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.

surreygirl1987 I had a similar experience (see my post above) and was terrified about giving birth again. However, I felt better prepared to deal with it being horrid and made sure I went in with a view to getting discharged ASAP. I shouldn’t have had to do that but it made the whole thing easier psychologically. They also seem to treat you better (ie that you’re not a total idiot) if your not a first time mum.

The problem is that we have been sold the myth that the NHS is free and we must therefore be grateful for it, for every little bit of it however poir it may be to imagine that by being grateful the turd will polish up very well.

TRUTH: it isn't free, it's only free at the piint of delivery. It's actually paid for by the people for the people. You can't actually polish a turd.

SOLUTION: complain, complain and complain again. We must stop standing for it and feeling sorry for every NHS employee who has stood and watched it happen.

@SachaStark I'm not sure, im waiting for my debrief so I'll see what they say. I was pushing (read: my body was involuntarily pushing) for 3 hours before shift change and the midwife at handover immediately getting the ball rolling for surgery. At a guess, because some midwives dismiss a woman saying they can't cope anymore as ohhh labour hurts they're being a wimp? Incorrect examinations? The incoming midwife knew without doing an internal exam. Either way, I have lifelong damage from it and bloody lucky my baby was strong enough to be okay. I didnt bond very quickly or breastfeed due to the emotional trauma and physical recovery. That said, I loved labour up until that point, just make sure your birthing partner is willing to stick up for you and what you need and back you up. I trusted I was in safe hands, which wasn't the case.

My 1st experience was the worst in my life and tipped me towards what I now recognise to be pnd. My second was only better because I spoke up for myself, had my mum with me straight after the section as I was first on the list so her and dh looked after my son while I ate and slept. How in God's name are you supposed to look after a baby a few hours post section with a ruddy catheter in and a stitched up abdomen still groggy from anaesthetic?

Mum and dh made sure I was fed as I was not given tea or toast in recovery or when I got on the postnatal ward despite having fasted before the operation. They then made sure I got painkillers every four hours by asking midwives to make sure I got it. The first time I was left in pain and only given painkillers if I asked, I had stupidly presumed after surgery I would be given it as a matter of course. No liquid morphine over here, I had to rely on dihydrocodeine and paracetamol (helped somewhat). The first time around I finally got paracetamol and ibuprofen when I asked and cried as the pain was so bad. I gave birth to my dd at 6.30pm was on post natal ward by 10.30pm at which point dh and my mum were shunted off ward as visiting was over. The midwife the next day wanted to discharge me and asked seriously why I did not want to go home. It had been less than a day that I had my baby and she was my first plus feeding was not established and I was in pain. I had people to advocate for me whilst I could not, maternity care I received post natally was woeful, prenatal however it was fab. I am in Scotland. The postnatal care being crappy puts me off having a 3rd but finally one person is allowed to stay overnight the day a woman gives birth so that would help me.

Some midwives are amazing however others should not be in a caring profession. Too many women think shitty postnatal care is just part of the course a pp was correct if it affected men it would be better.

I have ptsd from how I was treated on the post natal ward.
Not from the birth - That was great.
Now I have to live with that. Every year for a month around my (only) dc’s birthday, I feel like shit and want to die.

@Aisforharlot , I really know what it feels like. I really have been there. Please speak to someone or get an advocate to do it for you.

@Aisforharlot I am so sorry to hear this. Trauma and the effects of it aren’t something you have to live with - there is therapy that can help you, it’s not easy but it may help. It’s used with victims of trauma is all sorts of scenarios - look up EMDR. It may be available on the NHS in your area (it isn’t in mine) or you may need to pay privately.

The problem is the glorification of “our” nhs. medical care in the uk is pretty shocking (sorry, its a fact).
that it is free for everyone is a joke (and i’m in a higher income). it should be income dependent - free for people in poverty and children, income based prices for everyone else.

@SachaStark without knowing the full facts some women do involuntary push before they are fully dilated due to the position of the baby as this helps the baby to get into the optimum position for birth. For example if the baby is in a posterior (back to back position) as the baby descends through the pelvis the back of his/her head puts pressure on nerves creating an urge to push. This pushing may be the body’s way of helping the baby to rotate by increasing downward pressure onto the cervix and pelvic floor – the baby is able to pivot against this tension and move into a better position for birth. So the woman may have been involuntarily pushing for sometime, however it’s not the active second stage pushing. The active 2nd stage is defined as:

• the baby is visible

• expulsive contractions with a finding of full dilatation of the cervix or other signs of full dilatation of the cervix
• active maternal effort following confirmation of full dilatation of the cervix in the absence of expulsive contractions.

For first time mothers birth is expected to take place within 3 hours following the active 2nd stage. For women who have given birth before birth is expected to take place within 2 hours. If however the woman has been pushing for an hour, other interventions may take place such as emptying her bladder and breaking her waters. Also it’s not constant pushing as you get breaks between contractions as it’s the way nature gives the woman a bit of break before the next contraction.

Interventions will take place if birth of the baby hasn’t taken place within the 2/3 hour timescale such as starting a hormone drip if the contractions stop. Interventions will also take place if the baby becomes distressed such as trying forcepts/ventouse/cesarean.

@Aisforharlot please contact the hospital for a debrief and speak to your doctor about counselling. Or contact the birth trauma Association.

www.birthtraumaassociation.org.uk/#

Postnatal care is poor, I don’t blame the midwives at all. There’s only so much a human being can do after all, they are severely understaffed and underpaid to boot. You all deserve far more as do women and babies.

I struggled so much after my first DC was born. He was born just before midnight via emergency forceps delivery which was traumatic in itself and my DH had to leave at around 2am. I was devastated, I just sat there and wept. I’d had an extended episiotomy so I don’t think the word ‘uncomfortable’ even covers it, I struggled to move. DS just cried and cried, he was my first so I was clueless and kept having to push the buzzer for help. If my DH had been allowed to stay, I wouldn’t have needed their assistance so much but alas, this isn’t allowed (whole other thread on this subject on AIBU). I couldn’t physically move much so I decided eventually to just keep hold of DS but then ended up being told off incase I fell asleep and dropped him, this prompted more tears... I remember staring at DS wondering what on Earth I had done, I felt useless and cumbersome- like I couldn’t help him at all.

The whole experience triggered severe PND, I struggled to bond with him. It was a truly horrendous time and I can’t help but feel had I been better supported, I wouldn’t have felt so powerless. Not the midwives fault at all though, there just wasn’t enough manpower on the ward.

My midwife was amazing!! Couldn’t do enough for me, constant praise and encouragement. I just wouldn’t have made it through without assistance if it wasn’t for her. You guys do an amazing job.

I second what a PP said about healthy people taking up beds. Even though I gave birth at 7am I was made to stay the night. There were no complications, aside from DD wasn’t taking enough formula as they’d liked. She was eating though so I didn’t see a problem. I repeatedly asked to be discharged and was even in tears but the MW was very unsympathetic and rude. My DD was fine and is now a healthy 4yo who eats loads. I think MWs should listen to Mother’s more as they do know what’s best at the end of the day. If there were issues with feeding I could have seen an out of hours GP or community midwife at home. I think all mothers and babies should be allowed to go straight home if there are no obvious complications.

Another one with PTSD with the neglect myself and my son suffered on the postnatal ward.

We went through PALs, one particular midwife no longer works at the at hospital but I still cant even begin to come to terms with how they mistreated us.

@sachstark yes! I wasn't even offered pain relief until the day after the birth!! Despite a prwtty painful episiotomy (was in pretty bad pain for 2 werks afterwards). Also I really really wanted to go home on the Saturday morning (baby was born on the Friday monring) but I was made to stay until the Sunday night!! Apparently there was a backlog of women wanting to go home and the paperwork was taking too long to process so everyone had to wait. The stupid thing was, the ward was too full because it was so busy. Some women had to be taken to other parts of the hospital because it the postnatal beds were all full! Full of women who were simply waiting to go home!!