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

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.

Nobody said rooming in wasn't being pushed by various official bodies. I agree with the rest of your post though. 24/7 rooming in needs to be an OPTION for everyone who wants it. No more no less. It isn't acceptable to force it on women.

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.

Erm, what? I mean, by all means say you don't think this should be a priority, but that's a very bizarre justification. You do realise availability of overnight nurseries was standard in hospitals until well into the 90s? Do you think everyone thought the clinicians staffing them were nannies? And the bit about not wanting to look after their babies is pure misogyny. Like it or not, many of the women on a postnatal ward simply won't be well enough to do it themselves. This becomes particularly acute as the birthing population gets more old, heavy and ill on average, which it is. If you think the general public is so stupid they can't understand this, that's something a campaign could address.

I think this is a great idea. Postnatal care is such s mixed bag. But please don't campaign against partners in wards. I would have been lost without DH after my c sections, particularly the traumatic emcs. We all benefitted from having him there both practically and emotionally. Also, theyre his children too and that early bonding was important for all of us. I think it would be wrong to deny fathers that's early experience.

Postnatal care:

1. Please listen to women. (They wanted to watch me change a nappy to make sure I could- if they had listened to me they would have heard me explaining I had already changed him 10 times before that and I have worked with children of all ages for 16 years- half my life).

1. Sleep- don't wake me/other women up when me and baby have finally drifted off. (I had him propped up in the crook of my arm facing outwards).

1. Don't make women feel like shit for either not being able to breastfeed or not wanting to. (I managed to get the hang of it once I got home. I hated trying in hospital).

1. Don't make women feel like shit for natural bodily functions (My catherter and wee bag got disconnected and wee went all over the floor- midwife scolded me!!!!)

1. This may sound like an odd thing to say but I have found many of the non native medical staff to be much more empathic. When I had othef operations and hospital stays I had very caring Filipino staff in particular- all very good at canulars too.

1. Don't be unreasonable (When ds and I were discharged they wouldn't let us carry him out of the hospital in our arms- mine or dps. We explained we had a car seat but it wasn't the kind you could carry in. They decided a student midwife should carry 2 day old ds out in her arms!! She even walked down a flight of concrete stairs instead of using the lift! Which I would have used!)

I am with Dorothea about partner's on wards. I would desperately have loved my dp with me.

DS was taken for a feed for a couple of hours on my second night in hospital to give me a break as I was starting to struggle. In the UK in 2014.

I was supposed to sleep. It didn't really work as I was anxious about him not being there. I spent the entire time worrying about where he was and not being able to get to him. I was convinced I could tell which baby crying was him. BUT it did give me a break from trying to feed him which wasn't working and I was getting distressed about, and it helped to calm me down a bit.

As a result, I'm not totally convinced as to how much value a nursery would be to women as a whole. I guess it would be helpful to some, but actually potentially quite damaging to others. Especially if women felt pressured to use them by staff. Though I can see a genuine medical case for them at the same time.

I think my point is it comes down to how things are pushed and promoted, making the difference between it being a good thing and a bad thing and this can be a fine line. A fine line that I don't think a lot of hospitals do get right.

Conversely when they do get it right, I think its brilliant.

The advice about not using formula in hospitals with women who are attempting to breastfeed I do think is questionable for the same reason as the rooming in/nursery argument as a result.

I had been indifferent about breastfeeding before giving birth. Then the hormones kicked in, and I went a bit crazy about it, and beat myself up when it didn't seem to be working. Having a break from that self torture and having staff persuade me I was being too hard on myself was good and I don't think undermined the message.

Staff were sharp enough to realise how it was affecting me, and were at pains to stress how hard I had been trying. They then helped me again a few hours later. I think in the long run it was helpful to get a break, and not make me feel any more guilty than I already did, for doing so.

They really did get the balance right in that respect.

The trouble is, everything is so governed by protocols and procedure rather than taking the time to treat women as individuals and talking to them and working through options with them. Without that, it doesn't matter what you are talking about, it has the potential to do harm. And ultimately comes down to staffing.

Pressure by staff to use nurseries would of course be a potential problem, but as we currently have pressure (and actual forcing) by staff for very ill and incapable women to care for newborns even though they physically can't, I'm not convinced the current setup is any better. Indeed, it's dangerous in many cases. Equally, while I can see that some women would find it difficult to sleep when separated from their baby, that isn't a reason why other women should be denied that opportunity. And keeping the baby with you 24/7 is hardly guaranteed to be conducive to sleep either!

I, too, had nursing staff take my baby so I could rest after a section btw. In 2015. I don't think anyone believes it never goes on, just that it can't be guaranteed and women who ask for this assistance may be told no. That's not acceptable. Equally, since it clearly does go on, there's an argument that it would be better in a designated, specifically designed area.

I think everyone would want their own partner there, but would feel vulnerable and exposed with everyone else's partners there.

Ditto with the open visiting - lovely if your own visitors can come at times to suit you, but hell on earth trying to rest/feed with everyone else's visitors there from dawn till dusk.

That is why I really think a "step down" block near by with family rooms - all ensuite - with tea and coffee making faciities and a small fridge would be better all round.

Currently pregnant with DC1 and I hadn't realised some of the issues with postnatal care that are clearly experienced. So YES to campaigning on this issue - from my limited perspective it feels like more providing more information to pregnant mothers before birth to know what to expect in terms of postnatal care would be really useful, as well as good information available when you have had your baby. The other posters have all raised excellent points and the bounty lady should definitely do one that I think need to be highlighted.

Slightly off topic but I am now really worrying about postnatal care so I have started a thread to ask for any tips or advice on how I might prepare or what I should do to get the best experience I can - any input gratefully received!

www.mumsnet.com/Talk/postnatal_health/2648791-Now-worried-about-postnatal-care-any-tips-or-advice

I agree that family/private rooms would be the ideal but cost probably precludes that from becoming the default. That said, I wasn't remotely bothered by people's partners staying - they were no more disruptive or annoying than the other mums and babies. as I said above I think that opportunity for dads to bond and support their partners is important for everyone who wants it. This isn't a 'I want my partner but no other dads allowed' sentiment.

Average cost of an NHS bed for 24 hours is £400.

It must be possible to provide cheaper accommodation for people who don't actually need to be in a hospital bed.

These - Perspex co-sleeper cribs!

Dorothea I just think partners are a definite "no" on communal wards - there just isn't the space or the facilities and the safeguarding risk is huge.

I have shared this anecdote before but in a "normal" nightingale ward (not post natal) a junkie ripped my morphine pump out of my arm 24 hours post-surgery, buggered off with it and left me bleeding....that was in a supposedly "closed" ward after visiting hours. It has made me extremely wary of hospitals and all who sail in them, especially if there is going to be open season for the general public (which is what a partners-can-stay policy is - the HCP's don't have time to police it). There is no filter - anyone can give birth and demand their partner stay, irrespective of whether they are a rapist, child abuser, drunk or just an ill mannered prick. My DH and yours might be lovely and respectful but that is not necessarily the "norm". The UK's facilities are obviously third world enough - based on this thread - without family members kipping down on the floor or chairs. The need for partners to stay can and should be obviated by adequate staffing and that should be the goal of any MN campaign.

Also why should we accept that cost prevents private rooms? It seems to be perfectly possible in every other country with a publicly funded system. I have chosen my NHS hospital (currently 11 plus 5 weeks pg) purely on the basis that it is private rooms only. I would avoid a hospital that allowed partners to stay on a communal ward like the plague. This is the fifth richest country in the world FGS - not a field hospital in sub-Saharan Africa.

I think it's a great idea.

I would like to push for lots more detailed information about previous deliveries and post natal mother's health on the notes for subsequent pregnancies.

In my I had post delivery eclampsia both times, but it wasn't picked early on baby no. 2 as they simply didn't have anywhere in the notes about it happening the last time. Caused issues.

I simply don't understand the logic of branding new fathers 'general public'. Surely so are the mums? That's just part of being on a ward, you can't choose your roommates. When DH stayed he was in my section, slept on a chair, so took up no additional space or facilities. I needed him there to help me lift baby in and out of cot and to support me emotionally after a tough birth. If people are misbehaving on wards or making a lot of noise that needs to be addressed but a blanket ban in partners just seems a bizarre over reaction. Surely it's a time for new little families to bond and pull together?

No way would the midwives have had time to pass my dd every hour or two, help me in and out of bed, get me water, bring my meals etc even with double the actual staffing. Fathers/partners are important and have a vital role to play supporting mothers and babies.

There's not really anything you can do about the mums, though. They're the patients. They have to be there. Not being able to choose your ward mates isn't an argument for also admitting people who don't have to be in the hospital. The thing about tackling misbehaving partners sounds lovely, but in reality isn't going to work like that. We know this, because it already doesn't. Many hair raising examples have been given on these threads in the past, I recommend you search.

And of course your DH was taking up space and using facilities. Most postnatal wards already don't have a lot of room. He won't have stayed on his chair the whole time, and he'll have used toilet facilities in the hospital unless he has the bladder of a camel. He'll have made the place hotter too, because more people present in a room do that. If we are to have men in postnatal wards, which MN always comes out as opposed to, the discussion would need to acknowledge the extra space and resources they'll take up and look at ways to deal with this. Not pretend it makes no difference.

Dorothea - he wil have usd patient bathroom facilities, potentially depriving women of easy access to a loo or shower when they are bleeding. He will also have added to the general overcrowding, noise and - frankly - germs that are circulating in the room. It's also impossible to know whose dignity was compromised or how many women felt uncomfortable by the presence of men - I would not have been willing to tolerate it.

In my culture it is a tradition for women to remain at home with the baby for 30 days - the baby does not leave the home to protect it from outside bugs etc. Family may visit. These days it's viewed as slightly old fashioned, but I do see the logic. Frankly the idea of any old man/woman and their dog coughing, farting snoring and spluttering near my newborn is grim.

If HCP's had the time to be on bouncer duty for misbehaving partners then they would also have time to provide the care that, by general consensus, seems to be lacking in our ante natal wards. If your midwives didn't have time to help you do the things you needed, that is a staffing issue and improving that is a worthy focus of the campaign. Papering over the cracks by allowing something that (based on MN) a clear majority of women are NOT comfortale with is not a long-term solution.

Private rooms - no problem, as long as they are also en suite.

FizzyFeet that co-sleeper looks brilliant.

Where is the hospital in question?

It's awful for women who don't have a partner, as the default assumption would be that a partner could help them and staffing could be cut even further. But the women on their own wouldn't have this assistance. Staffing clearly needed addressing. I really think it should all be about the mother's rest, recovery and dignity as the only reason many women stay in is if they have a traumatic delivery or complications. No other patients would be sidelined like this in favour of visitors.

Needs addressing, not needed.

Exactly venus. This is an appallingly neglected area of healthcare that seems to BE neglected because it only happens to women. (If someone can point to a male patient being offered 2 paracetamol just after abdominal surgery and ordered to get out of bed, I will happily retract). Even within that frame of reference, to make it all about the "menz" and their need to bond with the newborn is just offensive. I despise the term "safe space" but if anywhere should be one it's a PN ward.

Yes, women who don't have a partner really stand to suffer from this.