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.

Haven't had time to read the whole thread, and I'm sure this has been said somewhere already, but I think it is completely unacceptable for there to be (a) too few toilet and bathroom facilities on PN wards and (b) dirty toilets and bathrooms. It is shocking that anyone in an NHS hospital should be forced to negotiate puddles of other people's blood and urine in order to use the toilet or have a shower. This is just basic common sense and hygeine. When I was on the antenatal ward in my hospital, the toilets were too few, some were broken and they were dirty (although there was no blood to contend with) so I went downstairs to use the spotless toilets in the main bit of the hospital. The chart in these toilets indicated a cleaning schedule of once per hour. Why can't the PN toilets be cleaned just as diligently? Lack of resources is no excuse for putting women and their newborns at risk of infection in this way.

This is what I would do to improve postnatal care:

Continuity of care from the same staff as much as possible - not different staff every single shift. I saw 80 different staff in 9 days at the Chelsea & Westminster. Paeds, HCA, midwife, Doctors etc... yet the same staff were on the ward so it would have been possible.

Staff that are less noisy and bullying and consistency of advice across staff about breatfeeding and hospital routines.

Quietness - TV's, phones, Other people having 4 or 5 adults about the bed, I didn't sleep for the whole 9 days and am traumatised by it, okay if you are in for one or two nights, really distressing not getting any sleep for that length of time with staff that don't realise how tired you actually are and tell you things like "you'll have to feed your own baby" when you can't actually physically pick them up through tiredness. Seeing my notes with "ONO is a little tired" was the understatement of the centuary.

Cleanliness - The toilets were soiled with faeces and blood and blocked for 3 days. There was broken glass under my bed for two days. The cleaning supervisior spent ages trying to get a cleaner to clean properly. The cleaner was arguing with her. If I hadn't had high BP I would joined in and told him he would lose his job if he carried on. It was unacceptable.

Food - Staff who care that someone gets fed and can communicate in English so don't take away food before it's eaten. Good food not one baked potato without butter and rotten carrots.

There's probably more but that's enough for now......

I would definately support this campaign - one of the reasons that I am going for a HB this time round is that I couldn't bear the postnatal care at my local hospital.
It would seem that a lack of staffing was the main problem where I was - no doctor available to discharge me, needing the loo but unable to get up as I was still numb from the epidural - when I buzzed someone to help me, she was rude and I was made to feel like I was being a pain.
I was confident enought to do the feeding/changing etc, so didn't bother them much at all. Overall, the staff were nearly all rude and abrupt.
So, my experience wasn't so bad in comparison to some, but I would definately agree that they need to prioritise the patients who are ready to discharge, as this would ease the load and make it much easier all on staffing levels. Better information available at your bedside in the form of laminated cards would be great too.

I discharged myself after a dire hospital stay with my first. They barely spoke to me the entire time I was there despite the difficult birth I had. It wasn't until I demanded to be discharged right that minute as I couldn't take another night of staying there that they suddenly seemed to realise I was actually there. This was nearly 9 years ago and the trauma of it still lives with me. I think it severely effected my bond with my daughter, I had PND and flashbacks to the PN "care" I received. It traumatised me so much that i had my second baby at home 5 years ago.
I wasn't offered food, I wish I had known I could have got my partner to bring some in. I had no appetite anyway but I could have done with some energy. I remember one HCP (no idea who she was) telling me to "pull yourself together".

I think a list of who is who would be incredibly useful. And perhaps some info before you have your baby about hospital guidelines, food, toilets, nappy changing, what you need to bring in with you etc ... would be really good too. I had no idea, I didn't even have a hospital tour before I went in.

Tbh I have no idea what the PN wards are like now, as I said my stay was 9 years ago almost. I do know that staffing wasn't an issue, there were loads of staff milling around the reception area talking.

I would support this campaign, my post natal care after an emcs was appalling. I'd been booked into the hospital's midwife led unit but DD was an undiagnosed breech in distress so I ended up with an emcs and 2 days in the post natal ward. The key things for me were food and getting information.

I arrived on the ward just after 12 after being in delivery for 12 hours and as lunch had been served, I didn't get offered a meal until 6pm. Availability of a kitchen with basic supplies - drinks, toaster, bread, jam, cereal etc -would have been so helpful. Ironically the midwife led unit upstairs from the post natal ward had one!

Meals were prepared and collected from a kitchen area and had to be carried back to your bed on a tray, but no-one told you this. So I missed 1 meal because I was alone and unable to get out of bed to get food, so I didn't have anything until DP came in later and went to the hospital shop.

When I'd figured out where to go as I still had a drain in my groin which was attached to some bottle of gunk, the only way I could carry it all was to put the drain bottle next to my meal on the tray...very dignified!

If food wasn't collected in the 10 minute availability window you didn't get a meal. There were no checks to see if you'd eaten or offers of help to get food. Other women in my section of the ward missed meals because they were breast feeding or in the toilet/shower!

An info sheet with key facts about the ward would have been useful - food comes from here, at this time, you need to get it yourself, visting times, lights will go out at 8.30pm for the evening etc. If I'd known some of this in advance I would have been prepared and might have packed better.

I look back now and think it was madness, but at the time I was disorientated, in a hormonal fug, emotional and just went along with it.

As mother to a 10wo DD who is suffering from her second infection follinwg her birth (induced 5 days after waters broke, she's been riddled with infection since) this campaign has my complete and utter support. Lets not just focus it on the hospital though - my postnatal check at the GP was a sham. And something should be noted that just because I have another child, doesn't mean I 'know what I'm doing' and its not 'like teaching your grandmother to suck eggs'. i need help, advice and support. And I'm only really getting it from you lot here.

Thanks, btw.

I'd be v glad to support this campaign too. I haven't anything similar to relate (DD was stillborn, so I had a private room with en-suite and DH was allowed to stay in a camp bed and all the MWs etc were really nice to me), but I work in organisational change and the system as a whole shocks me.

One key thing (already mentioned upthread): It is the system that is at fault, not the individual people.

The staff involved already know what needs to be changed, what they need is a bit of help to get it started. I would suggest to any midwives or other HCP out there that they try a bit of simple demand analysis. Basically, keep a record of everything you are asked to do for a whole day, and preferably encourage others to do the same.

Eg:

Demand: I want to know where/how I get food.
Who: Patient
Is this the first time they have asked this (of anyone, not just of you)?: Yes

You build up a picture of the top few demands, and the ones that patients most consistently have to ask repeatedly. Take your top demand and see if there is anything you can do to stop patients having to ask it (in this example, info leaflets would help to reduce the number of patients asking about food). It gives you some very powerful stats to show managers, and it takes very little time to do it. Obviously, some demands (eg I want to know when I can be discharged) may be without your power to change without extra staff/funding, but at least you can show your managers what the biggest demands on your time are.

sorry i have not read all of thread yet.
I wanted to add that while I was researching hospitals for my second birth I found on an nhs complaint website that a lady had complained about her terrible post natal care, The hospital St Thomas's London in response to the complaint said that the post natal staff would undergo customer service type training to learn how to be politer to patients and more understanding.

I will see if I can find the link

I have to say that the post natal ward was not as bad as I had expected at the hospital although the night staff were very hostile when you buzzed in the evening to ask for help to pass a nappy/cotton wool

One hilarious moment was when I asked a HCA if I could have dry pads under me as I was covered and the bed covered in blood. ( I had just had a C section couldnt move my legs and had a catheter- she told me to move myself so she could change the bed ..... I was incredulous I informed her I couldnt move and she told me it was not her job to move me)

however the obgyn who did my op was so kind she came to see me on her day off and signed my discharge papers as she knew I was desperate to get home!

ok I am really sorry I dont know how to do the linky thing but here is the url with the response from the hospital

www.patientopinion.org.uk/opinions/33818

I can see what St Thomas's are trying to do there but quite honestly stuff like that makes my blood pressure rise, rather than admitting that their staff are overworked and put under too much pressure to meet unattainable targets it must be because they don't understand how to talk to people. I'd bet an extra midwife every shift would have a much greater effect on politeness levels than some customer service course!

Just as an aside we (and HCA's) are not "allowed" to move you. We may assist in talking you through moving or support you whilst you move yourself but we are not able to lift you or move you up the bed etc. If we hurt ourselves doing something like that our careers could be over and the trust would not support us in any way. Of course that is not explained to women.

Mrs JRT, some of the attitude and behaviour of staff is not just down to being overworked etc. I'm sorry but some of the nurse and MWs I came across were just bloody rude and abusive. In these circumstances I think there should be a straightforward way of passing on a complaint, and a visible sign that something is being done to address the problem.

Whilst I agree that staff are over worked and understaffed it is no excuse for the rudeness that I and many other women have experienced. I work in the NHS and have been under pressure like this, have been threatened and even assaulted by patients. Yet every time I have gone on to treat the next patient with respect, politeness and empathy. Admitedly I will sometimes think to myself that the patient is overreacting or whatever but that is my problem not there's I may see it all the time but they don't and deserve civility at the very least which incidently costs nothing.

mine was dreadful from the moment I stepped into the maternity unit. mw at docs was awful as well, but common knowledge, so just saw my doc, who said"completely understood, she was always getting complained about"
on arrival
-ignored by mw gossiping round desk-we could hear and see them all chatting about last night out even though we were right in front of them at the desk. ignored with impassivity of a head waiter my dh said.

-told that i should go home as they were busy, even though told by consultant to do in as needed immediate c section. admitted with v bad grace after consultant got angry.
-was deceided to do cs, mw in labour unit FAB. she was as she disagreed with new consultant on my care, lucky for me as he was suspended on full pay after wanting to do illegal procedure on me that would, the new consultant said, have killed me.

• surgery, apart from already posted below, cut baby, student stitching, massive loss of blood which FAB MW dealt with also with army of efficient mw never to be seen again.

-ward- mw came when buzzed to hand me ds as i was stuck in bed with catheter. she picked up ds, said, be back soon and went off with screaming baby for 30 mins. in end another mum went to get her as i was hysterical as hadn't seen her before, it was dead of night and thought she had taken my baby. -refused to take out catheter as wasn't her job. told it was by irate other mw, still wouldn't. -they forgot to read my notes, forced me to take shower alone. i said i felt v weak after loss of blood. they said it would be ok. collapsed in filthy shower blood everywhere. another doc came and said i now needed blood transfusion. refused as now sure they were out to get me. (nutty i know, but understandable) -mw said i should just leave if not having bt as they needed the bed, despite still being on catheter. rang dh in tears, he called head mw who told horrible mw to stay away after my complaint being the last straw.

• mw wrongly calculated weigt of ds, i did it myself, turned out she had no idea how to do %. left hospital asap

-food- dismal, pre wrapped garage sandwiches and toast. no wonder milk takes so long to come down. and you had to get it yourself in from fridge in waiting room with all the visitors.

nightmare. surprised anyone has more than one baby.

i did complain in writing but of course go nowhere, letter unanswered and just a long form letter about how they were always working to improve themselves and how they liked getting feedback. The independent org that handles complaints said they they have this all the time and often it is more distressing to complain as often the response is ignored and handled badly, causing the new mother more stress when she should be enjoying her baby and recovering

MrsJRT - who would a patient need to speak to, to get help moving? Where is this explained to them?

I'm so shocked by this thread. I had daily home visits from midwives for 10 days, and four home visits and three phone calls from breastfeeding counsellors in 10 days. As soon I was discharchged by the midwives, the health visitor arrived. We get home visits from the same health visitor for 5 years, weekly for the first year, bimonthly for the next four. PN care in hospital was fab as well. It's terrible that women in other parts of the UK are treated so badly. There should definitely be a mumsnet campaign to improve pn care.

MrsJRT - so how do immobile patients in other wards get their sheets changed and bed baths etc? Is there really a hoist for moving all of them?

When I gave birth I couldn't move myself up or down the bed or sit up by myself - had been in a wheelchair for a few months. The staff through labour were fab at hauling me about with the help of my birth partners, and by themselves postnatally in their team of two.

I think inconsistency of both policies and how reality lives up to policy is a problem - for example I just had my booking appt and in my notes it has the hospitals breastfeeding policy. Allegedy 'all staff are trained to help you breastfeed' - now I would bet that the people who come and change your water, or the ones who clean you up after getting excretions all over your bed, haven't been.
And 'breastfeeding help is always available on the postnatal ward' - there was a specialist breastfeeding woman last time, who was great - and works 9-5.
And 'staff will pass you your baby if you can't pick them up yourself' - implies there's staff who will come within a few minutes and be happy to pick the baby up for you. And the staff just don't exist.
Then there's how every book on birth tells you about that wonderful tea and toast on the postnatal ward. Which doesn't exist in my hospital because for some reason they think it's OK for 'vulnerable' women to handle a kettle but a toaster is too dangerous! (I have this in writing)

Clearly every hospital is different but could the Royal College of Midwives (being the ones who get the stick, even though half the staff on the postnatal wards probably aren't midwives!) possibly coordinate policies and pre-birth info about postnatal care?

Desperately needed campaign.

Nearly 5 years later I still can't sleep if I start thinking about the postnatal ward at the hospital where I had DS1 (Royal Free Hampstead).

I think info about how things worked on the ward was provided where I was (hard to remember) but in my severely sleep deprived state I struggled to take it on board. I think this needs to be taken into account when preparing info sheets - make them as idiot proof as possible because noones brain is working well when they've just given birth.

I hated the attitude of some midwives that 'we're not going to help you change your baby's nappy (in the middle of the night when you've had no sleep and your leg in still dead from epidural) because how would you manage at home when we're not there?' IF I WAS AT HOME MY HUSBAND WOULD DO IT BUT HE'S NOT ALLOWED TO BE HERE AND I'M NOT IN A FIT STATE TO DO IT MYSELF. ARGH!

I nearly died from a PPH after DD...post natal care was appauling. They also suspected eclampsia but I was left all day with no monitoring. Nobody told me where to make a cup of coffee...I only knew things had been serious when I read my notes...nobody told me anything.
Mmmm...lunch...spinach flan if I remember correctly!
The night I had her on delivery I was left in a side room strapped up to every monitor, catheterised, drips in each arm, sorry if TMI but I was left in my own shit as the drugs used to contract my uterus went straight through. My baby was crying in the night, I couldn't get to her and nobody came.
I got shouted at for accidently pulling out a cannula in my sleep!
Midwives forgot my antibiotics both days for chest infection, I had to ask for a box to self administer. Also no pain relief offered.
I'm fecking disgusted by post natal care and reading this thread makes me realise it's not a one off.

so,so agree with you hildathebuilder - I had care after DD2 in Sara Ward and they were (generally) brilliant. There was one particular mw who added a few catty comments to my record, but she did seem to mellow in the two weeks that I was in.
So glad that my baby days are over now though.

How do Mumsnet campaigns work? - Obviously it's a topic that lots of people think needs to be addressed - me included. Is there a next step to be taken?

My experiences of complaining about post natal care was similar to kippersandjam. This was despite some extremely serious complaints such as my child being given formula without my knowledge and despite my having said I was solely breastfeeding. I also complained about the insistence on re testing blood sugars after a feed even if the levels were fine before each feed to cause unecessary upset to the baby.

My experiences in Chelmsford were absolutely horrendous each time and for the 3rd I seriously considered going private but didnt want to be so far from my other children. No option for home birth as they were all c-sections but I stayed less than 24 hours each time and that was far too long. Still find it hard even now to think of my after care in hospital without getting angry.

Very happy to help with a campaign.

I had good post natal care at Stoke Mandeville and they do (or did before I had DD) have some useful info on their website. However, I would still strongly support an info card as then I would have asked many fewer questions and those that I did ask would have been directed at the right person. One section which should be included is "What needs to be done before you can be discharged". At SM, it included things like DD being seen by a paed, having her hearing test & me doing 3 x 500ml pees in a pot, the pot having to be collected from a special shelf, labelled with your name using the biro attached to the shelf by string and then returned to the adjoining shelf. Personally, I would appreciate it if it said that you should write your name on the pot before you've peed in it! I would extend the "Uniforms" section to a more general "Who's Who" section too which would include doctor "ranks" (eg difference between a registrar & an SHO & the minimum number of years a person would typically work to get to that level - what I'm trying to get at is I would have liked to know if the doctor confidently telling me something had been working in this area for years, had seen a case like mine umpteen times before and therefore I could have confidence in his judgment that it was entirely normal or whether, as appeared from his youthful looks and the fact he kept disappearing to check things and ask someone else a question, he had just qualified and wasn't entirely certain of his diagnosis).

Other things I could have been informed of and so wouldn't have had to use my buzzer/experience for include:

• when food was served and, as I was on a catheter, that it would be brought to me;
• a map showing that there were two blocks of toilets (one of which was just next to the ward) and so wouldn't have keep going to the one which was on the other side of the unit;
• what time shifts changed and that it was much better to wait 20 mins and ask someone a question 10 mins into their shift than to have asked someone who was supposed to finish in 10 mins and already had a million and one things to do; I would have known that the doctor's rounds at the weekend were at a different time to weekdays and so wouldn't have chosen that time to go and have a shower;
• that the people in red tops were the breast feeding advisers; and
• someone came around mid-morning & afternoon and filled up your water jug.

I appreciate that some people may have felt overwhelmed with leaflets when they were in hospital but, even if only, say, 50% of the patients read it, that would still reduce the number of "buzzes" and therefore free the midwives and other staff up to be able to do more important things that deal with someone's questions about logistics.