Could we have a MN campaign for improved Postnatal care?

[AtYourCervix]

Reading the many threads on here it appears that Postnatal care is the most frequently complained about area of the maternity service.

In-patient stays in hospital - Women feel neglected, ignored and unsupported and Postnatal visits at home are rushed and women are 'lucky' to see a midwife 3 times.

I strongly suspect that with NHS cutbacks ths is only going to get worse and I think it is not good enough.

Ideas and opinions please.

[SuchProspects]

Katie - A bit of tumbleweed here. . I'm not involved with any MSLCs so not much help at this point. But I am interested in the campaign and I do keep checking in. I am so glad you're doing this and helping to keep the issue visible. Can you tell us what the RCM, RCO etc. are focused on?

[KatieMumsnet]

Hello, hope all OK with everyone. Apologies again for the delay. Firstly wanted to say thanks to EFR. Yes have read your review - was especially helpful as had to go to meeting at Guardian on Monday re state of maternity services, so great to sound so well read! The Royal College of Midwives and the Royal College of Obs and Gynae were also there, and while more focussed on longer term changes, all very receptive to the main points of this thread.

EFR and Blondieminx thanks so much for your suggestions - sound really promising, and hopefully we can help. If your MSLC say yes, then we'd be happy to host a thread asking for feedback/ top tips for those units so we can help produce a leaflet in those areas, as a start. Also think we could try for a couple more areas and see if we could get a bit of support for the leaflet.

is it clear what will happen to MSLC after PCTs are disbanded?

Maybe when we have couple of strong examples we can then think a bit bigger!

Realise there might just be me and the tumbleweed on this thread as a little time has elapsed, so I'll send you both a private message, but if anyone else is on an local Mat Services Liaison Cttee and wants to get involved, or just wants to get involved do shout.

[blondieminx]

Hi KatieMumsnet,

I'm on the Colchester MSLC. We discussed the MN Postnatal care campaign at our last meeting, and we are hoping to get the sort of leaflet discussed on this thread into the postnatal ward very soon.

There is some urgency to get as much positive stuff in place as possible before the PCT is disbanded ready for GP commissioning coming in. Also budgets in our area are currently being reviewed, so if we want funding for a leaflet we need to get on with it! The PCT has a brilliant administrator who organises all our MSLC meetings and holds a small budget for the MSLC but the pathway for after GP commisisoning comes in seems vague to put it kindly.

Any chance of MN getting in touch with the Care Quality Commission on this as well as the DoH? I would be very interested to see what they found on postnatal wards and what reports they have made in light of their findings.

I have also made a Freedom of Information Act request to the trust/hospital asking the awkward questions I mentioned upthread.

[EasyFriedRice]

Hi KatieMumsnet.
I'm on the local MSLC in Brighton. Happy to raise this as an issue with the chair and see what she says. It's a very good trust with lots of work currently going on to improve services so they might be willing to be a guinea pig!
Did you have a look at my research review?

[KatieMumsnet]

Hi Everyone and massive apologies for the delay in the update. The usual work and home shenagians , I wont bore you with, but rest assured we?ve been thinking of this thread lots.

Right ? Dept of Health (DH) meeting ? they were very engaging and interested, could relate to much of the thread, but AtYourCervix wins the gold star for correctly guessing most of this has to be done and trust and local level.

This makes a lot of sense as visiting times, ward layouts etc are all going to be difficult, but also is going to be a familiar factor in the new ?localised? NHS ? as we?re seeing on the miscarriage campaign (oh how I wish there was a big clunky lever in Whitehall we could just get pushed).

Anyhow ? they gave us some good info and we?ve had a think. Probably the best way forward is to start with one trust, see if we can get a leaflet up and running, and then share the love (or as I believe it is more commonly known ?best practice?).

In terms of how we work with the trust the DH said going through local Maternity Services Liaison Committees (there should be one for every PCT) might be a good idea (although their activity levels vary).

Is anyone a member of their local Maternity Services Liaison Committee or does anyone know a good local one? If so, is you area a good place to start?

Or does anyone want to make a bid for the first leaflet to be for their local hospital?

Once we?d agreed on the hospital and checked the trust are keen, we?d be able to put a thread on the boards asking for lots of info. about the hospital, but would also need you to do a bit of ground work and chatting to the trust.

When we have all the info., we can pull it together in a doc. ? which we can prettify and give to the trust to use. This would also be a template for other hospitals. At this point, we can also talk to NHS Choices, the main NHS website to see if it?s something they could carry.

We?re ?going live? with the next stage of our miscarriage campaign on the 10th of October so it would be great to have a feeling on the first trust we should tackle, and get started on compiling the info. a week or two after that.

Do let us know what you think

[SuchProspects]

EFR Thanks for writing that up. It is interesting to see that, apart from the few but horrific stories of cruelty, research seems to mirror the experiences people here reported. There's really no excuse for hospitals not knowing that this needs attention.

[EasyFriedRice]

Hi Everyone! Glad to see this one is top of the board. Can we revive this campaign please!
As promised I have done the literature review: Please PM me if you would like to use this in the campaign and want a word or pdf copy.
For the moment I've put it on my blog so everyone can see it.
here

Let me know what you think!

[AtYourCervix]

The RCM call for more midwives is all over the news this morning.

MNHQ - Could this thread be forwarded to the RCM?

[AtYourCervix]

I think any information leaflet needs to be done at Trus level as things like visiting hours and meal times will vary.

Will be interesting to see what - if anything - the DoH have to say.

The Trust where I work has had to save vast amounts of money - Sadly this has resulted in staffing levels on our postnatal ward being cut. It is now impossible to give any sort of decent care to women and until it is actualy 'dangerous' we get no help from anywhere. This means things that matter like spending time with women., talking, directing, helping with feeding, teaching and encouraging just cannot happen. We can do the basics. Nothing more and often not even that.

[WhollyGhost]

I went back to the hospital where my baby was born and had a look at my notes, as a result of reading this thread. The detail in the notes is astounding - I was shown how to use an electric breastpump, and I suspect that the midwife wrote more detail about this in my notes than the original instruction manual could have contained.

It would certainly have taken more time to write it all down than to do it. Who decided that this was a sensible use of scarce resources?

[blondieminx]

Watching with interest for update on meeting with the DoH...

[SuchProspects]

Bit late for the meeting with the DoH, but the points in this thread about Bounty/photographers could also fall under this umbrella.

Might weaken the chances of any success to be talking about removing revenue streams, but it does seem to be part of a trend of not recognizing women who have just given birth as being vulnerable and in need of a bit of care and consideration.

[WhollyGhost]

Thanks Katie, if there is anything we can do to help, just let us know.

[KatieMumsnet]

Hi Everyone

Many thanks for all your comments and stories, SarfEasticated, your experience is scarily familiar! Really tough reading at times, but also great to have so many positive suggestions.

We've already flagged the thread with the Department of Health, and are on our way to see them tomorrow morning (primarily to talk our miscarriage campaign, which we're hoping to do more on this Autumn), but have asked to put this on agenda.

I'm hoping to find out how practical and easy it would be to get information sheets on the wards. Can we do it nationally with the Department of Health helping us with a template? Or do we have to do it at Trust level, to ensure we get your real-life advice incorporated? If so, what's the easiest way to go about this?

I'll let you know how the meeting goes (and keep an eye on the thread before hand), so do let us know what you think.

K x

[higgle]

Sadly this year the maternity unit at St. Elizabeth & John is closing for births, but they do offer all sorts of post natal support ( including psychological).

[mamarara]

I support this campaign 100%. I was lucky enough to have a fairly straightforward birth but even then was exhausted, hungry, in a lot of pain (stitches), somewhat abandoned and had no idea what to do with myself (where the toilets, showers were, how to get food etc) or my baby (bf, nappies etc). So I can only imagine what it's like if you have had a traumatic birth/surgery as well. 

To add my two pennies: 
-- laminated cards in each cubicle and outlining the ward 

• map of ward, where facilities are, what facilities exist (showers, baths, bf room, where to get food, get drink and at what times)
  
• uniform explanations
  
• how often you can expect to see a hcp (eg straightforward birth - checks this often, for c section - checks this often) 
  
• what you are expected to do - change your baby's nappy, bathe your baby etc and where facilities are (bowl for warm water, bin for nappies etc), what to do if you go for a shower (take baby with you/leave baby etc), what to do if you go for a wee etc 
  

-- I also think that a copy of this info should be given to you in your ante natal appt. Eg I have 2 hospitals I could go to, so that's only 2 leaflets that would need to be given out. If it included things the hospital expect you to bring as well that would be helpful - I had a massive bag (first timer!) but no cotton wool and no nappy bags. Hospital were v grumpy with me about this and refused to offer me any cotton wool after the first nappy change. Had to send DH out on emergency cotton wool mission. 

-- a joint code of conduct for both patients and staff: both are expected to be polite and patient etc 

-- a mumsnet survey given to new mothers at first cmw visit post birth. If we collect hard data then we have evidence with which to lobby the powers that be. 

I also think we should be campaigning longer term for more resource as that is the root of the problem. Information is useful but only a bandage to the actual issue. 

Am happy to help in this campaign if you need any. 

[TSK]

I truly sympathise with you SPOUT and wish to support this campaign 110%, my sad ordeal is listed in the thread below too:





www.mumsnet.com/Talk/am_i_being_unreasonable/1268245-Midwife-made-we-walk-after-an-epidural/AllOnOnePage

[fargate]

My understanding notcitrus of why there are so many agency staff [with all the disadvantages they bring] is that it is due to unexpected sickness etc on the shift and the continuing lack of midwives.

[notcitrus]

Re HVs - in my area you don't get a visit, or one if you're lucky, unless flagged up as at risk for some reason. There are two HVs, and they have a caseload of over 1000 babies, or so I was told by a local SureStart person, in an area of huge deprivation, highest teenage pregnancy rate in the country, huge proportion of families who have little English, etc. In the circs, they do a great job - only problem is the 'healthcare assistants' who are only supposed to help weigh babies and help the HVs pretend to be HVs and come out with all sorts of rubbish. I had a low opinion of HVs until I found out four local ones weren't HVs at all!

A number of people have said daytime care was OK (mine was), but nighttime was terrible (ditto). Partly this is because you can't have anyone with you to help or chase anyone up, which on shared bays is unavoidable, but also in my case at least the staff were rude and unhelpful. One of the day MWs went as far as apologising for nighttime care in advance of the next night, but apparently all the night MWs come from an agency and thus they can't guarantee the quality or kick them out for being crap. And several agency MWs are the ones incapable of getting a permanent job.

Why they all come from an agency is a question I'd love an answer to - surely it must be more expensive for the trust? And surely there must be ways to ensure agencies provide suitable staff?

[bacon]

LaCiccolina I totally agree with your points on the HV. I really dont understand their understanding of the green notes. I had written depression suffer in my green notes yet she really didnt check me (even though I wasnt suffering that bad) I had had a terrible crash section and was in shock but no talk of this either.

As for community MWs too (in agreement with some friends) they come up with some verbal rubbish. After breaking down in fits she made no attempt to calm me or offer any help with my suffering - she should of known that there could be some mental health issues. They dont seem to like the word ROUTINE comments like "oh he'll be a night owl"...you what? They hate any books which are life savers for many mums. To me many of them have been brain washed by the NHS manual. I hear endless rubbish being thrown out to friends too so I'm not the only one.

[bacon]

What I really cant understand is why MWs are taking ops when on DS1 this was an axillary position and taking blood pressure/temps in the ears does not need to be completed by a senior MW. Very inefficient indeed.

[bacon]

kipperandtiger I would assume most NHS hospitals havent the available space for private wards - The Royal Gwent in Newport is crammed full as it is. Being left in a ward with some werid scarey people is no fun and for peace its flash backs for me!!!I wouldnt know any private birthing centres outside London?

Windows that open too! Cant believe that the heating is on and the windows are slightly ajar! Hot mammas need air!

[kipperandtiger]

I would put up my hand and say all the midwives at my hospital where I gave birth were brilliant (apart from the one on the phone who tried to stop my husband from bringing me in to give birth, maybe, haha) BUT the ones on the postnatal ward had an impossible job to do. Most of the time it seemed like only two midwives for about 20? 24? women and their babies.....so that's at least 40 patients - a baby is a patient too. OOHHHHH. Maybe that's the crux of the problem! The people in management forgot to count the babies as patients! They're not wounds or surgical devices! - they have their own heartbeat, their own needs, and certainly their potential and ongoing nursing (in both senses of the word!) needs and problems which are totally different from those of an adult postpartum woman.
Perhaps if the bean counters got their figures right this time (20 mums and 20 babies equals 40 patients, folks! Not 20!!!) we would get better funding for the wards - more admin staff, more IT/buzzers, more HCAs to help with meals, help mums reach their food and pick up their baby, more MWs to help with breastfeeding, better maintenance (no more 39 degree wards with no ventilation to kill mums and babies through suffocation please!) etc etc. And most employees are usually sloppy and rude when they're overstretched, though I accept that's not always the reason.
One final question - why can't some hospitals set aside a private ward for postnatal mothers who just want a bit more care, privacy and peace? The cost would be affordable for many and those who can pay for the extra benefits could free up the NHS wards for those who can't afford to pay. We tried to ask for this at our NHS hospital but they refused to let us go private just for the postnatal bit without going private for the labour part as well. I presume this was because there wasn't actually enough private postnatal beds to go round everyone.
PS. I think the list of suggestions for practical improvements is pretty good - is someone at Mumsnet noting them all down please?

[bacon]

Also being left in a ward after a c-section to get on with it!!! You cant move after a c-section - I saw no MWs popping by now and again and in the nights no one.

[bacon]

www.dailymail.co.uk/news/article-2021738/Richard-Talby-I-saw-wife-hanging-little-boys-dead.html?ito=feeds-newsxml

Proves my point with PND and mental problems - as in this event the mum had a traumatic 2nd birth but once again the medical profession missed this and I cant understand where the HV was on home visits.

Having suffered from depression in the past and made note of this in my green book no one picked up on this at all - what was the point of filling it out - for stats use??? Luckily I had no PND but did have 2 bad births and the second was a crash section which did leave me gutted and PTSD for a good few months but absolutely no one came and my husband did ask in the ward to someone to see me but nothing!!! I am still annoyed now I was left in a ward absolutely beside myself with the greive and shock of this operation and missing the birth of my baby.

Shocking story and unbelievable that this can happen!