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

It makes me wonder what training the sisters of postnatal wards get. No nursing experience, no sister experience? Could that be why ridiculous things like tvs staying on all night happen?

definitely support this. Post natal care nearly finished me off.

Just looking at the F&F ratings
www.england.nhs.uk/ourwork/pe/fft/friends-and-family-test-data/

There is a data set for March 2016 based on Post-natal ward responses (there is also another set in the same data for post natal community responses which is relevant to this)

This won't copy terribly well here but I will try anyway as I think its of interest to people and its a pain to go to the right excel spreadsheet for a lot.

I have just copied the Area / Trust, the number of responses that month, and the percentage who WOULD NOT recommend.

First of all by region:
NHS England London 2,483 / 4%
NHS England South West 777 / 2%
NHS England West Midlands 1,135 / 2%
NHS England Central Midlands 1,270 / 2%
NHS England Lancashire & Greater Manchester 708 / 2%
NHS England South East 1,240 / 2%
NHS England Cheshire & Merseyside 325 / 2%
NHS England North Midlands 747 / 2%
NHS England Cumbria & North East 852 / 2%
NHS England Wessex 527 / 2%
NHS England South Central 427 / 1%
NHS England East 950 / 1%
NHS England Yorkshire & Humber 1,247 / 1%

The problem at first glance looks most acute in London. Which doesn't entirely surprise me.
London has been known for the worst midwife ratios for some time, though I can't find any current data (DOES ANYONE HAVE THIS?)
This map from 2011 was the most recent I could find.

www.theguardian.com/society/2013/aug/18/midwife-crisis-lets-down-mothers This Guardian article from 2013 is worth reading as a bit of background as they think it will be 2026 before there will be anywhere near enough midwives.

The Care Quality Commission (CQC), the NHS care regulator, last year warned that one in seven of the 141 hospital trusts in England that provide maternity services did not have enough midwives. Maternity care was "emerging as a problem area for a number of NHS trusts, due to midwife numbers not increasing in line with demand and an increase in complex births, owing to risk factors such as maternal age, weight and co-morbidity", it said

I have to ask, JUST HOW MUCH IS ACTUALLY BEEN DONE TO ENSURE THIS DOESN'T SLIP BACK EVEN FURTHER???! We need to know, what has been done in the last 3 years other than pay us all lip service, in order to put on more pressure.

Anyway, back to those Friends and Family figures for March by Trust taken in a post-natal ward setting.
I've listed every Trust here with 5% or more would not recommend figure:
please also note the number of responses as well as the percentage of women who would not recommend as it affects the data reliability
I would also point out, is this a true reflection or do women in certain areas have higher expectations? as another cavet

THE ROYAL WOLVERHAMPTON 118 / 10%
YEOVIL DISTRICT HOSPITAL 55 / 9%
DORSET COUNTY HOSPITAL 35 / 9%
POOLE HOSPITAL 24 / 8%
BARTS HEALTH 53 / 8%
UNIVERSITY COLLEGE LONDON HOSPITALS 165 / 7%
NORTH BRISTOL 84 / 7%
BRIGHTON AND SUSSEX UNIVERSITY 86 / 7%
CHELSEA AND WESTMINSTER 174 / 7%
GUY'S AND ST THOMAS' 112 / 6%
BOLTON NHS 48 / 6%
UNIVERSITY HOSPITAL OF SOUTH MANCHESTER 48 / 6%
BEDFORD HOSPITAL 51 / 6%
LANCASHIRE TEACHING HOSPITALS 35 / 6%
LIVERPOOL WOMEN'S 18 / 6%
TORBAY AND SOUTH DEVON 36 / 6%
ROYAL CORNWALL 73 / 5%
CENTRAL MANCHESTER UNIVERSITY 76 / 5%
LEWISHAM AND GREENWICH 211 / 5%
NORTH MIDDLESEX UNIVERSITY 60 / 5%
MID CHESHIRE HOSPITALS 42 / 5%
SOUTHPORT AND ORMSKIRK 63 / 5%
CHESTERFIELD ROYAL 64 / 5%
UNITED LINCOLNSHIRE 66 / 5%
GREAT WESTERN 22 / 5%

I also had a look at the results for Ante-natal / Birth / Post - Natal in the community. There are percentages as high as 22% for one Trust for Ante-natal care.

Compare this with the same thing but for General Inpatients as a reference point to see whether post natal wards (maternity in general) are scoring badly or not:
ASPEN - PARKSIDE HOSPITAL 9 / 11%
MEDWAY 1,279 / 9%
CHELSEA AND WESTMINSTER 1,678 / 6%
ROYAL FREE LONDON 1,279 / 5%
BEDFORD HOSPITAL 394 / 5%
SHEFFIELD CHILDREN'S 868 / 5%
NORTHAMPTON GENERAL 1,633 / 5%

Oh.
Is all I have to say to that comparison.

The figures need a lot more looking at as these are monthly figures and so may not be as reflective as they could be, but there certainly seems to be a pattern there.

That's fascinating Red. Much much lower 'not recommend' figures than I would have thought. Maybe another day I'll come back and have a go at the 'likely to recommend' rates.

I've commented about the Bounty thing on this thread already, but would say that I generally received excellent care.

However, I definitely get the sense that mums whose babies end up in NICU often end up falling between two streams where there is very little communication between departments and they seem to rely on exhausted upset mums shuffling awkwardly down corridors at all hours instead of there being any support or help specifically for mums separated from their babies.

Whatever can be done to improve maternity care at such a vulnerable time would be amazing. My experiences do link to the other posts here but I think it's still worth noting. DS was back-to-back which led to a 4th degree tear for me and a stay on the NICU for him. Some of the staff were truly amazing, the behaviour of others still leaves me cold. Better training, more staff urgently needed. As well as better comms with patients, and between wards when parents and children are separated.

Comments I received:

• from the NICU nurse, told off for using a wheelchair to get to the NICU one day after giving birth despite the 4th degree tear, my evident pain and my inability to walk. For a normal person, it took 5 mins to get down the corridors, for me, 30 mins. I could only just about put one foot in front of the other. We tricked her in the end. DH took me down to the ward doors in a wheelchair, and I got out just before the door and shuffled through. Once she thought I was following her advice, she was lovely.

• being scolded by one of the nurses for not being able to urinate 24 hrs after giving birth and still needing the catheter.

My main suggestions:

• a ward that can deliver care to both mothers and infants when both are poorly or at least some postnatal rooms close to the infants. It was really hard being on the same ward as mothers who all had their babies with them. I needed 3 blood transfusions. The first one failed. It was hooked up for 4 hrs dripping in very slowly - when the nurse came to check it, she tapped it and declared it was still doing something so it must be ok. I just wanted to go down and see my son and I wasn't allowed to move whilst the transfusion dripped in. If we'd been on the same ward, I could have been with him the whole time. The only good thing was the Bounty lady was too scared to approach me for ages.

• more flexibility for provision of food/drinks if you are with your baby in the other ward and more flexibility on changing bedsheets if they come to do it just as the doctor/nurse comes round. I lay in dirty bedsheets for 2 days because of this and was just too exhausted to get things sorted.

• more communication from the doctors. I had read about 3rd/4th degree tears but no one really gave me any information at that point. I only knew DS was back to back because I saw it in my notes and I only knew it was a 4th degree tear because I heard the surgeon say so to one of the other doctors whilst they were stitching me up. (They had thought it was 3rd degree). I understand that it is difficult to be able to tell someone their prognosis because so much depends on recovery but just vague ideas at that point would have been reassuring. I was so scared. I honestly thought that was it in terms of my sex life, whether I'd be able to ride horses again, whether I would be continent again, whether I would be able to have any more children... All I was told was wait for the debrief and the physiotherapy - in 6 months!

• more joined up thinking between post natal care and NICU. Easier ways to transfer breastmilk down to NICU, opportunities to speak to the paediatricians (we didn't speak to any of the NICU doctors until the day DS was discharged, we didn't have a clue what was going on and didn't have the strength to try to find someone to tell us, we just took it one minute at a time).

I look back at that time with such sadness. Sadness that we could have lost DS, sadness that our time in hospital was so traumatic and that our time there was nothing like what we had imagined, and a real wish that at least one of us had had the strength to get things in order rather than just taking every bit of abuse and every lack of communication.

But there were some fabulous nurses as well - one of the senior staff cleaned who cleaned me up after the failed blood transfusion then spurted blood everywhere, gave me a hug when I burst into tears and told me that everything would be alright, that she'd had a tear and she was fine, and I would be too. She was lovely. And another one who got me onto a lower dependency ward after 4 days where I could be with my son for our last couple of days in a private room. Bliss.

I did complain to the hospital about my stay there. It took 3 years to get the strength to do it, and the lady who called me apologised sincerely and promised to do more to stop people being in the same position. I wonder how much can really change without the proper resources.

Luckily we are both ok now. I am the only one with scars (physically and emotionally) but I manage. At least I'm don't have to go through it again.

Please do this. My postnatal care was one of the main factors in me only having one child. The few days after I had my DC were some of the worst of my life. Agree with everything the first poster said - more staff, more empathy, more fucking kindness. I had numerous hospital stays before my pregnancy (for minor surgery) and on all occasions I was treated with more kindness, given more pain relief and generally looked after better than I was after a CS, trying to breastfeed a newborn baby, after no sleep for 48 hours.

More private rooms and YES YES YES TO A FUCKING NIGHT NURSERY! Rooming in is lovely if you want it but if you've just had your abdomen sliced open and a baby pulled out, you should be given a bit of fucking quiet sleep time if you want it. But also a lot of midwives need to have a long, hard look at themselves because frankly the ones on my ward were split 50/50 between 'nice but harried' and 'patronising, malicious cunts who need to find new employment'.

Can you see I feel strongly about this? It would have saved me from a lot of expensive private clinical psychology for birth trauma - something my psychologist said is on the rise and they are seeing more and more of. And my DC would probably have a sibling, rather than me crying every time I think about being back in a maternity ward

To add onto that. I am pretty sure I must have been at high risk of post natal depression but I had barely enough contact with anyone after we were discharged for it ever to have been picked up.

I literally just put all my experiences in a box in my head and didn't touch it. It was only because I have a counsellor who I at that time was seeing occasionally for "booster" type sessions, that I was able to open the box at a later date and properly go over everything and find a way to accept it. If we'd got pregnant again, I would have needed her help every step of the way.

GoldenWorld I could hug you for what you said about painrelief. I have said it a thousand times to any poor bastard who will listen. After MINOR surgery, I got sent home with ARMLOADS of painkillers, the heavy duty stuff. After a CS I got paracetamol and voltarol, which would be great if I'd, you know, twisted my ankle.

But instead I'd had my abdomen sawed open, a baby pulled out and the same baby attached to my nipples for about 4-6 hours a day. FUCKING PARACETAMOL?! Are they having a laugh?!

Please please do.
Our aftercare was terrible, it was like the second you went from delivery suite onto post natal suite they stopped giving two hoots.

We have to fight to get the postnatal wards sorted. They are just awful. They need to be staffed correctly. There are comments here saying they are caring for 8 women at a time. That's too many. But that's not even the truth is it? It's 8 woman + 8 babies. So 16 people! Some very emotional women. Some who've had major surgery. Babies who aren't yet managing to feed. All sorts of care required for 16 people. They need clerks auxillaries etc and adequate numbers of midwives. There needs to be more single rooms available and people should be able to pay for a single room of required. In no other circumstance do we expect someone to recover from major surgery with 5 babies in the room crying at night and all the visitors the room can hold during the day. They need to be realistic and compassionate about what postnatal women really need.

I wanted to add that although more support for BF on postnatal wards is a must, I personally believe that an awful lot of BF related misery is actually displaced birth trauma misery. When your body and mind are shredded AND then BF goes badly for you then I think there is a tendency to attach the negative emotions to the BF and to pass of post traumatic depression as related to 'failure' with BFing...when in the absence of trauma most women would probably be rightfully 'meh' about jacking in BF when the time was right.

I can easily imagine my own feelings would have run that way if it weren't for the fact that BF was the only bit that went right for us. This made it somewhat easier to ascribe blame for 4 years of mental illness where it properly lay, with dreadful labour and worse post natal care.

It's my DD's birthday today - 5 years on and I am almost feeling whole again.

Absolutely tftpoo. I had totally the same experience. Had to have food brought in as being busy in nicu meant I want able to get to dinner dead or time (most food gone in 10 minutes). Postnatal and nicu were both understaffed but no communication between them. I felt post natal only cared about my needs, and nicu about the baby, while I was stuck in the middle trying to be in two places at one. Having to wait an hour for tablets, when I should be with my baby. Being stuck in bed waiting for a breast pump for 4 hours dispite repeated requests. The worse was being told my baby had to be fed every 3 hours else he could go into a coma, yet would be 40 mins late giving hi his feed through the nasal tube. Also all staff to be trained on the same methods/procedures. I kept being told/shown different things by different people. X

More education about perinatal depression. I was trying to get an appt (so was my dr and mw) for 4 months. I got an appt through 2 dats after my baby was born 6 weeks prem due to pain and stress. A lot of the stress was the depression and anxiety. Awful pregnsbcy and won't be repeated as I really suffered mentally. X

Also far too much pressure to bf. Nothing is mention about ff. Extra pressure added. X

Yes! Please do this. I'm really struggling and in poor health because of post-natal problems, and the GPs, health visitors and everyone else just look blankly at me.

I only came to mumsnet because I was housebound for a year with postnatal illness after ds weaned. There really is a black hole in the care network here.

Ironically a neighbour of mine is going through all the same problems as I have and she is a consultant at the hospital. She routinely comes to me for medical help as she knows the GPs have no idea about post-natal stuff, and she also knows that I'm two years ahead of her and guaranteed to have been through everything she's experiencing.

I'm only starting to get things together because kind friends on mumsnet are helping me to self-diagnose and fix the problems.

I would absolutely love to see this campaign get going. I think that particular emphases on breastfeeding and the toll that it takes on physical and mental health would be helpful. Especially the effects of weaning on the mother after several years of breastfeeding.

In the LLL books they patronisingly say "If you wean after 12 years of continuous breastfeeding, you will just feel 12 years older than when you started", but that it patently not true. Awful, is how I felt, and two years later, I do not feel a great deal better. My neighbour felt so terrible that she was given an emergency referral to an oncologist.

Anyway, I could say more, but yet, please do run this campaign.

btw, the best thing I did in ds's early years was to just leave the post natal ward without permission. It turns out that they can't keep you in, if you just get up and leave. Home is where the food and the bath is, and there is much to be said for the mother being clean and well nourished, as she may not get five minutes peace between the birth and the start of school.

Post natally women should be treated in a way that enables them to maintain their dignity. The link between women receiving inadequate and callous post natal care and ongoing mental health problems is both clear and a serious failing on behalf of any health system. The voices on this thread, clamouring to share their experiences, show that it's really not good enough. For us to fail a group of people at their most vulnerable so thoroughly does not reflect on this country, supposedly a rich country with a universal health system, well.

all round.

Glad NICU has been raised. My own experiences in this respect were positive, I was given a private room while my baby was in there and, after I nearly dropped her when holding her, I realised I wasn't well enough so soon post EMCS to have much involvement so let DH take the lead in caring. Fortunately she was only in there a couple of days and I was so busy minimising it to myself that it wasn't as traumatic as it might've been. I can't imagine how awful it would've been had I not had that private room and a DH able to spend the entire day at the hospital because we live close by and had family on tap to care for our older child. So many women don't. Like others, I couldn't walk to the NICU myself and had to rely on DH being there to push my wheelchair. If he wasn't there, and I'd been trying to visit in the night too, it would've been impossible. And this was in a ward that I would describe as offering pretty reasonable postnatal care.

Yes. Even though Our hospital was pretty good most of the time. Things which, given people's experience here, should be standard good practise are meal cards. Our hospital - in every ward our family has had the (mis)fortune to be in gets meal cards for the next meal at each meal time. So at breakfast you get lunch, lunch gets the dinner one and dinner gets breakfast. You tick what you want on each, they're collected up and taken to the kitchen. There is space for dietary requirements and they are catered to. It's wonderfully helpful as if you get discharged, your meal is still sent up to the ward so someone who has been admitted gets a meal. It might not be their choice but it means there is something.

My biggest post natal problem was probably regular medication. They didn't seem to have a specific time other than first thing in the morning after breakfast and last thing at night, so I felt like I was badgering by going to the nurses station and asking for it in between those times. being sent away and then going back an hour later to ask the same thing. I did work out when was best to ask eventually during a 13 day stay but I can quite get why some people take paracetamol and ibuprofen in and self medicate. IMO this is dangerous as staff wouldn't then have a record of self-medication.

I was thinking about this overnight.

Whilst its crystal clear that the key problem is lack of midwives, MN can not campaign "To Increase More Midwifes on Post Natal Wards".

Why?

Because the RCM and the NCT and the WI have already done it. Successive governments have pledged to do so and have done precisely bugger all.

So we are going to have to up the ante on this somehow.

And I also think that, we think about not just increasing staffing through midwives (because there are clearly training issues with this that are going to take longer to fix) but also look at other areas of staffing and ideas that would relieve midwives - at least in the shorter term as the situation is so bad as we can't afford to wait another 10 years for there to be enough midwives (and I think we all know the chances of them achieving the target by 2026 based on the previous efforts is slim).

I have a few ideas but I need to get them straight and get some data to illustrate the point (In order to embarrass a few people and add a bit of weight to this)

If anyone else has any ideas along these lines, I think it will be massively helpful otherwise any campaign is just going to be more of the same (and probably just as ignorable unfortunately).

I should clarify, MN needs to campaign on staffing, and midwives still, but it needs to be a lot more aggressive and focused than just 'more midwives'.

Breastfeeding support is a must I think. It would be lovely to actually have someone (if you want it) sit with you and have time to listen, watch, talk through concerns etc.

My DD1 ended up back in hospital with a feeding tube after first attempt. Asked 3 times yesterday re DD2 breastfeeding and got fobbed off. Discharge papers even said "Witnessed breastfeeding upon discharging" - this didn't happen?!

Also sounds trivial and I'm not sure it won't be different in various hospitals across the country but I found it shocking in mine that you have to go get your breakfast/dinner/tea and it is not brought to your bed! Some people have just had ceasareans or have to leave their screaming babies before the food trolley disappears (after only being present a short time!) after being sliced open/stitched up - yet on other wards, food is mostly delivered to bedsides

clash- I agree. Other patients are treated much better than post natal patients and do not have newborns to cope with straight after major surgery. Poor post natal care is quite frankly, discrimination.