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.

OP it was clear to me, both times I gave birth, how busy all the midwives were - and to echo what you said, I remember thinking it was only a matter of time before something bad happened. After I’d given birth to DD, various midwives came into my room, looking for equipment - they started off knocking and apologising, but as the hours passed, they started just running in, searching for things, shouting for help, honestly it was terrifying. I remember saying to DH how glad I was that our baby had already arrived, because there clearly wasn’t enough staff on the ward that night. I never once thought the midwives weren’t working hard enough. But the shortage of staff wasn’t fair on anyone.

@SachaStark Yes, there would. Whilst the routine care slides, emergency care is in pretty much every case I have experienced, excellent. If we hear an emergency buzzer, we run and the systems we have in place do work.

OP, everything you have listed is why I nearly had a nervous breakdown and moved to community full time whilst I was pregnant with DS. Community is still a challenge but at least very occasionally I have sensible days! The amount of time I am expected to be able to do antenatal and postnatal clinic appointments in is an absolute joke though.

But who presses the emergency buzzer? If a midwife is only rushing by every 20 minutes or so, how would anybody notice? Sorry if this sounds daft, I’ve never even been an inpatient for anything, and can’t really imagine how a postnatal ward would be set up. I know I read once about a postnatal woman who just passed away in the chair beside her bed, and was found much later on I would want to know that I’m being monitored like a hawk in the hours following birth in case anything happened to me.

Yes at who presses it

DD1 was emcs

I was hooked up to morphine and worn out. Propped up in bed and baby put on to feed and curtains drawn for privacy.

Woke up next morning, still propped up with baby balanced, when helper came in to see about breakfast. I was wtf had been propped up but totally unconscious with newborn balanced for about 8 hours! I mean thank fuck she didn't fall off.

I said to woman what's going on this is odd but she just smiled, gave me breakfast and left.

That's not , is it.

@Fraggling same would happen in my hospital, I’ve no doubt. Except you’d be lucky if anyone bought you breakfast. In mine you had to queue up for food and if you didn’t queue then tough no food. I suspect you’d only be found when they wanted the bed.

@sachastark Where I work we ask that where possible, women keep their curtains open whenever they are not attending to personal care or feeding their babies (if they wish to have privacy for this of course). Midwives have desks in the bayside writing up their notes, and perform most of their care at the bedside or nearby. There are also cleaning staff, catering staff, maternity care assistants, student midwives, breastfeeding support workers, numerous drs (obstetric and paediatric ), hearing screeners, the bounty lady (as much as I’m not a fan), physicians associates, countless visitors... and goodness knows who else I have forgotten! It would be incredibly rare for there not to be a member of staff in your immediate vicinity. Even overnight I would be visually checking up individually on my women and babies at least every hour or so.

@SachaStark the emergency buzzer would be pressed by a staff member. Women should have access to a bedside call bell which is answered by a member of staff, in an emergency situation the emergency buzzer would be used which alerts other member of staff to attend the to the woman.

A lot of the postnatal wards allow one person to stay with the woman at all times, so they could alert the member of staff if there’s an emergency.

Also like tiny mentioned there’s generally other staff, patients, relatives ect in the vicinity so it would be very rare for a women to simply be left to deteriorate.

Also I know that some women may feel that they have been left for what felt like hours and not been seen by anyone, but you have to remember you may be in medication, are tired, and may have been sleeping ect and not noticed that a midwife/other member of staff had been checking on you

Volunteers would be amazing on a post natal ward. Do any hospitals have them?

Mine did. They'd get food and drinks, help with baby care and with feeding, look after babies whilst you showered etc. One woman was 75 years old and was a retired midwife. We worked out that she had actually delivered my husband 30 years prior which is just bizarre!

'A lot of the postnatal wards allow one person to stay with the woman at all times,'

This is where men address allowed to stay overnight on womens wards, to plug gaps in staffing.

Not seeing this as a positive thing in any way.

Some women don't have anyone to be there overnight in case it all goes tits up.

This would be utterly unacceptable in any other area of treatment.

'Also I know that some women may feel that they have been left for what felt like hours and not been seen by anyone, but you have to remember you may be in medication, are tired, and may have been sleeping ect and not noticed that a midwife/other member of staff had been checking on you'

Right, and not thought, hmm, I'll take this newborn off where it's propped up on the drugged unconscious woman and put it in the cot where it might be safer?
Yeah right.

Why do good threads about poor care which is not the fault of the people working there always turn into am exercise in minimising and explaining away womens experiences.

It's so predictable.

Why do good threads about poor care which is not the fault of the people working there always turn into am exercise in minimising and explaining away womens experiences

I’m not trying to minimise or explain away any womans experience! I’ve tried to put some context around some of the issues being discussed. I’m sorry that you received poor care.

Right, and not thought, hmm, I'll take this newborn off where it's propped up on the drugged unconscious woman and put it in the cot where it might be safer?
Yeah right

If I’d have noticed this, I certainly would have placed your baby into their cot, and alerted you so you weren’t sat up.

Yes it was poor care.

Not deliberate, not anyone's fault.

But just so lucky she didn't fall splunk onto the floor from really quite high up.

I didn't compain or anything i had other things on my mind which is probably a theme as well with medical care in general.

I do think though that the idea that pregnant women aren't 'ill' plays into this a bit. And womens socialisation to not make a fuss and get on with it etc.

Every midwife I have come across always seems to be overworked. I've had 4 children in the same hospital and feel very strongly that you are all trying your best but it's never really appreciated how hard you work.
After my first son i found myself continuosly defending the ante natal unit and all the midwives and care givers on it.
Not everyone seems to understand that underfunding and lots of major cuts are at fault and not the midwives.
I'm not sure if that all makes sense but it is a subject I am very passionate about. I've had 4 children, multiple miscarriages and am ready to pop with baby number 5.
I think you do an amazing job!

In 15 years as a midwife I’ve know three newborns fall on the floor so no excuses from me. They were fortunately all ok but I’m not denying it could happen again especially if a woman is in a private room.

Its totally possible on a manic night that nobody would notice. The main reason I’m in favour of partners being able to stay is that it keeps Mother’s and babies safer. It shouldn’t be necessary but it is.

The main reason I’m in favour of partners being able to stay is that it keeps Mother’s and babies safer.

Problem is, it drives other women out of the hospital. If my consultant hadn't got me a private room, I would have been leaving hospital within hours of my 2nd emergency section because my mental health could not tolerate being in a vulnerable state with strange men around overnight. Not because I think they as individuals are in any way a threat I hasten to add.

@SachaStark Its not too bad if you have a plan and the right mindset. Have your partner or another adult stay with you as long as possible - this is really important - do not expect staff to do anything or help you in any way apart from when baby is imminent and in the delivery. Other than those times there is always some more urgent case in another room. Make sure you always accept pain meds when they are offered on the ward round as you are unlikely to be able to get any at any other time - especially at night. Check any medication you are given or your partner check it - I was repeatedly given medication that makes me sick - fortunately at second birth I was with it enough to refuse it and request the alternative. Take your own food. Get out as quick as possible. You will be fine. As others have said, the emergency stuff is all fine. Its the care that is lacking. I had an emergency section and a delivery by ventouse, both all OK. Remember in the past a very high % of women died in childbirth. Being treated like rubbish is horrible but ultimately you won't die of it. Although you may cry. A lot.

It doesnt necessarily make mothers and babies safer having men on ward overnight, at all, this is a v short sighted idea.

On what other wards are they open to visitors 24/7 to provide basic care for the patients.

Women are being fucked over because we are just not important. Is what it is.

When we see film from other counties where family are expected to bring food to hosp and supply basic care we say oh no bad.

Unless it's women giving birth when it's suddenly OK to hand off this stuff. In the uk on 2019.

Also I know that some women may feel that they have been left for what felt like hours and not been seen by anyone, but you have to remember you may be in medication, are tired, and may have been sleeping ect and not noticed that a midwife/other member of staff had been checking on you*

Yes these blimming women don't know if they're asleep or awake. Or what happened to them in hospital.

When we see film from other counties where family are expected to bring food to hosp and supply basic care we say oh no bad.
I actually consciously went to have my second child in one of those "other" countries, after experiencing the NHS utopia with my first. Yes, the hospital there does not provide food / non-medical care, can look a bit run down and you are trusted to be able to seek advice on breastfeeding or smoking cessation yourself, but the medical care, frills aside, is actually better.

I agree with you fraggling.
I'm really against men on wards all night. I remember having my stitches examined, trying to breastfeed with my boobs out, hobbling around bleeding in my hospital gown, all within literally inches of strange men who, because they were someone's husband, were seemingly allowed to come and go as they pleased 24/7. I didn't even have a partner anyway, so what was I supposed to do for care?
Oh, I know, medical care should be supplied by medical staff!

So the NHS has gone to pot, education too judging by others threads... What's next? How do we change things?

Education and health care are are the backbone of any society and it's clear that the powers that be simply DO NOT GIVE A FUCK.

I was in an extremely fragile mental state on the postnatal ward. If my husband hadn't been allowed to stay with me I doubt I would have made it through and still be here today. Being alone would have only exacerbated the difficulties I was having.