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.

[PenguinArmy]

It is a odd one as more support is needed but a lot of isn't needed by midwifes per se. I had no idea about dinners but never asked as I had pre arranged DH to bring it all in assuming I wouldn't get anything anyway (am vegan).

Although one of the helpers brought me in some toast and took DD away as she had been awake for hours and I was on the verge of crying.

Most helpers were great, had ones who told to buzz every time I wanted to feed her, didn't change a nappy myself. Although I felt the focus was on making sure DD was fed as I left the hospital not setting me for long term success.

As others have said more information would be great. I noticed a MW on here said she introduced and caught up with her ladies, I never had that.

[Llanarth]

I assumed I wouldn't be allowed to bring food in, so it never crossed my mind to get DH to do so. If I had known I was allowed to (via an info sheet) that would have improved the quality of my stay enormously - my hospital meal the first night after giving birth was a corned beef sandwich and a yoghurt.

Even including really stupid things about where you/your visitors should go to collect a vase from to put flowers in would free up buzzer time.

I personally would devour a laminated

[Llanarth]

....devour a lamintated card upon admission to the ward - but then I'm the kinda gal who always reads the hotel info upon check-in

[notcitrus]

I think something to refer to is vital, because even if staff do a wonderful explanation of everything on the ward, someone who's just given birth is not going to remember half of it. In my case most of the explanation was given to my terp before I got to the ward, and then to us while all we could think about was 'is ds in SCBU going to live?' I certainly wasn't listening.

Turned out there was a wonderful explanatory poster - outside the entrance to the ward, which we only saw 3 days later as we left! Totally useless!
It would have been great if copies of that had been given out when we had tours, or at an antenatal visit - the tour of the postnatal ward implied you'd be well looked after and there were loads of staff on call to deal with any questions then. Couldn't be further from the truth!

Anything that is only going to cost say £200/year to maintain (copies of info will go missing), but means half the women on the ward use their buzzer say twice less than otherwise, because they don't need to ask 'When is lunch and how do I get it', must be value for money.

Also a question about discharge - once a paediatrician has signed off your baby as OK to go home, is there any reason why you can't just walk out? Ds and I finally got the all-clear at 10am but weren't 'allowed' out until 5.30 because it turned out we had to have the official lecture on contraception (surely no-one takes it seriously right then?), and someone kept wanting someone else to sign some forms, and it meant another 8 hours of being forced to stay awake rather than be at home.

WOuld it make someone's life really difficult if next time I just say 'Look, I'm taking my officially-OK baby away right now, this is my name' and walked off?

[kenobi]

Anything that is only going to cost say £200/year to maintain but means half the women on the ward use their buzzer say twice less than otherwise, must be value for money.

A laminated sheet is something that could easily be sponsored, meaning no cost AT ALL to the NHS. I know a lot of people find the relentless branding of the UK very annoying but if a service this simple and helpful could have the costs farmed out, even better.

I reckon someone like Pampers/Huggies would leap at the chance to have their branding handed to just about every single mother in the country.

Not sure I'd let baby milk brands do it though...

[JustineMumsnet]

Hi all,
Thanks for your thoughts on this - reading about people's experiences it certainly seems like there is a lot of room for improvement. It would be good to see if there is simple list of requests/actions we could hone things down to. We'll sticky the thread for a bit so it gets to as wide an audience on here as possible over the next couple of weeks. Please do add your thoughts and experiences if you haven't already and please do also raise any potential problems/ objections if anyone has any.

Thanks.

[paddypoopants]

I would absolutely back this campaign- my postnatal experience was horrible and it was the single worst thing about the birth of my ds. Thinking about it just wants to make me cry. Understaffing at night was basically the issue I think. If the staff are rude it is probably because they have so much to do. Care during the day was haphazard- I only got painkillers once in 2 days. Tonnes of breastfeeding help bizarrely but no actual medical help.
If they haven't the staff to look after vulnerable women they should at least let their partners stay overnight.

[PelvicFloorOfSteel]

notcitrus You can just walk out, the staff can't make you stay, although it does appear to create a paperwork nightmare.

I waited to be discharged with DS1. I had DS2 at home but had to go into hospital for stitches (although it turned out I could have had the stitches done at home afterwards), the second the stitches were finished I said "I'm leaving now", gathered my stuff together and walked out. The midwife had to chase me with my notes!

Did cause no end of issues as we had to go back for DS2's baby check up and he had no hospital paperwork, I had no drug chart and I had been given my labour notes, which should have been retained by the hospital. I still have no regrets about getting home to my own shower and then snuggling up with DS2 in my own bed instead of waiting to be discharged properly though.

[dreamingbohemian]

Justine, thank you so much!

From reading both threads, I might suggest prioritising two things:

One practical: the information sheets (or whatever we want to call them)

In an environment where women need to care for their babies, 24 hours a day, frequently alone, whilst recovering from childbirth as well as medical complications, they need to have as much information as possible to see that the needs of their baby and themselves are met. Currently, the only way to get this information is to ask midwives and other staff, thereby distracting them from more important clinical care. Thus, we ask that postnatal wards be required to provide written and easy accessible instructions on their policies and procedures to every incoming patient. This will improve the ability of mothers to provide their own care and free up staff time to care for patients.

It should be noted that this would cost very little to implement and may have significant efficiency savings.

One political: let's hold David Cameron to his pledge to increase the number of midwives

At a time when NHS resources are stretched to the limit, it may seem infeasible to call for expanded staffing in one area. However, if the emphasis today really is on efficiency and best practice, then hiring more midwives will reduce costs across other areas of practice and in the long run.

[providing we can find the studies that would give this evidence]

It would also be great to do something at the professional level, i.e., to highlight the professional code of conduct for postnatal staff and improved monitoring or training to deal with abusive or negligent staff. But in this economic climate, I'm not sure that will get off the ground. Perhaps something minor could be done though, like have some kind of professional code of conduct posted on the wall or acknowledged in the information sheet.

Actually, perhaps the sheet could mention who to contact if you need to make a formal complaint. The midwives on these threads have encouraged people to complain, saying that's the only way things will get better, so can we make it easier for people to do so?

I am happy to contribute with writing/editing (and roping all my friends into this!)

[MrsJRT]

No there is no reason why you can't just walk out but it causes an administrative mess. Also things like hearing checks, follow up appointments and community midwife visits can get missed. Also if you leave without your notes if you do get a community visit it means that the cmw has no idea what kind of delivery you had, what was done on the postnatal ward or who cared for you in the hospital, meaning vital information can get list or miscommunicated. That said I completely understand why you might not want to wait for your discharge medication but it really isn't our fault the hospital pharmacy only delivers once a day or the labs haven't processed your bloods or the doctors are busy on delivery suite or the paeds are attending a compromised baby. Gawd, I'm getting defensive now and I'm really trying not to because I know postnatal care leaves a lot to be desired but I guess it's just important to me that people understand that just because midwives are the most visible presence on the ward doesn't mean we aren't working to other peoples timetables and workloads a lot of the time. Which brings us full circle back to the understaffing issue, which is rife throughout the NHS not just in midwifery. Sometimes if you are in the middle of something you have to drop it as someone else is available to do something you have been waiting for them to do and it's the only time they can fit it in and so we have to work around them.

[dreamingbohemian]

Oh and also -- we should perhaps emphasise in this that it's a two-way street, that patients also need to respect the staff and other patients. The threads have also told of really awful patients making life difficult for everyone. So perhaps the information sheet should also ask patients to respect the rules and each other.

[MrsJRT]

Ok so exactly what information would be beneficial to a bleary eyed new mum on the busy postnatal ward? First things first. How to identify staff?

[dreamingbohemian]

MrsJRT -- I hope you don't mind me asking this. Let's say you had a chance to sit down with David Cameron and ask him to fulfil his pledge to hire 3000 more midwives, even though the NHS has to make cuts and the economy is taking, etc.

From your inside knowledge and experience, what do you think is the most convincing argument? It's obvious that understaffing is a huge problem. Why do you think it's not being dealt with?

Are there other things that could be cut and the money used to hire more midwives?

[dreamingbohemian]

Oh sorry, x-post.

Yes, how to identify staff, and who you should ask for what.

A general sense of 'what happens now' -- for example, If You Have Had a C Section: a list of the things that need to happen, and roughly when, before you are discharged (obviously it will vary by patient but things like you will have your catheter removed at this point, you will need to have your wee checked, obs will be taken every hour or whatever, the doctor will examine the baby, hearing test, etc.)

An explanation of the food service (when it comes, how to order if you must do so, if you have to go to another room)

What to do if you need help with breastfeeding
What to do if you need formula

Visitor policies and rules

If the toilets are soiled, who you should tell
Does the ward provide maternity pads?

Perhaps something explaining why it might take some time to receive meds, be discharged -- set realistic expectations for things

That's just off the top of my head, will think some more...

[dreamingbohemian]

I think it could all be framed as: How to Take Care of Your Baby in Our Postnatal Ward

I think they do provide a good amount of information on how to take care of yourself whilst pregnant, and then how to take care of your infant at home. What's missing is this link -- how to take care of the baby whilst you are in this strange environment, and recovering yourself.

I think it might also have the benefit of standardising postnatal advice (to the extent it can be) -- for instance, I had one person tell me it was fine DS went X hours without feeding, another one tell me I was completely irresponsible for letting it go on so long. Maybe the process of putting a sheet together will encourage staff to get on the same page.

[kenobi]

Absolutely to previous posts, and:

Where to get drinking water (I was soooo thirsty and ended up drinking directly out of sink tap).

When to worry if your baby is sleeping too much/not eating.

And yes to a patient's code of conduct. It is a two-way street.

Deffo full list of what to expect with c-section, plus a list of things you should and shouldn't expect, ie that you should expect help with your baby as aren't supposed to get out of bed (no matter how much the MW grumps at you for asking for help with your 10lb baby).

Sorry, got a bit diverted there!

[dreamingbohemian]

Oh yes, when to worry is a good one

I was really unsure when to ask if something might be wrong

[gallicgirl]

In regard to Mrs JRT's comments about discharge and what can go wrong if you just walk out - is it worth looking at what happens with HBs?

I had a HB and everything managed to fall into place for checks and things (apart from GP not contacting me for 8 week check!). I think the CMW took my notes away to be entered onto the system and baby records came back a few days later. I forget exactly what happened but it must mean that it's possible to do some of those discharge duties at a later date maybe? There are fairly efficient lines of communication between hospital, CMWs and GPs so maybe these can be utilised more.

[marriedinwhite]

What sticks in my craw is the insenstivity about one's most personal parts and the inability to treat women (me) with a little delicacy. I shall never forget the first midwife who visited my home. She asked about sex, when I was going to have it again and instructed me to start pelvic floor exercises straight away. I ventured that sex was at present the last thing on my mind. She then raised her arm in the air held her elbow with the other hand and waggled the arm in the air at the same time as saying "well if you don't do them your husband he going to say this is how it feels when you do". Sorry but would a midwife like to come on here and tell me why I should respect a profession that employs people who treat women in that manner.

Overall attitude and respect for women. Respect has to be earned.

[Funtimewincies]

I found that the advice and babycare side was fine but basic stuff like access to food was really difficult. With such a high turnover of patients, the 'fill a slip in for the next patient' system really didn't work. With ds1 I got one cheese salad in 28 hours, wasn't allowed to bring more than basic snacks in, would have had to discharge us in order to go to the cafe downstairs and was relying on crisps and choclate. Needless to say, with no proper food, the early days of bf'ing were even harder .

With ds2 I watched for those paper slips like a hawk and he was born at a more convenient time, so I got to eat.

[RozziPringle]

I support this campaign 100%, Judging by the responses to the thread i started a hell of a lot more obviously needs to be done. The fact that this is so widespread is something that surely cannot be ignored any longer, Women and children are been put at risk by chronic understaffing and in modern day britain this should not be happening.
Women in vunerable states should be supported shown the upmost respect and not treated like an inconvenience and in some cases abused.

[happywheezer]

I really support this campain.
For the reasons outlined in the previous post. It's amazing poor post natal care has been able to go on so poorly for so long.
My experience was recent- 10 weeks ago, but some are 15 years ago.
It seems post c section care is especially patchy and neglectful.
Basically I was told that 24 hrs after section that I would get no food unless I walked 400 metres for it. That's not good enough. And nobody checked.

There was a report recently about old folks who are poorly treated in hospitals. What about new mothers?
It just makes me mad.
How many mothers never have children again due to the poor care they have received?

[happywheezer]

It's campaign and in the end my husband brought me in food, he wasn't allowed to get me food because it was "women only".
How stupid is that?