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.

I was also going to make the comment that Fargate has made. Writing verbose notes is a defence mechanism. Really notes should be concise and factual rather than covering your back notes.

In my work now, where we had a massive waiting list and used to do loads of admin, we now have a dedicated admin team and the waiting list has been slashed. It's probably a little more difficult in a very acute situation but certainly most wards do have admin anyway. Again the problem is organisational. The better the hospital care the less likely the staff are to get burnt out so is less stressful so patients complain less and staff are happier, it's a circle really.

I wonder if we should think about ways in which technology can help solve some of these problems?

It does sound like note-taking is a big burden. What would help make that better? Is it structural changes having someone other than midwives doing it, training them to do it differently or could technology help?

Could we have buzzers in the loos that alert the cleaning staff directly not the midwives when there is a mess?

Is there some kind of scheduling software that can help with discharges, to better coordinate all the people you need to see?

Could some kind of automation help with the food service -- with ordering meals, coordinating around SCBU visits, making sure women don't miss meals, etc.

I know massive IT projects are not going to happen in this climate, but if a modest investment in infrastructure produces big efficiency savings, that can be sold right? So, equipping midwives with PDAs for note taking increased the amount of time they were able to spend with patients by X percent, which given evidence of the costs of poor postnatal care can be extrapolated to saving Y pounds in the long term.

lots of good points being made here. Did not read all 330 posts, but could we add to the campaign something about giving women appropriate medical/nursing/psychological support and treating them like sentient beings with feelings (physical and emotional)?
After an instrumental birth in theatre, haemorrage, lots of stitches I found myself being kicked out of the high-dependency unit less than 12 hours after the birth because it was Sunday night, I was the only person on it and they wanted to shut it. Note that, aside from what is described above I also had various high-risk factors that made the first few postnatal days particularly tricky. When I explained I was not ready to be moved I was given 20 extra minutes to be. As a result of the move, I had to wait 48 hours for a transfusion (the reason being there no longer was space on the high-dependency unit the following morning and nobody on the PN ward was qualified to give one).
Nobody came round to explain this to me, or to explain why I felt so rubbish and how things would be much better after a transfusion. All medical explanations I got from my mother (thankfully a doctor with good experience of transfusions etc) and she in turn only got info on what was going on by being rather bolshie about it all. Had it been DH and me we would have waited for ages not be a nuisance/pain. And I would point out that in real life we both have senior professional jobs where being assertive and able to deal with adversity is a pre-requisite. But after 27 hours of labour and a near-death experience we were both completely unable to be our own advocates.

I could go on, and on, and on. The simple point is that HCPs on PN wards need to be given appropriate resources to make the experience at least comparable to that on other surgical wards. And if necessary maybe split the women needing least care from those needing most, and focus resources on the latter- but do not then try to classify everybody as needing low levels of care when they definitely don't.

And if we need to pay more taxes, so be it. It is unbelievable that in first- world country families who have just had a baby should be treated so badly AND that people think that's fine.

Sorry for the rant but even 18 months down the line this makes my blood boil.

I found staying in my dressing gown during the day in the early days after the birth sent a clear message to anyone visiting that I needed taking care of - and everyone made me tea, did the washing, cooked me meals etc etc. Once I got dressed they thought I looked like a woman that could cope. My tip - stay in your PJs for as long as you possibly can! Forget the housework, ironing, cooking - its just you and the baby for as long as you can. I realise it's much harder when you have more children - but lots of readings and colouring works a charm for older kids. And it won't harm them to watch a bit of telly in the early days just to give you a rest!

It completely goes against the Superwoman image I know - but Superwoman (if indeed she exists at all) usually cracks after about 6 weeks and admits she's really suffering from postnatal depression, hasn't bonded with her baby and is desperate for some help (although her house us immaculate and probably her nails too!)

Ensure the midwives and health care assistants are as friendly and visibile (ie, popping their heads into your cubicle, as much as the Bounty lady and the women trying to flog professional photos of your baby!

On a serious note; a kind word, a smile and a willingnes to help a vulnerable mum are basically what's required. I think that sometimes, the staff forget how scared, vulnerable and in pain, the new Mums are and I think they also forget that they are actually being paid to do a job. If they were volunteers, I wouldn't moan but it's their job!

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!

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.

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?

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!

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.

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.

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?

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.

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

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.

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).

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

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

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.

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

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?

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.

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

MNHQ - Could this thread be forwarded to the RCM?