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 was fortunate in that I had excellent postnatal care. However I would definitely support a campaign to promote improvements across the board as it seems I am very much in the minority!

This thread is interesting. In my experience (years and years and thousands of postnatal women) I have never met any woman who didn't want to see the Bounty rep. Many women are most put out if they go home before the rep arrives.

Also many many women want their partners to stay with them. And not one has ever complained about other women's partners staying.

Campaigning for more private rooms is pointless. There isn't money to do building work (or fix leaks in the ceiling that have been dropping for over a year).

There is No money available for more staff, breastfeeding specialists, midwives, or more postnatal visits.

While there is no money being allocated to maternity services I'm afraid nothing will change. In fact it will probably get worse. The NHS cannot cope with anything except the basics. If you want anything extra you will have to pay for it yourself.

Can you think of a reason why no women have complained about other women's partners staying other than them not minding taggie?

It's often the way the question is asked which leads to people thinking it's ok to raise an issue about things.

Like "would you like your partner to stay" compared to "would you like to sleep less than 3 ft from someone else's partner"

1) All future planning and building of maternity units to provide substantially more private rooms or all private rooms.
The argument that we can not afford it, does not stand up. Most maternity hospitals in Scotland now have this. There are several in England that also do. How come they were build and manage to function if they are unaffordable?
Not only this, but there are potentially much better clinical outcomes from this. The number of women who report being on the ward as being so bad that its affected their mental wellbeing and ability to cope with their new baby is appalling.
Sleep deprivation is a known torture technique, yet a ward with lots of newborn babies on, doesn't exactly promote the rest and sleep that women who have just been through labour need.
Sleep deprivation is also known to be a trigger for women who do have mental health issues, and can make the difference between coping and none coping.
Whilst I accept that most women do not want partners on the wards, I do think there are cases to be made for some women on health grounds to have partners overnight. This requires both the facilities to accommodate this and a method to help identify women who would benefit from this, whilst protecting them and other vulnerable patients. Can this be explored along these lines and these grounds rather than purely viewed as a luxury?
This was something I received and feel made an enormous difference to me post-natally.
In summary there needs to be a reflection in all future planning that private rooms are an essentially part of maternity care, as it is an issue of giving women proper and appropriate care that current facilities are failing to provide. To put it bluntly, current facilities are not fit for purpose.
There is also a real danger that women discharge themselves early or lie about their health in order to get out of wards earlier than they should as a result, putting their physical health at risk. (Been on a few threads on MN)

2. Linking Ante-natal and Post-natal care

Part one - Ante-natal to Post-natal.

Better identification of women who need extra support in postal natal wards BEFORE THEY EVEN GIVE BIRTH. This should be part of ante-natal care. It is related to mental health provision. Which is currently incredibly poor and does not have full UK coverage.

Given that the Maternity Review from earlier this year, said that funding for maternity was to be split into two pots - one for giving birth and one for mental health then this is very, very doable. Or should be. It is at least arguable because you now have two areas of care that are directly linked and its much easier to make the case about 'downstream costs'.

IF the issue is taken seriously and training actually done.

There is evidence that women who are identified as high risk, but are given good advice and support during pregnancy and immediately after giving birth are much less likely to develop PND. It is difficult to access these services as a) they don't exist b) they are oversubscribed where they exist c) women don't know they exist d) women don't want to access them as they are afraid of the stigma.

They need to be extended, promoted and encouraged.

Again I found my experience post-natally was good, because I was identified in this group. But how can women in areas where there is no peri-natal services at all, get identified early to help prevent problems post-natally? Post-natal care starts before you give birth.

Whilst we are at it, why are MN not members of the Maternal Mental Health Alliance??? Or is mental health only for Netmum's members? maternalmentalhealthalliance.org/

3. Linking Ante-natal and Post-natal care

Part two - Post-natal to Ante-natal.

Better identification of women who need extra support in ante natally AFTER THEY HAVE GIVEN BIRTH. This should be part of post-natal care.
At the moment there is no joined up thinking on this. The thought process is that, the process is Ante-Natal, Birth, Post-Natal. It should be Ante-Natal, Birth, Post-Natal, possibly Ante-Natal.

Women need better advice doing the post-natal period about what their birth experience means for future births.

At the moment feedback in this area is very poor. For example, women who have CS are not made properly aware about options open to them for VBAC or ELCS - even though this should be done and is part of the current NICE guidelines. At the moment its part of ante-natal care alone, but this is very unhelpful and bewildering for a lot of women who have concerns about getting pregnant again in the first place because of their experiences. Some advice during post-natal care would help signpost women and might help control anxiety in subsequent pregnancies by 'nipping it in the bud'.

The same goes for women who have had bad tears.

Many women are seeking ELCS as a result of a previous traumatic birth. While for some this is right, an earlier intervention – BEFORE THEY GET PREGNANT AGAIN – might mean a different course of treatment is viable because they are not racing against the clock in the same way. This might be a more appropriate treatment.

At the moment, there is little or no understanding that women can discuss this with a GP if they are not pregnant. Technically it is in the NICE guidance that any woman of child bearing age with mental health problems should be able to discuss pregnancy and birth with a HCP, but in practice this is not known or followed by women or HCP.

Placing it in post-natal care somehow, is very relevant and appropriate due to the prevalence of trauma and its costs economically and to women’s long term health.

4. Traumatic Births This links back to 3 really but its own point too. At the moment there is poor awareness of what a traumatic birth is. There is a lack of awareness of what is 'normal' both physically and mentally and what is a cause for concern.

It is easier to identify physically traumatic births, but not all are being properly identified. Women do not always know if something is an issue or not. And if there are far too many cases, where women are being dismissed if they do have a problem as 'normal' (Lots of threads on this – not my forte). There is clearly a problem with GPs and training here and there is clearly a lack of information for women. Why is it taking so long for some women to get access to a specialist or are forced to go private?
The high number of private cases, means the problem is hidden. There is also potential for a conflict of interest here with many private specialists also working in the NHS. It’s not necessarily in their financial interests – or the NHS’s - for the NHS to treat such cases.

There should be an investigation into just how many women are going private for reconstructive surgery or surgery relating to incontinence after childbirth.

Then there is mental trauma. There is a misguided belief that you are only traumatised if you have had a 'bad enough birth'. This is not true.

The Birth Trauma Association say:
'Birth trauma is in the eye of the beholder’
Cheryl Beck (Nursing Research January/February 2004 Vol 53, No.1)

It is clear that some women experience events during childbirth (as well as in pregnancy or immediately after birth) that would traumatise any normal person.

For other women, it is not always the sensational or dramatic events that trigger childbirth trauma but other factors such as loss of control, loss of dignity, the hostile or difficult attitudes of the people around them, feelings of not being heard or the absence of informed consent to medical procedures.

Research into the area is limited and, to date, it has largely focused on the importance of the type of delivery. It is clear however, that there are risk factors for Post Natal PTSD which include a very complicated mix of objective (e.g. the type of delivery) and subjective (e.g. feelings of loss of control) factors. They include:
•Lengthy labour or short and very painful labour
•Induction
•Poor pain relief
•Feelings of loss of control
•High levels of medical intervention
•Traumatic or emergency deliveries, e.g. emergency caesarean section
•Impersonal treatment or problems with the staff attitudes
•Not being listened to
•Lack of information or explanation
•Lack of privacy and dignity
•Fear for baby's safety
•Stillbirth
•Birth of a damaged baby (a disability resulting from birth trauma)
•Baby’s stay in SCBU/NICU
•Poor postnatal care
•Previous trauma (for example, in childhood, with a previous birth or domestic violence)

In addition, many women who do not have PTSD, suffer from some of the symptoms of PTSD after undergoing difficult birth experiences and this can cause them genuine and long-lasting distress. These women are also in need of support.

Take this. Run with it. Beat Everyone Over The Head With It!
It’s crucial. Women need to know.

I’ve already seen UntidyAn0n comment as follows:
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..

Yes it does! Absolutely it does. The Post-Natal period is the 12 months after birth so any health concern that develops as a direct result of birth in the months after is a post natal issue. Anxiety is a health issue.

5. Breastfeeding LOOSE BREAST IS BEST!!! It’s an awful slogan that beats up women struggling. Can we have more of a focus on actually being supportive rather than making judgments over method.

Women are not stupid. Breast is Best really does have certain tones about it, that suggest women are. It’s an unhelpful culture. Perhaps one that acknowledges openly its hard for some women (unlike Jamie Bloody Oliver’s comments)

Then can we talk and acknowledge there are training issues going on here, rather than blaming women as that seems to be where its being pinned at the moment. I still can not understand why out of 7 HCP who looked at DS for tongue tie, three said he did have it, four didn't. What's that about?!

I expressed for DS for 4 months as I ended up with no confidence in breastfeeding support and all the conflicting information was quite frankly detrimental to my mental health at the time. I ended up feeling I was better off without them! That’s not right.

No one knew anything about expressing either, and I got some crap advice about that too.

As an ex midwife I would support a scheme where there would be "post natal travel lodge type establishments" where people who had uncomplicated births could have a family room (loads cheaper than a bed in a hospital) for 1 - 3 nights with one midwife on site and postnatal visits by community midwives as necessary.

This would allow efficient use of community midwives' time.

The majority of a community midwife's time is spent in the car.

Partners would be able to stay because there would be no need for sharing facilities.

There would be adequate car parking and visitors could bring food etc.

That would reduce the costs to the NHS and the only people who would need a hospital bed would be those who needed actual care - post epidural or caesarian section or those with additional needs.

6. Bounty
   Still. Inappropriate. Incompatible with privacy and proper safeguarding.

7. Staffing
   My experience of post-natal care was great overall. Yet even then at times the staffing was a real issue. The midwives were all great. I was encouraged to pester them as much as possible. However I still felt bad about doing this because they were so busy. I was lucky to have DH with me, so it wasn’t much of an issue for me in the same way it could be for others. I would have struggled without him. I felt bad for asking for help I needed as they were so busy.

I also had pain relief forgotten about on two occasions. Another midwife later picked it up, and sorted it. But it shouldn’t have happened in the first place and I did suffer in silence for it.

8. Equipment Why has no on invented a crib that fits up against hospital beds so that women who have had a CS can reach their babies and don’t need the assistance of someone else to lift them and breast feed them. It would take pressure off midwives surely?

Its 2016. I fail to see how this invention couldn’t be done and wouldn’t be cost effective and beneficial to the health of mothers and babies.

Stupid, but simple.

9. Encouraging 'Complaints' - Or Rather, Changing The Culture of Silence (Rephrasing as Feedback without chasing compensation).

There is an overall culture of 'put up and shut up' with regard to poor post-natal care. Your baby is fine and healthy, you are alive, therefore everything is ok and you have nothing to complain about.

This culture amongst women themselves needs to stop. There need to a shift to getting women to speak up and recognise what is poor and unacceptable care.

This campaign is a massive part of that. We perhaps need a charter. Something like a list of things should get and what's poor care, so that women feel like they have a justifiable reason to speak up.

This is not to beat midwives with. This is to highlight the problems and to actually SUPPORT midwives to get the funding. One of the problems that popped up with Bounty was that hospitals didn’t and don’t want to do anything because no one is complaining. They are using this as a way to dismiss complaints that are made through social media because they haven’t had official ones. They deny there is really an issue.

Since there are not complaints, then its ok politically to underfund maternity. It’s a vicious cycle we have got into and we need to break it.
We need to make this a political issue. Money will come if it’s a proven vote winner. This has to start being more than the half arsed promising of the recruitment of more midwives (which has not happened).

At the moment there is a mentality that criticism, is a criticism of the profession. I think we need to get away from that and shift the focus quite deliberately to it frankly sexist and a failing of successive political agenda making. Can we get some female MPs on board? Preferably cross party. And a perhaps a few men too. Or get someone like Norman Lamb who has a special interest in mental health and a huge part of this relates to poor mental health provision. (Also see Andy Burnham who has special interest in health care though didn’t address the issue whilst in government but might be a useful tool anyway still).

10. Money. Where can we get 'extra money' from There is no extra money. We don't necessarily need it. There is plenty of badly spent money. Identify it.

Insurance - One of the biggest costs to maternity is insurance. This primarily is with birth, but does go over into post-natal care if issue are not spotted early. Its easy to argue that poor staffing is contributing directly to high premiums. Because its true. If we can find a few examples that directly highlight this, that would be particularly helpful.

Birth Trauma - Poor Post-Natal care is listed as a cause of birth trauma. Therefore there is a cost to it.

Peri-natal Health - Poor peri-natal care costs £8.1 Billion to the UK each year according to report from 2014 everyonesbusiness.org.uk/wp-content/uploads/2014/12/Embargoed-20th-Oct-Final-Economic-Report-costs-of-perinatal-mental-health-problems.pdf How the hell can we afford that and not better peri-natal care (estimated at £325million to get to basic recommended levels)???
Loads of additional resources on this one here

And if we are honest, if facilities for private rooms with NHS care were available to buy, people would. We shouldn’t have to, but if that’s the only way we can get it, perhaps it should be on the table since there are so few private maternity facilities in the UK and we don’t have the choice that is available with other health issues even with private insurance.

Indeed. There's obviously an argument about whether it should be possible, whether the NHS shouldn't just provide these things without charge because they're part of clinical care, what should happen when someone has a greater clinical need than the paying person etc, but the reality is that many women would pay for a private room and a night nursery if those were available and couldn't be guaranteed otherwise. It is a money making opportunity for someone. I'm not saying it should be, but it is.

Yes to a campaign. Agree BF support, especially for new mums or 1st time BF support. Yes also to more time needed for staff on the wards. I've just had a baby. The emergency side if post Natal care was excellent. Out with that it was a moderate shambles. I feel quite strongly that it isn't that staff don't care, but they didn't have the time or resources to give the care needed, (and frankly I didn't need much).

Now experience of Mental health care, but if general health is under resourced mental health will be

Locally the six week check is also rubbish. It us held at eight weeks with the baby check and usually the first vaccination, and is a quick "How are you? "

Sorry for multiple posts. Typing and BF. Also agree more needs to go into

Sorry for multiple posts. Typing and BF. Post Natal physio -another area of need.

I have just thought of another point - if you have a baby, go home, and in a couple of weeks your baby is admitted to hospital, you will be able to stay overnight with them and be there 24 hours a day.
If your baby is born early or ill, and goes to SCBU/NICU, you'll be discharged from hospital and not able to stay with them. I managed to hang on in postnatal and then get a rooming in bed in SCBU by the skin of my teeth. Otherwise, you can be sent home to travel for hours a day to try and see your baby (it was 45 min drive to the hospital for us, if he'd been any iller, he'd have been moved to a hospital at least 90 minutes each way).
This can't be right - if babies and children need a parent with them, surely a mother who is bleeding and recovering herself should be able to stay as well.

I would also support this and agree absolutely with Red's comments above regarding private rooms. It is the direction of travel for the NHS and not before time. I don't have any children yet although currently pg. Unfortunately these issues are not confined to post-natal wards and the lack of hygiene and privacy on communal wards are a major reason behind me insisting on ELCS rather than natural delivery. I want a date and a named consultant, not just to rock up and hope for the best.

I am pregnant and writing my birth plan (ELCS). It's incredible that - thanks to this thread - I now know that I need to ensure I request adequate pain relief well in advance and send DH out for food if I want to stay sane. That's a pretty sad indictment in the world's 5th richest country in 2016. Luckily DH is a consultant within the same Trust (or whatever they are called now) but what a sad indictment of our healthcare system to worry about who will advocate for you as a new mother before the event. Poor care has been normalised and that is pretty disgraceful.

I will also be arranging a private lactation consultant.

Yes to everything RedToothBrush has said. Well thought through, MNHQ take note please.

Taggie, some women are not even getting the basics though for which there is no excuse. Numerous posters on this thread (myself included) have not even been provided with food and drinks on post natal wards.

Yes please do it. I was stuck there for 5 days. Desperate shortage of staff no one to even hand me my baby to breastfeed when I wasn't supposed to get out of bed after caesarian. Not enough breastfeeding support then when I started bottle feeding no one told me how to sterilize safely

Please do campaign. I can't write my full story down as it makes me cry and will give me night mares tonight..

But briefly:

• post c-section, spinal not yet worn off, was told I'd need to walk to the dining room for food (hadn't eaten for 5 days as was nbm during induction because they kept saying I "might have a section" - which I did eventually.

- again due to immobility, couldn't get dd out of the crib each time she cried.. Also she cried all night, and I couldn't cope as I had had approx 1 hr sleep total for the previous 5 days.. Staff complained that dd was keeping other people awake, didn't help and got miffed every time I buzzed for help.

• complained I felt faint every time is stood up, BP was dropping, I lost 2 L blood during section, nobody bothered to check my Hb levels until I told them I was self discharging as baby was fine.. Turned out, I probably should have had a transfusion, but there was no way in hell I was staying another minute, so went home and risked iron tablets sorting things out in the next few months.
• complete lack of continuity. I was looked after by 18 different midwives during induction and post-Natal. Some continuity would have recognised I was a completely different person from the start, my mental health was deteriorating every day, and they didn't recognise that it hadn't been normal for me to cry all day and all night.

I work for a different "Cinderella service" so I'm well aware of the pressures of an understaffed, high pressure NHS environment but compassion was utterly lacking from most of the staff. And people understand that you are busy if you explain it and apologise, but I was treated like a nuisance.

The only thing good that came out of this was dd and I think my own nursing practice improved.

Breastfeeding support - I am still upset that I was discharged and turns out hadn't actually managed to feed my newborn anything much for days. Having the community breastfeeding nurse come to my house at week 4 and tell me to stop for my sanity still a very low point

Also diagnosed PND but nobody told me till two and a half years later!!!!