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 couldn't move my legs after my planned CS and I had a catheter fitted.

Anyway - back to the point of the thread. I would like:

• food for women who arrive on the ward after meal times - I had nothing to eat for 36 hours, despite having had a major operation.
• better care from MWs who know which women have had CSs and which haven't
• strictly enforced visiting hours and numbers
• continuity of care so that someone knows when you're supposed to be discharged, can organise meds for you so that you can go home (and yes, that might be on a weekend) and there is follow up post-natally once you're at home for the first 6 weeks
• breastfeeding support on the ward

Why would anyone lie through their teeth? To what end? It doesn't make sense.
I had an elcs but had no choice about it in practice. Two days notice, as DD turned breech at 41 weeks, and not enough room to turn her.
I had diamorphi with and was catheterised as couldn't move until several hours after the surgery. Catheter was removed the next day. I had no pain relief other than paracetamol for first couple of days. It bloody hurt.
I have the classic CS overhang. I used to have a tummy pooch if I was carry extra weight but despite having a very neat scar, I have a solid ridge where my stomach muscles were severed. Do now I have a tummy pooch and a CS overhang.
My scar still hurts. It randomly aches and if DD sits on it its very sore. It's been nearly 3yrs. I was told this is normal.

Supermum- this is very much a debate about the UK NHS, not USA experiences. Sadly, every woman on here is likely to be telling the truth. It's shocking, but true.

I had an emergency c-section with epidural with dd1, I could move my feet 1hour later possibly sooner but i was a bit busy
Dd2 was spinal blocks and multiple epidural top ups I was really poorly but definitely couldn't move for 3-4 hours and I have a slight over hang at c-section

Yes yes yes.

1. We need more staff. The staff on my postnatal ward were mostly lovely but there just wasn't enough of them to look after the women and babies properly.

2. NICU/SCBU needs more parent rooms. In our hospital there were 3 rooms for parents and 24 cots for the babies. Some of the mums will be still on postnatal ward (usually about 3 at any one time) and there is usually a set of twins but that still leaves over half of the babies whose parents can't stay overnight.

3. Better facilities for mums on the postnatal ward who have babies in NICU/SCBU. When DS4 was born I was in a 4 hour cycle of expressing milk, sterilizing and taking it down to NICU. Then it was time to express all over again. I remember crying in pain because I was walking up and down so much. It would have been so much better if I could have been on a ward closer to NICU or if a HCA could have done some of the sterilizing for me.

4. Better management of visitors. I understand that women want help from their partners, mums etc and want to see their older dc but it's not necessary to have 10 people crowding round the bed and being loud. My DH came in with our older dc but left as soon as they were getting restless, after 10 mins or so. Meanwhile the lady opposite had her DP, parents, sister, bil and 2 friends, all chattering away to each other and squealing, making way more noise than my dc who had been taken out.

5. Get rid of the bounty lady, or at least don't let her approach women, let the women ask if they want photos etc.

6. Better help for women who have suffered birth trauma, need help with breastfeeding etc.

7. More tlc for new mothers who haven't got partners with them. It's such a huge thing, giving birth, and I know I felt like I suddenly became a lesser being in the eyes of the HCP's when the baby was born. I needed a bit of nurturing and for someone to refill my water jug and to tell me I was doing ok.

8. better pain relief. I've had my tummy sliced open, I want proper drugs.

I realized my post wasn't clear so added that I don't doubt anyone on MN. I doubt people here in the US.

I paid £5 for a surgical abdominal support for my friend and she too has no overhang. It's also so much better for helping you BF, get out of bed and pass your first poop.

Again it comes down to funding. The NHS is woefully underfunded. Nothing is going to change until the money is there to provide the care that any other developed country provides.

Yes. Post natal care is poor but to be fair a lot of it is down to understaffing.

My own experience has put me off having any more children as I never want to be stuck on a post natal ward ever again. I was there for 4 days and was desperate to go home after the first night.

The woman in the bed next to me was in for a section and was given anti sickness medication that reacted with her own medication and made her vomit all night. After the second time it happened no one came to clean up the vomit for 4 hours and the whole ward stank all night and half of the next day.

Food was another issue. I didn't eat for 34 hours due to labour and missing the evening meal by the time I got onto the ward. As it was Sunday all the shops in the hospital were shut and as it was past visiting hours DH wasn't allowed to come back with food for me so I had to wait until the morning (for 1 little wheetabix). Food was delivered the ward but put on a table so you had to go get it. In my ward everyone else had sections so I ended up taking the food over to 2 of them because they physically could walk to the table.

BF support wasn't pleasant. I couldn't get DD to latch and after almost 45 minutes of one particular MW trying to shove DD on the breast I got told I would have to hand express and the would feed her with a dropper. (Baring in mind my milk hadn't actually come in yet). I couldn't manage to hand express, I tried my best for over an hour but it just wasn't happening. The MW was very annoyed I couldn't manage it and said my baby was hungry so I would just have to figure out a way to do it. By this time it was 3am and between this and the woman in the next bed vomiting I had had enough. I decided to ask for formula to feed screaming DD and try again in the morning. They told me I would have to think about it for an hour first and made me sign a form to say I was going against thier advice by giving formula. Honestly I was just relieved to be done with the failed hand expressing as my breasts we excruciatingly painful by this point. I was in tears and sent DH a very long and desperate text. I tried BF again over the next few days but every time DD latched on she would pull away again. I decided to feed expressed breast milk but the hospital would let me use the machines so I had to wait another two days until I got home to express. It was painful and I leaked a fair bit but fortunatly I managed to hold on to my milk supply. DD had 90% expressed milk for the first 4 months.

Painkillers- I did get some but no idea what. I was just handed pills - I had a second degree tear (stitched by student MW and they forgot to numb the area first so I felt every stitch and that hurt more than child birth TBH).

Anyway I think I have gone on enough so I shall leave it at that.

Omg you had a 2nd degree tear stitched by a student. Mine was done by a gyne doctor.

Hand expressing is so blinking sore. I managed to express a syringe worth then DS fed of me they put the syringe in the fridge.
Later I asked for it, remember it was sorely gained, oh yes its in the fridge but we can't give you it because nobody labeled it. FFS that took me ages and was so bloody sore for it to go in the bin.

Hand expressing shouldn't be sore. If it hurts you haven't been shown right.

Yes, a campaign about this would be hugely welcomed.

I understand that the NHS are seriously under resourced, but postnatal care was the worst care I have received when staying in hospital. After other operations that meant I was in for a few days, I was really well looked after. I was lucky I could stay on the labour ward in a private room for 12 hours post birth for close monitoring. The care there was amazing. Once I was moved to the postnatal ward though, despite being in a unit close to the nurses/midwives' station again due to close monitoring requirements, I really, really struggled once my husband was made to go home. My medical care was good in that I was given pain relief when I asked, given the blood transfusions etc that I required. But the actual basic care of food/breastfeeding/moving baby which I couldn't do at that point etc was awful. If no staff are available for this, more private rooms, which I would happily have paid for, with the option for a family member to stay over would make a huge difference.

Yes, a campaign about this would be hugely welcomed.

I understand that the NHS are seriously under resourced, but postnatal care was the worst care I have received when staying in hospital. After other operations that meant I was in for a few days, I was really well looked after. I was lucky I could stay on the labour ward in a private room for 12 hours post birth for close monitoring. The care there was amazing. Once I was moved to the postnatal ward though, despite being in a unit close to the nurses/midwives' station again due to close monitoring requirements, I really, really struggled once my husband was made to go home. My medical care was good in that I was given pain relief when I asked, given the blood transfusions etc that I required. But the actual basic care of food/breastfeeding/moving baby which I couldn't do at that point etc was awful. If no staff are available for this, more private rooms, which I would happily have paid for, with the option for a family member to stay over would make a huge difference.

Yes I agree partners could only stay if a room is private, but my fear is that the govt would NOT them employ extra staff on the grounds that women would have "help".

Plus many hospitals still have the communal bays and that would be a huge upheaval to convert those to private rooms.

More staff and more HCAs and smaller midwife to patient ratios is the key.

Celtic believe me every drop of the 5mm syringe was bloody sore. I did eventually get to grips with BF but that was so sore.
I'm not someone who complains about nothing.

I will also agree other hospital stays, burst appendix, swine flu pumonia, couple of minor ops in day surgery I was much better looked after than post natal.

I think the extra room needed and linen changing would be a hassle and expense if partners staying plus them chatting half the night, some of them will have arguments. For most women it's only 2 or 3 nights. They can spend the night with their partners after that.

I agree about partners definitely not stasying in communal wards for about a hundred reasons, but if private rooms were available, I would have fewer objections. It would be no excuse to keep understaffing though and rooms would need to be ensuite so post natal patients wouldn't be sharing toilets with other people's partners.

I'm not 100% convinced that partners should say even in a private room. Its a bit freaky to think men could wander into someone else's room while they sleep. 99% of men will be fine but sooner or later some sleezy git will overstep the line.
Would you be happy to sleep in a hotel without locking your bedroom door?

More staff not men and who looks out for single mums or mums who need men at home to look after other kids

I never had my 6 week check. Male GP them at our practice, just booked you in and told you when. I couldn't ask for a female one as it was discrimination. At any other time I've have fought back and told them this was bullshit. 5 weeks post partum? I just left it.

No men on wards other than visiting hours.

A limit on how many visitors at once and this being enforced.

MrsE I believe you! I am not denying your experience, but saying that you were let down. I have supported hundreds of women to hand express and I always tell them it shouldn't hurt. You should have had better support.

I did a long post this morning that disappeared. As a student mw I love postnatal care but the things I love about it are spending time with women and supporting feeding, and those bits of the role are gradually being given to other (cheaper) staff. It's a bit crap for mws to spend all their time giving drugs and doing paperwork. I dunno what the answer is.

Men on PN wards - whether single rooms or not - is a hugely bad idea. And yes WEP, I'm looking at you with your naive middle class experiences of post-natal care.

Celtic - it's absolutely crap that's what's you spend your time doing. Your patients want and need you to be spending time with them

I think visitors other than partners should only be allowed on shared wards for 1-2 hours a day. There were so many people in the shared ward I was in. Kids screaming and running around. People with 5 plus visitors. All this on top of the 6 women and babies. I'd just had major surgery. In no other circumstances would you be expected to recover from major surgery in those circumstances.

Also, pain releif for those who've had csections or similar. Again with any other surgery you are sent home with proper pain releif why should csections be any different? The doctor prescribed me stronger pain killers to take home but the midwife wouldn't give them to me. She said they don't like to send women home with anything other than paracetamol and ibuprofen. Why are women with c sections treated differently to anyone else in the hospital who's had major surgery?

Also to add that the post natal ward is so bad where I live that i felt I had no choice but to discharge early as I would have better support at home. However I did not feel physically well enough to be at home. I still had medical needs. So it was a choice between staying on the post natal ward and risking my mental health (it was making me feel depressed and anxious) or going home and risking my physical health. New mums shouldn't be put in that position!

I feel my unexpectedly complicated delivery was managed really well, all decisions explained to me etc but the postnatal ward was just chaos. My medical needs were met but general moral support was very poor.

• Company: baby was born around midnight, so husband had to leave more or less straight away so I was alone for the next 12 hours until visiting time.
• Sleep: despite my baby sleeping a lot I got no sleep at all in the 36 hours I was in (after 24 hours of labour and an EMCS). This was a combination of my own stressy tendencies plus four babies crying at different times plus buzzers going off all night: when a patient pressed the buzzer it kept beeping until a member of staff came. There must surely be a better method eg a flashing light on a board in the staffroom or something.
• My baby needed regular blood sugar checks as his blood sugar was low. They kept saying they needed to do tests 'pre feed' and 'post feed' which really didn't work with trying to establish breastfeeding. There was no proper support to improve the breastfeeding (which I suspect would have sorted out the blood sugars) just more testing.

My sister had her baby in another city in a university hospital and the support for breastfeeding there was much much better.

Yes please do!
I found a huge difference in the level of care I received following the births of my DDs (age 8 and 5-almost 6) and my DS 3. Only 2 and a half years difference between my youngest DD and my DS but the difference in care was stratospheric. The hospital they were born at had made big changes that in my view meant the care was inadequate- even dangerous at times post giving birth (as well as during actually). The staffing was far too low, buzzers went off all night - on one night I gave up after fifteen minutes of nobody turning up, aware my buzzer must be driving everyone mad, and put up with the pain instead. I was on a ward whereas with my DDs I had a private room, which meant I was much more relaxed and rested, and you couldn't hear everyone's buzzers going off on the tannoy- I think they have now changed the buzzers/call buttons but when I had my DS it was dreadful. I was shouted at by a clearly stressed midwife due to a miscommunication and left in tears, after a horrific birth experience this was the last thing I needed. Better designs of wards- maybe moving back to private rooms, no loud call buttons, more staff would have made my experience much better. Also, in the event of a traumatic birth, a bit more one to one with a midwife, who can go through what happened with you, and ensure you know what you need to know following it- simple things like knowing how to deal with the trapped air pains after a section, knowing that the baby will likely choke on fluids coming up that are normally squeezed out during the birth process- I didn't know these things, and when my son was choking I couldn't reach him- I pressed the call button and it took a long time before anyone appeared- I had to drag myself up using the bars on the bed to get to him and hold him on his side as best I could- very difficult just an hour or so after a section, and when the midwife came she said very abruptly 'don't you know all section babies do this'. This was my worst birth experience- I really needed someone to spend some time with me, some attention and to know a bit more about the after effects of the emergency c section I had had.
Finally getting home was a relief. Once again though I saw the difference in the level of care I received after my DDs and my DS. After my DDs the community midwife spent time at each appointment talking to me- now they barely lasted five minutes, she was in and out, and had little time or regard for how I was dealing with the birth experience. My son then became gravely ill- when I called the midwife to explain I wouldn't be home as he was in an intensive care ward, she offered no sympathy. She was the same midwife I had with my DDs who I had good experiences with, so I can only imagine the pressures of the job meant now everyone was simply a box to tick. In my opinion this is very dangerous- these appointments are integral for spotting a child who may be in danger, to spot signs of depression etc. I needed the most care this time around but got next to nothing. I had bed sores and told her so, but she didn't check them and I was just advised to use sudocrem. When he came home, instead of the midwife somebody else came around, filled in the paperwork and left. It was literally ticking boxes. I felt unheard.

I can only put the changes down to less funding, less staff, more concern over costs than over what actually is best for the patient, and more reliance on agency staff rather than employing people fully.

PS I had paracetamol and ibuprofen and was pretty comfortable (as long as I didn't overdo it) so for some people it works.

I also second a pp- I had my DS at ten pm and my husband had to leave as soon as I was on the ward, leaving me alone for almost twelve hours until he was allowed back. If he had been able to stay I wouldn't have needed the midwives as much.