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.

Reikizen: 'Is what you want to be looked after by nurses on a gynae ward and treated as invalids? It seems as if you have no interest in protecting normality or seeing childbirth as a normal life event.'

I'm sorry but having abdominal surgery is not a normal life event. If that is how midwives see section patients then yes, I would rather be treated by nurses on a gynae ward.

And no I don't have any interest in protecting normality, I don't even know what that means.

I think all the suggestions here are totally in the spirit of helping midwives do the most important bits of their job, which would hopefully make life easier for them. I think the campaign really needs to emphasise that above all.

Childbirth might be a normal life event, but it hurts, and a lot of women are left in considerable pain after the event. Why should they be treated with less care than a hospital patient who is in pain for any other reason? The postnatal care after my emergency CS was horrendous - like many others have mentioned, I was left numbed from the spinal block, and yet scolded for being unable to get out of bed. I hadn't slept for about three days, nor was I allowed to eat (I was actually light headed and faint with hunger) due to having been in pain with contractions, yet when I asked for help with my baby, I was told 'and what are you going to do when you get home? We won't be here to help you then!'. Er, at home I have a husband. The postnatal experience was the worst of my life.

On the other hand, the after care in my own home from the community midwives and health visitor was excellent.

And also, my local hospital does not allow you to bring any of your own food or drink into the hospital, so heaven help you if you end up missing a mealtime or whatever.

I understand hospital policy in some areas makes it almost impossible but if mums were encouraged by the antenatal teams to include (sealed) snacks in their hospital bags, because food might not be available after labour, this would help for when you're flagging, back on the ward at 3am, ravenous and tired.

I was tipped off by an experienced mum and took bags of peanuts and raisins, choccie bars, flapjacks, juice and all sorts in my hospital bag, the hospital didn't seem to mind anyway so I could graze across the 24/48 hours I was in second/first time, it was so lovely to just stick my hand in my bag and get something to eat out, especially as they were the things I liked to eat. If I had to wait for the set meals I'd have fainted with exhaustion and the one time I had to do the john wayne shuffle to collect it it wasn't worth the trip.

If and when there was another I'd get more inventive and have a tupperware of pasta, a flask of tea... Only hope hospital policy wouldn't confiscate them.

I want to add that I have found all the gazillion midwives I have seen (fleetingly) along the way to be absolutely fabulous and where I've had gripes it has been the systems or procedures, not the individuals.

I haven't read the whole thread but I did read the thread about experiences of post-natal care. I don't have my own experience to draw on (am still ttc) but it seems to me that what is needed is not medical help but old-fashioned "sicknursing". Basically someone to get you a drink when you are thirsty, pass you your baby if you can't sit up after a section, help you get to the toilet, etc. From the sounds of it, people don't need more medical care in most cases, they just need more care. Hospitals seem to have forgotten this most basic part of their role. I guess it has got lost in staff shortages and too much paperwork.

What struck me after having DD1 5 months ago was the bizarre allocation of funds. I experienced poor postnatal care in the 24 hour hospital stay post-partum, and then a week later was offered a five week baby massage course on the NHS, for no particular reason (baby didn't have colic or such like...).

I realise that there are different pots of funding, so it is not as simple as saying that by cancelling the massage, more funds could be directed to hospital care, but I do wonder whether a full review is needed which includes these additional services.

Reikizen: 'Is what you want to be looked after by nurses on a gynae ward and treated as invalids? It seems as if you have no interest in protecting normality or seeing childbirth as a normal life event.'

But it's not really a "normal" life event, is it? At least 50 % of the population never experience it, and everyone's pregnancy (and post natal needs) are different. This should be reflected in the way the patients are treated.

Where I work there is a big push for one to one care in labour which will be wonderful, making births safer for women and hopefully will improve normal birth rates and birth experiences for women. However it all comes at a cost and all women who deliver normally without complications will be expected to go straight home regardless of how they are feeling and what support they will need with feeding. They will not be offered extra post natal visiting by midwives but will be expected to access breastfeeding groups run by childrens centres and hv's if they need further bf support. All the midwives here find this difficult to accept but have no choice but to send women home early.

As an aside I have seen overworked midwives being rude to women and there is no excuse whatsoever for rudeness. We need to remember that it is a huge scary thing having a baby and a smile and friendly face can go along way even if the person is extremely busy. It is a minority of midwives and support workers that do this but sadly when a woman is very emotional after having a baby it can do great harm at what should be an extremely happy time in her life.

Another thing is that many women have complained that they didn't have help with general babycare, getting their dinners, going to the shower and toilet. It doesn't have to be a midwife who does this sort of thing and I feel that if there were more maternity support workers well trained to work in maternity this would help immensely.

I was shocked and horrified that someone posted that their hospital don't allow people to bring in their own food. That seems totally wrong, especially if they are not going to provide a decent feed for a woman who has just given birth.

I had never held a newborn and the only thing I asked for was that I was shown how to hold a baby when giving my daughter a bath. Got sent home 8 hours after giving birth to my first baby still not having been shown how to do it.

I spent a lot of time in hospital before and after delivery and on the whole they were amazing. There were a few mws who were miserable but most did their best to help. My main concern is they are shutting down the ward so everyone will need to travel much further and if you spent as much time as I did that would be a real headache.

With regards to scbu mums it would be good if they could bf put on a ward without babies as this helped me. Would have been inconsolable on a post natal ward with screaming babies.

The day room had a fridge with left over yogurt etc we could help ourselves to and biscuits.

One of the worst things was everyone had their curtains shut and didn't talk in the room but more chatty in the day room. Mws with little post degree experience were expected to do far more than their pay grade and were overstretched.

As someone said something needs to be communicated about pharmacy times and the fact that drs take a long long time to come round. Would make the wait easier.

It was me who posted about not being allowed to bring food into the hospital - my hospital has big posters up all around it saying that visitors etc are not allowed to bring food, flowers etc and says it is for patient safety as an 'infection control measure'. I had just assumed that it was a nationwide NHS policy, it wasn't until reading this thread today that I discovered it was unusual.

I was in hospital for 8 days when DD was born and had no food at all for three of those days. It was brutal.

eurochick I couldn't have said it any better.

1. Make it possible to have food at all times not just providing you're on post-natal by 9.30am. Some hospitals do picnic packs at any time of day or date. An idea that should be copied.
2. Don't delegate important things such as pain relief to HCAs who can't read charts. Make mws or medical professionals responsible for these items. It is not acceptable to have to go 24 hours after a major surgery with no pain relief.
3. Get more staff! There's no way 2 mws can adequately look after 40 women.

My personal view is that women need their partners with them for the first 12 hours after the birth, and perhaps the trade off would be that more of those with straightforward births would be encouraged to leave within this 12 hour period. Yes this would mean a need for more private rooms. I do take the point about school runs within 24 hours but thats nothing to do with the NHS...

I also think that there needs to be more breastfeeding support and a number to call for the hospitals BFing counsellor, that you could pop in and visit even if you'd been discharged. Doesn't have to necessarily be 24 hour but would need to be available 7 days a week.

The after care when I had DC1 was not good; DH had to leave at 8pm, the ward was noisy all night (midwife had loud discussion with a non english speaking mother about a) why her baby needed vit k and b) that the hospital couldn't supply nappies) plus crying babies etc. TBH I can't even remember the food, as it somehow didn't seem relevant. They then lost my notes so couldn't discharge me but we decided to leave anyway as i was so tired i was sobbing after 2 nights of no sleep (one in labour and one on post natal ward), and other than lost notes no other reason to stay.

Both DC2 and DC3 born in birth centres and could stay in labour room until we left (and DH could stay) - what a different experience.

Haven't read the whole thread but the title did force one thing to my mind.

Can midwives/healthvisitors not be so quick to diagnose you as PND and that it is actually just tiredness?

Also, if you are going to advise family members to help, please do so in a way without the words "Watch her like a hawk".

I refused to see any health visitor after that because she made me feel so crap. I did complain but heard nothing from it.

My post natal care with no. 1 was fab and I was apparently well looked after. I think it must have been because it was a very complicated delivery, with magnesium sulphate infusions for severe pre-eclampsia, and 2 nights in HDU for me afterwards. Then DH paid hundreds for a private room for the following 2 nights.

No. 2 was not so great. This was because although it was the same hospital as before, they had changed their post-natal notes format. Nothing was recorded on the notes about the problems I'd had last time. I was pressurised encouraged to be getting home after 6 hours to a 22 month old toddler and no family, which I resisted. However, I was sent home the next day, with a perfunctory obs performed - where the nurse noticed my raised bp, but didn't comment, because she didn't know the previous history.

Result was that the community midwives sent me back into hospital twice as it kept on shooting up, so I was yo-yoing back and forth with my newborn in a blimmin car seat, and had two extra nights in hosp while they sorted out my medication.

So I think there just needs to be more attention paid to the patients' history. I felt like it was down to me all the time to remind people of my bp problems and promt them to check it, rather than it being visible when they opened up my notes. I was treated like a first time mother in many regards.

In response to some of the other comments:

1. We took loads of food in to hospital. I do think its a bit unrealistic for the hospital to be able to provide proper food if you can't have dinner at the right time as you are in advanced labour and are starving at 10pm. It might be nice if there was a bread and a toaster and some jam though.

1. I don't think its the hospitals job to show you how to bath your baby on a post natal ward.

1. re: school run within 24 hours comments - in the community in which i live this just doesn't happen. someone organises a meal rota for 2 or more weeks, others bring the older children home from school or do playdates for them. i don't think thats up to the nhs though, other perhaps a mumsnet campaign on that would be good - when DC3 was born both DC1&2's school PTA and our synagogue called to ask if we wanted meal rotas, and I didn't do a school run for weeks.

I think a lot could be learned from The Rosie at Addenbrookes. I was there as an inpatient antenatally and both ante and postnatal women had access to a day room, breastfeeding room and a canteen where the food was served. If you couldn't get out of bed they brought it to you, and if you'd put a slip in saying you would be around for meals, and then missed it, they saved it for you.
The canteen was open 24/7 and had tea and coffee making facilities, cereal and biscuits and water, so if you got the munchies in the middle of the night there was somewhere to go.
There were a selection of vending machines just outside the door of the ward so again there was somewhere to get things at all times without having to go to the main hospital shop.
There was a small kitchen with fridge and microwave, and I sent my husband to Waitrose nearby for a stash of nice ready meals.
The bathrooms were spotless. The staff worked mega hard and yet were always pleasant and wanted to help. I transferred to deliver elsewhere so I never got to see what it was like post delivery but as the post delivery girls were down the end of the same ward I can't imagine it was hugely different.
Jolly well done to The Rosie, IMO!

foreveronadiet I'm not suggesting you should be fed a hot meal any time of day or night but it's not reasonable to get onto PN at 10am having been in labour for over 24 hours with no food and be told you can't have lunch or supper because you didn't order it at 9.30.

foreveronadiet should we then say it's not their job to help you breastfeed? All aspects of babycare should be adressed as soon as a new mother shows insecurity.

I can see that there are limited resources and so these have to be used wisely. I still think the most important thing is that your partner can stay for the first 12 hours.

re: food. As I said I took with, because I expected the hospital food not to be nice. I recall being offered toast (made by the midwifes) after I'd given birth, but I didn't need it as I had smoked salmon bagels in my bag. It might just be very expensive to organise meals outside the normal schedule, and if there are limited resources I am not convinced that this should be a priority. Clearly if you are there at mealtimes, but didn't order in advance etc they should try to accommodate. I remember with DD (DC1) arriving on the ward and them asking what I wanted to eat the next day and me saying, don't order me anything I don't plan to be here tomorrow, and then having discussion that it was too late to order for that day. In the event a breakfast did appear and I left at 1pm so didn't need lunch (although thats other whole story because we left without a discharge as they lost my notes, I had wanted to go home straight from labour ward but DD was a bit distressed at birth so we had to stay in for 24 hours).

re: bathing, I stand by what I said before. Again of course if there was infinite amounts of money they'd be able to accommodate but I don't think this should be a priority. Of course they should show you how to breastfeed for obvious reasons, but learning to bath a baby can be picked up from a book, from youtube etc etc not rocket science. Also babies don't need bathed immediately and the midwifes visit at home the next day so maybe this would be more appropriate? No one showed us, I'd also never really held a baby, or changed a nappy we just worked it out, looking at a book, never occurred to ask the hospital staff. Ideally the hospital would run ante-natal classes showing how to bath a baby, breastfeed, etc etc so that this wouldn't need to be covered on the busy post natal ward.

BagofHolly When were you in the Rosie? I was pleasantly surprised to read your experiences, as I've been reading this thread nodding along to SO many of the comments and horrid experiences. I had DC1 at the Rosie and my experience of the postnatal 'care' there was one of the main reasons DCs2 & 3 were born elsewhere. I missed meals because I didn't know how to access them, the toilets and showers were not clean (blood). I was left not knowing when my epidural would wear off and the support for breastfeeding was frankly shit. Discharge took hour upon hour. I could go on. But, this was 6 years ago and I would be delighted to hear things have improved .

I think the single most important thing that could be done to improve pn care would be to have compulsory feedback forms for every mother to fill in before discharge and the the results were collated and made public every quarter.

I am currently 17 weeks and the anxiety of post natal care is ruining my pregnancy. I will have a ELCS for medical need, so already know I face at least 2 sleepless and stressfull nights in hospital. With DC1 I had a post operative heamatota (sp) because I had done too much moving around apparently. I just did as I was told!

I am currently googling if I can claim anything on Bupa for example a private room, but not having much luck.

It just seems so wrong what they expect post CS ladies to be able to do, they wouldn't expect a post hysterectomy patient to pick up a 7 pound plus weight up to ten times in a day, nore would they tell you to get up the next morning and fetch your own toast.

foreveronadiet breastfeeding can be read about in books too. What I really meant by my post was not that every mother should be shown every aspect of caring for a baby but that there appears to be a huge pressure to send you home as quickly as possible and let the insecurities be delt with by someone else but me because I'm busy. It's not the right attitude. A 2 minute chat about it and a smile would have done it for me.

Bagofholly. IME the Rosie is very good at somethings but my postnatal care was there and my comments about the bounty lady, keeping nicu/scbu mums together and away frm crying babies, not being able to get drugs because I was on the NICU with ds were in respect of that hospital last year.

One other comment I would add which could improve thigns is that at no point should I have been made to keep the curtain around my bed open when I was in floods of tears (not just because of DS, but also because my FIL died while I was still in hospital and my DH was trying to deal with that and arranging a funeral as well as caring for me and DS) to be faced with another mother, her baby and countless visitors in the next bed. As I said before I didn't know that my ds would live. I was mobile and had no catherter/drugs etc so although I was in hospital I didn't need careful observation.

I just wish they could have kept the sara ward open. the staff tried their best, many were lovely, all were overworked and some were rude. The staff on NICU and SCBU were so much more helpful. The scbu staff encouraged me to complain as my comments were comments they heard time and time again in scbu and nicu.

I would however say that getting one to one care for babies on NICU is still a long way off despite NICU being an intensive care ward and that is I believe a higher priority.

I also spent a night on a gynae ward the same year. the care there was much much better than postnatal care, despite the fact I was there after an early pregnancy problem.