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.

[Llanarth]

I'm wondering, with the current economic climate, whether a campaign to improve postnatal care founded on increasing staff numbers could ever be successful/implemented.

Whereas the info cards described here (perhaps along with a charter about dignity/respect in postnatal care) is much more likely to be adopted.

If such cards meant that MW are able to instead focus on clinical needs rather than the minutae/caretaking of the ward, then some (but not all) of the appalling clinical issues flagged in the other thread might be avoided. It wouldn't be a perfect solution, but it would at least stand a chance of being adopted...

[HomemadeCommunistRussia]

Another vote for an improvement in antenatal care based on giving Mums better information. Here's my post from 19.20 Tuesday in case it got lost in the flood:

I don't think these places can ever be pleasant; all these sore, tired, panicky people + screaming babies, bedlam is bound to ensue.

I had some snotty nurses/midwives, but they were a bit better with me when they realised I was 27 and not 17 (Sometimes looking young is not a good thing) I really felt for the actual teenage mothers.

There were some rules that didn't seem to make any sense-why did we have to have food that the lady in our bed from the day before had ordered?

I think that it would help if during antenatal classes more attention was paid to explaining what it might be like after the birth. I for one was convinced (both times ) that I would go home within 12 hours and have no problems. I did not really prepare myself for my time in post-natal.

A lot of the stuff that the staff are trying to do on the in post natal could be done antenatally, like how to change a nappy and bath a baby.

Rules could be on display so people know when and where food is available, what kind of help they can expect, and not expect, which bathroom to use and so on.

Things like discharge papers, really need to be sorted out throughout the NHS I think, as it seems to be exactly the same on the paediatric wards I've been on too. It seems quite normal for people to wait until the next day to be discharged, because it's such a low priority for the DRs which of course makes sense, but I'm sure in the 21st century a better system could be used.

That feeling of being trapped and wanting to go home and sleep is horrible, especially 3 days PP.

We could all help ourselves to some extent by bringing food and supplies and by seeking out some hands on practice with real babies and by going on the tour of the ward before hand so we know our way around.

Of course having a baby hardly ever goes to plan.

[BellaBearisWideAwake]

I whole heartedly support this campaign

My care was average. Best quote: "well, I could sort out your discharge paperwork so you can go home, or I could look after all the other women on the ward. Which do you want me to do?"

[lalalahahaha]

I think improved information for post natal women should also include more information and communication relating to the post natal visits from the midwives. I remember waiting at home for hours for the midwife to come and visit, only to ring up and be told yes she is definitely coming, until I rang up to be told, oh no She won't be coming now, it's too late.

I think the midwives should make contact to let you know that you are on the list, roughly what time they expect to be there, ask you if there are any problems etc. Those visits were really important when I had my first because I needed them to tell me that everything was all right! I also think they should come more frequently for women who need/want them to. Good support in those early days at home might help to ward off post natal depression for some. I think it would also really help if midwives/health visitors could put new mums on touch with others in the same area. That's another way to prevent pnd.

[peekmum]

I think there sould be enough supprt for women to stay in hospital/maternity rest for up to 7 days. fair enough - i know some women just want to get home and that's fine but for others who may have had a difficult birth/first babies/have a hectic homes life etc it gives time to recupperate, bond and concentrate solely on baby. It gives you chance to establish breastfeeding, get to know your new baby and recover. All of this conveyor belt action pisses me off. I actually asked to stay in hospital an extra day as I just didn't feel ready to go home 12 hours after giving birth.

[wearenotinkansas]

Would definitely support a campaign. I can't think of any other major procedure/surgery where you would get a ward full of patients in recovery without a nurse in attendance overnight. Also, standards of cleanliness could easily be improved - as well as general health care/assistance.

I think women who have just given birth generally have enough on their hands without kicking up a fuss about the post-natal care - so it gets sidelined by managers. What is more - I don't think consultants are generally interested in recovery for most women - so they don't prioritize it either.

Where do I sign??

[MrsJRT]

Just from a midwifery perspective an average day on the ward can be thus: you're given between 8 & 12 high risk women, inintroduce myself to them all, have a quick chat about their night, take a set of obs and do the baby check, take any required blood and document everything I've done. Then I prepare myself for the ward round where I have to be up to speed with all womens histories. I then set about following any plans of care made by the medical staff, answer buzzers as and when and again document care. Chase up blood results and start discharging women who are able to go home, interrupted by a new admission, orientate them to the ward, assist with tube feeding a small baby, attend the complex social needs of a methadone user and a baby who is withdrawing. Contact social workers and community midwives to ensure discharge plans are in place for those who require extra support. Document. Again. Assist with breadtfeeding, give out medication, apologise as haven't been able to discharge, assist with breadtfeeding, answer buzzers. Document, emergency buzzer goes, women having huge haemmorhage, assist other staff stabilising woman, try and get on top of discharges. Apologise, document. It's never-ending. Rudeness is not acceptable but we desperately need more staff. I think this is a great campaign for mumsnet to get behind and as a hcp recognise it is completely necessary but I thought I'd just give you a look from the other side of the fence as I saw someone was asking just what we do all day.

[BagofHolly]

MrsJRT, can I pump you for info?

Who has the most power to influence change at ward level in your dept?

Having read THIS thread which of our suggestions do you think wouldake the most difference to patients?

And which would be most welcomed by ALL staff?

Ta!

[gallicgirl]

I think it's important to point out that this is in no way a witch hunt. We just want more funding for more midwives and more training.

[BagofHolly]

Well that's one nice outcome Gallicgirl, but I dint think it's necessarily the first one. I understand your feeling the need to clarify there's no blaming here, just finding a way through.

[MrsJRT]

I guess the ward sister has a lot of power in terms of change on the shop floor but any power they are given normally comes from the head of midwifery. The information sheet is a good idea but many women are just not motivated to read info at that point, I don't mean it in a derogatory fashion but it's an exhausting emotional time in your life and if someone was to thrust a bit of paper into your hands it'd be unlikely to be read straight away. That's not to say it's not a good idea, perhaps given antenatally though? But then the info will probably have been forgotten at the critical point. I don't know what the answers are, it is something colleagues and peers have debated many a time. I watch this thread with interest though and will no doubt come back to it.

[BagofHolly]

I wasn't thinking a bit of paper, more a laminate card on the side of the locker/tied to the telly/in the day room/in the toilet etc etc. And PERHAPS a staff version relating to orientation, eg;
Have you:-

Welcomed the patient
Introduced yourself
Given a laminate card
Pointed out the toilets and refreshments

Etc.

[PelvicFloorOfSteel]

Brilliant idea for a campaign.

Something which comes across from MrsJRT's post is how hard it is to find time to discharge people because it's always non-emergency, so it keeps slipping down the list even though getting rid of patients quicker makes the workload smaller. I had to wait 12 hours to be discharged when I had DS1, during that time I was blocking a bed, needed feeding and I desperately wanted to get away. I think there must be a better way to prioritise discharging (where this is what the patient wants, I have every sympathy for people who felt shoved out of hospital before they were ready it just wasn't where I wanted to be) leaving midwives free to cope with the patients who actually need to be there.

[BagofHolly]

What do you think? I'm sure all this has been debated before but where do you think it might have fallen down? What could we learn?

[messybedhead]

I wholeheartedly agree with the idea of a Mumsnet campaign and I posted my experience on the other thread.

But...

at the top of the page under the topic Mumsnet Campaigns it says:

PLEASE NOTE: This topic is for discussions about campaigns Mumsnet is running or may be planning to run. It's not the place for promoting other campaigns or petitions. If you do that here, we will either delete your thread or move it to a more appropriate place on our boards.

Let's hope this thread isn't lost.

[dreamingbohemian]

Thank you for posting MrsJRT, it's great to hear from people actually doing this work.

I'm surprised you think information sheets aren't a good idea though. Of course I was exhausted but I still needed to know certain things and it was so frustrating waiting ages to get any information or help.

[dreamingbohemian]

Oh good catch messy! Yikes, I didn't see that

But I might interpret that to mean you shouldn't discuss campaigns being run by other people, so asking MN to start a campaign might still be okay...

[MrsJRT]

Nooooo I didn't say they weren't a good idea, I specifically said they were but I'm just wondering about the best timing for these info sheets. I know when I was on the PN ward I was given a handful of leaflets that I barely glanced at as I was so busy gazing adoringly at my newborn whilst trying to keep my eyes open. I think perhaps a two pronged attack might be beneficial, initial info given at parentcraft perhaps with laminated versions at various points on the postnatal ward. Or perhaps as an insert to your antenatal handheld notes, I know as a first time mum I devoured every bit of info in those notes such was my excitement to actually have a set of them!

[messybedhead]

Ah ok dreamingbohemian hopefully you are right.

I see there are lots of different threads under this topic about starting mumsnet campaigns and they still stand so this one should be okay too.

[lalalahahaha]

MrsJRT's post from the midwife's point of view was very interesting. I'm sure that the main problem is a lack of staff. But in both hospitals where I have given birth, it was very clear that several midwives knew very little about breastfeeding. Thus us definitely an area of postnatal care that needs tp be addressed. One of the hospitals (Liverpool women's) us in a region with among the lowest rates of breastfeeding in the country and I'm not surprised. I saw women who had had caesarians who couldn't even pick up their babies struggling to feed and the midwives didn't really help them. It was definitely partly a time issue bur also a lack of knowledge.

[dreamingbohemian]

Ah sorry MrsJRT, I misunderstood you Thanks for clarifying. Great suggestions!

[ada07]

Wholeheartedly support a campaign.

My atrocious experience on a postnatal ward is 15+ years ago. Shameful that exactly the same sort of things are still happening now. I didn't complain as it wasn't a priority at the time and I expected a poor service.

Why can some units provide an undeniably positive experience and others not? What has happened to sharing 'good practice'? Would more complaints help this inequity.

Laminated information sheet sounds a great idea.

Am loathe to suggest more involvement of voluntary workers [Big society issues]