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 fully support and agree with the comments about a lot of things on the postnatal ward being unacceptable. There is no need for rudeness from staff, women should be treated with compassion and get support, food, medical/personal care, food.

I do have to say though with regards to people not waiting for discharge and getting up and leaving........it really bloody annoys me. As jrt said previously it's not our fault we,re waiting for a dr, a paed, meds, etc. It's the one area that I get the most abuse over and believe me people can be very aggressive and nasty about it. My mum was shocked when I told her, she said when she was in hospital you wouldn't even ask when you could go home never mind be ringing the buzzer every twenty mins getting arsier and arsier. I think people's expectations have changed sadly. There is only one paed and one obs sho and I am sorry if they can't come but the chances are someone needs them more than the person wanting to go home. If we upped everyone's ni contributions to 20% maybe we could afford more drs - do you want to do that? No, didn't think so.

If you leave, someone fills your bed within twenty minutes. So I still have just as many women to look after, plus all the paperwork from a woman who is no longer there. It can cause problems for the woman as she has no postnatal notes to take home. I also have to fill out an incident form which takes another twenty/thirty minutes. I have literally chased women through the car park begging them to come back and being ignored or told to fuck off.

Maybe a leaflet put on the beds when they are changed between patients would be the way forward. The MW/porter/HCA escorting you to the PN could then say, "here is all the info about the ward that you might need to know."

That way women would receive the information at least, and wouldn't have to hunt for it.

Thank you for your insights from the MW point of view MrsJRT.

At my hospital, all follow-up MW visits had to be organised yourself - you had to phone a different hospital. Ditto hearing checks, GP 6 week check, the lot. No discharge meds either, just told to buy painkillers from the chemis. No continuity of care anyway, so it couldn't get worse.

It would be useful for patients to know that the pharmacy only deliver once a day, which means if there's a cockup in giving you prescribed meds just after birth, it's going to take 24 hours to sort out even after a doc has been tracked down to prescribe them, unless it's a life-threatening emergency.

This was explained to me eventually, but having gone from 60mg codiene 4x daily before birth and then not had any during 2 days of labour, and then it turned out no-one had told the post-natal staff to give me any - to be fair, someone did come and tell me some had been prescribed within two hours of being aware of the situation, but it was nearly 36 hours later when someone turned up with half my usual dose on the grounds that 'the doc said 30-60 so we thought we'd give you just 30' !!

Actually, that's another question - is it really necessary for MWs/nurses to walk round when they have a spare moment with little cups of two paracetamol and supervise you swallowing them? Given that it got to well over 6 hours between promised 4-hourly visits, and pregnant women have been coping taking the stuff for ages, does it have to be doled out and supervised simply because you're in a hospital?
Especially if you're fine and not really a patient but just having to stay in because the baby is there?

Yes it is necessary to supervise patients having paracetamol as its part of the rules and regs surrounding prescribing that the medcine is given and observed to have been taken. There have been cases where people have stockpiled paracetamol/codeine, either because they felt they didn't need it at the time so saved it for later and then unintentionally had too much too close together, other people have attempted suicide and how would a m/w know that its not left unattended and then swallowed by a visiting toddler?

I must admit when its really busy I just tell the woman she must take it now and leave it with her but I'm risking my registration doing that.

Please please don't frame anything as how to take care of your baby in a postnatal ward. There are usually a number of women who are in the postnatal wards where their babies are in NICU/SCBU. Postnatal is not just about the baby and for those of us who do not have the baby with us it is hard enough being ignored when the staff of necessity concentrate on those who have babies with them. And its worse when you do not know if your baby will live and you are surrounded by mums who have their babies with them.

I support the campaign wholeheatedly, but I thought when I was in hospital than prem mums get a raw deal, and I still do.

If there is to be information on a laminate or similar there needs to be one for babies who have babies in nicu/scbu. And ideally these women should be together whenever resources and space allow away from other mothers.
And bounty people should be banned from coming anywhere near. In fact if it was up to me Bounty people would only visit if you ask them to.

And if you are in NICU when the mw come round with the paracetomol (which I was every day for 4 days) it is not helpful to have a snotty member of staff moaning at you. Chances are you are more stressed than them.

The system where they left a card and told me where and when to go and get the paracetomol when i wasn't about worked very well however.

Oh gosh Hilda, I'm sorry, that's a really good point.

What do you think about having two information sheets: one for Taking care of yourself, which everyone would get, and one for Taking care of baby, which would only be given to women who clearly have babies with them.

notcitrus Thu 28-Jul-11 09:12:42
"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."

I think this is a really important point - value for money will need to be demonstrated to get the info sheet scheme adopted at the Trust level, sadly I don't think lofty aims about empowering/enhancing the mother's experience will cut it.

We would need a small scale study (one postnatal ward, 24 hour period) and get all buzzer-answering staff to log how many buzz's (and how many questions asked at the desk/on the ward rounds) are ones that could be avoided if a comprehensive information sheet was available. From this it should be possible to monetize the benefit of the sheets, i.e. reduce buzzer calls by xx %, each buzzer call taking x mins to deal with, means x more MW-hours available for clinical duties.

Could any midwifes here comment as to how much time they think might be freed up by an info sheet? Or are we barking up the wrong tree?

I would really support this campaign, not because I have had a terrible experience with PN care with either 2 of my children or that I expect to receive bad pn care with my 3rd due in Nov but simply because I have read, with mounting horror, how badly other people feel their care has been and how much it appears to have contributed to decisions not to have more children or to PND. In todays society I really do not think that is at all acceptable. I think the idea of information sheets that are available in a variety of formats (I work with people who are visually impaired so am always championing the need for accessible formats!) and languages is a great idea. It is often the little questions that are actually the ones that you need answering the most!

This is really interesting. I am involved in local neonatal networks and there have been changes made in NNUs because they are encouraging parents to be involved and really listening. In fact my local networks now have the opposite problem of information overload and are looking to reduce the amount of info given out to new parents on the unit. There is plenty of will and some funding available, why the difference from postnatal care? Is it because it is usually a short term experience and people leave and never look back? Or is it to do with different commissioning arrangements? I don't know.

I think the info sheets would work well. And the idea of a 'what to bring' list is a good one too.

Hildathebuilder I think we are on the same page re NICU mums and the dreaded Bounty lady.

Is the Bounty lady the one who takes pics? What's she for?

Our bounty lady is normally very good and always asks which mums she should avoid.

Willbean I agree that the NICU had lots of info, And it was brilliant and listened. But it was all about the baby nothing about the mother and the postnatal care. I could have been in two different hosptials for the difference it made

Llanarth, that's a really good point.

How can we find a postnatal ward somewhere that would be willing to help us get that information?

And I agree about emphasising the practical benefits. I mean, it's never going to be really pleasant being in hospital. I don't think any of us are asking for super luxury treatment. Really, we are asking for just a bare minimum of care: to be fed, monitored, clean environment, treated with dignity. This bare minimum is what is missing for so many women right now. So in that sense, the information sheets are simply a measure to bring the standard of care up to a minimum standard, it's not asking the NHS to do anything beyond what they should be doing anyway.

I agree i'd like a campaign on improving post-natal care, and letting women know situations like mine and many others should NOT be tolerated.

I appreciate that Trusts have budgets - so cost is relevant - but I can't help feeling that part of the solution must be to spend some more money on pn care. Mvs and nurses - no matter how good - only have one pair of hands - and unless there are more people, the level of care is always going to be stretched. I know this might mean diverting resources from elsewhere, but a lot of pn women had had major surgery or procedures - and deserve to be looked after properly. And some things - like regular cleaning of bathrooms should be relatively cheap to implement.

My mum trained as a nurse many years ago and she always said that the Ward Sister regime worked well - as everyone was terrified of them and they kept standards high. I don't think we have the same system any more - I wonder if they should reintroduce it?

I think you're right about the ward sister. We have ward sisters still but where I work you rarely see them on the ward. They have an office near the entrance to the ward so they come on the ward, go in their office, sit in the office all day doing paperwork and leave at 5:00pm. They can go weeks without been seen on the ward.

We have ward sisters and they are reasonably visible, although they do spend a ot of time in their offices coming up woth more time wasting rules to follow or paperwork to complete. So much of our day is taken up with paperwork, a lot of it we have to do ourself, such as documentation, but discharges etc could possibly be delegated to a ward clerk type person. We do have a ward clerk who works until half 3 but she is busy all day every day and doesn't work weekends. Delivery suite on the other hand have someone on a 12 hour shift during the day, including weekends. I'm sure it does help.

Was it on this thread that someone was asking about hospital volunteers? Yes we do have them within the hospital but never in the maternity department as it is too much of a security risk, we are a locked ward (another time waste, dealing with the constant ring of the door buzzer, and woe betide if you don't answer it immediately despite their being polite notices explaining we might be busy dealing with YOUR baby or wife or sister or whatever) and although you are right volunteers could help so much it is a matter of what we are actually trying to achieve I suppose. Relying on unpaid help to run a busy hospital ward is not on, many midwives already feel their job is being eroded to the point of being paperwork machines, many of us came into the profession to help women and babies, we like doing the breastfeeding support, the sitting up through the night holding your hand whilst you have the baby blues and showing excited new mums how to bath their baby but we just rarely get the time to do it, that kind of stuff is more and more being delegated to healthcare assistants or support workers who don't have the training we do to assist you adequately, but they're cheap and that is why there are more and more of them and less qualified staff. That is not in any way to be disparaging to support workers, a good one is worth their weight in gold but they are not midwives, they don't go to uni for 3 years (or 18 months if nurses first) to learn the stuff we do and we find it so frustrating that we can't do the parts of our job that we love because we're so bogged down doing other stuff.

I think one thing that would help is tell patients that something will take a while eg for a Dr to be free. Personally I would feel more comfortable with that than being told they will be a few minutes then still noone hours later IYSWIM.

The idea of an information sheet was one I suggested to Princess Anne in Southampton for all the reasons everyone has said. I got told in no uncertain terms that it was a complete non-starter as they would have to translate it into umpteen languages and therefore they wouldn't even contemplate it.

duffy - Translation is expensive, but again, it's something that could be paid for by sponsorship.

Duffy oh that's interesting.

That kind of sounds like a made-up excuse though. Does anyone know if they would in fact be legally required to do this?

I certainly got loads of pamphlets just in English.

Also, not to get all 'big society', but translation is something that you can get volunteers to do, especially as it would just be a short thing. Just thinking of friends of mine who would be willing to do that, I could get you French, Italian, Turkish, Russian, Polish, Bengali, Persian...

OOh looky - we got a sticky
This is brilliant.

I'll have a thorough read through later but so much good useful suggetions and information.

A few thoughts.

I think every postnatal ward needs information cards/sheets specific to that particular area (standardising maternity care nationwide might be too big a jump) but maybe from all the info MN could do a 'recommendations' list. So things like mealtimes, drinks, visiting, maps, discharges, drugs etc. (other languages also v important). .

I heard today about an area just the other side of here (so we have women from that area in this hosp, but over the health authority border) where midwives do NO postnatal home visits AT ALL. Women are expected to get to the clinic friom the day after they are discharged (whether they have sore perineums, stitches, wounds etc or not). I also heard on the grapevine that there is a proposal to discharge women from community midwife on day 5. The implications make my mind boggle. It cannot go on.

I didn't have a CS but I couldn't help but compare the treatment of the cs women and the care I received post-ectopic (on gynae ward). The point about women who have had a cs being seen as 'post natal' rather than 'post operative' is an important one. The cs women just seemed to be left to fend in the same way as the women who had a normal delivery.