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

[Wo0lly]

100% support a campaign for this. Would be amazing if you could change the way things are.

I also had a horrendous experience in the post natal ward. Which I think contributed to my pnd afterwards.

Lots of errors but the main one I think was around food. I had a traumatic birth, leading to a severe injury in my hip. I had a catheter in and didn't know how to move with it. Arrived on the ward at 2pm and didn't get anything to eat until the next morning as I hadn't realised I was supposed to get up to get my own dinner. I couldn't move. If I was in any other ward my dinner would have been brought to me but after labour I was just left. It's really put me off having another baby.

As a prev poster suggested a guide to the ward would've been helpful. At least then I could have tried to drag myself for dinner!

So sad that what should be a special and happy time for women is turned into hell by the aftercare.

[Flisspaps]

Yes!

[ilovesthediff]

Yes, Bounty. I complained and had s response saying women wanted it and I was a lone voice.
Much better postnatal physio straight after, education re diastasis and pelvic floor - in physio now after my GP was awful and had to fight for a referral. Better breastfeeding support without midwives panicking.
Health visitors actually reading research and keeping training up to date.

[RedToothBrush]

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.

Oh but that's such a myth... Poor post natal care results in more expensive and unnecessary down stream costs.

[TychosNose]

I can't even talk about the first few days after ds was born it was so horrific. added to the awful post natal stay I had a 40 minute drive each way to the hospital on day 5 because the midwives don't do home visits at the weekends!
That was nearly an hour and a half of driving with heavy bleeding and incontinance with a screaming newborn vomitting in the car and me with baby blues (turned into full blown pnd from which I haven't recovered).
I have no idea what I'd have done if I'd had a cs and couldn't drive. I ended up sitting in the hospital foyer for ages after my appointment because I was too frightened to drive home.

[CutYourHairAndGetAJob]

I would absolutely support this, the postnatal care after I had dd was one of the worst experiences of my life and was the main reason I had a home birth with dc2.

The main things would be

Staffing levels
Hygiene
Private rooms if your baby is in special care
Access to food and pain relief (I ended up buying my own paracetamol...)
Breastfeeding support

[Gazelda]

I'm definitely in favour of this campaign. My ante natal care and birth were fine-ish. But I felt abandoned post nataly. I failed to get the hang of breastfeeding and slipped through the net of the health visitor team. I was invisible. This greatly contributed to my difficulties bonding and my slide into PND.

[2nds]

I posted earlier but I just want to add that when I had my csection I was so ill and I knew something was wrong. For 9 days I asked to be scanned and they kept refusing to scan me, but I was right because the docs had left a surgical swab in me which had made me extremely ill and it had went undetected for 2 weeks and 6 days in total.
So I'd suggest that each and every woman who has had a csection should be scanned at some point before leaving hospital (If possible).

[DifficultLemonDifficult]

Yes - absolutely! I'd like to see better post-natal breastfeeding support. They push the agenda but don't back it up. I had a reasonably OK birth (induction, epidural) but struggled to feed. DS became jaundiced bit NO ONE told me it was OK to give him formula and they watched me struggle to feed when I hadn't got any milk yet. Nobody (including the NCT) explained this to me! I was told - five days postpartum with first child - to get on a bus and go and find a support group. DS is five today. Still makes me feel sad.

[CMOTDibbler]

YY, a simple laminated card(s) with a guide to the ward - when you can get food (and what to do if you have a restricted diet - no one told me you had to go and tell them 4 hours before every meal), who does what, what has to happen before you go home, and so on costs absolute peanuts and would make a big difference. And having a mw who was responsible for women with babies in NICU/SCBU wouldn't be additional staffing, but would mean someone was thinking about them, and able to deliver their care.

[Flannelmcpoppety]

Yes please! I had completely terrible experiences twice on NHS post natal wards. The staff were, for the most part, rude and some were deliberately cruel. We were told not to bother them wth ringing our buzzers for pain relief. We were patronised and ignored. I hated the practice of having to leave your newborn in the nurses' office if you wanted to eat anything (having to go and bolt down horrible food in the dining room). Why don't they let you bring the babies? Or give access to sandwiches or something closer and quicker?

More and better staff training is a must.

What shocked me most was the comparison with the labour and delivery nurses and midwives who were - again, for the most part - incredible and caring. I can only think it's because the post natal staff are trained to focus on the baby, so they ignore or look down on the messy inconvenience that's the baby's mother. Can't they realise that we're a unit? And that looking after the mother better will serve the baby well?

can you tell I feel strongly about it?!

[flutterworc]

Yes! Absolutely yes! My postnatal care was mostly poor with occasional moments of good, and this is true for about 80% of my friends.

Care immediately postnatal is inadequate - insufficient staff who are overworked and often stressed to the point of being unhelpful, critical and at times borderline neglectful.

Postnatal mental health support is difficult to access and waiting times are too long, with new Mum's hitting crisis mode when it could have been avoided. GPs are not well-resourced and unable to cope with the needs of mums. Midwives and HVs appear equally overworked so there isn't enough time for them to adequately support new Mum's.

Solutions essentially boil down to staffing the NHS effectively - more, better staff who are properly treated and paid.

[Ashhead24]

Yes!

I gave birth in Plymouth, and whilst the staff on the post natal ward were fantastic, there weren't enough of them. Was ready to leave on day 3 first thing in the morning, didn't get discharged until 4pm due to lack of midwives, was walking the halls all day in tears with awful baby blues and also constipation (needs to be advice to ask for laxatives too, I hadn't considered that it would be a problem).

Private rooms and ability for partners to say would have been good, but really the basic facilities need improving, walls and floors in the showers were covered in black mould and were crumbling in places. Whole place needed overhauling.

Breastfeeding support for me was great because I was in for so long and because I asked for it, but I know a lot of girls who were out the same/next day who didn't get it and then didn't know where to turn when they had problems. Better signposting and support available in home would be great.

And the children's centres down here are absolutely fantastic, great emotional support as well as breastfeeding support, so better signposting to these would be great, information on this sort of thing needs to be given out in hospital rather than bounty packs.

[timeisnotaline]

Postnatal care needs to acknowledge that at least some mothers are patients too. I was treated like an accessory to my baby who was the patient- midwifes basically didn't believe I needed any medical assistance unless they were made to. They suggested I just take Panadol instead of the prescribed morphine etc etc

[boatrace30]

Yes please. I had a c-section and was shocked at the lack of care. No one was bothered about my wound. I had to ask for it to be checked at the six week check. The GP just wanted to talk about contraception which was the least of my worries. I was lucky that all was fine but it was luck not judgement. I have also been lucky with breastfeeding but so many friends haven't and support is sooo poor. Mad as the NHS could save so much money down the line if breastfeeding rates improved.

[boatrace30]

Also the postnatal ward was horrendous. I discharged myself after one night against advice but it saved breastfeeding for me I'm sure.

[pitterpatterrain]

Better care is needed. As many PP mentioned postnatal care for me was very poor and upsetting.

There is a huge focus (potentially due to litigation) on safe staffing levels whilst giving birth. This focus does not seem present when considering postnatal.

There seems to be limited evidence for what good quality and caring staffing looks like (level of resource) and no way of preventing postnatal staff being moved to other parts of the service as needed as a result.

Funding models seem inadequate and not reflective of changing needs, if the tariff is based on historical understaffing/underfunding then perpetuating this seems pointless. Broader cost effectiveness models are needed to think beyond just the birth intervention.

Partners seem to be used as postnatal care. It would have been a much more frightening and unsafe environment for me without my DH there.

[NeedsAsockamnesty]

I would rather swing naked from Big Ben singing ive got a lovely bunch of coconuts than ever spend time in a nhs post natal ward as a patient again.

I would do anything I could to support a campaign that did away with bounty,improved hygiene, gave patients access to food and prevented partners staying in shared spaces and did something about the inadequate staff and lack of them.

[MerilwenRose]

I completely support this idea! I was in back to back labour with DD for the better part of a week, had meconium in the waters and an emergency c section due to her heart rate dipping - and postnatal care is the part I look back on with the most horror. I remember being on that ward, bed bound, DD in the cot next to me, staff there knew I was on my own (DP needed sleep after being awake for 36 hours pretty much) and a first time mum, and not one bloody person came to check on me. I just remember wanting to pick her up, then when I finally rang the buzzer the midwife was horrid to me. As soon as I could move again I did everything myself, we struggled to establish breastfeeding and I took the formula option so I could get home. I've told DP that he is sleeping in the bloody chair next time, I will not be left alone on that ward under any circumstances!!

[PickleBot]

This is a good idea for sure. I've just read through the thread and when I has ds in 2011 I received much better care than this. BUT what I got should be a minimum. My ward was clean (although loud, hot and too bright to sleep), there was food avaliable at meal times in the dining room, but also cold from a little kitchen. The staff were kind, organised and professional. I was given the meds I needed when I needed them. They spotted me struggling with a cluster feeding baby after a 3 day labour and offered to give him couple of formula top ups so I could sleep for an hour. And when I went to the loo after being bed bound by the catheter and made a HUGE mess due to not having changed my maternity pad they came and sorted me out and made me feel like it really wasn't a problem. I'm hoping the same level of care will still be in place when I have my next in a few weeks time!
I do think more care needs to be in place for women with pnd to address the problems they are having with their babies instead of just giving them pills and expecting them to get on with it. Especially in areas of the country where people have moved away from family like where I live.

[ToadsforJustice]

I believe that post-natal wards should be like a post-surgery ward with doctors, nurses, breast feeding experts and no Bounty reps. This way, women will get the proper nursing care, drugs and support that they need and midwives can concentrate on torturing helping women during labour.

[Wilberforce2]

Yes this would be an amazing campaign!

I am done with babies now but the level of care with my last was shocking right from the birth all the way through to my diagnosis of PND and then being given Antidepressants by the gp on a repeat prescription and the HV coming once at my request, no one knew how I was coping which some weeks was not at all.

6 hours after giving birth I was taken to the ward and my dh sent home (which was fine) but my bed was broken and they said no one could fix it until maintenance came in at 8am (it was 3am when I got to the ward), so I spent 6 hours sitting upright in my bed unable to sleep and I was beyond shattered. I had excruciating after pains in my back because baby had been born back to back so I asked for some pain killers at 4am but no one came back and I ended up getting my dh to bring some in at 10am.

[UterusUterusGhali]

Marking place, sorry.

[Wilberforce2]

I forgot the "no access to food". I ate at 5pm, gave birth to my dd at 10pm and was put into a ward at 3am. The hospital ship was shut and not one person offered me a drink or anything to eat. About 5am I asked if they had a biscuit or anything at all to give me because I felt sick and I was told to wait for breakfast at 8am. Breakfast was cereal and warm milk or bread but no toaster. This all sounds petty but I was tired and hungry with no energy and a wide awake baby!!