I have got a place on the Maternity Services Liaison Committee! What would you want your hospital to consider?

[Miaou]

This is for the NHS Highlands, but many of the hospitals face similar issues to elsewhere.

The first meeting isn't until April 5th (and I'll bump this nearer the time) but I would be interested in what issues you think they should be considering. My major concern is that support and information regarding breastfeeding is improved.

I'm still a little hazy on exactly what their remit covers (I guess it's all maternity care, not just hospital/birth issues) but will be asking some more questions before I go.

Any thoughts welcome/appreciated!

In addition to support for b/f, as you say:

Support for homebirth
Policy re infection control on postnatal wards (MRSA AND C-diff)
How late miscarriages and stillbirths are managed - have they read and implemented the SANDS Code of Best Practice for Health Professionals? Do they have a designated Bereavement Midwife
Policy on screening for Strep B

You go, girl. Great news. (I have some cotton to send you finally, sorry have been such a slacker. Dd and I were indisposed at the weekend)

Thank you Marina - some really good ideas there. Is is possible to read the SANDS information online? Would really like to see that. Bereavement Midwife is also a really good idea, particularly in the more populated areas (and maybe training for the midwives in more rural locations).

(Thanks for the cotton btw! I will keep an eye out for it and get my needles at the ready )

go here and then look at Improving Care (no direct link)
Lots of useful stuff there

Focus on the mother and baby - some m/w and hospitals still treat women with a lack of respect (ask Aloha).

Ensuring local hospitals offer nuchal fold scans (not all do) and implement NICE guidelines on maternity care (see National Institute for Clinical Excellence website).

Patient feedback - capturing the experience of women who use maternity services. You often hear stories of appalling births where the woman is too distressed or too lacking in confidence to complain. Feedback about things that have gone wrong but the staff aren't aware of it could help improve services - and positive feedback will motivate staff. Invite new mothers to interviews or focus groups or to complete questionnaires a few months down the line when they may have the time to give you.

Staffing - need to have midwives on shift at night when most people actually give birth. Should be aiming for as close to 1-1 care in delivery as possible. Many places suffer from a shortage of midwives - this should be a trust and PCT board level priority but rarely is because the patient group tends not to shout loudly so it's not as high profile as heart surgery or A&E. So the committee should be piling the pressure on and doing their best to plan so women meet the hospital midwives who will deliver their baby before turning up in labour.

Point out this will save money by reducing the rate of avoidable complications and the number of cases where things go wrong and the patient sues. Also the govt. policy of patient choice means a hospital's reputation matters - if patients don't like you they will take their business elsewhere and you will lose funding. If you piss off women in labour, they won't want to come to you for other services so you will lose elective patients. And they will tell their friends. So trusts have to raise their game or lose funding.

Agree re b/f - all midwives should have specific training in supporting people to b/f as well as thinking about how to support people who don't want to and may object to what they see as m/w giving them a hard time. Hospitals should be working towards Unicef baby friendly status. Point out the long term benefits to hospitals and local health economy (PCTs and other health services) from improving rates of b/f).

Post-natal wards - hear a lot of people saying they are unclean and staff not supportive. Again, capture feedback, ensure there is proper staffing and think about the service you offer from a patient point of view.

That's great Miaou!

In addition to bf support, what about support for safe co-sleeping in hospital?

Thank you tatties and edam for your suggestions. Edam, you raise some really good points that I will definitely follow up. Regarding the "going elsewhere" issue though, sadly that is not often an option up here as hospitals are so far apart (often nearly 100 miles). The meeting I am going to is at my nearest city hospital which is over 100 miles from where I live! (Fortunately I can give birth at the midwife-led centre which is only 45 miles away, but if I develop any complications (or if this was my first) I would have to go up to the main hospital). But that's why I was so keen to get onto this committee - I really want to gauge just how "accountable" the services are here.

Good luck with this Miaou. I definitely think feedback should be addressed. When I left hospital after having my baby it was a really odd experience; I'd been through a 3 day labour that ended in a crash cs under general, and while the surgical care I got was great, I felt that my sort of labour hadn't been dealt with well at all. I just took ages and ages to dilate and was left alone ALL the time, until the third day when I finally had an epidural, when I had to have a midwife monitoring me.

I strongly felt that if I had had the support and encouragement of a midwife in the first two days of labour, I might not have got to the crash situation. Who knows...but I felt this very strongly.

And after the birth - there's no-one who even asks the question! I work in a voluntary agency, with clients, and when I finish involvement with a client it's part of my service level agreement to gain feedback from them. I send out questionnaires, and if that doesn't gain enough feedback then the expectation is that I would get someone in to do some consultancy work with ex clients.

I can't believe the difference between what maternity services have to do (ie Nothing!) and what I do. Where is the accountability????????????????

You need to be very proactive in getting feedback I think. Lots of hospitals wait for women to come to them.

Agree with everything suggested, except mw and bfing.

Hospitals should consider liaising with organisations such as the NCT, BFN, etc, to have breastfeeding supporters/counsellors on the pnwards for several hours every day, so that mums can ask for and obtain help from women who really know about bfing, rather than rushed and pressurised mws. After all, the bfcs have trained for up to 2 years (albeit part-time), so it's a bit much to expect mws to do the training as well. Also, bfcs are volunteers, so there should not be much added cost to including them on the ward, except perhaps for insurance and coffee.

Other things to conisder:

Not sending the partner home, but allowing them to stay as long as they like, even in the wee small hours.

Food available for the new mum and her birth partner at all times, even if it's 4am.

Better food! We leave the delivery room with a lecture on the need for dietary fibre and moving our bowels, and then have white bread toast for breakfast, and macaroni cheese for supper.

Providing some form of staffed creche at a-n clinics. In theory there was one at most of the a-n clinics I attended, but it was never staffed.

How about ensuring that someone (maybe a midwife or health visitor) contacts the mother at some point after she has left the hospital?

I was wondering that Jan - do people think that the m/w who visits you in the week after the birth would be an appropriate person to take feedback on the birth experience (if you wanted to discuss it at that point)? I've always had good birth experiences so I don't know how that would sit with those who were less than happy with their care.

If you had a poor experience, would you have considered discussing it with the midwife on the home visit after you were discharged if you were asked? Is this feasible do you think?

Miaou I think its even more basic than that. They need a system to ensure that someone has contact with the mother after the birth. For whatever reason. Just to ensure that you are not cast out and never heard of again.

Another thought - might it be feasible to have a system in place where you can find out before you arrive at the hospital if the unit is closed?

Good for you Miaou and I think you already have very good suggestions here. In case it is within the remit, I would add making sure that women know homebirth is an option. The de-briefing (patient feedback) suggestion is excellent.

Grat , Miaou ! I have joined the one where we are , went to the first one in January ! will be watching this with interest ! some excellent things to consider here

i was quite amazed and delighted to have a phone call last week from the midwife who ran antenatal classes - i gave birth nearly 2 yeras ago! i got the impression she was doing this becuase she wanted to rather than to get any formal feedback. anyway she wasn't attached to the unit so was a good impartial contact - she held a debrief session after birth too but again i don't think this was monitored.

You also need to consider the needs of mothers who have a baby taken in to special care but are on the ward while they recover. They have no baby and are ofetn traumatised by the speed and unexpectedness of the delivery. They often put the needs of the baby in SCBU before their own recovery and don't get enough support.
Also what happens when they leave hospital. In my case and I have been through it twice, I was beyond the 28 day period for midwife visits and since the MW hadn't been the HV wouldn't come because she had no notes handed over on me.

As Slalomsuki says, it is sadly quite common for women never to be seen by a midwife or health visitor after they leave the hospital, and there should be a failsafe system in place to ensure that this doesn't happen. Quite apart from general follow up of the baby for weighing etc, in many cases there are basic medical procedures that should be followed - eg: stitches to be looked at/taken out.

Definately agree re nfection control, I had MRSA and because they'd never had it on the post natal ward before, the mw weren't really up to speed with it, being inconsistent with the wearing of gloves and aprons and procedures for my visitors, I had loads of questions they were unable to answer, infection control weren't availabe until after weekend.

Also, visiting hours for DPs - DH had to leave at 8pm, I was induced at 10pm in labour by midnight - not allowed to transfer to labour ward until 3.30am and therefore DH not permitted to return until this point, I was in agony on ward where other ante natal mums were trying to sleep - sorry! Had a rough time after emergency CS and really could have done with extra pair of hands till 10/11pm at least, had to buzz for mw to do minor things DH could have done and I'm sure MW had enough to do already, they were more than happy to help and didn't mind but if they had been really busy, I would have been in a mess, sorry have ranted on a bit here but feel good about getting that off my chest!

MRSA - definatly, I was in the hospital during my miscarriage and was worried I wouuld get it.

two words

CONTINUITY OF CARE.

sorry that's three isn't it?

Havent had chance to read all so sorry if I repeat.

To stop woman who have miscarriages having to sit in room with other pregnant woman and ladies who have prem babies to be forced out of hospital because bed is needed.

Visiting hours extended for partners, especially if in labour but too early to go to delivery.

Lisa

Infection control definitely. It's all very well all the MWs and consultants etc. following hygiene procedures, but the procedures need to be enforced much more strongly with regard to the general public. EG much clearer signs about using the anti-bacterial handwash, and enforcement procedures.

Ward security and making sure that the doorbell thing is manned at all times.

Access to water pool if desired/appropriate - not just on a first come first served.

General cleanliness.

Good quality food available 24 hours.

Staffing levels and breastfeeding support obviously.

Miaou, see if you can get them to send you the minutes of the meetings for say the past 12 months if you haven't seen them already. It will give you some flavour of how the meetings are run and what sort of topics have come up for discussion already and whether some of your questions have already been addressed.

Unless of course this is a brand-new/resurrected MSLC!

Midwife staffing levels esp. in the middle of the night when most people actually give birth.

B/f support - is the hospital actually accredited as baby-friendly and if not, why not? Are all midwives actually trained in b/f (ditto)?

Also, what are they doing about the fact that there has been an absolutely shocking rise in maternal deaths nationwide over the past three years - how are they monitoring their own performance?

And what systems do they have in place to listen to patients and learn from what went well or what went wrong?