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

[Snowwhiteandrosered]

Yes there should be a campaign for this. In any other ward, patients are made to rest and have their meals brought so why are postnatal women made to queue up for their food or starve and get on with things straight after major abdominal surgery? It makes me so mad that in a first world country that postnatal women in some cases are treated so imhumanely.

[ICJump]

More private rooms.
Food - after vomiting for 24hours and then giving birth to a 10 pound baby I was given a bowl of corn flakes! That's it.

Breastfeeding support - I don't mean posters or leaflers I mean real proper support, plenty of high quality info early in pregnancy -plus lots of post natal support including easy access to ibclc
Innovative care such as CenteringPregnacy (which is cheap to run)

[Moondancer146]

I completely agree that post natal care and support needs to be improved massively. I had a very traumatic labour and EMCS followed by 6 hours in surgery because I haemorrhaged.
The care both I and my DD received afterwards was terrible. I was in the delivery suite intensive care room afterwards and had a midwife supposedly assigned to stay with me all night but she left several times and my DD was left screaming for a feed with me unable to move and unable to reach my buzzer.
Because I couldn't get out of bed no one was interested in helping me breastfeed and once we finally reached the ward we were put in a private room and largely ignored.
The only thing the midwives were interested in discussing was what contraception I intended to use.
After 4 days I'd had enough of not being able to look after DD properly and told the doctors at ward rounds that I wanted to go home and they were happy with that but I then waited 13 hours for my discharge paperwork and altogether waited 86 hours before anyone bothered to do DDs baby checks.
On the other hand the surgeon and her team were fantastic, they went out of their way to check on me several times and I got an appointment with them 6 weeks later to discuss the problems I'd had and any issues it might cause with future pregnancies.

[WhoTheFuckIsSimon]

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.




The nhs is a business with seperate business units. Downstream costs will not come out the maternity budget. So the people who allocate maternity resources won't consider this.

[ToucanPlayThatGame]

Yes, something has to be done. My priorities:

1 - no partners/relatives staying overnight on communal wards. Either make more wards private rooms only, or get rid of 24 hour visiting. The midwives insisted on leaving my curtains open, and having had a section, I couldn't get up to close them. Woman opposite had her teenage son with her all night. I felt very uncomfortable and nearly jacked in breastfeeding because of this.

2 - get rid of Bounty.

3 - better understanding of the situation that multiple mums are dealing with. In the middle of the night I buzzed for help to position both babies to feed, only to be told to get the second baby out of the cot myself. How? I got no help at all with the breastfeeding that they kept banging on about how important it was. Nobody had any specific advice for feeding more than one baby. "Just swap sides when you feel empty!" Really? What will baby two eat?

4 - better follow up care, taking into account all sorts of needs. I have experience of being a mum to both a single baby and twins. After my twins were born, I got the same advice as I did for my single birth. But it's different with twins. Thankfully TAMBA went some way to solving some of my issues, but there are other situations where mums might need advice specific to their situation, and there isn't other help available.

5 - more staff on post natal wards. Nobody should be waiting several hours for pain relief.

[shrunkenhead]

Yes to a Guide to the Ward leaflet/information! I felt so helpless not knowing who was who, who to ask for help, what the protocol was for going to the toilet.....do you have to take the baby with you, or leave it in the cot? To this day I don't know and ended up wetting my bed! The hospital environment is so unfamiliar and unsettling to most of us.
A chance to talk about the birth experience afterwards to proper trained professionals esp for those who had a traumatic experience.

[Tribblewithoutacause]

Mumsnet is it worth speaking to the RCM about this? Or even birthrights?

[sepa]

Yes. I recently started a thread as I still have flashbacks from my DCs birth/aftercare.
They need to be more consistent with care. I was kicked out after 2 days following emcs but a friend (same hospital) was allowed 4 days following a natural birth. Both of us needed BF support. Only 1 of us got it!
Community midwives (not all!!) need more constant info they are giving out. 1 told us to feed DC by a certain amount and the next day another MW told us we were starving DC.

At the moment that's all I can think about but I'm sure there is more

[sepa]

Another - ban on TVs unless headphones are worn. There was a woman who had her TV on around the clock with no headphones which meant when all babies quiet you still couldn't get sleep because of the tv

[afishinthepercolator]

I think this is an excellent idea for a campaign.
There just isn't enough care, as soon as you've given birth that's it.
Everything what pp's above have said as well as postnatal mental health.
A quick are you alright at your 8 week check doesn't cut it to be honest.

[BonerSibary]

As a poster said upthread, we need the return of nurseries. It is inhumane when women who have just given birth, and are in many cases quite unwell, to be forced to take overnight care of a newborn instead of rest. Compulsory rooming in is no better than the bad old days when your baby was sent to the nursery whether you liked it or not.

I actually had a reasonable experience in postnatal during both of my births, with care from many kind midwives. Those same kind midwives took one baby overnight so I could rest and the other was in special care. This is why I look back at postnatal more positively than many other women, because I was able to get some rest. After my EMCS I should not have had to be relieved that my baby was in special care because I knew I wasn't capable of looking after them and would have to if they weren't. Yet that is how I felt.

[Terrifiedandregretful]

Yes. I found post natal care very poor, it seemed chronically understaffed and the lack of knowledge and support for breast feeding was shocking.

Left completely on my own in post natal ward with screaming baby who wouldn't latch. They wouldn't let me go home as she wasn't latching, but when I asked for help to get her to latch they didn't know what to do.

Once at home midwives didn't return my phone calls until I left one in absolute meltdown

Nobody recognised dds tongue tie

Dr didn't know that a breast fed baby under two weeks should not go 4 days without pooing as this means they are not getting enough milk

Dr didn't send off my referral letter for tongue tie op until 2 weeks after I had been to see him. When I tried to chase with reception they said 'we have a lot of patients you know'.

Midwife discharged me from post natal care with no follow up despite me spending the appt howling in the foetal position on the bed.

Breast feeding support relies too heavily on volunteers and is very inconsistent. One bf cafe was brilliant. Another I had about 10 people crowding round me calling out advice and trying to launch dd at my breast while I howled uncontrollably.

There is no way I'm ever having a dc2!

[Unicow]

We urgently need more health visitors. I was left with horrendous PND and no health visitor support. The health visitor just didn't show up. Thankfully my midwife at the docs refused to discharge me until she knew they had been and my DH had got me to the docs. It took weeks to get a health visitor and then they only came once. If it wasn't for DH and a midwife who went above and beyond I would have been totally screwed.

[WellErrr]

No more Bounty reps.

No partners overnight.

[yorkshapudding]

Like many previous posters, the care I had whilst giving birth was great but my experience of the postnatal ward was thoroughly unpleasant.

The facilities and staffing levels were very poor compared to the Labour and Delivery ward. The ward itself was dirty, cramped, way too hot and had only one toilet for all patients and their visitors to share. The food was truly disgusting, I'm not at all fussy but I couldn't eat it.

"Breastfeeding support" consisted entirely of an angry woman (who never bothered to introduce herself) turning up at sporadic intervals, roughly grabbing my breast (without asking) and shoving it into DD's mouth. No advice, no discussion, that was it.

With regards to previous posters calling for Dad's to be allowed to stay on the ward, this wouldn't be necessary if postnatal wards were fully staffed and resourced to meet the needs of new mothers and babies.

[yorkshapudding]

Also Bounty reps should be banned. They are a fucking menace.

[Shizzy]

Better perinatal mental health support. I work with a local postnatal illness charity supporting mothers with all sorts of postnatal mental health issues. The current level of understanding and education within the NHS (generally) is quite frankly appalling. If you could do anything to champion this cause, that would be amazing.

[BertieBotts]

You know, I actually felt my experience was fine but now I look back on it...

I gave birth in October 2008 where there was apparently a lot of babies being born. I was told there were no beds on the postnatal ward so because I had been booked for a home birth, I would go back into labour ward with my baby and go home the same day.

I was happy with this at the time, but looking back it was completely inappropriate. I actually ran into a pregnant friend while transferring. Was confused in my post birth state until she said she'd been having contractions and needed steroids in case her baby was born early. WTF? I had a healthy newborn and they put me on a ward with women who might have been losing their babies.

Anyway. It must have been mid morning by the time I got there, it was 6.30pm when I was discharged, but I was given no food during that time. I had some grapes from the hospital shop and that was it.

Also, I fell asleep almost immediately on getting to the ward, so did DS, I woke up early afternoon and panicked because I hadn't fed him or changed him yet and he'd been born about six hours. This was the nice bit - when I called for help a lovely midwife was very helpful in getting me started with breastfeeding and supportive of me feeding in bed.

I wasn't really able to sit up when I left hospital which strikes me as a bit strange now but I was happy at the time. I was lucky enough to see the same midwife at home post birth as I had antenatal ly. And the bf support I got at home postnatally was good.

[RedToothBrush]

The nhs is a business with seperate business units. Downstream costs will not come out the maternity budget. So the people who allocate maternity resources won't consider this.

Depends on how you make the case.

[Andbabymakesthree]

Proper breastfeeding support.

The provision here is doing birth centre up to 4 weeks post natal and they will try and help. After that it's all down to peer supporters once a week at children's Centre. The feeding clinic at birth centre has gone because despite peer supporters being available midwives were no longer resourced.

A friend who recently had a baby wishes their was somewhere she could go to be shown the things she was worried about and talk through issues. Personally not the sort of thing I'd want third time around but would be great for those who needed that support.

Postnatally many of us rush out of hospital high on adrenaline a week or so later we need the support!

[MargaretCabbage]

Haven't RTFT but I think this is a good idea. I was lucky in that my postnatal care in hospital was actually good, but I was really disappointed by the lack of breastfeeding support when I left hospital.

Two weeks in I was really struggling, and the only local help was a phone number staffed by volunteers. I needed someone to look at the latch really, but my only option would have been to walk half an hour to a children's centre in an area I didn't know a few days later. I'd had a third degree tear and that didn't feel like an option, so I switched to formula feeding in desperation. I had really wanted to breastfeed and suffered with guilt and sadness for a long time (still do a bit).

[BertieBotts]

I have to say I would not support night nurseries or partners being allowed to stay on ward accommodation (night nurseries because of cost and also because I think if it's there it interferes with BF) but in no situation should a mother be left unable to pick up and care for her baby. There needs to be support 24 hours for baby care and I think it's fine if they can take a baby or few at a time to the nurse's station if a mum really needs it.

Would support more private rooms but really it's the care which needs to improve.

[BertieBotts]

The UK has appalling BF figures especially compared to countries like the US which have poor maternity leave allowances, which you would think would affect it more - it is strange and I'm certain a large part is the state of immediate postnatal support.

[BonerSibary]

To refrain from supporting night nurseries because you think they interfere with bf is disgusting paternalism. You're saying you don't think other women should be allowed rest overnight without having to care for a newborn, in case it stops them from doing something a significant minority of them won't be doing anyway and the rest have the right to choose whether they want to prioritise. I mean seriously, how dare you? That sort of attitude is exactly what we need to eradicate in maternity care. We can't have other women making a choice I don't want them to make, so let's stop them from having a choice at all.

And the idea that babies can be left on the nurses station instead is hopeless naivety. While plenty of us had this good fortune, the reality is that it's not available to all.