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

Yes yes yes. Both babies I've had pretty appalling post natal care. The first time I was totally let down and it's only now I can look back and see how dreadful it was. It was only through the support of family, close friends and a chance meeting with a health visitor that it didn't turn out very differently.

This time I've had much better care but still huge problems like having to have my anti d injection outside in the middle of nowhere in gale force winds

Some care has been excellent but I really feel in most cases of bad care it's been down to huge managerial errors putting midwives and health visitors under strain.

God yes, get involved!

Bounty reps removed from wards. Frankly they should be marched off the wards and shot. Absolutely disgraceful that they have such access.
No postnatal wards (except high dependency.) ALL women should have a private room. Other European countries with publically funded health services manage this.
Better bf support.
Better staffing levels.
Proper care. That means, for example, putting the health of the mother over your desire to get the c section rates down. I've had three friends permanently damaged by being forced to have s vaginal birth when they really needed a section. If you want to reduce section rates you do it at the front end, by providing better ante natal care, NOT by 'hoping it'll be ok' at the time.

pathways.nice.org.uk/pathways/postnatal-care#content=view-info-category%3Aview-resources-menu

This is NICE's resources menu:

Under the heading, a supportive environment amongst other things it states the following.

Hospitals should ensure:
• round the clock rooming in
• privacy
• adequate rest
• ready access to food and drink.

(oooooo looky, we have a couple of things NICE say and don't match with things people have said on this thread already! )

NICE guidelines are great. They provide a cracking framework to create an argument around, and ask why the clinical guidelines are not being adhered to.

The NICE Guidelines for Postnatal care are here
www.nice.org.uk/guidance/CG37/chapter/Key-priorities-for-implementation

Also have a look at the Baseline assessment tool for NICE guideline on Postnatal care (CG37) on the page linked here
It is an excel spreadsheet. The data sheet has a list of NICE recommendations, the year of the recommendation and whether it is a key priority for implementation.

It includes things that were recommended but were not listed as priorities for implementation:

For example:
A documented, individualised postnatal care plan should be developed with the woman, ideally in the antenatal period or as soon as possible after birth. This should include:
• relevant factors from the antenatal, intrapartum and immediate postnatal period
• details of the healthcare professionals involved in her care and that of her baby, including roles and contact details
• plans for the postnatal period.
This should be reviewed at each postnatal contact.
Year of recommendation: 2006
Key priority for recommendation: Yes

Women should be offered an opportunity to talk about their birth experiences and to ask questions about the care they received during labour.
Year of recommendation: 2006
Key priority for recommendation: No

At each postnatal contact the healthcare professional should:
• ask the woman about her health and well-being and that of her baby. This should include asking women about their experience of common physical health problems. Any symptoms reported by the woman or identified through clinical observations should be assessed.
• offer consistent information and clear explanations to empower the woman to take care of her own health and that of her baby, and to recognise symptoms that may require discussion
• encourage the woman and her family to report any concerns in relation to their physical, social, mental or emotional health, discuss issues and ask questions
• document in the care plan any specific problems and follow-up.
Year of Recommendation: 2006
Key priority for recommendation: No

Amongst others... it continues in the same vein.

I would be very interested to know whether NHS Trusts are implementing all these NICE recommendations cough freedom of information requests and how far along they were with the issues that aren't regarded as priorities.

AND

Whether this matches up with the experiences of MNetters at these same Trusts.

Its probably worth focusing on one or two key issues and getting some MN volunteers to use as case studies. And then start asking some probing questions....

Given this goes back to 2006, knowing whether there are areas where no progress has been made in 10 years would be a very big stick to beat people with.

I appreciate this is BIG area and topic to cover, but it is doable if you poke the right stick in the right place.

Trusts don't like the NICE guidelines being poked. NICE have a solid reputation and role. It makes it hard to say, "well yes we are ignoring the guidelines" as NICE look at things like health and cost economics and don't recommend things that they think are too expensive.

I've now had three babies here in the US and stood by two babies delivered by good friends in the UK. The post natal care in the UK is just awful. Let's start by funding it properly.

A mother can't care for her baby or babies if she isn't well herself. Discharge after 6 hours is absolutely ludicrous. Things can go wrong but every mother should go home having had at least one night of good sleep.

Wards need to be redesigned, no more than 2 mothers per room with an ensuite bathroom that is cleaned twice a day, beds that the mother can adjust herself. I had 3 CSs and I was able to haul myself out of bed 24hrs after because of the bed.

Automatic extra day if the mother wants it if delivering 3rd or more child. Also get a nursery going so mothers can recover. When the baby cries you wheel it to the mother so she can feed. Lactation consultants need to be plentiful and visit mothers either in the hospital or at home who are struggling daily until BF is established and not painful anymore.

This takes money to do but we are a developed nation and our health should be a priority. I delivered at a not for profit hospital in the US. The food was excellent and had been a focus point for improvement 5 years ago. I had freshly prepared food that was healthy. They also had a BF menu.

At a bare minimum I would like to see every mother assessed for PND before they are discharged. I didn't know I had a problem after the birth of my first but the screening they do here resulted in me being assigned a psychologist who spoke to me about the delivery. It was a 5min conversation and helped me process everything. That 5min conversation saved everyone lots of heartache. I'm flagged for each subsequent birth and havjng my third I was flagged for a social worker to assess if I had adequate support at home as DS is autistic.

Quite frankly what my friends in the UK was horrific. Neither BF and if I hadn't been there they would have been screwed. I washed the bathrooms and handed out ice filled perinatal pads. These mothers didn't need painkillers so much as ice.

Please, please, please do this. 4 years on and I am in counselling, a lot of the things troubling me have escalated from poor post natal care. If I had been dealt with properly and sensitively I would without doubt be better than I am currently.

More staff on postnatal wards. More Private rooms. It is ridiculous to be expected to share a ward with other mums who all have screaming babies all crying at different times. I asked to go 27 hours after having a section as I was so exhausted and hadn't had a wink of sleep. I wasn't ready to go but they were more than happy to let me. One less patient to look after. No instructions on what to do with my wound care. The journey home was horrendous I was in so much pain but I just couldn't cope anymore without any sleep. In what other developed country are postnatal mums on wards?! They use the excuse that you need to be after a section so the midwives see you more but it's utter rubbish. If they had enough staff it wouldn't be a problem. I am happy to pay extra for a private room if needs be but that option isn't available.

If you do develop a campaign, please have a mechanism for feeding back positive experiences. I was lucky enough to have excellent support from my community midwife that made a big difference, and it saddens me that so many women have had such poor care at this critical time.

NICE guidelines support rooming in rather than nurseries; you can disagree if you like but I do think rooming in is best as the standard. Babies do better when they are with their mothers. Besides even if you can argue some benefit for nurseries, it's a small benefit which doesn't outweigh the cost argument. I'd rather that room go to support more private rooms or just more beds in general.

If there were more support staff then it wouldn't be any problem to take some individual babies to give mothers a rest, which I agree is absolutely an essential part of good postnatal care as an option, but again less mothers would be in need of a rest if they had the support to begin with. Likewise if private rooms were available for partners to stay the partner can take over this role. So interim facilities like this made on a case by case basis is much better than a blanket provision of a choice: nursery or rooming in because both choices are not equal.

The argument is moot anyway, I think the cost one is the biggest factor here in reality. I don't see NHS hospitals introducing nurseries any time soon.

Nobody said NICE guidelines didn't support rooming in bertie. That doesn't mean forcing postpartum women to care for their babies 24/7 with potentially no respite overnight, which is what you do when you oppose nurseries, isn't an outrage. And your comments about thinking babies do better with their mothers and both choices not being equal are more disgusting paternalism.

The cost argument is one thing, though you don't appear to have any data to support whether this would be cheaper than eg private rooms (which don't mean partners can take over the role anyway, since mother will still be in the room to be disturbed by baby, so that's a silly argument) or paying for more PND etc further down the line triggered by exhaustion. You've basically just hazarded a guess. So until and unless you prove that, the only thing to discuss is your apparent feeling that you're entitled to decide you're more capable than an individual mother about whether her baby will do better cared for by her or nursing staff while she rests. You don't seem to be getting that you don't have the right to make that call. MYOFB and stay out of the way of other people's postnatal care needs.

Cut a bit off there: and really, this distinction between more support staff to take babies and formalised nurseries won't wash. In order for all women who need it to have the option, you need room. There isn't always room on all nursing stations. If you want all women who want it to have access to this, and we've established that partner and private rooms isn't the answer even if all women had someone who could come and stay, there needs to be room for the babies. There isn't now. There wasn't in the postnatal ward I stayed. There'd need to be room. It doesn't matter whether you call this arrangement of a space where nursing staff can watch babies for any mother that requests it a nursery or something else. Also the claim that more support would mean women wouldn't be as tired is also highly speculative. Women who have just given birth are tired because they have just given birth and because they are caring for babies who wake them up a lot.

Sorry but rooming in is a WHO guideline which they have just introduced here in the US in NJ. After experiencing both before and after rooming in was encouraged I think every mother should have a nursery available to them during their stay. Checkups of the babies were done in the nursery too. Much more efficient IMO.

Oh and the WHO guidelines, which is what I think the NICE guidelines are based on, was clearly dreamt up by some childless male whose sister was one of those 'unicorn' mothers who breathed out their babies in 2 hours.

Well it took 22 hours of painful labor followed by a CS to get DD out. I was exhausted. The nursery enabled me to sleep so I could recover and properly look after my baby on my own. I also think it helped prevent PND as I didn't get so badly sleep deprived.

PLEASE overhaul BF support. For all HCPs - GPs, midwives, HVs, etc. In my experience, the advice and information is hugely inconsistent, full of myths, old wives' tales, and just nonsense. I do not know anyone who has had a full breastfeed observed by a midwife post-natally. As a BF Peer Supporter, I have had more training than a lot of HVs/midwives. Most first-time parents haven't even heard the title 'lactation consultant' yet those with the IBCLC qualification know more than all the other HCPs put together! And they can work miracles.

I have had awful experiences of BF my three sons, all of whom had posterior TTs. Post-natal depression, guilt, worry - I still worry about the eldest as he was mixed-fed the longest. I think a good post-natal programme badly needs joined-up BF support, and seriously if EVERYONE were to do that Unicef 3-day BF course, it would make a massive difference to the advice and support given. Even if a midwife only has five minutes to spend with a new mum helping her feed, you still want it to be five minutes of clear information, practical support and facts about where to go next etc, rather than ineffectually waving boobs around at a sleepy baby.

Also maybe a simple handout for each new mum by the bed, put there when beds are changed - one side about BF, and the other about safe sterilising etc for mums who bottle-feed.

After my second baby, I got told off for asking for a catheter (had spent the whole morning drinking water/ juice as felt dehydrated but had not been able to have a wee). Was told to wait until I was 'in real pain' before asking. I waited. I was in real pain. I asked again. A tutting midwife ("I'm very busy, you know") came to put in the catheter, and after a few seconds started shouting to a colleague to 'bring more sick bowls!' as there was SO MUCH WEE. I found it funny at the time. It was fairly inhumane though really...

Much-needed campaign, Mumsnet. Yes please.

I have noted at least three posts in the last month from posters commenting how a GP had advised them that, they had breastfeed long enough and should give it up now or otherwise tutting about breastfeeding.

Two of these posters had a baby under six months old.

A single comment on MN like this, I would be dismissive of. But three in such a short space of time makes me go, 'hmmm, that's odd'.

I was given leaflets about both breastfeeding and bottlefeeding before giving birth. I was so pleased about this as I found reassurance in this as I was worried about caring for my baby. In the end I breastfeed and didn't need it. I understand getting this leaflet was unusual (again I got it, as I was viewed as high risk and in need of extra support).

After giving birth, I was given no less then 7 more breastfeeding leaflets (all the same one) from various different sources. (I used to work in the print industry. I know how expensive leafleting is. There is another cost saving for you - I only needed two at the very most!). It highlighted the lack of cohesion between everyone giving me advise in a very clear way!

I have to say that I also found plastic dolls and fake boobs as breastfeeding demonstration tools are frankly insulting my intelligence and about as useful as a chocolate teapot.

red their is a GP in the practice that I use who is incredibly anti BF post about 3 months.

If you do BF she uses it as a reason to not prescribe you any thing ever if you BF after 3/4 months she makes openly snide remarks about it,ive sat there with a very sick 14 month old who wouldn't eat or drink anything (result of illness not normally) and the only thing they would do was BF she made lots of comments about it being unacceptable and she should be on solids now.

I had the confidence to say "Dr x, I am not a fool,she is on solids perfectly normal healthy food, obviously I'm here seeing you now because at the moment she is so poorly she won't eat" then do the smile and head tilt thing but I have lost count of the amount of people I know who don't and she writes in their notes they don't know how to feed their child.

She's been doing it for years.

I gave birth in 2008 and 2012 in the same huge hospital. The antenatal and delivery care was excellent both times but my postnatal neglect the first time - which I eventually managed to write to them about, and eventually a new SoM replied to say stuff was being done - meant I ended up taking up a good couple hours of extra MW time and half a dozen appts with the perinatal psych team, plus all associated admin and some extra GP appts, when it came to my second pregnancy.

Which would have cost a lot more than a couple more associate nurses or whatever the fab women who clean up beds and all are called. Thankfully my postnatal care second time was exemplary though I hear staffing shortages mean there are still some problems - turned out they had managed to fight for more permanent staff especially at night so they didn't get often-crap agency staff who were slow because they didn't know where anything was.

Would it be possible for trained volunteers to provide tea and toast and a listening ear? It would at least solve the problem of lack of food after giving birth - no toast allowed on my ward as staff had no time and visitors and patients had set alarms off too many times, so if you didn't bring your own food you could easily be admitted to the postnatal ward after 24 hours of no food and then face 10 hours before breakfast.

Yes please!

My first experience of post natal care led to a notifiable incident (is that the right term? Hospital had to change how it did things) due to a pre-existing condition causing issues, my newborn DD screamed for over 40 minutes before anyone bothered checking on me (I was unconscious).

Second experience led to me being put on a standard postnatal ward having just had premature triplets, 2 stillborn and 1 very poorly in NICU. And the evil (yes, I mean that) Bounty lady said that the 2 stillbirths didn't really count, I still had one baby to take home so why was I so upset? Hateful bitch.

Third time round, I left after 36 hours post-section and was glad to be home.

Here in the US the pantry on the ward was stocked with jello cups, Apple and orange juice plus sandwiches. The sandwiches were a selection of turkey, ham and cheese, tuna and roast beef. There were little sachets of mayo, mustard and ketchup in a drawer. If you were hungry you just helped yourself or a nurse would pick one up if you were bed bound. This meant that coming up to the ward at 2am, DH was able to get something to eat without leaving me.

It wasn't expensive either as the sandwiches were made in the hospital kitchen. There is no good reason why this couldn't be done in the UK.

Yes please do! Having had my first baby earlier this year I still can't quite believe the stark contrast between the antenatal and post natal care I received (I literally noticed the difference right from being moved from the delivery room to the post labour ward). I personally found that

1. I had an assisted delivery and the physical aspects of my injuries weren't sufficiently explained and little/poor aftercare advice was given. The lasting mental trauma of my injuries was brushed aside and, in hindsight, not treated with the empathy or prominence it deserved.

1. I struggled initially with breastfeeding and found that the 'support' given by hospital staff was actually very negative and I was made to feel like I was constantly failing.

1. The advice from midwives and health visitors has been contradictory. Very poor handover between midwives and poor communication.

1. Six week check (for me) was a waste of time and very much a tick box exercise.

Glad this is area of care is being looked into!

Rue De Wakening so sorry for your losses, that must have been awful

Skiptonlass no one deserves to be shot so don't be so ridiculous.

Please run this campaign. (I think this has been requested before?). When I had Dd1 in London 9 years ago the aftercare was dreadful. About 20 women on a ward and one night no nurse only a health care assistant. And a woman still anaesthetised after an epidural being told to feed her baby without help.one woman collapsed in a toilet and it was ages before anyone found her.

Dc2 born in Scotland was better. But still not much support for the woman who couldn't get her poor baby to feed and sleep, keeping the others on the waRd awake, although thankfully only 4 of us in a room.

Yes, I'd support this. Breastfeeding advice atrocious and resulting in my DS having to be readmitted after a few days (starving and dehydrated).

I don't think baby nurseries is something Mumsnet should campaign on. it will just look like Mumsnet is full of women who've watched "five star babies" and don't want to look after their babies, but put them out to nannies at the first opportunity.
I also think everyone having single rooms is unaffordable and impractical. Everyone in an NHS hospital would like a private room. There isn't the money. The current government would just use these sort of requests to say "women obviously don't like NHS care and really we should all have private insurance so women can have private rooms and nurseries"
I would focus on increasing staffing, ensuring postnatal wards are big enough to cope with the rise in population (many staffing and hospital size projections done 10 years ago presumed the population would continue falling and didn't factor in young migrants of child bearing age).
We need more postnatal staff, and more compassionate postnatal staff who are trained in breast feeding support. Compassion is often one of the first qualities to go when you are busy and stressed though so the "more" staff mainly midwives is essential.
I also agree with fixed times for visitors and women having protection from other people's visitors with curtains etc if need be.
Headphones should be compulsary for anyone watching TV in a hospital.
The food issue is also important. It wouldn't be difficult or expensive for the postnatal ward to be stocked with a variety of sandwiches for postnatal women for the first couple of days postnatally (which is all most women are in for anyway) to top up the hospital meals.
From my own experience I'd also like some help showering if needed. I'm normally fit and active but was really weak , tired and nauseated postnatally and showering alone when bleeding heavily just seemed like an impossible task at the time.

Breastfeeding support!

Thr support on wards was really diabolical.

The emphasis on promotion in the community (live in an nationally low BF area) rather than support has really affected my BF. My experience showed the need for more lactation consultants (we have one locally who is constantly unavailable ), better GP training (unfamiliar with NICE guidelines and pushing Formula) and quicker access to tongue tie clinic's.

As other posters have said, the desire and sometimes pressure around BF, can further drive PND and invoke feelings of guilt.