postnatal - maternity & midwifery forum
TRANSCRIPT
Postnatal CareProfessor Helen Cheyne
Postnatal care
➢ Postnatal care is the period of 6–8 weeks after birth, marking women's expected recovery from giving birth and the end of routine NHS maternity care (NICE, 2006).
➢Avoiding harm
➢Care that respects peoples needs and preferences
➢Supports physical & emotional transitions to parenthood
➢Establish infant feeding & care
Inverse relationship between policy & improvement effort and burden of morbidity & mortality.
➢75% of maternal deaths occur in postnatal period (Knight et al, 2018)
➢ Increase risk for women from Black & Asian ethnic backgrounds
➢1 in 5 women experience perinatal mental illness (RCOG, 2017)
➢Multiple physical health problems (Bick et al, 2020)
➢ Infant feeding problems
What do women say about postnatal care?
➢ 82% of women rated their postnatal care in hospital as good/excellent
➢ 56% experienced infant feeding difficulties
➢ 53% always received consistent advice about feeding
➢ 90% rated community based care as good/excellent
➢ 67% had enough advice & support to care for their baby
➢ Enough information about physical recovery (59%)/ emotional changes (62%)
➢ (Scottish Government 2018)
What women said …
➢‘I felt I was forgotten about. I didn't even get shown how to bathe my baby’
➢‘Only criticism is that midwives / maternity care assistants all gave contradictory advice on caring for baby’
➢‘Very good experience in the hospital. Get the help I need and staff are very kind’
➢‘the reply I got was "How do you expect to leave here when you can't even change your own baby's nappy?’ ➢ (Scottish Government, 2015)
What midwives said…
➢‘You can’t catch up with daily checks and discharge procedures’
➢‘There’s no opportunity to talk to women or even to do the postnatal check’
(PRAM)
Postnatal care in hospital
What women said ….
➢‘I was shocked at how long my physical recovery took. A bit more info, explaining that it can take a long time to physically heal, would have been good’
➢I found it very reassuring to have visits from both the midwives and health visitors after my baby was born’
➢‘Seeing different [number removed] midwives at home after giving birth meant I did not get consistent advice regarding breastfeeding.’
(Scottish Government, 2015)
What midwives said
➢‘We do a lot of, you know, reducing women’s expectations of postnatal care’
➢‘We try and offer continuity but it doesn’t always work’
(PRAM)
Community based care
What postnatal care are women getting?
0.0
0.5
1.0
1.5
2.0
2.5
3.0
band 2 band 4+ band 2 band 4+ band 2 band 4+
staf
f-h
ou
rs p
er m
oth
erassociated activities (ward)
liaison & referal
documentation
midwife procedure
infant feeding advice & assistance
assessment
parent education
administration of medicines
personal care
additional physical examination
standard physical examination
communication
admission recovery discharge
Much of a midwives time is taken up in admission/ discharge and admin
• Data from Nursing and Midwifery Workforce and Workload Planning project
• activities attributed to admission, recovery and discharge by a sample of experienced staff
Postnatal care pathway (Scottish site)
CMW visit day following D/C
Day 2 & 3 visits depended on hospital LoS
Day 5/6 visit
Extra visits at the discretion
of MW
Final visit10-13
Health visitor
Case conference as
required
Additional input in some
areas, B/F support
Additional telephone support in
some areas
Extended support
Extended support
Postnatal Care pathway (English site)
Health visitor
Day 3 /4 Clinic/CC with
CMW/MCA
Day 1 after D/C clinic visit
with CMW
Day 5. Clinic/CC appointment
with CMW/MCA
Day 10-11. D/C meeting in clinic/CC with CMW
Day 1 after D/C Phone
call by CMW
Day 1 after D/C Home
visit by CMW
Day 3,5&7 visits at home
if required
Additional visits at
discretion of CMW
Additional phone call at discretion of
CMW
Extended support
Day 7 Phone call by
CMW/MCA(checklist)
The impact of COVID-19
➢Women from Black, Asian and other ethnic minority groups, and those with pre-existing morbidity at increased risk (UKOSS, 2020)
➢Increase in anxiety & depression (Davenport et al, 2020)
➢More women experiencing domestic abuse (Women’s Aid)
➢1/5th more babies experiencing non-accidental harm & increase in unintentional harm (Ofsted)
COVID-19 & Postnatal care
➢RCM/RCOG guidance – keep mothers & babies together, support breast feeding, hygiene
➢Reduced visiting/no visiting in postnatal wards
➢Reduced face to face postnatal contacts
➢Social isolation/ loneliness
What is contemporary postnatal care.
• A service under pressure
• High volume
• Low resourced
• Low priority – focus on A/N and intrapartum care
• A missed opportunity
• At risk of further reductions
Thanks to the Hoskins family
Postnatal care: what’s needed nowBick, Duff & Shakespeare, 2019
Policy/ service
➢Leadership
➢Service level planning
➢Care pathways appropriate to acuity
➢Locations for postnatal care –must facilitate care needs and choice
➢Joined up services
Person focused care
➢The crucial first 24-48 hours post-birth
➢early baby feeding support
➢Individual postnatal discharge plan
➢Continuity of care
➢Women at increased risk
➢Don’t forget the woman
Postnatal care: what’s needed now.Bick, Duff & Shakespeare, 2019
Policy/ service
➢Leadership
➢Service level planning
➢Care pathways appropriate to acuity
➢Locations for postnatal care –must facilitate care needs and choice
➢Joined up services
Person focused care
➢The crucial first 24-48 hours post-birth
➢early baby feeding support
➢Individual postnatal discharge plan
➢Continuity of care
➢Women at increased risk
➢Don’t forget the woman
We cannot afford to ignore postnatal care.
Current provision and content of routine postnatal care does not meet maternal health needs and fails to utilise opportunities to improve maternal health.
Bick et al 2020