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

My experience here in the US was that I was sent home with oxycodine and 600mg ibuprofen. If I needed more than that to control the pain I wasn't ready for discharge.

My obn has delivered all 3 of my kids and I've seen her and her colleagues throughout my 3 pregnancies. That in itself is very unusual in the UK. Also, my obn wasn't comfortable discharging me until I could cope with moving about including going up and down stairs as well as feeding being established. I was taking 200mg ibuprofen every 4 hours after the 2nd day. I was still kept in for 5 days.

I haven't yet read the whole thread but the postnatal care I received (or didn't!) was shocking. The fact that I was not treated with respect during my son's traumatic emergency birth is another story.

I was given absolutely no aftercare advice about looking after stitches or advice to help aide healing and I feel had I been told certain things I wouldn't be waiting to have scar tissue sorted out 4 years later.
On another note I was given no explanation whatsoever about why things were done to me and handled the way they were in the delivery room. I was discharged the next day with injuries I knew nothing of! That in itself is disturbing and wrong!

The postnatal ward... I was lumped there after I was told to have a wash with no help from them then left after being told someone will be round to help establish breastfeeding. That someone never showed up. I buzzed for help and no one came. The next day the only help I got with breastfeeding was someone grabbing me and shoving me into my son's mouth whilst she wriggled his head about as he whimpered. Their response after I complained was 'babies have stores so staff were not concerned by his lack of feeding at this time'. I wanted help to ESTABLISH feeding so I could then go home with the confidence to contnue myself. I gave up a week later.

Overall the breastfeeding issues are the least of my concerns.

Birth trauma and PTSD are not considered. Maybe for those who have more obviously traumatic experiences but any emergency or intervention can cause someone to be traumatised. It's not recognised or acknowledged. Leaving a woman without an explanation for why a doctor has just burst into the room to say they're cutting your baby out is outrageous and inhumane to be honest. That deserves an explanation. Any procedure performed on a woman deserves an explanation regardless if it's done all the time or they see it everyday. What causes trauma should be included in their training i.e. no communication, not obtaining consent, not making sure the woman knows what you're doing to her and why, emergency situations, being rushed for no apparent reason, lack of explanation. Episiotomies I think are seen as nothing more than a 'small cut' to get baby out when they can be traumatic and leave a woman with life long problems, in some cases they are debilitating. To not be given an explanation for it just makes it even worse!

I was left feeling violated and disgusting to the pont I started to self harm. I saw it as nothing more than cleansing myself from what was done to me. That is how I was recovering. I was so disturbed about what was done to my body because I did not have any explanation for it. I shouldn't have had to find out about the birth debriefing service 3 years later to then arrange to find out information I should have been told then and there, I realised after that I was not made aware of half of the stuff that happened and what caused my son's birth to dramatically turn nasty. I wanted to know why I was given an episiotomy, why was my son taken from me straight away as I cried out thnking he was dead and no one said anything, why was I then given a managed 3rd stage I did not want, and what was being checked internally afterwards. I had no idea I had stitches inside and down for injuries as well as externally until I went home! Gross. I found out from my debrief I actually had 5 injuries and not the one, episiotomy, I knew about. Because I was not told about these injuries I believed I had been cut more than once as no one had said otherwise.

I was suffering with PTSD and did not find out until last year when I started therapy. It could have been avoided had I been treated with respect and dignity during and after my son's birth and not been treated like a thing for them to manipulate and stitch up without my knowledge.

Community midwives and health visitors also have a part to play when it comes to trauma after birth. They need to be trained to spot the signs of PTSD before it gets out of hand. I feel there were things I did and said during the time midwives were doing home visits and during appointments with the health visitor that were missed because they have no idea probably that it can even occurr let alone know what they're looking out for. That is appalling. Now, 4 years later, I'm going through therapy, I've finally found out information about what happened to me and my son during the birth, and I'm seeing a gynea about the damage done and it should NOT have taken this long at all.

Of course it could have been avoid and nipped in the bud from the beginning but because of inconsiderate staff and the lack of communication I have to rebuild my life after a dark start in motherhood. I don't think I will ever see motherhood in the same light as I did before I had my son and that horrendous treatment again! I can't trust them now and question everything they do.

Want2b I assume your care was privately funded? What sort of care do US ladies get if they don't have insurance? The vast majority of UK ladies rely on NHS care which is completely underfunded.

I gave birth abroad but maybe the same problems exist in the UK. I wanted to breastfeed and couldn't. I tried to get someone to help me but nobody would. I was given the number of a breastfeeding counsellor but I would have had to travel to her on the bus, through the snow, at night with two premature babies. I gave up trying to breastfeed!

If he had been able to stay I wouldn't have needed the midwives as much

i think the problem is that there are not enough midwives which is why people want partners to stay. If partners stayed, funding would get even worse as partners would be expected to the jobs of a HCA. So wrong!

MrsEBear The maternity care is the same for those privately insured and those on Medicare. You still get your own room, your own obn and help with BF or formula through WIC.

Better breastfeeding support!
2 on site workers all times
Mandatory 30m feeding chats with all new mums giving local details, booking at home visits etc

Also... GPs. When I went to numerous doctor appointments about stitches coming apart I was told 'men wont notice', 'that's just how it's going to be', 'does it effect intercourse?' (what? 6 weeks? I didn't even know if I wanted sex again!) and 'they wont do anything'.

My notes on the system are wrong too so I was told all sorts of reasons why I might have been given an episitomy and I now know they were all wrong but didn't help me whilst I was suffering from PTSD because of it. I think GPs need an understanding of trauma after birth as well and maybe more knowledge about why certain things are done. I was also told 'now you've been cut once you'll get cut again' (she definitely put the nail in the coffin with that!) which isn't true due to the reason I was cut. They seem to have old-fashioned views.

The deriefing service should be made more accessible. I mean maybe even done routinely because like... you have a right to know what's been written in your notes whilst you're in the same room and you deserve to know what happened. It shouldn't be treated as a secret to be closed and filed away until you find out you can actually see your notes!

Who has more right to know what's gone on with your body, your baby and your birth? Not the f*cking midwives and doctors that go home thinking they done a good job when a woman they "cared" for goes on to have flashbacks and scratches her body so it bleeds she's that distressed because she sees them as a threat and feels violated!

Yes a campaign would be good. With my first baby, the care during the birth was excellent. But as soon as I entered the post natal ward it was like I'd entered another world. I was shouted at for getting blood on the sheets, for not changing my catheter (hadn't been shown how), and was so horribly weak and exhausted after giving birth but was treated like a nuisance. My baby wouldn't sleep, she just screamed and screamed. The one saving grace was a supportive and kind midwife (the only nice one!) who supported me with breastfeeding - thank GOD for her, I would have been traumatised otherwise because she helped me rock my baby asleep after I'd had no sleep for 3 days straight with being in labour and then having a baby who, looking back, I think was traumatised by the birth (she cried constantly for days and didn't sleep).
I don't know exactly what needs to change but it needs to be a supportive nurturing environment for mums some of whom have just become mums for the first time and may feel overwhelmed, some of whom may have had a traumatising experience, most of whom are utterly spent and exhausted yet have a new and needy baby to take care of. In my experience the staff acted like "oh we've seen all this before, you and your baby are nothing new" but it IS new to us, it is the most life changing thing ever! And we don't know what we're doing! Just because you see it every day doesn't mean you should treat mums and their babies like a production line.
The person who helped me (I think a midwife) was clearly trained to support breastfeeding and was so good at it. But when I buzzed and a nurse came they looked cross and didn't know how to help. If made me wonder if they were fed up on getting called on to help with something they hadn't been trained in adequately.

Mental health post birth.

Like others, fantastic care before and during c section. Post birth i was genuinely traumatised. Severve post natal depression, possible PTSD. Im embarrassed to say i have only recently bonded with my son and he is 6 now. Always loved him but have only just experienced that surge everyone talks about..so sad.

Hell yeah!!!

Postnatal care can be so inadequate. As if you aren't in enough shock from actually birthing a baby you are then literally left to fend for yourself in hospital.

Just thought I'd throw this out there as I thought it interesting point for discussion.

www.kcl.ac.uk/nursing/research/nnru/publications/Reports/NNRUMidwiferyReportDec10.pdf

The association between midwifery staffing and outcomes in maternity services in England: observational study using routinely collected data. Preliminary report and feasibility assessment.
Kings College London
Vania Gerova Peter Griffiths Simon Jones Debra Bick

December 2010

We only explored „readmissions within 28 days‟ as an outcome and found it negatively related to the standardised staff/birth ratios of midwives. Readmissions were negatively related to the standardised consultant midwives to midwives birth ratios and; the consultant obstetricians to midwives birth ratios and; positively related to the standardised registered nurses to midwives birth ratios.
p9

The finding of poorer outcomes associated with a higher ratio of registered nurses to midwives is interesting and warrant further investigation into the role of nurses and supporting staff on maternity wards. The relationship of higher readmissions related to higher ratio of registered nurses to midwives in maternity services is worthy of further exploration in order to understand how nurses are deployed and whether there is some work substitution between RN and midwives. These findings also have potentially significant economic implications in terms of cost of readmissions and the related staff costs but also the costs associated with the higher staffing ratios implied. The data available to us had information on the level of healthcare assistants FTE in maternity services, which did not differentiate between maternity support workers and maternity care assistants. Healthcare assistants were excluded from the model because of colinearity with other staff groups. The support workers may become a more significant part of the workforce in future (Prowse and Prowse 2008) and therefore including them in future analysis will be of interest.
p10

More stuff.

Is it just me, who thinks that some of the figures below are quite shocking given this is a CQC survey?

This is not a small sample
The 2015 maternity survey involved 133 NHS trusts in England, who sent questionnaires to a total of 50,945 women. Responses were received from 20,631 women, a response rate of 41.2%.

CQC
2015 survey of women’s experiences of maternity care
www.cqc.org.uk/sites/default/files/20151215b_mat15_statistical_release.pdf

Summary of findings
Looking across the survey responses, women’s experiences of antenatal and postnatal care have improved. All previous surveys had consistently shown postnatal care to be poorer than antenatal care and care received during labour, and birth.

After giving birth in the hospital, 54% of women said they were always able to get a member of staff to help them in a reasonable timeframe, which is lower than the results for the same question during labour and birth (64%). Once returning home following the birth of their baby, 97% of women reported that they had a phone number for a midwife, which is very similar to the antenatal findings (98%). Overall, 77% were always given the help they needed if they contacted their midwife, which is a higher percentage than for antenatal care (74%). A further 17% were sometimes given the help they needed – leaving 3% who did not receive the help they needed and 2% who were not able to contact a midwife.

Ninety-two per cent of women said that their midwife told them about arranging a postnatal check-up on their own with a GP, which is a one percentage point increase since 2013. Also, 54% of women said that they were always given support and advice about feeding their baby if they needed it during evenings and weekends. Twenty-two per cent said they were ‘sometimes’ given support and advice and almost a quarter (24%) said they were not given advice and support at all.

Overall, 81% of women said their decisions on feeding their baby were always respected by midwives, 15% of women said sometimes, and 4% of women said their decisions on feeding were not respected.

Over half (52%) of the women surveyed saw a midwife three to four times after going home (down one percentage point from 2013). The number of midwife visits should depend on the needs of the woman and baby, and 76% said they saw a midwife as much as they wanted to.

Overall, 78% of women said their postnatal midwives were aware of their medical history and that of their baby. The remaining 22% said they were not.

In 2015, 62% of women said they were always given the information they needed in hospital after the birth, which is a significant change from 2013 (59%).

Of all women who responded, 77% felt that after the birth of their baby their midwife always listened to them, which is lower than for the same question asked about antenatal care. A further 20% said that they were sometimes listened to.

In 2015, 71% of women in the survey said they were treated with kindness and understanding after the birth of their baby in the hospital (compared with 66% in 2013). This is the highest percentage since the survey began.

However, there were substantial differences between primiparous and multiparous women for this question, with more multiparous women reporting that they were always treated with kindness (75% compared with 66% of primiparous women)

Three quarters of women (75%) said they were told who to contact if they needed advice about emotional changes, leaving a quarter of women who said they were not. When it came to physical recovery, 57% of women said they had definitely been given information about their physical recovery since the birth of their baby; 32% said they had received information to some extent; and 11% said they were not given enough information about this.

I suffered with post natal psychosis and wasn't even aware that it existed until after I had recovered, I think there needs to be a lot more information given to mothers and fathers on pnd, it should be discussed in the ante natal classes so we can identify symptoms before they get too serious. And reassure mothers that they won't have their babies taken away as a result. More funding for mother and baby mental health units is also a must.
I also think that infant first aid should be included in the ante natal stage, it's life saving information which is simple to learn and really important yet it's not really seen as necessary for people to learn unless they work with infants.
I had brilliant care during my labour and c section, however the after care at hospital was a disgrace there needs to be a lot more help and support on the wards for mothers especially with breastfeeding.
I think there should be more opportunities for partners to stay for at least the first night to offer support for the mothers and bond with their babies.

I sometimes think that surveys are phrased in a way that ends up putting words in your mouth. That survey doesn't seem to touch the real problems, although it's a bloody good start.

More realistic questions could be:

Post section, did you get the feeling your midwife had better things to do than pass you your hungry baby?

Did a midwife ever say "you should be doing this yourself"?

Did a midwife ever send you down the corridor to get your own breakfast even though you were in great pain and could barely shuffle?

I would be saying YES to all these questions.

Post natal care post C section made me feel like an uninvited guest who had outstayed their welcome.

Better breastfeeding support in the post natal wards. There's should be a dedicated person for this so that they can sit and spend time without feeling time pressure with all the other things you have to do. When outside the hospital breastfeeding support needs to be much better. Here there is 1 clinic a week (or another one 40 mins drive away). If you baby is not eating at all how can you wait a week for help.

TONGUE TIE - my friends baby had tongue tie. It took far too long to diagnose for a common complication and then there was no one who could fix it. Literally no one! They didn't know who to refer to because no one had the skills. In the end they found a skilled Dr who did it on his lunch break from his day job as there's literally no one able to fix tongue tie that baby could be referred to. Absolutely Appalling!!!

Post natal care post C section made me feel like an uninvited guest who had outstayed their welcome

This. As I said up thread, care for my babies in NICU was exemplary. I, however, felt like a total nuisance which they couldn't wait to get rid of.

It seems to me that a woman post section is as much a patient as her baby(ies) but apparently not according to the NHS. It seems that because a c-section is a reasonably common surgical procedure, it has become seen as 'minor' in terms of recovery. It is not a minor procedure. Post c-section patients need adequate pain relief, support with basic care (i.e. toileting, washing, eating) as well as caring for their baby(ies). Potentially for more than 24-48 hours depending on the circumstances of the section, blood loss, etc.

Hello all

Just wanted to say thanks so much for all your thoughts so far. We're going to leave this 'pinned' in Active for a few more days so that we get as much input as possible, and then we'll have a proper read-through and try to pick out the common themes and thoughts.

Thanks
MNHQ

It seems to me that a woman post section is as much a patient as her baby(ies) but apparently not according to the NHS. It seems that because a c-section is a reasonably common surgical procedure, it has become seen as 'minor' in terms of recovery. It is not a minor procedure. Post c-section patients need adequate pain relief, support with basic care (i.e. toileting, washing, eating) as well as caring for their baby(ies). Potentially for more than 24-48 hours depending on the circumstances of the section, blood loss, etc.

I think this post is bang on the money. I have written before on MN about my horrible delivery & post natal experience (failed induction, EMCS), although possibly under a different name. The head of midwifery came to talk to me about why I'd opted for an ELCS second time around with DS2 when I was on the postnatal ward because the trust was worried about its rising CS rate. I talked her through my first delivery/postnatal spell & the utter crapness of the whole experience, how unsafe, uncaring and neglectful it felt, the lack of adequate pain relief (written up in my chart but not given to me, so no you can't have any more until x o'clock). She was quite shocked but conceded that it was understandable that women who'd gone through similar might prefer consultant-led care and a more predictable (if invasive) process. There was no way I would have attempted a trial of labour (VBAC) after my first experience. As it happens, I had better postnatal care with DS2 and they had sufficient empathy to put me in a bay with other mums with nicu/scbu babies so at least we were able to sleep and support one another. But I had packed snacks, juice cartons and my own painkillers just in case...

I think dreadful postnatal care has definite long term costs for the NHS, as well as women and their babies.

I am also able to compare & contrast with more recent post-surgical care for a much less major procedure and the quality & compassion of my post-surgery care was miles ahead (same hospital/trust). Post-natal care smacks of endemic misogyny - that's the only way I can rationalise resourcing it so poorly.

Yes, yes, please go into bat for us on this one. The way you're treated postnatally has a huge impact on your experience of motherhood as well as the very first stages of your relationship with your baby. I had very, very different experiences with my DS1 and DTS post-birth care.

The things that would have made the postnatal experience better with DS1 would not have been expensive to implement, and I feel would have gone a long way to help avert 12 months of PND.

I'd also like to add my voice to the others asking for an update on the Bounty issue.

Yes, CS is major surgery.
The morning after my CS I used the hospital bed lever to lower it to allow me to gingerly step onto the floor. My husband helped me to the shower. I realised I couldn't undress myself. My husband removed my knickers and blood soaked sanitary it owes, and replaced them when I got out. Pretty shocking for both him and me. I walked like an d lady back to the bed in tiny painful steps.
I cried in pain, panicking about how I would care for my baby whilst practically immobile and in agony.
You are sent home having had major surgery and given this little creature to keep alive st the same time. People who have hystrtectomies are told not to hoover of drive for 6 wks. I was lugging a Moses basket around. It's extremely challenging situation.
And to top it off, those who have had natural births think we'd had it easy.

The morning after my CS the midwife told me she would watch my babies while I had a shower. I gushed loads of blood in the shower, tried to clean it up and nearly fainted. I staggered back to my room to find the babies totally on their own. I vomited in a cardboard bowl that was on my table and then pressed my buzzer for some help as I thought I was going to faint. When the midwofe came she told me off for vomiting in the bowl - apparently I was meant to have weed in it instead to prove I could wee without the catheter. She told me off for weeing in the toilet. She told me off for making a mess in the shower (by bleeding!!) and despite me begging didn't get anyone to clean it so I could hear all the other women going for a shower and being confronted by a scene from a horror show. She didn't clean the vomit away for ages.

I definitely know people who are nicer to their pets than that midwife was to me.

The worst thing about it is that it's the women who've had difficult births who have to stay in postnatal for the longest. Women who've had easyish births get to go home after a few hours; leaving those who have already had a bad time and really need to be looked after, stuck in the hellish postnatal ward for days.

The one positive thing about my stay in postnatal was that when I finally got home, having proper food, a clean toilet, and dp around to help with the baby, everything seemed like a doddle.

Please don't think that candy, I had a horrendous 'natural' birth, brutal forceps delivery with no pain relief but would still rather have had that over a CS and the resulting recovery so I definitely don't think you had it easy. Sgoinneal is right, there is no easy way of giving birth and we should all be in this together