lost" me for 7 hours at one point and despite my distressed state being obvious to the women on my ward and the cleaners...no midwife raised a concern. I was later diagnosed with postpartum psychosis when someone finally thought I really needed to see a psychiatrist.

I'm afraid my sympathy is lacking. I did a job working with vulnerable people where we were overworked and understaffed but I never treated anyone with the distain, the lies (told I'd had an unnecessary episiotomy by one midwife who was holding my notes...hadn't had one at all but only found that out weeks later) and the contempt I encountered.

My entire experience from pre natal to post natal was just shocking.
They unnessecarily risked my baby's life three times:
Once in pregnancy with the wrong drugs, Once in labour when there were no doctors for hours and hours when needed (after an hour of being ignored when I said the baby was stuck and told I wasn't trying hard enough). .
Once after birth when they told me my baby was not jaundiced and discharged us, only for the health visitor to, thankfully, notice when she visited.
When on the ward I heard one utter bitch of a midwife shouting at a mother who could not nurse her baby.
I was told my poor slashed up fanny was because I had had a big baby and "shouldn't have eaten so much when I was pregnant"( I was very skinny btw) was treated like an idiot when I asked where to change the baby ( in the cot apparently).
I was given no help with feeding whatsoever and nobody checked whether I could do it or not.
I was young ish and very alone but I couldn't wait to get away from the atmosphere of sneering contempt. (WHY are women treated that way in maternity care? ?)
The home visiting midwives were good but every single nurse or midwife I encountered in hospital was callous, incompetent or just plain vicious.
I wish I had complained at the time but I was frankly too busy and tired. If I had to give birth again I would rather take my chances and do it at home.
So I'm sorry if it's hard for you OP, and I appreciate you probably are not like the women I have described but in my experience you are in the minority.

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?

I was asked none of these.

@cleofatra the questions tend to be asked as part of a conversation, so you might not have recognised an assessment was/had taken place.

I tend to ask questions as I’m doing other things, so if I’m taking the womans/baby’s observations, or tidying the room ect I’ll be assessing the woman and her baby by asking questions as part of a conversation, not asking a series of direct questions as such.

I am a hcp of over 25 years so do realise what the assessment consists of. I had to take my own hourly obs.

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

Same! Thankfully I'm at peace with just having one.

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

Same! Thankfully I'm at peace with just having one*

Me too! In fact mine was over 10 years ago so I have no idea why I still get so triggered. I need to "move on".

@cleofatra why did you have to take your own hourly obs? If you were on hourly obs you were clearly unwell.

@Blahblahblahnanana they had me on transfusions and so I had to take and record my UO every hour on the bed chart. I was given a large cylinder measure and asked to go and to record the volume every hour. Obv I couldn't do my own BP.

I was left alone for hours as there wasn't a bed on the postnatal ward, alone with my baby as my husband had to go home. Midwife came in only when the Dr did rounds and when I burst into tears because I hadn't had anything to eat or drink for something like 16 hours and I was worried I was going to get ill as my drip had run out, midwife told me I should have just got the water from across the room. And carried my catheter and drip with me presumably, and hopefully not collapsed or bled on the floor. (I was anaemic and had been told by midwife on previous shift not to get out of bed.) She clearly was just ass covering why she hadn't checked on me.

So I'm sorry and yes I'm sure some midwives are massively over stretched and all of that. Most of them. But some just don't care, as is the same in all jobs. Perhaps professional detachment goes too far? But my shit postnatal care was far more traumatic than my emergency section with my eldest and I probably should have complained about it but at the time I just couldn't.

I also was prescribed the wrong thing and had to get it changed. Repeatedly. Fortunately it was medication that just makes me throw up rather than a genuine allergy but someone clearly wasn't reading the notes.

@Blahblahblahnanana well for that check to happen you'd need to have a conversation with a midwife in your time there... and I know that I at least did complain to the hospital with my HV because after being home for a few days she was shocked to find out that we hadn't had a midwife visit us at home either.

@CurlyhairedAssassin I LOVE this idea, because simply put it would put your expectations at exactly where they should be, so if they'd fail to do that it would be pretty obvious that it was them and not hormonal you.

@MrsTwiceslice I'm so sorry for your experience, it sounds truly awful throughout!

Wow written like that, it’s obvious how stretched maternity services are.
I had twins, one with low blood sugars and one with jaundice... thank you to
All you fab midwives and HCPs for all your hard work getting my babies well enough to move to a maternity hospital x

@cleofatra do you mean you were asked to record your urine output?

I’m a doctor (senior consultant) and my post natal care was so awful...I felt ashamed to be part of the NHS...of course there are dedicated overworked midwives doing their very best...but empathy, compassion and good communication skills which mean so much to very vulnerable women post birth were sorely missing following both my births...one fairly routine and the other premature by 7 weeks with crash section.

OP, I do hear you. And I also hear you saying you take your break because you should, and you shouldn't be expected to be a saint.

I think @CurlyhairedAssassin's suggestion of a booklet explaining postnatal ward functioning is genius. Has it ever been done? It would be great.

But even so, you can't get around needing more trained people with more time.

When DD was born she had an infection and ended up with sepsis, and she was tube fed. We were 'taught' to do it by someone (nurse? midwife? I don't know) who told us it was really easy and we barely needed telling. You used the tube to suck up a bit of stomach acid, tested the pH, and if it was the right acid level you started feeding in milk. We didn't really understand what this was for and at some point asked a question about it, and were told 'ok, don't bother with that bit then'.

When DD was moved to another ward they were utterly shocked and very gently told us you test the pH so you know the tube is in the stomach rather than somewhere else, so you're not pumping milk into a sick newborn's lungs. Which could have killed her.

I know people are over-stretched and I don't blame anyone there, but it still gives me such cold shivers thinking we could have killed her because we did not know what we were doing.

I’m sorry some of you had utterly shit care, shit even in the context of a stretched system. Nobody should be spoken to with contempt, ignored or treated cruelly.

And this isn’t a plea for women who have just given birth to cut the midwives some slack, why should you have to? In many ways it’s an apology, an apology for the care you get that I hope isn’t as horrific and neglectful as some of the stories but is still substandard.

As a former midwife I beg all of you who had shit care, if you feel you can, TELL SOMEONE. It’s not good enough for you and baby to be alive if you felt abandoned and not cared for and traumatised by your time on the ward. Head of midwifery, PALS, someone - these experiences are bloody valid and need to be heard by people that can make changes.

Having spent years working on the wards I could have written this OP. I have never worked harder in my entire life, and while some midwives/MSW’s are terrible most were also running about trying to do their best. The number of times I didn’t have a break, barely drank anything, because I felt like the women needed my time more. I felt like I was shouting into an abyss when you’d say ‘we need more midwives’ because labour ward will always come first.

This is just one reason I’m planning a homebirth for my baby. I don’t want to go near the ward.

It was also really noticeable in my second birth in 2014 that of all the staff - and I had a lot as I had an assisted birth and had extra scans in pregnancy as well - maybe half of the staff in the local hospital were English. The other medical staff were all European - registrar was Irish, midwife who delivered baby was Eastern European, many of the nurses at the hospital are Portugese. How much shitter is care going to get in the future with Brexit? How much worse has it already got in the last few years.

Thank you so much for this @mwunderground
I had my son less than 3 weeks ago by emergency section and the post natal care was so supportive even in what must have been very difficult staff circumstances. I will always remember how I was looked after by staff throughout the night and how kind everyone was.

I had my last planned c section in 2010. Shocking lack of care and also knowledge. Forced me to get out of bed after less than 24 hours and I had to lift my suitcase onto the bed so the whole bed could be wheeled to another bay. I was still on morphine and begged for a porter to do it but was told “no because of health and safety”. I still have pain 9 years later.

This is a large teaching hospital in the south.

This has reminded me to write to the hospital I had all three of my babies in to say how amazing the care I received was. Prenatally, during the births (natural, induction and a EMCS) and postnatally. I honestly couldn't have wished for better care, especially for my last baby who had quite a few serious issues, we were in for six weeks, but is thriving now. I know midwives work under enormous pressure and I'm sorry not everyone feels they get good care, I'm very lucky to live near a great maternity hospital.

I’ve never had a baby, but hope to one day in the future. Birth petrifies me enough, but everything I’ve read on mumsnet about postnatal care sounds horrific. And very scary. There are dangers that still exist even after you’ve given birth: what if you start haemorrhaging or fitting? Would anybody even notice? And if they did notice, would there be enough staff to save your life who could come quickly enough?