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

My post natal care was all atrocious...except for the nursery assistants I think they were called. They were, invariably, lovely and gentle and sweet and helpful. I completely dissolved on one of them 4 days after my twins were born and she just took me in hand and sorted everything out - made a paediatrician come and see my baby and sort her out, showed me how to BF properly and helped me settle both babies so I could sleep. She spent about 3 hours with me but they were the only 3 hours I felt that me and my babies weren't just a massive nuisance to everyone. Ironically, she also gave me to confidence to take my own discharge in the morning!! It is nearly impossible to look after newborn twins on your own after a crash section after 2 days of induction when you can't move your legs.

Am going to go and have a good cry about it all now. And for you all, I'm really sorry that it's happened to you.

Definitely! I used MN as my main source of help postnatal, MNers were much more helpful than local services.

• After the birth, in stages, and depending on what happened. Eg first few hours, first 12 hours, 24 hours etc depending on how long you're there.

I think all women should be 'birth triaged' if that makes sense, straight after birth establish how she is physically and mentally, make sure you discuss the birth with her (again physical and mental/emotional), and revisit this before discharge as well.

• Provide solid advice or recommendations on personal care, including any injury care (don't get me started on the mess of what should have been straightforward healing post DC1).
• A starter kit should frankly be provided, eg a jug or squeezy bottle for cleaning at the toilet, maybe a sheet with info BEFORE the birth so parents can stock up, eg witch hazel, Anusol.
• Breastfeeding advice, not just positions but what to expect, eg 5 days possible delay until milk comes in (IIRC), signs of mastitis, relief options.
• Local MWs should visit on first day home, check any injuries, plus continue birth triage discussions, and should visit more regularly. There should be more visits after the 10 days you're discharged, eg a visit around 1mo, 2mo etc.
• 6 week check had absolutely nothing to do with me both times, so if it's supposed to include the mother then that should actually happen. Again a MW or similar should do it, ours was with a GP who hadn't seen me at all in pregnancy or post birth so wasn't too keen to strike up a new discussion on stitches!
• Baby clinics are not the place for new mothers to seek help, at least not in my experience.
• Needs to be clear who does what. I suspected a loose stitch and infection, I was told to talk to MW at home visit by hospital. She came, didn't want to check me, said to see MW at postnatal clinic/baby clinic 2 days later. Did that, she said 'maybe, maybe not' and to give it a week and check, and if it was still bad then the GP could prescribe! Already having spent 3 days in agony I nearly crawled straight to the GP, pain was that bad, who immediately put me on cocodamol and ABs and I spent 2 weeks in bed, followed by months of sensitivity bitter, moi?
• Sure it needs more money, it's an incomplete service at current. Just because childbirth is a natural event doesn't mean it happens risk free or without problem, but we seem to take that approach. I always say take the pregnancy/child bit out of the equation, and imagine all those symptoms or injuries happened. I do feel the support and treatment would be different, and better. But there are also birth specific issues to deal with, like the postnatal ward, which needs 24/7 support, people to help with changing, dressing and feeding babies for the first time, and I really think people need to be available to watch babies or hold/take for a stroll if appropriate to allow new mothers the chance to sleep in between feeds. Could you imagine having surgery and then being expected to get up every 2 hours or however often and barely resting?! I also think there should be a visitors area, which is comfy and accessible for new mums, instead of having visitors direct to the ward, given the patchy sleep scenario which means mums may be trying to sleep during the day and also mums and babies are being checked, tested etc.

I highly doubt all this would happen but the bare minimum would be clarity on ward visits and access (including Bounty as mentioned), and the birth triage, and support for longer and more regularly from local services.

People on post-natal wards are frequently exhausted and drugged, exactly the sort of state in which cosleeping becomes dangerous. Add onto that the fact that the single beds are relatively small and frequently women are physically unable to lift babies back into their little fishtanks and you have a recipe for tragedy. Babies have been suffocated, babies have fallen out of bed onto hard floors.

The ability to say, "I'm sorry, I am really not safe to be left alone with a baby until I've had some sleep/the drugs are out of my system" without guilt, the worry that the response will be 'well, you have to learn to cope', or being talked into trying to cope is not a luxury; it is a life saver. Whether or not you think women should be breastfeeding should not figure into the decision. It is far far better to have alive ff baby than an injured or dead one. The option of night nurseries needs to return.

This is a great idea, something which is close to my heart.

• more 'junior' support on maternity wards after having a baby. Midwives are massively overstretched and if there is a crisis they are (quite rightly) averted to that, leaving all the other new mothers with even less care. Maybe a health visitor station at hospitals? Which leads me to...
• better training for HV's. They all seem to sing from a different hymn sheet! Different advice, some have no idea what they are doing.
• not post natal care but this would help; improving antenatal NHS classes. Our was a video from the 1980's and a demo of how to change a nappy!! No mention of post natal depression, how to settle a baby, etc. They need to get realistic and focus on the important stuff.
• more training for mental health crisis teams on PND.
• The gap between a midwife coming to see you and the 6week check is huge, can this be brought forward

I'm sure there are loads more I want to include! Please do this, it worries me all the time that after care is so poor and that other women will go through what I went through.

Just saw previous post on care for the baby after giving birth which I so agree with - I had a three day labour with my first and loads of complications. Needless to say I was exhausted, I could barely even see straight. I was put on a ward that night with my baby, someone checked on me twice the whole night. Baby wouldn't settle and I had no idea what to do so I just held her and tried to feed her. I was drenched in my own blood in the bed. No one offered to take the baby so I could sleep or try and help me settle her. As a new mother I was too frightened to ask. I honestly think if I could have got some sleep that night my MH wouldn't have unravelled as fast as it did.

You may well be right juxtaposition. The effects of sleep deprivation on mental and physical health are well known. There's a reason it's such an effective and popular torture technique, and yet we inflict it on women who've just given birth and aren't well enough for discharge. Someone will be along in a minute to tell you you're a posh cow expecting the NHS to fund your nanny, though.

Beautifully written swg. You put it far better than I did.

Tongue tie specialist midwives. Trained to detect and snip tongue ties on the ward. All this buggering about I did with phone calls and "well you'll have to just bottle feed or go private".
Also painkillers. When I had gyne surgery I had very good painkillers. Told not to reach for things for a bit.
When I had a c-section I was paralysed from the waist down and told to get on with it!

Please campaign on this issue.

I know you've worked on this before, but Bounty reps still bloody there, rude and manipulative. When I said no thanks, I didn't want a pack the rep was openly aggressive, shouted at me. A few hours after birth.

Partners seems too divisive an issue for mumsnet to campaign on helpfully. Personally after a traumatic EMCS I needed my partner there - I couldn't lift the baby and was totally out of it.

Advice on feeding needs to be more constructive. I was told not to worry if my son didn't feed much (he never cried) then kept in for a week because he was losing weight. I had no clue how often to feed him.

More compassion. A woman on the ward was crying hard all night. Midwife kept saying 'what's wrong? You have to tell me what the problem is.' Anyone who's had a traumatic birth knows it's not a one sentence answer.

Private rooms on post natal wards. I know it's too late for some hospitals that have already been built, but this should be the norm as it is in most other developed countries.

Partners should NOT stay overnight on communal wards. It's not fair on the other recovering patients. If there were more private rooms, this wouldn't be a problem.

There should be 24/7 auxillaries to help with passing babies, filling up water etc. IME there were far too few staff and all were overstretched and impatient and needed elsewhere. It's not fair on the midwives or the patients that the hospital was so short staffed.

I can see from this why some people would like the option of night nurseries - but for me, the idea of being separated from my new baby, having someone else cuddle and feed it, is horrendous. (And I have had three v different births, none especially straightforward, one particularly long and exhausting with an eventual forceps delivery, so am not talking from a perspective of someone who had the lovely four- hour lavender-scented water-birth...)

If nurseries becomes an option, they need to remain just that - an option. I would never push BF onto anyone but there are issues to be considered if baby's first feeds are formula feeds and the mother wants eventually to breastfeed. I guess a compromise would be that babies could be brought to mothers every 2-3 hours for a feed?

I would have loved the option of co-sleeping cots affixed to beds, so that sleep can be made safe, and to enable mums who have had surgery to be able to cuddle and feed their babies.

I remember being exhausted after a three day labour and desperately wanting to sleep when I arrived on the recovery ward but a well-meaning midwife insisted on "orienting me to the ward" as soon as I got there.

This basically involved her reeling off a list of all the things that were "not allowed" (keeping your curtains closed, charging your phone etc) but very little in the way of useful information. I was exhausted, heavily medicated and completely shell shocked. I was in no position to take in and retain information let alone think to ask questions such as "where are the toilets?" or "where do I get food?"

The whole exercise was utterly pointless, it would have been much more sensible to hand me a laminated card or leaflet with all the information on so that I could look at it once I was feeling slightly less dazed and then refer back to it if I'd forgotten anything. Instead, I had a succession of midwives and HCA's bark "that will have been covered in your orientation!" at me every time I asked them anything as though I was a lazy teenager who hadn't bothered to study for a test, resulting in me then being too frightened to ask them for anything for the rest of my stay.

And it's ok that you wouldn't want to be separated macaroon, you shouldn't be forced. That is your feeling and it is valid in relation to your own care. As you say, nurseries need to be an option. If you're not interested, fine, but it's not ok that others who would want/need a nursery are denied one.

In terms of the cosleeper cots, I recognise that other women would find them easier so would be supportive of that, but I must say they wouldn't have helped me at all after my EMCS. We had a cosleeper cot at home and I simply couldn't lift even from that. Took about ten days before that was possible. So I think it's truer to say that they'd help some mums who've had surgery.

I've always thought that mothers who have school aged children would be the perfect people to have help new mothers with getting to grips with the basics. It was an assistant in her 50's with 5 kids who helped me when the baby had nipple confusion and she refused to Bf. She knew more about BF than any of the nurses and doctors.

RedToothBrush the co-sleeper cribs are in a Dutch hospital - story here: www.goodhousekeeping.com/life/parenting/news/a36148/new-maternity-bed-with-bassinets/

Would have been a godsend after my section. I desperately wanted baby close to me but was too zonked on drugs to co-sleep safely, and too incapacitated to reach her easily.

MNHQ - someone said it upthread, but please can there be a way to feed back positive experiences and places where the care is excellent? I had brilliant postnatal support and it is horrifying to think that so many other women have not had the same.

The other thing that I would like to see recognised is that 5-15% of women (we do not yet know the true figure) will simply not ever be able to produce enough milk to breastfeed. A much higher percentage than that will have babies who simply cannot wait until milk comes in - all the guff about them being able to cope is just not always true. So you will get some babies who lose too much of their birthweight, who have low bloodsugar or jaundice and for those babies early formula is not a bad thing.

I have two children; both of them had serious jaundice issues and the second also had low bloodsugar (which we were highrisk for because of severe gestational diabetes). Baby1 ended up back and forth from SBCU where they gave him formula and expressed milk because every time his bilirubin levels stopped being so insanely high and got sent back to the ward I would be encouraged to EBF a baby that was increasingly unhappy about going hungry when he knew they were options. We stayed in 8 days, I ended up perilously close to PND and a few weeks later my repeated attempts to cut out the formula had him being monitored for low weight. I felt like a horrible mother, started feeding him expressed milk so I could see him eating it and never went back.

Baby2 I was far more confident. This time I picked up the signs of jaundice before the midwives - and I'm still pissed off at the woman who refused to help me wake a baby who was under orders from SBCU to feed every 3 hours because of low bloodsugar, so the poor little devil slept 5 hours after which yep, jaundice totally obvious. We'd decided prebirth this time that we'd rather have mixed feeding than a hungry baby, so started it straight away. The difference in pressure with that decision made has been immense and hey presto, at 3 and a half months we're mostly breastfeeding with maybe 100ml formula a day.

All happy, except for one thing. I no longer trust that anyone following the breastfeeding agenda wants what is best for my baby. Having had people basically encourage me to starve Baby1 I am far less inclined to trust HVs who tell me Baby2 is doing fine. He's naturally a small baby and my friends and family get asked a lot if he is growing, right? He looks bigger? Because the HV said so, but HVs lie.

Put the individual mother and baby first, not your wish to improve stats for breastfeeding or whatever. The only stats you should be looking to improve is "percentage of healthy babies" because otherwise you will improve numbers at significant cost for some babies. And the thing is, once a mother realises you've done that, the trust is lost and you will not get it back - and three months down the line, or next baby, when they really should be talking to someone about something that is important they're going to hesitate, and that hesistation could cost you heavily.

In terms of the cosleeper cots, I recognise that other women would find them easier so would be supportive of that, but I must say they wouldn't have helped me at all after my EMCS. We had a cosleeper cot at home and I simply couldn't lift even from that. Took about ten days before that was possible. So I think it's truer to say that they'd help some mums who've had surgery.

I would have liked to have been able to touch DS. I couldn't even do that when he was in his crib. Never mind pick him up.

Fizzy thank you. That's useful to know to push the idea.

My care was good and I do feel seems to be the exemption to the rule. I have tried to use it as something to compare and contrast with what has gone wrong for other people and to think about how my care could have been even better. I hope that my experience can be something that was not just good for me; and whilst I was looked after for good reason due to certain additional medical concerns I think the very best thanks I can give for that, to the midwives who did that for me, is to try and make that a reality for other women.

I was exhausted after labour with DC3 and simply unsafe to hold him, but he wouldn't settle. I could feel myself falling asleep while sitting and comforting him overnight and trying to get him into the bassinet without him crying. A kind midwife took him around with her in the ward pram and i got 3/4 hours sleep - just enough so I was safer to care for him. But no way could she have done this for every woman on the ward and I've never had such support postnatally before. Nurseries to take babies for a few hours overnight are a safety issue - at home I could have sent DH/family member out with baby in a pram or got them rocking him to sleep. But in hospital it was just me with none of the support or facilities I have at home, ill, exhausted and perilously close to dropping my baby. BF guidelines that support rooming in are great, but rooming in while neglecting the mother's basic needs is simply cruel and inhumane and doesn't help anyone breastfeed.

I'm currently pregnant with DC1, and am already incredibly anxious about being on the postnatal ward.

6 of my friends have had babies at our hospital in the last 2 years- all strong, successful, confident women. They are all traumatised to some extent by their experiences. The main issue seems to be the massive emphasis put on breastfeeding antenatally, but a total lack of support to succeed with it postnatally. Women feel that they have 'failed' their babies when really the system sets them up to fail. Our hospital's literature assures me that I will see a breastfeeding consultant and will be shown how to bathe my baby- none of my friends received any such support.

I resent that a Bounty rep will have access to me and my baby when my Mum can only visit during a 2-hour window.

I intend to discharge myself at the earliest possible opportunity.

to all those who have suffered.

Yes to campaign. First step could be a survey to work out the percentages that felt that they had terrible/poor/adequate/good/superlative post-natal care? It's been a long while since I have been on a post-natal ward, but I can still remember the good, the bad and the ugly bits of being there.

MNHQ I'm so, so glad that his is on your radar.

Do you need this to be a focus of a campaign? Yes. Without a doubt. Please - this is desperately needed.

Antenatal care was pretty good. Fairly joined up etc, everything ran as it "should" - by NHS standards, rather than how it "should" in a patient's eyes.

But postnatal was a different ball game.

DH was allowed to stay which was a godsend. Drugs weren't dispensed on time and I had periods of being in agony. DH was able to "chase" these up. Ds was also really unwell and ended up in SCBU - I needed him there. He needed to be there. It would have been utterly distressing for him to be turfed out.

Bounty wasn't too much of a problem - we just said no thanks and she went away. Although I don't agree with it at all, and she did imply that it was the only way to claim child benefit, it was manageable. It would be so much better for new mum's not to have to deal with it though.

Breastfeeding support was adequate - but not enough staff to really be of any great benefit. I didn't get the hang of it until I saw my community MW on day 4 and she just helped me to do it instantly.

Staff shortages on the ward were dreadful. 1 MW and 1 HCA for an entire ward on a day shift was not adequate.

Postnatal community was not joined up at all. We missed 2 appointments simply because we weren't told about them. Appointments are precious, and for them to be wasted because of rooky errors is unforgivable.

The worst part was inconsistencies in advice. MWs told us not to use barrier cream, not to bath Ds for a month, never to use bottles - I've forgotten most of the rest of it, but the advice was beyond shit. Everyone told us something different and we didn't know what the hell to believe. 14 months in and I'm actually still quite angry about it. DH and I are fairly sensible, I'm NHS management and know how the system works - but this was bad. Bad bad bad. Which is a shame as things could be done so much better.

Yes please. All in all my experience wasn't too bad compared to some previous posters, but it's the inconsistency that has shocked me. My GP did a six week check for me and DD2, but like a previous poster had no idea about the birth, asked me if I had any tears or stitches and when I explained it had been ELCS he asked why. I said it was due to having EMCS with DD1. He just nodded and went on to contraception. That was it, check done. No questions about my scar, how I was coping mentally, etc.

Please make sure all staff are properly educated and assessed to make sure they know correct information regarding breastfeeding, with DD1 she was a few hours old (born by section) and she was crying and writhing with wind. I buzzed and a nurse came up. I asked her to pass baby to me as she seemed like she had wind. She tutted and said "breastfed babies don't get wind" and walked off. Left me feeling confused and very upset as DD was obviously not happy and I couldn't get to her at all.

Please do take this on. In my single experience, postnatal care completely ignored my very real medical needs, and from support and advice I've received on MN as well as general discussions I've read, I doubt I've been the only one.

I would like to see women who have had traumatic births and additional complications such as stroke, heart failure, eclamptic seizures etc given 1-1 or even 1-4 support to help with their babies, even if this is a more junior "extra pair of hands" type role.

I would also like clear guidance on who should and shouldn't be on the ward, particularly when the women are physically unwell and not able to 'gatekeep' or 'host/entertain' people she doesn't know well, but are keen to get a look at her baby and threaten to take it away/refuse to hand the baby over and take up the whole of visiting time etc. It would be helpful if there was someone watching the area generally so that babies can't be removed from the ward by visitors when the patient/new mum is sleeping, as I found this terrifying to wake up to. I would have liked my own parents to have priority or at least equal access to the ward as my PILs (who I'd only met a handful of times before).

I had a reasonable experience with the Bounty rep but know this isn't the case for everyone, and think having them there contributes to this image of new mum as 'fair game' for people to take advantage of - so added to substandard medical care 'because you're a mum now', intrusive visitors who you have to placate and be nice to 'because they just want a photo with the baby' and you're exposed to high pressure sales techniques when you're unable to sit or stand, trying to look after a screamy non-sleeping hungry baby, and will agree to anything to get a moment's headspace or privacy.

It would also be really helpful for women who have had a high risk or traumatic birth to be able to have follow up appointments if and when they are considering another baby. I have not been able to get a straight answer on whether or not it is advisable for me to risk another pregnancy and time is now running out. Advice has ranged from 'you will almost certainly die' to 'there is no medical evidence for 4th degree tears happening more than once to the same woman'. I was particularly annoyed when I was told that most 4th degree tears can be predicted from anatomy prior to birth, and think this should be part of pre-birth checks (I know that's not the focus of this campaign but could save a lot of time/effort/resource down the line post-natally).

Use of more empathic language is something I'd like to see as well. I would be really encouraged if the culture could be changed in this respect. Use of the dreaded 'not coping' and 'failure to thrive' could be couched in much more supportive (and less triggering) ways. Language used in the HV mental health check should be looked at as well, if you're completely blindsided about everything that's just happened to you, you are going to think your reaction is normal and it's okay to be down about it, which can stop you from accessing help to process the situation.

When issues caused by pregnancy and birth don't 'magically go away' i.e. incontinence, SPD, PND/PTSD etc it would be great to receive additional specialist help beyond the one-year limit you can receive from the NHS, and better GP education to help with these - in fact a few commenters have alluded to a whole-system approach across acute and primary care, which would be excellent.

Lost notes was a huge issue on my ward after they were handed back to ward staff (we had the women held maternal record in Scotland, not sure if this is UK-wide now, or has changed since I gave birth) and led to delayed discharge of at least 3 women, and meant that there was no record of my traumatic birth, which has made it difficult to access the ongoing help I needed and continue to need because there was no evidence of what happened, therefore it didn't happen, therefore no treatment/help could/can be provided. Better records management should be included in any campaign.

Finally, in terms of BF, there is a significant number of women who are unable to BF or have issues BFing due to under-development or non-development of breast tissue during puberty, and I don't think there is enough awareness of this, which means there is little or no support for this cohort of new mums.

Def run a campaign.
1, Get rid of bounty, women are vulnerable and need rest not harassment by them.

2, More staff, lots of women seem to want partners to help, really we need more staff. I
would not be happy with men on the ward at night. Second time mums might need partners to be looking after children at home. It would also make more sense for mums to have better care in hospital so dads can take their time off when babies come home.

3, Get the curtains open, hospitals are depressing enough without people shutting the curtains all day. My DS had jaundice he needed daylight I swapped beds when the lady left. The next occupant arrived shut the curtain then shined her light through it at night. Wonderful she got dim light her side and mine was like Blackpool lights.

4, BF support tell ladies how, and advise on 2 tops to save being completely exposed etc.

My experience wasn't as bad as others but this time I won't be hanging about and will consider signing myself out.