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.

So sad to hear so many of the stories here

I have 4dc all of whom were high risk due to PPROM and so I was at the hospital a.minimum of 3 times a week for several hours at a time ( DC ahead teen to preschool) so have met my fair share of MWS. Most have been utterly amazing esp in antenatal care, often listening to me far more than the doctors/ consultants, one in particular spent HOURS chasing down a particular consultant for me just because she agreed with me ' something wasnt right'and she felt the doctor before had been dismissive.

The only poor care I've felt I received from midwives was in labour and post natally... my 2nd dc was born at 34weeks onto.yhe bed ( no one to catch!) because they insisted i wasnt in established labour. This then repeated itself with dc4. Postnatally I was.ignored I guess because I didnt have a baby with me I dont want to go into further details as I get quite upset.

However overall MW care has been fabulous and it must feel draining knowing every shift you'll be fighting against the tide...so thankyou for all you do

@Blahblahblahnanana yes, I understand I would have been the only one to be able to measure my urinary output but handing a woman with a drip and transfusions plus a new baby a large cylinder and telling her to go for the long walk to the toilets every hour to measure and record UO is a bit rough. I also had to do my temp, they left the thermometer by me (which is odd as I imagine they didn't have many), and a symptom checker. Someone did my BP for me as I only had one arm in use. The recording was the bit that got me. Knackered, no shoes due to swelling and a Hb of under 4.
Anyway, no more babies so I don't know why I am still so triggered.

I don't know about having partners on the ward. My DH was never with me for mine. I went home the same day with my first as no beds....

But I was on my own for two of them. My third was a home birth which was amazing. So 2nd and 4th alone in hospital.

The men caused for fuss than the women. Up and down, opening and closing suitcases. Keep it open FFS and under the bed. Every 5 mins loud zips opening and closing when you and baby trying to sleep.
Their loud yawns and complaining about being tired. Insessant talking to newborn. (I know you are happy and proud, that's great! But do it quietly)

Yes curtains to be kept open but when I'm bleeding and need to change a pad because the only toilet is always full and I want to breastfeed in peace. In comes the midwife whips the curtain open mid pad change/breastfeed for all the men to turn and stare at you. I think men shouldn't be allowed unless exceptional circumstances or theu should have a room for families with men etc.

I'm very grateful my husband could stay with me. This was in a private room though, which he had to argue for. Without him I would have just left the hospital, at best.

It’s basically pretty brutal. Though I’ve noted in my local large teaching hospital that if you are in the higher risk unit, you get much better care, a better ratio of midwives to women, and a nicer environment. The bulk standard “floor 2” post natal Ward was like the Wild West. Not great, when you’re riskier than average but not high risk enough, and struggling along with no help and an HCA who seemed irritated by any questions or requestsz

@mwunderground I agree that someone with the new mum is a good idea, I disagree the partner is the best person. The number of times I've gone in to a bay and found the partner snoring away in the bed while she's in the chair, or he's on & off the ward for a smoke constantly, or she's buzzed for help being passed the baby (which is fine) and I have to clamber over a sleeping partner who then tells me to fuck off when I put the bedside light on to help her with feeding. Obviously not all partners, but I wonder how helpful it is? I know I'll be sending my partner home for a few hours kip (if we go into hospital) so one of us is well rested rather than us both being tired and crabby!

I don’t have a birthing experience, but wondered if you had seen the show last week about getting volunteers on hospital wards to do the jobs like you say that nhs staff don’t have the time to focus on (patient care, feeding, talking etc). I knew the NHS was struggling but I’ve never had a hospital stay and it really did open my eyes to how much pressure is on your shoulders and how understaffed and overworked people are. My hay goes off to all nhs workers, you’re all brilliant

We already know.
We see more than you realise.
We know it's not your fault.

I gave birth on a bank holiday weekend with my second child... there was 1 midwife to around 18 patients that day.
She looked like she wanted to cry.

I completely understand that it is not the staff's fault. When I had my son 11 years ago, I couldn't fault the care I received, but with my three younger children I noticed a massive difference.
One of the midwives got my surname mixed up with the woman next to me and my daughter was nearly fed another woman's breast milk. And with my fourth child, I was put on the wrong ward and forgotten about, given no painkillers or food until I asked and asked.
They were so apologetic though and I know they were overstretched.

I had my babies in 1992, 1993 and 1999. The post natal care was excellent. I have lovely memories of my first, being helped with breast-feeding, comforted when crying, generally supported by midwives and support staff. You got given a Bounty pack but no reps came to pester you. Visiting times were regulated and there was a period after lunch (food was fab, and HUGE portions!) when no visitors were allowed and we were encouraged to rest if our babies were asleep. If a baby was crying, there was always someone to take them for a while. The care I received greatly contributed to how well I recovered.
I'm shocked reading some of the experiences on here. We all know how under funded and stretched the NHS is, and I do realise that 20 years ago things were different.Tthis is a major women's issue. If it was rich, white men using these services can you imagine how different things would be? If it was rich, white men having their issues diminished and and being subject to poor, often dangerous levels of care? If it was rich white men who had to put up sharing a room with strangers when they were most vulnerable, just so they didn't actually starve or fail to get their medication?
It's setting the bar pretty low when we are told to have someone with you to ensure you get the care you need. Women being dismissed, ignored, expected to get on with it, not complain, be nice...
To all of you who have experienced these things, I'm so sorry you have been left with traumatic memories of what should have been a time when you felt supported and cared for. Shame on this bloody government (of rich, white men!)

You’re right, Sagittarius, it’s definitely an issue that women’s pain is simply not as important as men’s pain.

Another question I’ve got: why is it that so many posters on post-natal threads are being left for so long without pain relief? Or only being offered the mot basic of pain relief? (Ibuprofen doesn’t work when I’ve got a headache!) Why isn’t women’s pain being properly managed in hospitals?

Can you bring your own pain relief in? For example, I have a chronic pain condition, and I keep medication for when I get flare-ups. Couldn’t I just take that in with me and take it when I want it/take ibuprofen when I want it without having to wait for someone to bring it to me?

I had my baby in 2007. The post natal care was shockingly poor and I was very poorly with an MS relapse caused by a hospital obtained infection.
I blame the lack of basic health care was

.. from so called healthcare professionals who were subsequently criticised for it.

@SachaStark the main issue as I see it with people taking in their own medication is that the medical staff need to know what medications you have taken and when in case anything they may need to give you is contraindicated, but that shouldn't be a reason for you not to be able to take medication with you, it just needs to be monitored in the same way as anything the hospital gives you.

My experience with post natal care after having DS was good on the whole, the midwives clearly cared about their jobs, but were undoubtedly pushed for time and resources. I had a wonderful student midwife help me with feeding in the middle of the night too, she made a scary dark night much easier. However I waited a good 4-5 hours after the doctor and anaethetist had agreed I coould be discharged before the midwife could complete the paperwork and release me and baby. The woman in the bed opposite was also waiting to leave, and her mother, who'd come to pick her up, was incredibly rude to the staff in her pursuit of getting her daughter and baby discharged, and as a result she was discharged first, by a very stressed looking midwife. There were four birthing suites in the unit, all four occupied at that point with labouring women, and four midwives on duty. Clearly those women's needs had to come first, my wait was nothing in comparison. But there's no question that if there were more staff, both I and the other lady on the ward would have been discharged and out of the way much earlier in the day. Having said all that the midwives never made me feel like I was a burden, or that they didn't have time to spend with me or baby. They were lovely from start to finish.

@SachaStark I took paracetamol in (how ridiculous though that after major surgery paracetamol is deemed as enough pain relief for many women); but I was made to feel like a naughty child as I was meant to have them at rounds. This could have been a plan, if it wasn't for the fact that they didn't come to me on rounds other than to leave one of the injections you do in your stomach by my bed when I was asleep for the 2 nights I was in. I really want to find the positive, but aside from 2 amazing midwives pulling blanks to be honest. At the postnatal appointments baby had lost a lot of weight (milk was delayed coming in due to blood loss, I didn't know this could be normal at the time), we were told to go in every day, and then told it wasn't long enough to see a change. I asked for advice on how to know how much formula to give and was told to 'google it as we don't support artificial feeding); and then when I broke down saying can we do every other day I was snidely told that I could discharge myself but there would be concerns over my baby then. They were all spiteful to be honest postnatally, even though the same midwives had been lovely and supportive. If I hadn't had amazing support around me I'm not sure where I would be now to be honest.

This is why home births should be promoted more. Had all mine at home and didn't have to deal with any of this. Obviously only suitable if you are low risk etc etc.

I'm not at all surprised to read this, I recently had my first child and saw how rushed off their feet the midwives were.

But I was that lady who had a traumatic birth, needed hourly obs, my baby needed blood sugars checking, I was severely anaemic and needed help breastfeeding...every single HCP who dealt with me was incredible and sensitive to my needs, from the student midwife who discharged me to the midwife who delivered my baby who came to the postnatal ward to find me after her own shift had ended on labour ward, simply to give me a big hug and check I was ok.

You're all amazing

My experience (2017, Scotland) was not a positive one but it was more to do with shite resources than attitudes of the HCPs. I was in 8 days in total and my PND definitely got started during that time, or at least the seeds were sown.

I was in a bay which was tiny due to the fact there was a sink in the corner which everyone was using so I was constantly disturbed. The side of my bed was broken so any time I put my control/remote thing down it fell through onto the floor and I had to get out of bed to pick it up. The ward was so busy day and night. DS had jaundice and struggled to latch so I was on a 3 hourly feeding plan with pumping and formula top ups too. It was either roasting or freezing.

The staff, however, were very kind. Lorna, Dorothy, Kirsty, Dr Amy - they all sat with me at different times while I cried, and helped as much as they could. I still feel emotional thinking about how much they obviously cared about my tiny wee boy.

But my God, they were up against it. That ward wasn’t fit for purpose. I remember my mum saying it was ridiculous how much money had recently been spent doing up that hospital but the postnatal ward, where babies start their lives, was such a state.

I had excellent post natal care recently in an NHS hospital. Yes it was busy, but staff were caring and professional, and there were an array of support staff doing breastfeeding support, blood pressure checks etc which meant the midwives could concentrate on overseeing more effectively. Men were allowed overnight only in private rooms. The place was spotless. Only criticism really was the terrible food!

I wonder where all these supportive nice postnatal wards and staff are. They’re definitely not in my local teaching hospital. Sitting with you?? Like, stopping long enough to have a conversation not laced with irritation and indifference?

Aside from the incident where I had to lift my case onto the bed 24 hours post c section because of H&S, I also had a catheter incident. The nurse arrived to put the catheter in and started, at the exact time my DH texted to let me know him and his family had arrived at the ward to visit. There I was, legs akimbo, begging the nurse to check that the family weren’t going to open the curtain and see me in all my bloody glory. She just shrugged and said she didn’t have time and they probably wouldn’t touch the curtain anyway. Surely I should expect better than complete indifference to my in law family potentially seeing an intimate medical procedure down there? I was frantically texting and crying and she just carried on with the catheter?

I'm sorry you midwives have it so tough. I really am. I still feel that there was no excuse for my abysmal experience.

My son wouldn't latch (he had a severe tongue tie ... was a checked by midwife who said he was fine but was picked up on a month later). I struggled alone for hours and he was beside himself, screaming with hunger. I buzzed and buzzed and was crying my eyes out, and was ignored for ages. Finally a midwife came in. She moved the call buzzer so thst I couldn't reach it then say she'll be back in a minute ... never saw her again. Then when I staggered out of the bed to get the call buzzer, buzzed it for another 10 mins or so on and off and a different midwife finally came and told me to just give him formula. Luckily I had expressed colostrum antenatally and wanted to use that before giving him formula, but nobody seemed to know where it was (I had handed it in when I had arrived at the hospital - it was frozen).
I also pointed out that there seemed to be something wrong with my son's neck. I was patronized and all but laughed at. Turns out he had severe torticollis and a tumour of scm muscle due to very aggressive ventouse delivery. Identifying it early could have led to a very different path for him. Unfortunately another month went by until I mentioned it again and got him referred for scans and physio etc. Additionally the toilet floor was covered in womens' blood, with bowls of urine lying around. It was disgusting and wasn't cleaned during my time there. I actually ended up putting in a formal complaint about my experiences.
So yes, I understand that it must be very very rough... and I don't expect it to be a picnic. I don't expect to be fussed over. I don't expect any more than the bare minimum. But I also think that there needs to be a minimim degree of care expected. Unfortunately I did not receive this.

I don't know what to do for next time. The postnatal ward is the one thing I'm dreading about having child number two.

My postnatal care was pretty good after what felt like horrendous care during labour which ended in an emcs because they realised after 2 hours of pushing that my son was stuck.

And then him ending up on neonatal with a 'spontaneous' collapsed lung, being told this at 4 in the morning while i am on a postnatal ward without my baby, and not allowed to see him until i could feel my legs again, that was fun.

In the middle of the night i used to get up and walk to neonatal to see my son as i couldnt sleep and at the nurses station they had several cots of babies there and they (maybe the nurses im not sure) were watching the babies so the mums could rest, i thought that was amazing.

It took me along time to get over what happened during labour and how sick my son was, i wish i had got a debrief to know what went wrong and why and to know if it could happen again but i couldnt face it at the time.

My husband still wont consider having another one because he doesnt want anything like that to happen again, but the one good thing out of it all is that i would have an elective caesarean if we had another one.

Postnatal care was pretty non existent when I had my DC's 10 and 7 years ago. Dc1 I gave birth in triage after being turned away several times and was discharged from there within a few hours as there were no beds on the ward. I don't remember any checks being done on me at all either time! Dc2 was a homebirth and the care in labour was much better but both times we only had 2 home visits and that was with concerns over baby's weight and me with an infection - I gave up asking for support from the mw and went to the gp. It's awful to think that things have got even worse

For both of my births I’ve had amazing care on the labour ward and an utterly shite experience of post natal. Some of it was no doubt being overstretched but not all of it was. With my first, I had a few days of lovely but overstretched midwives. What broke me was the evening I had horrid midwives (who were probably busy but seemed to have the time to piss about on the internet). My husband came back in at 3am because I was so distressed and no-one could be arsed to help me. That night of care could not be attributed to being overstretched. It was a lack of compassion basically.

I’ve got another of my random questions! (Sorry, I’m completely terrified of childbirth, and I feel like you can’t really ask these things IRL, but I feel like I can’t even consider TTC until I know what the hell is going on!)

This is more to do with labour and delivery rather than postnatal, I’m afraid: why is it that so many women report that they pushed for multiple hours in labour? A woman I follow on SM recently stated that she pushed for FIVE HOURS before having a c-section. How is that physically or mentally possible? Five hours is an incredibly long time, though I suspect is very unusual. But even two hours like many women report is still a very long time. You could watch a whole movie in that time, or I would teach two classes in school from start to finish. I just don’t understand how you could physically stand to be in so much pain and doing something so strenuous for such a very long time.

Why is it that you have to push for so many hours before they will allow you to have a c-section?