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.

[sprinkles77]

Count me in. Post natal was dreadful. Some of the midwifes were OK, but several things stick in my mind, following my EMCS

1. Theatre staff had put a pad between my legs. Fell out (nothing holding it in place, I didn't know it was there) when I got up. Blood everywhere, including on pressure stockings. Stood there for ages (couldn't move cos attached to catheter and drip). When someone finally came to help I got a big telling off for being out of bed. Noone had said I couldn't.
   
2. They took 10 hours to get me clean stockings. In the wrong size. Good job they were a size too big, cos I'd swollen up so badly I could barely get them on (obviously noone helped me).
   
3. They really frightened me about DS's reluctance to feed. Surely they should have known that a 12 hour old baby who had IUGR due to dodgy placenta, whose induction had started 4 days previously and failed was probably going to be too tired to eat.
   
4. That after 4 days of failed induction, no sleep for the same period and EMCS, I was unlikely to have much milk to offer anyway, so some time to rest rather than being bullied into attempting feeding with cups and bottles would have been more appropriate.
   
5. That it took 36hrs to get me discharged after DS had been declared OK to go home. Just cos there were no doctors.
   
6. That after than it took another 6 hours.
   
7. that I lost nearly a litre of blood, and noone mentioned it till I was about to be discharged and was given iron to take home.
   

If there is a next time I will probably have an ELCS. I will also probably discharge myself as soon as they take the catheter out and I have done a wee, so hopefully within 24 hrs.

i know that they are understaffed. I know they are rushed off their feet. I know that there were people there sicker than me with sicker children. But a little care and respect would help. Some clear information instead of misguided opinion. An understanding that while the staff see what is happening everyday, to new mums the whole experience is often emotionally and physically overwhelming, often the first time they've experienced it, and is life changing.

[kenobi]

Count me in, not because my care was bad - on the contrary - but because while I being looked after generally very well, at the same time less than 3 miles away a friend's bladder nearly ruptured after the MWs on the admittedly very busy ward refused to empty her colostomy bag.

This was at a large, well-respected west London hospital which has a quiet reputation on the side for terrible pn care.

That level of postcode lottery is unacceptable.

[kenobi]

aubergine - I love your idea. I too fell foul of not knowing what the uniforms meant and asking the wrong person. I also found it weird they'd get a bit cross about it. I know nothing about hospital working policies and uniforms - how could I possibly know who to ask?!

[spidercatcher]

Do count me in. My experience was really horrendous and definitely contributed to my post-natal depression. I won't bore anyone with details but I'm still scared of the idea of having more children after that.

I second (third? fourth? er?) the idea of cards for patients; possibly with a map to show where things are like visitor rooms, kitchens and loos. It's not always obvious.

Some training for care assistants in the medical tasks they're supposed to do - Royal Berkshire in Reading use a lot of them, but I found some of the tasks (taking blood samples for instance) would need training that not many of them appeared to have had (taking blood involves pulling, not pushing in air..)

A whiteboard at the foot of every bed with any key information (like - note: baby to be given antibiotics on SCBU ward at 3am) writ large so that care assistants or midwives can easily see what they need to do without having to leaf through notes. (DD had three missed appointments because nobody thought to tell me until the nice people at SCBU came down to see if there was a problem)

I know that post-natal wards are desperately short-staffed and I do feel for the HCPs who work there. As a (HCP's words) ignorant first-timer who didn't know ANYTHING, it would have been lovely to have access to something straightforward that told me what I should be doing instead of having to ask harangued HCPs about it. Such as - your baby will need to be weighed and examined within the first x time after coming to the ward. Bring them to x location at x time or let us know if you have problems doing so.

Interesting about the varying experiences on notes - I never saw mine and neither did anyone else by the looks of it! Nobody seemed to know I'd had a C section, but everyone seemed to think I had pre-eclampsia which I didn't..

[Llanarth]

agree with BagofHolly's card idea, not least because having it all set out in a leaflet left on each bed when you enter the ward would mean that there would be lots of less buzzing for the MW's, freeing them up to respond to clinical requests.

(I can see how frustrating it must be for a midwife to answer a buzzer from someone asking how she should go about ordering food for tomorrow's breakfast, when there are hundreds of clinical duties to attend to. I can almost see how some might be snappy and patronising in those circumstances. But if the information isn't provided, how does the mum find out such info?)

Additional facts to include - what is the discharge procedure, maybe simple babycare instructions - stump care, the procedure for nappy changes (for us it was a very complicated procedure involving specific sinks, hospital-provided containers but your own cotton wool), where the clinical waste bins are (and what should go in there versus the bedside bins) etc.

Campaign still needs to address the understaffing and poor amenities though.

[KatieMiddleton]

I agree. It is my latest campaign. We seem go be losing HV service round here too.

[WillbeanChariot]

I would definitely support a campaign. The cards are a great idea.

My care wasn't too bad but to throw in a simple suggestion, could wards try to keep women whose babies are in NICU/SCBU together in one bay rather than dotted around surrounded by other babies.

[dreamingbohemian]

These are all great ideas. I think it would be good if the information could be put on posters on the walls as well (in case booklet gets lost in shuffle) with illustrations for mums with less English.

I got given a load of booklets when I was discharged, they were all pretty much useless. This sounds like a better use of resources!

[hildathebuilder]

As I mentioned on the other thread I agree very strongly with Willbean on keeping women with babies in NICU and SCBU together. It is better for us, as someone nearby understands what you are going though and will udnerstand if you fear you rbaby may die, and better for the other mothers who really really don't want to hear us sobbing away while trying to stop their babies crying. It would also be easier for the midwives and doctors as we are all around on the postnatal wards when we are banned from the NICUs due to wardrounds, and we need different advice and support from those whose babies are with us (emotional support, counselling, expressing help, as well as information on long term practical issues like parking discounts when you are discahregd without your baby).

[dreamingbohemian]

Also, hospitals should be more realistic in terms of telling you what to bring with you. I was encouraged to bring lots of cozy but unnecessary stuff, they should have told me to bring my own paracetamol, food, water, wipes, etc. (thank god I did).

[WillbeanChariot]

And to add another of my pet bugbears, if the Bounty people must be allowed in (they wouldn't be if it was up to me) tell them who not to go and see. This would again be easier if all the NICU mums were together. I was far too polite to the Bounty lady who came in with a camera and demanded to know where my baby was.

[dreamingbohemian]

I'd like to help too -- I'm not in the UK anymore but would be happy to do some online editing/design of any information sheets or what have you.

Was just thinking that maybe they should be laminated. Bit messy, the postnatal ward

[tigana]

yes.

need info for the full on daft anxiety things like "I need a pee...can i leave my baby alone in the hideous plastic fishtank by the side of my bed while i shuffle to the toilet?"

also need to improve the CARE.

Pressure on Dept of health, sHas and PCTs to add a KPI/contract incentive around pt experience on PN wards (eg "90% patients respond with excellent or good when asked about pn care in a survey").
Thing is...why (i mean, apart form the blindingly obvious)? Can we find anything about improved outcomes? reduced re-admissions? reduced need for medication (PND?)

[UntamedShrew]

I've been involved in a campaign for better maternity care for multiple mums which focused largely on postnatal care as this was clearly where the majority of problems lie. So, if anyone does do anything with this idea and wants to know how we got on/ what we did please feel free to get in touch via PM.

[MrsChemist]

Do you think that this is something that could be organised with the help of PALS? I'm sure I saw a few PALS leaflets last time I was in hospital

[dreamingbohemian]

That's a very good question... what is the why? I think you could break it down into several categories:

1. Fewer short-term complications for mothers and babies
   

We have seen many stories here of serious medical complications from lack of attention.

1. Fewer long-term complications
   

Many women feel their PND or other difficulties can be traced to poor postnatal care.

For both sets of complications, would need to provide whatever data is available (surveys?)

1. Improved efficiency
   

They should love this! Some of the things we are talking about, like information sheets, would allow staff to concentrate on more important things.

1. Professional ethics
   

In short, it goes against every code of professional ethics for staff to treat women in the way that many women here have documented over the years. It is simply not acceptable and should not be tolerated.

I saw an NCT press release for a survey they did on postnatal care it's possible the survey itself was very good, but I found the press release to be very counterproductive. The leading finding that they emphasised was that women are not receiving enough emotional support or being treated with enough kindness on the postnatal wards. Now, this is probably true, but it is too easy for people to dismiss that to say, well, the NHS is not there to provide emotional support. So I think it's important, in giving a rationale for change, to emphasise the more tangible problems and costs, the kind of things that people can't really argue with.

[KristinaM]

I am strugglijg to understand how this is all about staffimg levels and the need for more mw. I was in for 24 hours aftre a ECS. Aftre i left recovery and went onto the ward, the only " nursing" care i recieved was

Remmoval of cathtere 1min
Replacig bag on drip. Ditto
Dispensing of 2( i think ) doses of drugs -i understand this is a two person job, so say a total of 8 minutes

So say 10 minutes. Allow a further 10 minutes to write these event up. That a total of 20 mins in 24 hours. Obviously i needed a higher level of input as a cs patient. So im wondering, what did they do for teh rest of their shift? Apart from sitting around the desk for most of the night, chatting loudly to their colleagues and keeping the patients awake?

When i had a instrumental delivery i was told they were too busy tko give any care as they were helping the cs patients

[KristinaM]

All the thimg i needed help with could easily be done ny a HCA

Passing the baby to be fed wne i was bed bound
Food and water whei was bed bound
Returning the bbay to cot befroe i fell asleep and dropped him on the floor
Adjusting the bed so i coudl breast feed ( despite having given birth to a breast fed baby apparently)
" watching " my baby while i went to the loo and had a shower ( we were notvLlowed to leave the baby unatended)
providing a clean pad and blanket


I rrealise that i am speaking from my own experince, but lots of women on the other thread seem to have had similar complaints

[allhailtheaubergine]

YES YES YES to a map explaining what facilities are available and where they are.

Ds latched on within 30 minutes of being born and refused to let go for most of the next 24 hours. To give my poor, sore nipples a chance I walked up and down the corridor for hours and hours that first night. It was either feeding, walking or screaming baby. Every lap of the corridor I passed the midwives sitting at their desk. At about 4.30am one of them asked me why I didn't try rocking him in the breastfeeding room?

WHAT BREASTFEEDING ROOM?????????????

Yup, there was a lovely room just opposite my ward with nursing chairs, footstools, magazines, breast pumps, dimmed lighting, a radio...

And not one of those women had thought to mention it to me

[BagofHolly]

Gosh this is fascinating stuff! I no longer have journal access but there are plenty of published studies about the various aspects of postnatal care, which could be referenced.

I wonder if we could find a "tame" maternity services commissioning manager?

Fwiw I think steering well clear of Nct would be a good idea - they don't necessarily have the finest reputation in relation to acute maternity services. I'd also be wary of going via Maternity Services Liaison Committees either as in my experience they don't have the teeth to really implement fast, and can sometimes be a vehicle for paying lipservice to patient involvement. [ducks for cover!]