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See all MNHQ comments on this thread

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

405 replies

RowanMumsnet · 27/05/2016 13:43

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 Grin); 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

OP posts:
CurlyBlueberry · 31/05/2016 09:44

Red I wonder if there may also be a problem with where midwives are? So if London wards seem to be so busy, maybe more could be done to attract midwives to London? Well, not just London, to places/hospitals where there seem to be more acute shortages. So it's not so much of a postcode lottery and the numbers of midwives more accurately reflect the numbers of women - and not just numbers but "type" in that places with high CS rates, for example, might need more staff. Please note I may be talking out of my arse here! but it's just something that occurred to me when reading your posts...

I would also massively support campaigning for more HCAs or maternity support workers or whatever title they would like! They require less training than midwives or doctors, and are able to provide some basic care and attention (I say 'basic' but it's apparent we aren't even getting the basics right) and this can make such a huge difference.

MissBattleaxe · 31/05/2016 09:52

I would also massively support campaigning for more HCAs or maternity support workers or whatever title they would like! They require less training than midwives or doctors, and are able to provide some basic care and attention (I say 'basic' but it's apparent we aren't even getting the basics right) and this can make such a huge difference.

This is what I think. Midwives are spread too thinly and they really need people to take some of the bread and butter jobs away from them. They need ward clerks, and people to change beds, bring meals, provide water and pass babies. It's such a logical solution and it is far less expensive than stretching few midwives over far too many women and far too many tasks. HCAs should be on hand 24/7.

TradGirl · 31/05/2016 10:09

I should add that I got a very strong feeling that some midwives were overly invested in 'natural birth' and very sniffy about ELCS. A couple (the cunty ones generally) sneeringly asked me why I'd had an elective section, as if I'd sort of done it on a whim. 'Hmm, I think I'll have major surgery today for shits and giggles, what the hell, how bad can it be, right?'

I had excellent reasons for having a CS, not that it was their business but even if I hadn't it shouldn't matter. I'm an intelligent, professional woman who discussed options with my consultant and made an informed choice. Not for MWs to judge, which they did and made no attempt to hide it. They should have been there to support me but I can say hand on heart that the greatest care and kindness I saw on the PN ward was from male doctors not female MWs. How completely fucked up is that? So much for the sisterhood.

babyconverse · 31/05/2016 10:13

Absolutely agree about the HCAs - lets reassess the role of the midwife on post natal ward and see if staffing can't be improved that way. They simply have too much to do - and not all of it requires them to have the midwife training

Tonytonymacaroni · 31/05/2016 10:21

This is such an important issue - for many first time mums especially, the first few days after giving birth are the most frightening, painful, unsettling and insecure days of your entire life. I was in a very busy London hospital with competent but overstretched staff, and I was one of the lucky ones with a (paid for) private room but it was still pretty awful. I was kept in for 3 days due to a raised temperature when in labour (I went into labour while suffering with flu symptoms) and even though DD was discharged on second evening, there was no sign of my paperwork or anyone to tell me how long it might be. I self discharged
10pm on night 3 as it was too hot,disorganised and unpleasant to sleep there- and that was with a private room! My bed was also broken and fixed at the highest elevated position so I had to literally jump to get on and off- not the best with stitches to your undercarriage- and the promises of fixing it became comical in the end. I look back on my difficult back to back birth with forceps and imminent threat of emc more fondly than my post natal care. That's clearly wrong and it's upsetting to see its such a common experience. Happy to support this in any way I can.

IceBeing · 31/05/2016 10:49

red I don't think we need more midwives, we need more carers. People who care, and have time to. People to hold babies and hand them to women who are bed bound. People who can just be there instead of women being left alone with newborns in that 8 hour period after a general anaesthetic.

MrsWooster · 31/05/2016 11:18

Yes, to all the things you said. Awful, uninvolved postnatal wards and although I got lucky with my pnd care in Leeds others haven't ... Some acknowledgement on the ward that yes, this might be another shift for you, but something pretty fucking amazing / fundamental has happened to me.

milliemolliemou · 31/05/2016 13:11

Problem is money with the NHS under strain any way. Probably a proper study would reveal that putting money in to postnatal care would save money in the long run (as well as maternal health/child's health etc). Has it been done? Trouble is no one would want to be in the group of control patients - but you could do it with one good and one bad hospital. I had a 16 hour labour 20 years ago with delayed epidural, forceps et al - my husband fought for a private room which was an utter blessing, but they come at a cost if you are more ill than I was and can't press a button to summon help. I also had help with breast feeding and the help of a health visitor who spotted 10 days I had a retained placenta ... that alone could have incapacitated me. There are charities dealing with some of these issues - undoubtedly MNHQ know about them and their support networks?

mumandgran61 · 31/05/2016 13:21

Just signed up to Mumsnet as I was browsing through and saw this campaign and wanted to give my pennyworth. Better post natal care is definitely needed. I had my children many years ago, one in London, one in Lancashire. The post natal are for both was exemplary, apart from the first night in the hospital with the second child (transferred to maternity hospital after that and the difference was amazing!). When my DIL had her first child three years ago, it was all just like that first night. No help, made to feel you were stupid if you couldn't do something, no peace - she just wanted to get out of there as soon as possible. So, it seems to me that post natal care has degenerated to a far worse position than it was all those years ago. Yes, campaign for better post natal care - mothers and babies deserve far better and I'm sure there would be less trouble with breast feeding, less mental health issues, less bonding problems (not that my DIL had any of those!).

RedToothBrush · 31/05/2016 14:54

Problem is money with the NHS under strain any way. Probably a proper study would reveal that putting money in to postnatal care would save money in the long run (as well as maternal health/child's health etc). Has it been done? Trouble is no one would want to be in the group of control patients - but you could do it with one good and one bad hospital. I had a 16 hour labour 20 years ago with delayed epidural, forceps et al - my husband fought for a private room which was an utter blessing, but they come at a cost if you are more ill than I was and can't press a button to summon help. I also had help with breast feeding and the help of a health visitor who spotted 10 days I had a retained placenta ... that alone could have incapacitated me. There are charities dealing with some of these issues - undoubtedly MNHQ know about them and their support networks?

Actually I think it is doable to at least get a good idea of what's going on.

We have data for Friends and Family.
There is a 2014 study which looked at which trusts had peri-natal mental health cover.
There was data about midwife ratios (though could do with trying to see if there is more recent ones)
There is data about the number of births at hospitals.
Not sure about breast feeding. Its not something I'm familiar enough or looked into at all about what information there is available - there are others on MN who have more knowledge in this area.

I am willing to bet if you look at the data available you will see a pattern emerge with correlations just from one or two bits of this information.

You wouldn't need something research quality to start being able to at least ask the question and poke people with it. This is really what's needed imho to get the ball rolling and really get some heavy pressure about quality of care.

I'm trying to stat monkey at the moment, but its a big thing to do and I'm not sure I have enough time at the moment to do it justice but we shall see. If I can find at least enough to say, 'hey you need to explore this further' to someone that might be sufficient.

I know the money is there to be found and effectively reclaimed, its just a question of making a good case for it. At which point it starts becoming a political hot potato and one that might actually get a bit of interest and political momentum behind it.

Looking through the Friend and Family stuff alone, is proving somewhat eye opening (noting that its publically available as month by month, but doesn't seem to be in a year long period, which makes it difficult to compare easily). I am intrigued as to how this data is currently used and whether particular bad scores are investigated or whether its more of an exercise in pretending to give a shit rather that something from which change is actually happening from. From the look of the data, there are clearly some hospitals that seem to be under performing on a regular basis.

I did think that the Friends and Family thing might be a really good way in to get people's attention and to go 'Hey we are looking at you'. My previous suggestion of Mumsnet drawing a charter of some sort up, could then be something people support and kick people with. In feedback, saying on the card, 'I support the Mumsnet Charter, please do more to get care up to their campaign' Or something a lot more catchy and easy to remember would be a good way to get people to realise that you aren't alone and there is a political force to be reckoned with. (Hey doesn't everyone want women's votes at the moment?)

If my suspicion is right, then there is also definitely a particularly acute problem in London. Which start away feeds into the current political agenda. There is a new Mayor out there who has said things about housing and rightly or wrongly is under scrutiny for his agenda with regard to women.

Like I say, I'll try and work on the theories I have...

Sleepybeanbump · 31/05/2016 15:02

YES YES YES. And I'd do whatever I could do help any campaign.

I have birth 6 months ago and was, an still am, totally horrified at the postnatal care. I will detail more later but in my experience the priority is breastfeeding support. So much hinges on that, and getting it in early.

ateapotandacake · 31/05/2016 16:56

Yes. Yes yes yes. I'm a midwife and postnatal care has been decimated in the last few years. Campaign!

angelicjen · 31/05/2016 19:06

It's been said but I agree that post natal wards need lots more caring, empathetic nurses who are trained to support breastfeeding and don't tut if you need to buzz them over to help with something.
Also better food. I couldn't believe when I was given a leaflet about post natal care which told me to eat plenty of fruit and veg and drink decaf, followed by a dried up white bread cheese sandwich. When I asked for decaf tea you'd have thought I'd asked for a pint of Moët.
Agree no partners over night.
And must wards be so bloody hot?!

ToadsforJustice · 31/05/2016 19:15

YY to other PP. You are not a prisoner when you are in the post-natal ward. You and your baby can leave anytime without a formal "discharge".

stealtheatingtunnocks · 31/05/2016 19:35

Yes to better pelvic floor care, too.

Postnatal chats aren't enough - need really decent education. Will post more later.

Yes to the campaign. So much medical misogyny on this thread, awful.

Fourfifthsof · 31/05/2016 19:46

YES, YES, YES.

Breastfeeding support with healthcare workers who understand and can identify and take action on tongue tie, rather than just shoving your boob into the mouth of your frightened, hungry, frustrated child who will never be able to latch in a month of Sundays.

Pre and post natal mental health support - absolutely shocking. I was at a big teaching hospital, apparently a leader in MH care for mothers and was referred to their Maternity MH team on FOUR occasions during my pregnancy. Never heard from them despite chasing them up and repeatedly asking for help. Post natal, my MH history and requests for help in pregnancy was only ever mentioned once, by one midwife, when she was discharging us. She went to look for the MH midwife but there was no-one there / available. Help when asked for could have saved me from pre and PND.

More hands on help on the ward for people with C Sections / Injuries - DH was allowed to stay, thank goodness, or I have no idea how I would have coped physically or emotionally in the 24 hours after birth. I couldn't move due to spinal block / section so couldn't pick up my baby if he cried or put him back in his cot after he had settled. I couldn't change his nappy. I was also on morphine so even if I could have picked up my baby, I would have needed help to do so safely. DH did EVERYTHING for the first 12 hours.

Health visitors and community midwives who have the time to listen and help. I have been consistently ignored when trying to discuss my feeding concerns by my GP and by the health visitors in my area until now, when my DC should be on 3 meals a day but still isn't weaned. NOW they are interested because they can't tick their little box on the 1 year review. If they would have listened to me 6 months ago, we might be in a different situation. I think they were too busy to spend any time with me or wrote me off as first time mother / PFB. Probably both.

Campaign.

3littlefrogs · 31/05/2016 20:00

I think it would be very difficult for midwives to afford to live in London IME.
London weighting for NHS staff is just a drop in the bucket.

We need lots more affordable housing for key workers before things can improve.

MrEBear · 31/05/2016 20:28

Its not just midwifes we need, auxiliary nurses to do some of the other jobs that need done. Passing babies to tried, ill, mums take food to poorly mothers.

Physios to help with pelvic issues. And show CS mums how to move causing less pain.

Admin took me 9 hours to get discharged. That could have been done by admin. Amazingly enough midwife was at my hour barely 12 hours later.

3littlefrogs · 31/05/2016 20:58

I trained as a midwife in the 1970s.
You had to be a registered nurse in order to do midwifery training back then.

We had auxiliaries, enrolled nurses, student midwives and nursery nurses.

It wasn't perfect, but staffing levels were higher.

We used to keep first time mums in for 5 to 10 days, 2nd timers 48 hours.

Community midwives visited every day for 10 days, but were expected to continue visiting for up to 28 days if there were any concerns. They officially handed over to the HV when the mum and baby were discharged from midwife care.

Things changed dramatically in the early 80s and staffing levels dropped.

Post natal care has been the casualty of al the changes.

Want2bSupermum · 31/05/2016 21:41

I have no idea what they are doing differently here in New Jersey USA but I've had 3 CS and I've never had a problem with not being able to move and I've always been able to get out of bed by raising the back of it to sit up and then lowering it to get out.

I had spinal blocks for my 2nd and 3rd and I had horrible itching and nausea. I was wiggling my toes before leaving recovery. From the stories on here about CSs let's start there and improve the techniques. I also have no idea what people are talking about when they say overhang. My incision was glued together on the top. It's perfectly flat. It's been 8 weeks and it's a clean scar even though it's my third section.

I don't know if I am just lucky or other mothers here are lying through their teeth.

Want2bSupermum · 31/05/2016 21:55

When I say mothers here are lying through their teeth I mean mothers here in the US.

Rainbowshine · 31/05/2016 22:15

Yes please campaign. For me having a birth "debrief" for every mother, should be a basic part of care. It should be available when the mother feels ready, rather than have a time limit on it. When I had DS I was told if I didn't request one within a week you lost your chance. I was still in a massive haze and on a shared ward at one week, with no sleep to speak of there's no way I was able to evaluate if I needed it. I did need it, very horrible birth experience. Six months later I was getting terrible flashback dreams etc and I still get them occasionally now 3 years later and end up a complete teary wobbly mess for a week afterwards.

2rebecca · 31/05/2016 22:22

Agree with turning the temp of the ward down. I was oedematous postnatally anyway but the heat in the ward just made my ankles worse. I see no reason for hospital wards to be hotter than houses. You can put jumpers on if cold.

PersisFord · 31/05/2016 22:24

want2be I couldn't move my legs after my emergency caesarean but could after my elective one. And I definitely have an overhang - not scar but tummy skin. I can assure you that I am not lying about either of these things. But neither of them is the point really, and neither is your private medical care in the US.

Want2bSupermum · 31/05/2016 22:33

persis My first was an emergency and my 2nd and 3rd were scheduled. I didn't leave recovery until I could wiggle my toes each time. They had pumps on my legs too, something which my friend didn't have and when I asked about it they said it wasn't necessary.

I always thought people were talking about the overhang around their scar. I have slight belly overhang this time because I didn't opt for a belly bind until I went home. Normally they bind your tummy before they take you to recovery as it helps with getting up and about.

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