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.

applauds cardamom

Thank you mousy . Another point - MWs and other HCPS cannot simultaneously claim that CS is major abdominal surgery that necessitates a longer recovery time (used as argument to try to get women wanting CS to consider VB) and claim that nursing on a PN ward should not involve nursing as this detracts from making child birth a normal part of life and that to give assistance to a woman post-CS is unreasonable as she would not get this kind of help at home. If a baby has been cut out of your uterus, you have had a major operation and nursing care, with all that that should imply, is appropriate. Further, I would argue that women who have had tears that include the muscle layers, and particularly those that have extended into the anal sphincter, should also be considered as if they have had surgery. Sure the rip came from a baby forcing its way through rather than it being a cut from a scalpel. But surely this results in more trauma to the area, not less, and, again, a need for nursing care. To reiterate: if you have been admitted to a PN ward you are a patient and are entitled to receive care that is appropriate to your needs, just as any other patient is.

Some excellent points being made here.

also applauding cardamom

This idea that childbirth, even when there are complications, is just a natural, normal thing and women should not be coddled too much postnatally sometimes seems to me to have become an ideology. It's an attitude or party line that seems to be adhered to even when obviously contradicted by reality.

Agree that something needs to be done but in current times, it's unlikely there any funds available to address it. Also, as dreamingbohemian pointed out, a lot of the care required is not strictly medical and volunteers/a charity would help the situation. Is this not something for a charity to take on? I'm thinking of the NCT in particular. It's a charity that already has strong links with the NHS maternity services and is well-respected. However, I've absolutely no idea how to get such a charity involved!

Thanks dreaming [blushes a bit]

Dreamingbohemian - yes it really does seem to have become an ideology.

The trouble is the 'least intervention' ideology has morphed into 'least care'.

The dogma that women should be leaping around self-sufficiently both just before and just after giving birth fits in conveniently with NHS cuts as well.

Oh yes and I wholeheartedly agree with the earlier poster who said that giving birth was certainly NOT a normal everyday activity for her.

Even when everything goes smoothly, pregnancy and childbirth is a HUGE physical and emotional upheaval, especially if you haven't done it before.

I would be very wary of saying that volunteers would be useful. I had enough people bothering me and the idea of another person doing so but probably even more badly would just make things worse. The point really is that if some hospitals can give good care so can others. I have worked in different hospitals and the culture varies between them. Really it is about good management and organisation rather than money spent on the service. Some hospitals think it is efficient to have a different midwife see a person every shift however actually it isn't because time is wasted reading notes and trying to process information before and during each interaction. This means the midwives make a view of a woman before they even reach the bedside and get burnt out and then are bitchy and vile rather than looking at individual mums and the difficulties that they having.

"doctors don't get this defensive" I can't recall who said this, no doctors don't get defensive, mainly because if most people have a poor experience with a doctor then they accept it is that doctor who is at fault and has undesirable traits. It seems to me that if someone has a poor experience at the hands of a midwife it is because midwives as a whole are a shit profession. Midwives as a collective are nasty lazy vile bullies. I'm sick of it. I've been supportive of this from the start, accepting there are major failings in the area of postnatal care, I will no longer continue though because it's just become an exercise for people to complain about midwives as a collective yet again. Yes there are some shit midwives, I don't doubt some of you have met them but we aren't all like that. No doubt someone will be along soon to tell neck shouldn't take this so personally, guess that is easier said than done.

I've been thinking about this problem for a few days now.

MW are already a scarce and precious professional resource and there is no money to increase their numbers. The birthrate is rising and the majority of cuts have yet to be made. Should MW be providing in-patient postnatal care, at all?

The role of MW in a postnatal setting seems to be staggeringly large and rather diffuse and doesn't utilise the majority of their core skills. I imagine these things would be a source of stress and disatisfaction without the ever present pressures caused by under-staffing.

Much of the paperwork, answering the phone, opening the door etc could and should be done by ward-clerks who could be charity/voluntary workers. Nursing staff are responsible for infection control not for the cleanliness of toilets & bathrooms - a dedicated cleaner making frequent checks should be able to do this without supervision.

BF support should be available 24/7 and could also be provided by commited volunteers or MW assistants. They could also help with personal care

Post op care after CS or surgical repair [20-25% of mothers] should be of the same quality and standard as in any other surgical wards/units in a hospital. And maybe should be cared for separately by nurses with surgical rather than midwifery expereince.

Rather long and rambling.

MrsJT - I am truly sorry you are feeling that you and your entire profession are being got at. I don't think anyone here has said "all MWs are rubbish". Some may have said that all the MWs they encountered on the PN ward provided a level of service they perceive to be substandard. If that is their experience, then they should be able to express that and complain about it, either here, or more formally. I'm sure you must have come across colleagues who you felt have been rude to someone or who have not provided the care to a woman or her baby that you felt was appropriate. I don't think anyone here is expecting you to apologise for poor care provided in PN wards to which you are unconnected. Your defense that MWs are overworked and overstretched in working conditions that are far from ideal and sometimes downright uncomfortable may be an explanation for the poor level of care some women here have reported. Be that as it may, it is not an excuse and mothers either individually or collectively should not have to accept substandard care with these poor working conditions given as justification. A lot of the posts here have pointed out the difference between care provided on other wards and care provided on PN wards, with further comparisons being made between care and conditions in MW led birthing units and in PN wards. This is not MW bashing. You raised similar points about PN services being the poor relative in the NHS. Once people have brought forward their experiences and we have a list of reasonable complaints and ways in which PN services tend to be lacking, we have two questions. 1. How to get these issues addressed at the PCT (or whatever it is it's called these days - I lose track) level such that PN care won't be the Cinderella service any more; 2. Within an overstretched system, what small, low cost measures can be implemented to improve care? (and hopefully make MWs' jobs less stressful and more rewarding).

Good post northern rock

I'm sorry some of you have had such awful experiences.

There were some bad examples of individual midwife behaviour in my postnatal stay. 'Terse' and sometimes seemingly neglectful I suppose would be the least emotive ways to describe them. In these cases at the time I assumed (was made to feel?) someone else needed them more or was worse off than me - though I was in a pretty bad way.

I can think of many fabulous midwives I met too and some fabulous examples of care.

However

The over riding negative (a year on looking back) would be the seeming lack of time most midwives had to 'help/assist/care'

by the time I left after 8 days I was convinced this was due to the
their responsibility for keeping a detailed handwritten transcription/record of conversations in my notes rather than what I had previously assumed to be too many patients per midwife

I was staggered about the note keeping.

The midwife who was responsible for me in labour (induction/failed epidural/mal presentation/episiotomy/forceps) spent an incredible amount of time writing notes. Fairly early on I said something like gosh you seem to be writing an essay .... She said something along the lines of 'well yes we have to write everything down so if afterwards a woman says you didn't keep her clean or something you can proove you did and at what time etc'

Has there been a trial anywhere of minimal or alternative forms of recordkeeping (if this is really so essential) therefore freeing midwives to do more midwifery?

What training is there on notes surely facts would be more useful than the things I found eg notes say 'Inspirachion complained she had not seen a midwife today' - actually I went to the desk early afternoon to say 'who was my midwife for today (different most days) as I needed to see her as hadn't had any painrelief yet and should I just continue to wait on my bed'

I don't think anyone is going out of their way to go after midwives as a whole Mrs JRT.
Personally I am recounting my own experience, in The Whittington Hospital which was that the labour and post natal midwives were variously:
Disinterested
Sloppy
Rude
Callous
Absent
Bitchy.
Not just to me, but to everyone they came in contact with, that I could hear/see.
I only saw one doctor on the ward, and although he was an idiot (he discharged my bright orange baby as being Not Jaundiced) he was at least polite, and actually it was the unpleasantness of the midwive I encountered that most offends me.

The visiting midwives who came to see me after I got home were wonderful and thank God for them.

We can only say what our own experiences are, and if I sound angry and hostile towards the maternity staff I had, thats because I am, for bloody good reasons.

I have been thinking this over for a few days, and the more I thought about it, the more it annoyed me. I think that the post by Reikizen back on page 7 of this thread pretty much sums up how a lot of people feel about their postnatal care. Although I'm assuming her intention was to point out her frustration at how overworked they are on postnatal wards, in actual fact it came across as ' I know many of you have had surgery, and many others have had interventions that have left you in pain, but frankly, I think you are making too much of a fuss. I can't change everyone's dressings/catheters/soiled sheets, so most of you will just have to wait, and to hell with the consequences.'

So, in actual fact, in trying to explain the midwives situation, she has really just left me feeling that 'yes, it is attitudes like yours that sum up why so many people on here rate their postnatal experience as the worst of their lives'. If you consider postnatal patients to be such an unpleasant, whining, unreasonably demanding group of people, why on earth have you chosen a career which is meant to involve looking after them? Its a shame too, as the other midwives who have contributed have all had such positive contributions to make.

And for the record, I had some wonderful midwives, but individual wonderful midwives are not the same thing as getting good overall care.

And my health visitor was outstanding.

I would completely support a campaign to improve maternal care from start to finish, but particularly post-natal. For a large proportion of women in post-labour wards (those who haven't had cs or major complications) it's not actually difficult to improve their experience at a relatively low cost.

Agree with SnoozleDoozle.

And for individual midwives to take umbrage on behalf of midwives everywhere just smacks spectacularly of Not Getting It, sorry.

"Then perhaps midwives could visit their patients and spend time with them in hospital, as they do in the community."

Avril - that makes sense to me. And sorry to hear about your experiences, they sound horrendous.

Midwives, like all NHS clinicians, have a legal responsibility to keep clear, complete and contemporaneous clinical records in line with agreed standards.

They should, by neccessity, also be concise. Writing unneccessarily detailed essays protects no-one from litigation but can be a powerful psychological defence against the anxiety of making an error or the fear of being sued .

Then there are all the care plans,risk assessments etc etc which run in parallel/replicate the clinical records wh nursing staff are obliged to complete - there's got to be a way of reducing this unproductive make-work.

Even recently qualified MW seem to be 'burning out' when they should be at their most enthusiastic.

OP, an excellent post, I can so relate to much of this. Just TTC DC no.2 and already I have a list of things that I am certain of...

• I want the number of a private bf expert who can be there when i need her. I'm afraid that the fact that the bf expert when dd1 was on holiday didn't really cut it and those first few days of getting it so painfully wrong set us on a tricky path. I'm lucky that is an option for me but it shouldn't have to be and they wonder why so many people end up giving up. Experienced midwifes were understandably busy and well meaning young trainees were supportive but not actively helpful

-I was lucky enough to be given one of the private rooms at the hospital, not sure why, I just got lucky and should that happen again, I'll be taking my own DO NOT DISTURB sign - medical staff excluded but is it really necessary when I have only been in the room for the first 3 hours with my baby and I'm half naked and trying to sleep that about 3 different men come in to empty the different bins!

-Food - nothing special, just food that looks like you would want to eat it and yes, my husband does also need to eat when there are no shops at the hospital!

To be honest, having had one experience it has made me more determined to do as much myself and not have to rely on getting the care i will need, I might get great care but you can't rely on it sadly.

Yes, I don't understand why a busy maternity ward wouldn't have a receptionist/administrator to deal with the door and visitors. Could they not also deal with admin tasks like requesting cleaning staff to attend if there is a big mess in the bathrooms or wards, and help with some of the mountain of paperwork?

It seems mad that midwives are also acting as receptionists and administrators if it is stopping them from looking after women and babies.