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

GPs used to do a 6 week postnatal check as part of their antenatal package but this was then taken away from GPs and the funding for it given to midwives and obstetrics. The fact that midwife care stops at 2 weeks postnatal so no-one is now doing the 6 week postnatal check didn't seem to occur to anyone. GPs are no longer paid for any postnatal or prenatal care and won't be keen to have secondary care dump this back on them unless they fund it again.
Many health visitors are so busy dealing with child protection issues and addict parents that they don't have time for breast feeding support and well baby checks unless in a posh leafy suburb.

If more private rooms can't be arranged, then could there be separate wards/bays for women who want partners th stay over.
I know it's a necessity sometimes because of severe staff shortages but I'd of hated being so overcrowded!

Yes. Top of my list are breastfeeding support - and grouping breast feeding mothers together on wards and better follow up on mental health after traumatic birth.

Deffinately worth while. My three have all been born in different hospitals and counties. The consistent thing was staff were desperately overstretched an i was desperate to get out from the overheated overcrowded space asap.

Space was a big issue for me. I'd like to see more opportunity for new mums to bond with their babies and a return to the cottage hospital style spaces with day rooms, secure outside space and the chance for mums to gain confidence in their abilities, ask questions even make some friends.

Yes. I didn't receive any help from my family apart from my darling husband and I really struggled.
I also feel like I might have had postnatal depression but the fear of social services stopped me from saying anything.
I think it needs to be made easier to discuss how we feel.
Another thing was that I was discharged 10 hours after I gave birth and I totally wasn't ready. I was in a lovely birth centre and was told that there was people possibly waiting for the bed, I would have to go or be put on the wards. It didn't seem fair at the time, I didn't have time to enjoy the experience or relax and had to go home to my other children that I had to look after.
I was crying every night for a week, I had really bad baby blues. I do feel that some of it was due to being discharged so quick. There wasn't even time for anyone to visit me and see the baby in hospital and that would've been nice. The midwives who visited me were surprised at how quickly my birth and stay was and kept saying that you could've had a home birth. I was thinking hell no. Being in hospital was the only break I would've got and the only time to heal.

Yes please, my postnatal 'care' was dehumanising and neglectful.
Small things like following an emergency c section I got to ward too late for meal, nowhere to get anything, birth partner and baby dad sent away as visiting hours over. Because I'd been on drip since 4am Sunday morning I hadn't eaten or had more than a mouthful of water in 24hrs
Was left post c section in wrong type of bed, traumatised, alone with newborn. Just that bit of info following me, that I needed access to food, would have helped.

Hospital later admitted they knew there were problems with staff culture on that ward. Sadly, my friend had very similar experience two years later so nothing learnt.

So for me
Better transfer info
Allowing someone to be on ward with you, esp if you've just had a section and can't move
No sales reps
Proper breastfeeding support
I'm sure there's more...

Please do this.

I had two ELCS and both operations were a complete breeze and fantastic. The post-natal ward, both times, my God the horror.

Really, my privacy was invaded as it shouldn't have been, and one other woman's privacy, well it's too awful, it brings tears to my eyes even now. I'd had DD2. She was being split up from her baby. MY GOD. It was fucking horrendous, it should not have been like that.

More privacy. That's the main thing.
This was North London.

Yes I would fully support a campaign.

Quite frankly the postnatal 'care' (and I use the term loosely) was fucking horrific. Care plans that had been written with specific actions to be taken were ignored, I wasn't allowed to use my wheelchair on the ward as it was too big (electric). I couldnt walk to the dining room yet I was told they wouldn't be bringing food to my room as 'I needed to bond with the other mothers'. Choice of crawl along the floor or starve.
Breastfeeding support was a joke as well. The support consisted of grabbing hold of my boobs and stuffing them into my baby's mouth. I switched to ff as soon as I got home- formula was 'banned' on the wards apparently as they were a baby friendly hospital and forced encouraged all mothers to breastfeed.

Only silver lining in a really grey cloud was that their admin was so fucking poor they forgot to invoice us for the private room we asked for and was told we would be paying for.

Yes please
I haven't read the thread but for me and I see others mention it too. The birth trauma. And a lot of us then go on to suffer anxiety about the birth in subsequent pregnancies.
I think women need more support processing the birth, particularly those who have complications.

I feel quite traumatised after both births and now have severe anxiety about medical procedures which I didn't have before.

Not sure this falls under postnatal care though..

More staff, more staff and more staff!
I was incredibly lucky that i had good experiences in post natal (but know that is not the norm) for both my babies but the poor staff were run ragged. The fact of the matter is there just isn't enough staff,i gave birth in a fairly new (about 10 years old) maternity hospital but half the rooms were empty because there wasn't the staff to put women in them,yet labour ward was desperate to get people to the ward. I was expressing milk for my daughter but felt guilty about buzzing them to bring it to me or take it to the fridge. When it came to discharge it took about 10 hours to get out of there because they were so busy they couldn't get a chance to do my discharge paperwork, i was posting about it here at the time asking what would happen if I just walked out.

And get rid of the bounty reps. I am convinced the one on my ward was able to access my information (from notes beside my bed not from staff) when I wouldn't give her my details as bounty somehow still got hold of my address.

I don't think I have ever felt so uncared for as postnatally. DS was born early and whisked straight to SCBU when he was born. Once I'd delivered the placenta and a lot of blood the midwives disappeared - fortunatly I had a doula who got me in the bath and made a cuppa (dh was with ds) and then I was just dumped in post natal. Because I didn't have a baby with me, no one was interested, told me what was going on, or even how to get food. You had to work everything out for yourself, and there was no help to get to SCBU, you missed meals and drinks because you were there, and they wouldn't even take your milk round in the night so I was dragging myself round to SCBU, get buzzed in eventually, put milk in fridge, wobble back to the ward, get buzzed in again every 4 hours. No one on the ward ever asked about ds, and the bloody Bounty woman was awful.

I'll have a good think and post later.

I think its worth thinking something along the lines that post-natal care is early ante-natal care for the next pregnancy.

By that, I mean, if you get post-natal care wrong it causes problems and potentially adds cost to ante-natal care at the other end.

And it links in closely with mental health and knock on costs to society.

I'll try and drag some concrete to pour into the case once I've had a good thunk.

But yes, it needs a campaign.

Definitely yes.Highlights of my week in post natal included being :being told off for ringing for help 2 days post EMCS, (with sepsis and haemorrhage) , being accused of smoking in the loo the first time I dragged myself into the shower, and a complete failure to notice I spent all day every day in tears. No-one should have to deal with such "care" at a vulnerable time.

Yes, I'd wholeheartedly support a Mumsnet campaign on bettet postnatal care, it's a great idea. I've been shocked at some of the stories here.

Yes please, a campaign would be great!

After my first child the postnatal ward was full so I was put in the special care bay - the midwife who admitted me said 'don't ring the buzzer if you need anything as we won't come, you'll have to come and find us' at 11pm when I've just given birth . Whenever we needed help you couldn't find anyone as they were with other patients. My son had a posterior tongue tie and couldn't latch, no one could recognise this in the hospital or once we'd left, it was only employing a private lactation consultant after 2 weeks that spotted it and got it sorted. If breastfeeding is to be encouraged there need to be lactation consultants available on the wards and postnatally on the NHS. The whole experience stopped me bonding easily and caused PND.
My seconds DS was in a different hospital, much better postnatal experience and a lactation consultant available (although only twice a week). However, there needs to be more respect by staff that new mums need to rest - I know there is a need for care around the clock but visiting hours should be adhered to and there should be an attempt to be quiet overnight!

When mum and baby are separated for a period of time would it be possible to at least have a video link up so mum could see/ hear/ talk to baby?
I was separated from my baby for 3 weeks, long story but I was kept in one hospital and she was kept in another and I think for women and babies who have to go through that kind of separation I think to be able to have a video link up would be wonderful.

Please please campaign on this. I had a planned CS (placenta previa). Was cathaterised for 24 hours so could not get out of bed. DS in normal 'tank' next to the bed. I could not reach him. I could not lift him out. I was at the end of the ward (last bay) and when he cried I rang for help but no-one came. Later told there were only 2 staff and they "had to feed triplets so couldnt help anyone else". DH was told to leave at 7pm and not allowed back in until 10am. So DS cried all night, with no one caring for him.

I was fed 1 bit of toast for breakfast and there was only a salad sandwich left on the lunch trolley by the time it got to me. I had not eaten for the previous 36 hours due to anesthetic.

Due to blood loss / low blood pressure I fainted in the shower, but was so desperate to leave I lied so they would discharge me (told DH).

I was v vulnerable - had severe Anti-natal depression and was v v high risk for pnd. This was all in my notes but still in was given such terrible care I put my physical health at risk so I could leave.

When I got home DH ensured I was well fed, and passed Ds to me every time he cried.

I wrote a letter of complaint when I was strong enough, but didn't even get an acknowledgement

A campaign would be great. But until the NHS is properly funded nothing will change. Maternity units are hopelessly under funded and under staffed. So acute areas (where higher risks exist) will always need more. There really is no money available to improve post-natal care.

Yes!

I would support this a million percent. My experience last time round left scars, physically and mentally, and I know I'm not the only one. If post-op care was as bad as post-natal, there would be a national outcry.

Yes, absolutely, please do this. I feel so strongly about improving the quality of postnatal care after my own experiences.

Things I think need to be improved and how:
-Continuity of care. This should actually be resolved by the recommendations in the recent review, but caseloading midwives who sees woman for antenatal, intra partum and post natal care is vital. Building up a good relationship will mean that women's concerns are listened to, that women will be supported, that things like PND and feeding difficulties would be identified earlier. I actually received excellent PN care from caseloading midwives AFTER I was discharged from hospital. It's the gold standard and all women should have access to it.

-Conditions on PN wards. PN wards should be 100% private rooms (PN HDU excepted). This is the direction of travel for all new hospitals, and solves the issue of partners on wards. Personally I desperately needed my partner to support me through the night and I wasn't allowed this. Cosleeping cots should be available to those who want to use them. Qualified BF support (by which I mean IBCLC) should be available for a minimum of 12 hours a day, 7 days a week, with peer supporters or well trained HCAs available at other times. Hospitals should have feeding teams well trained I tongue tie evaluation. And just better educated midwives re breastfeeding, there is so much misinformation around. Better training for doctors about breastfeeding, I'm not sure it even forms part of training at the moment.

Most of this can be solved through better staffing; especially at night. PN wards operate 24/7, and yet staffing is reduced at night. In fact women often need MORE help at night because partners are asked to leave.

A simple 'guide to the ward' laminated card at each bed would help a lot; with info such as how to access the feeding team, what uniforms everyone is wearing, how to get breakfast, what checks are usually carried out on baby.

-Better integration with community health services, especially HVs and GPs. Better, up to date information and training for HVs and GPs about post partum complications, feeding difficulties. Clear referral pathways back in to acute services where required so women and babies aren't left waiting for weeks or months (eg gynae surgical services, feeding support, mental health etc).

After dh had his gallbladder out he was painkillered up to the eyeballs and waited on hand and foot. All anyone wanted him to do was lie in his bed and recover.

After I'd had an emergency c-section complicated with an infection I had to beg for paracetamol (same hospital). There was no breakfast as I couldn't walk to the breakfast room. No support in helping me look after my baby when I could barely move. Support staff cleaned the room, brought lunch and dinner and refilled water but midwives and Drs were few and far between. It took days for my infection to be correctly diagnosed and treated. I knew I needed help but I wasn't going to get any so left as soon as I could. I was never assessed for pnd afterwards.

I'm currently pregnant now with number 2 and I'm crossing everything in hope that I have a better experience.

I feel a campaign is desperately needed and we all deserve better.

BeBesidetheSea my experiences after a c section on a PN award were very similar.

Agree with the need for more training and flexibility for mothers who are separated from their children.

My son was born at 26 weeks and was taken straight to NICU. I was initially put in a bay on a postnatal ward where I had to listen to all the other babies and sobbed all night. A wonderful hca recognised what was happening and got me a private room the next morning.

For the next 4 months I received no care at all - they provided a room. I had no postnatal care after 12 hours from a section and was expected to get myself to NICU of my own accord. Yes yes to the poster who has already said about missing meals and tablets.

YES! Thank you for taking up this campaign. I had such a traumatic time on the postnatal ward with my first DC that I hired a private midwife to sit by my bed second time round.

First time the staff were so brusque and unhelpful that I felt I was being punished in prison.