MNHQ here: after your thoughts on a possible campaign on postnatal care

[RowanMumsnet]

Hello all

As lots of you will hopefully know, we at MNHQ run campaigns every now and then on issues that really matter to MNers. Ongoing campaigns include better miscarriage care (keep an eye out for developments on that in the next month or so), support for families caring for children with disabilities and additional needs (MNHQ has signed up to a new campaigning alliance on that and we'll fill you in on what's happening soon), and rape myths.

We've been thinking for a while, though, that many of the most urgent and upsetting things our users talk about fall under the heading of - frankly - inadequate postnatal care.

MNHQ was involved in the National Maternity Review recently, and even among the senior NHS professionals there it was evident that there's a consensus that postnatal is the 'Cinderalla' of maternity services: underfunded, poorly resourced and rarely thought about - except when it goes horribly wrong.

Obviously this is a huge area and a very complex issue to address - so we'd like to hear from you:

• is this something you'd like to see MNHQ get into?
• which aspects of postnatal care need to be improved? We're already thinking about things like: breastfeeding support; perinatal mental health; staffing and conditions on postnatal wards; partners on postnatal wards (we know most of you aren't in favour ); care in the community from health visitors and community midwives; injury care for women post-birth, and longer-term care for pelvic floors; the six-week check and whether it really works for women and babies... but we're sure there are more.
• what solutions would you like to see? What's needed (up to and including money) to improve postnatal services for women and their families?

The aim of this thread is to find out whether you think this is a good idea overall, and to get a sense of which issues and which problems you think need attention - so please fire away and let us know your thoughts. When we've got something to work with we'll put together a survey for all our users so that we can get a bit of data to help us make some decisions.

Thanks
MNHQ

I remember being treated with a lot of impatience by midwives, especially after my 2nd CS, which left me in a lot more pain than the first one. I remember calling one to hand me my baby. He was crying and hungry and I needed to BF him. I was in agony and couldn't reach him. The midwife showed up but said "You should be doing this kind of thing yourself now." I said "I would if I could."

I can't think of any other post surgical situation where a patient would be spoken to so dismissively.

This is why I think they need auxillaries who can do these kind of jobs and take the pressure off midwives. They are cheaper to employ and can help with passing babies, topping up water and helping recovering mothers- whilst not taking midwives away from the jobs they were trained and qualified to do.

I feel quite angry that post natal mothers are not treated with the same consideration as patients who have had say, a tonsillectomy or an appendectomy. A C Section is a major operation with a 6 week recovery, yet once 24 hours had passed I felt like a malingerer.

Better staffing on post natal wards.

No partners staying overnight.

Lactation specialists on ward or better training for midwives - both my DC had severe tongue ties that were missed by multiple midwives, which caused no end of stress around feeding for the first couple of months.

More staff and proper trained bf support. 81% of mums leave hospital bf but this number very quickly drops away due to lack of support. Bring back the Call the Midwife days when new mums got twice daily mw visits rather than, as some in my area have to do, taking yourself back to the hospital to see a mw.

Need to go back to system of training as nurses then qualifying as midwives. Lack of nursing experience a factor here.

Yes, definitely something to campaign about. Post natal seems to be a Cinderella service where "care" is very patchy. I couldn't fault the ante natal care, the time DS spent in SCBU, and the couple of days we both spent in transitional care. No real issues with any of it. But the time I spent on post-natal, when DS was in SCBU, was awful and made everything about my situation worse. The midwives and HCP seemed overworked and stressed. They were abrupt and hostile, not at all caring. Also, putting women on the main post natal ward when their babies are in SCBU is cruel. We paid for a side room in the end, as I couldn't stop crying when on the main ward. That was marginally better, but I felt that I was basically ignored by the staff, treated like a nuisance, and don't recall any midwife actually asking about how I was doing. I also had a shitty run in with the vile Bounty woman, who shouldn't have been allowed anywhere near a new mum with a baby in SCBU.

I would also add my voice to the list of those who don't want partners to stay on wards with curtained bays. I don't mind them being allowed to stay if it was all private rooms with ensuite facilities. But no way should they be staying in curtained bays and using shared bathroom facilities/breakfast rooms etc. It's an unfair system too, as those without partners would have to put up with all the extra worry and lack of privacy, without having any of the possible benefits. It's a cheap (and bad) way of trying to address the failings in the current levels of post natal "care" being provided.

Good idea. I don't have children but I'm a midwife and I find working on the postnatal ward completely chaotic and disorganised so it must be a million times worse for women.

From my perspective, we're given 8 women and babies to look after. IMO that's too many. Things can get confused between people and I don't have the time to spend with anyone properly, or I spend all my time with a couple who have got very complex clinical needs and the rest get ignored. I've gone whole 13 hr shifts before barely seeing women because I've spent hours sorting other people out and because they haven't had a c-section, are able to get out of bed, they're just left to it. Which is wrong and I'd love to spend time supporting women with feeding properly but sometimes you need a good half an hour and with 8 women you can't possibly do that.

The main issue I find for midwives is the pressure for beds. The first thing you're asked by the co-ordinator is who can go home when I've barely had a chance to see the women properly. I get told off if I'm not discharging them quickly enough. It's such a conveyr belt system and I spend half my time on the computer filling in discharge forms, I feel more like admin staff some days and I often wonder if this is really the best use of my skills. We need more mcas or ward clerks to help with this so we can actually spend time with the women.

Lack of staffing as others have mentioned - often can go up to 7 or 8 hours before we get any sort of meal break. Might get a tea break in the morning if we're lucky but that's a quick 10mins. Postnatal ward can very stressful and is physically hard work. I'm not excusing any midwives' poor behaviour but I can understand why they can get stroppy. I've been guilty thinking of this myself when the buzzer has gone off for the 10th time in half an hour. You know it's not the poor woman's fault but when you've already got a million other things to do it's just another thing to add to the list which is completely the wrong attitude. I've also been guilty of forgetting to give women pain relief because someone else buzzes me or I get asked to do something and suddenly 2 hours have gone and I think shit, I didn't get it! Which makes me feel like a shit midwife for not being able to attend to basic needs like that.

Unfortunately, you have to deaden yourself to it and accept that sometimes you can only give basic care. I hate it and we complain and moan about poor staffing but it sometimes feels like managers don't care as nothing ever changes. A lot of midwives hate working on postnatal ward because of this so when you've got staff who are stressed, tired, grumpy, and don't want to be there that is a bad combination.

Women, I urge you to complain, complain, complain about your bad experiences and staff shortages. Managers never listen to th staff but if they get enough complaints they do have to look into it.

Oh and one more thing about c-sections I agree that the pain relief options we offer are pathetic. Even emergency ones are starting to be discharged one day after now which I find shocking, and I'm not convinced it's in the women's interests but because of pressure on beds. They don't like women going home on morphine so are expected to just have paracetamol and ibuprofen. People take that for a mild headache for god's sake, not major surgery! It's absolutely nuts.

I do actually love working on postnatal ward though and there are midwives out there who are trying their best in limited circumstances so it's not all bad.

Other things I wanted to add.

Community care is a postcode lottery. In my hospital we do up to 28 days or even longer for women with past depression or if they need extra support which is amazing. But other areas, have 1 or 2 visits and that's it. It should be the same across the board. Although my community mentor said she thinks community postnatal care won't exist in 10 years as it's being eroded so much and everyone will just go to clinics or see a GP. Their mileage is monitored and she gets moaned at if she's done too much. They're definitely trying to cut down the amount of visits and travelling midwives are doing so that's definitely something I think campaigning about.

Also don't agree about the nurse trained thing. There are still plenty of nurse trained midwives about and nurses are still training as midwives. Lots of them work on postnatal ward so I honestly don't think it makes any difference. I'm direct entry but I've looked after plenty of women post c-section and on high dependency/after transfer from intensive care.

I get told off if I'm not discharging them quickly enough. It's such a conveyr belt system and I spend half my time on the computer filling in discharge forms, I feel more like admin staff some days and I often wonder if this is really the best use of my skills. We need more mcas or ward clerks to help with this so we can actually spend time with the women.

That doesn't surprise me.

The irony is that I was told at 9am they would discharge me before lunch. So I was ready to go. I ended having lunch and dinner (an extra expense that could have been saved if I'd have been discharged quickly) and not being discharged until after 6.30pm! (which also meant not getting home until 7.30pm which didn't leave much time to settle and be ready for that night) I also sapped money by occupying a private room I'm sure someone else would have loved.

It was very obvious to me that it was a problem with midwives juggling actually caring for women with ensuring that paperwork was complete. Its nuts.

If there is that much pressure on beds, yet it takes that long to get discharged (which I've seen a few others on this thread comment about too) then the solution is a basic one for management. One that could pay for itself almost immediately.

Yes to the campaign

I think that there needs to be more care for those who have their children at home - ie more visits and for longer as they don't get the support with starting breast feeding etc that those in hospital do. (There are good reasons for home births including the squalor of the wards in some London hospitals...)

Pelvic floor also - we should have a system like the French where you get those toning devices to use - especially for those who require surgery after tearing - would save a lot of women incontinence and other issues later down the line (sighs)

Better support for PND - I found that I was unable to communicate by phone or email so APNI wasn't any use - eg having a PND drop in once a week at children's centres and one o clock clubs so you knew there was someone to talk to would have been an enormous help.

Yes. My opinion is that really post natal wards should all be private rooms with space for partners to stay. Partners should be able to stay but it's impossible with a ward type arrangement. More private facilities available- I would happily have paid but just not available anywhere but London.
Breastfeeding should be gently encouraged but not as much as it is now, it creates upset, guilt and negative feelings if you have to FF. I still feel a lot of well, hatred, to put it bluntly, to certain health professionals who should have known better.
On the other side, BF support should be much more readily available (if not pushed down your throat in a negative fashion!). I rang the infant feeding coordinator at our hospital on a Friday afternoon for help and her attitude was come back on Monday. By Monday I had washed my hands of the whole silly business and was FF.
Don't tell everyone with infertility and a high risk pregnancy they will get PND- some of us are quite happy thanks!

To add- for CS just keep asking for pain relief and ask to see the anaesthetist. Anything else is barbaric.
As for complaining- well I did on my feedback form, never had a response!

Literally just left ward- and the worst thing is lack of care due to staffing issues was stuck with all the lights on till 11.30 (eventually turned off ourselves) as had not done drugs rounds due to staffing levels. After hours care was awful and I really struggled I breastfeed and could barely stay awake while feeding- (the hormones make my sleep) and almost dropped DD was ringing for help and asked someone to sit with me or wind DD after and put in cradle ( had c- section) but they didn't have time ended up having to let them cup feed DD for her safety something I felt pressured into. All I wanted was my DH to help why can men stay overnight on wards? I got severely depressed and had nightmares after last birth due to the so tired could not hold baby so could not feed and felt a failure as a mum.

I would be behind a campaign on this. Women need all the help they can get, we should not be having to rely on partners and family to provide care in the wards.

I'd also like to see better mental health care.

It looks like the biggest problem is staff shortage.

I worked in NHS admin and I was amazed at hoe many high paid mangers didn't very much. I minuted meetings where nothing was decided, yet everyone took 2 hours out of their day to drive to the meeting venue.

Meanwhile, on the wards, there were not enough staff and the midwives were stretched to breaking point.

They need ward clerks for the paperwork and auxillaries for the bread and butter jobs. This would free up the midwives to do the job they worked for years to qualify for. They need more midwives so that women can get the right level of care and attention.

They do not need more managers in an office block attending useless, pointless meetings.

They do not need partners staying overnight on shared wards to "help".

I would definitely support this campaign. I have a 7 week old and my postnatal care was, for the most part, very good. The midwives were great but clearly very overstretched. I had a c-section and a very heavy baby so my husband had to stay as I couldn't lift the baby or do very much for first few days. If I'd had to keep buzzing for help I think this would have been very stressful as staff were just too busy to support to that level.

We also ended up staying for 5 days on a ward with 3 other mums and babies. Our baby slept but we barely slept at all due to noise, snoring, light, other babies crying etc. so a private room would have been much better for that length of stay. By day 5 I was very tearful and stressed largely due to extreme sleep deprivation and increasingly conflicting advice from the numerous members of staff we'd met. Discharge paperwork took so long that we weren't discharged until 11pm on a very cold night with newborn!! By this point we were desperate to go home though so would've left whatever time!

As a first time mum also would've appreciated more frequent visits from midwives and health visitors in first few weeks just for reassurance. My postnatal check is at 8 weeks at same time as my baby's and it feels like a long time since my scar was checked, for example.

beewales- I know it was a help to you, but I think it's wrong for partners to stay over on wards.

If there were more staff, this wouldn't even be considered.

If everyone had their partners to stay on a four bed bay, there would be eight people overnight on a ward plus four babies. That's just WRONG in a developed country like the UK.

It's not a dormitory, it is for the recovery of post natal women. It is a unique time where privacy is absolutely paramount.

There's no other department in any hospital where patients would be expected to put up with this.

I gave birth 12 weeks ago. The delivery staff were absolutely amazing. Once I was on the ward, the midwives were kind but far too busy and overstretched. I was an emotional wreck after a traumatic forceps delivery and struggled with bfing - DS had to be syringe fed expressed colostrum for the first 24 hours and despite staying in another night we had not properly established feeding before I was discharged, but I was so desperate to get out. The best staff were, as others have said, the HCAs. A fantastic one showed me how to express colostrum into a syringe at 2am and stayed with me for over 30 minutes. Then another who came round to change the beds first thing in the morning after my awful second night stayed with me and comforted me when I was so terribly upset because DS had screamed for much of the night, feeding was going so badly and I desperately wanted my dh but of course he wasn't there because he couldn't stay over.

I managed to dodge the bounty rep through good fortune of always having a doctor or midwife there whenever she came round but I listened to her scamming other vulnerable new mothers out of outrageous amounts of money for a photo on a key ring and think they should be banned.

The key thing is really ten times the number of staff are needed.

Once discharged my community care was very good. I had home visits on my first day home, day 3 and day 5 as standard, and extra ones to help with breastfeeding on day 4 and to reweigh on days 8 and 10 as DS had lost quite a bit of weight. Each time they probably spent upwards of an hour with us as I was struggling emotionally and very anxious. They usually discharge to the HV on day 10 but they kept visiting me until day 14 when I felt ready to be discharged.

MissBattleAxe, I agree. It was necessary but shouldn't really have to happen. I would much rather there were enough staff to support women. If I had other children at home, he wouldn't have been able to stay so I would've had to depend on the staff. We did pretty much keep our curtains closed to try and maintain some privacy as it was a busy ward with all the partners and visitors. Not really an ideal environment to recover and bond with baby.

Yes please.

The support I had during pregnancy and induction was fab but afyer that went downhill.
I didn't have my labour explained to me and still an struggling with how brutal and traumatic it was.

Post natal ward was ok but night time midwife was horrible. Told me I was feeding wrong. Due to no support I ended up with infected nipples. The wards were so busy and no one told me what was going on. Advice needs to be given more.
My anxiety is particularly bad at mo but I only saw my midwife once afterwards as I was given appointments to see others at 5&11 days which were at local places. What I needed was the same midwife throughout for me to speak to.
People to tell me how crap id feel afterwards with stitches etc. No one explained this.

Two areas spring to mind.

1. More awareness in how staff deal with mums of babies in NNICU. The post natal ward was where I experiences some of the most ill thought out treatment and callous unthinking comments. The thing that bugs me the most is, it wouldn't take much money to do, just some awareness training, and better logistics so women like me aren't stuck post c-section on a post natal ward full of babies whilst their babies are in another part of the hospital fighting for their lives.

1. Get rid of the bloody Bounty woman and instead encourage volunteers like Bliss into the ward to talk to mums. The hospital I am closest to don't allow me as a Bliss volunteer on to the ward to speak to parents. We can only go as visitors and that relies on the parents knowing we exist.

It comes down to staff. If mothers and babies were counted as separate patients, that might help. I noted Celtic's post saying there were two (qualified?) staff for 24 beds, well that's 48 individuals. Clearly that's not ok.

Private rooms. It would be great to know how many private ebsuite postnatal rooms there are in the NHS now - probably more than we think. Would be great to make it a priority.

Friends and family ratings. On another thread I went off to have a look at the figures and was shocked rigid to find a London postnatal unit with an F&F rating of 22% likely to recommend. On the wards I work on, there would be hell to pay if the rate fell below 90%. The unit ds was born in, which was ok if not brilliant, was 64% - pretty poor really. Could MN do a bit of work on these, look at patterns and trends? There must be son postnatal wards that do well, what are they doing that I different?

By the time I left postnatal I had been awake for nearly a week straight. I told the nurses that I was terrified of dropping my baby off the bed because of falling asleep while feeding. They said "don't do that!" I nearly did, too. There wasn't even enough space in the bay that I could sit on the cold hard floor to feed. When I got home I got on my king size bed with my sidecar cot and fed and slept and fed and it was like heaven. I'd really like there to be some kind of provision for breastfeeding mums to feed safely while exhausted.

Yes please do a campaign! Everything you've said in the OP plus access to health records and or debrief. 20 months later and I'm still filling out various forms and lost count of the various people I've asked for my notes. Seems from other threads I'm not alone in this.

The more I read these stories the more it comes across loud and clear that women are second class citizens. Most of these nurses and midwives are women. They seem to think women don't need or deserve decent care. I've just had an argument with my mum, who had an emergency caesarian in the late 80s and was able to rest away from her baby, and my brother (that baby) who thinks it's like a zero sum game and of course the NHS can't afford to look after both the mother and the baby so whatever the state of the mother, the baby will take priority. They are normally caring and decent people, but they don't get it.

And better support for mum of premature and/or sick babies. DS was late pre term but thankfully well enough to be on postnatal with me but we were in for weeks (large ward with 24 hour partner and friend visiting) and some midwives were quite nasty. One asked why I hadn't got small enough clothes for DS. One asked why he was so small. One said my dates must be wrong because he had a full head of hair. One criticised me for not getting feedimg established and said I was taking up a bed others needed (and I REALLY wanted to go home actually) Many didn't have time to read the notes and admitted this.
When I got home I read lots about prems and suck reflex not developing until later, and long hospital stays being common. Even if a staff member had had time to throw a relevant leaflet in my general direction that would've helped as there wasn't any knowledge in this area