We have an incredible health system in the NHS, and are so lucky to have it. It does as much as it can do with its seriously overstretched resources – about that, there is no doubt. However, while much postnatal care in the NHS in the UK is good (according to a survey by Mumsnet about postnatal care and feedback from bodies like the Care Quality Commission, it also shows that for about one-quarter of new mums, their experiences of postnatal care are really awful – and in many of those cases, they say it contributed to a real decline in their mental health and/or physical wellbeing.
So the question is, how did we get here? And how do we get out of it for those mums who are experiencing terrible post natal care? To get to the bottom of it all, I talk to Rowan Davies, Head of Policy and Campaigns at Mumsnet:
Many mums feel their needs are not being met after they’ve had a baby – why is this happening? And in what way is this happening?
Why is it happening? There’s the ongoing problem of scarce resources. Midwives working on postnatal wards are often called to the labour ward if that is understaffed – and postnatal wards tend not to have a very high level of staffing in the first place. (Ideally they should be reaching something called the ‘BirthRatePlus’ staffing standard, but our understanding is that not many do.)
This means that midwives on postnatal wards can be too busy to give each new mother the nursing care, help with eating, help with infant feeding, emotional support and medical assessments she needs. This problem has become more acute because most women on the postnatal ward have had a section, or have had a very difficult birth, or have other health needs, or have babies who need extra care; most new mothers whose births were relatively straightforward are sent home pretty quickly and often on the same day as the birth. This is a big change from a couple of decades ago, when almost every mother stayed on the ward for a couple of nights. So the level of need among patients on the ward has increased dramatically, but staffing levels have not.
This lack of resources extends out into community care after the birth: specialist services in areas like mental health, care for birth injuries, physiotherapy and breastfeeding support can be very patchy, and GPs are no longer paid to perform six-week checks on mothers – so many don’t.
More broadly, lots of Mumsnet users and clinicians think there’s a broader social and cultural issue here: the extent to which women think that feeling miserable or experiencing pain or incontinence is just a ‘normal’ thing to happen after you’ve given birth. One clinician said to us ‘pain in labour can be normal; postnatal pain is a different thing, and should never be seen as normal’. New mothers are often so tired – and let’s face it, sometimes quite overwhelmed, especially when the notorious ‘day 3’ effect of hormonal changes kicks in – that prioritising their own recovery falls off the bottom of their to-do list. And of course it can be really difficult to approach a healthcare professional and ask for help with your mental health, or with your incontinence, or pain during sex, or perineal pain.
And overall, postnatal care has always been considered the ‘Cinderella’ of maternity services. There’s an awful lot of focus on pregnancy and maternity care; postnatal care has always been a bit of an afterthought (which is why the strapline for our campaign is ‘Aftercare, not Afterthought’).
In what way is it happening? We did a big survey of women who’d given birth in the NHS in the past three years. Among those who’d stayed on the postnatal ward:
- 62% were sometimes unable to access staff attention when they needed it
- 57% were sometimes unable to access food when they needed it
- 46% were sometimes unable to access medical attention when they needed it
- 42% were sometimes unable to access pain relief when they needed it
- 22% were sometimes unable to access water when they needed it; and
- 19% were sometimes unable to access washing facilities when they needed them.
Of those who spent time in hospital and whose babies needed special care:
- 42% were unable to access food because they were with their baby
- 47% missed ward rounds (for them) because they were with their baby
- 27% missed medication (for them) because they were with their baby
Among all the women we surveyed, over one third (36%) reported that sex post baby had become uncomfortable for them some months after the birth, and 42% say they have experienced problems with continence or their pelvic floor. Of those who reported that sex had become uncomfortable, only 4% reported that they had received ‘great’ medical care, and a further 13% said they had received ‘adequate’ care. The overwhelming majority – 75% – had not asked for or received medical help. The figures were similar for those experiencing continence or pelvic floor problems, with 18% receiving ‘adequate’ or ‘great’ medical care, but 70% not seeking medical care.
More than one-third (34%) of women who tore during birth or had a caesarian said they did not have adequate care for the surgical wound or injury in the weeks following birth.
What is the real impact of of a woman’s postnatal care experience?
In our survey, 19% of those who stayed on postnatal ward say the stay on the PN ward affected their mental health for the worse; and 5% say they developed PND and that the PN ward contributed to it. 20% were frightened for their own or their baby’s wellbeing .We’ve seen some really harrowing accounts of women being in a lot of pain on postnatal wards – we should stress that this isn’t the norm, but for those women who are affected it can have a really serious impact, especially given that they’re likely to already be exhausted and some will have had difficult births. Some women say that the combined experience of a difficult birth and a lack of care on the postnatal ward contributed to postnatal depression or PTSD. Those less seriously affected will still sometimes say that it meant it took them longer to recover fully from the birth and to adapt to all the many demands of having a newborn baby.
And of course, as discussed above, mental health care for these women isn’t always as good as it should be, which can make it difficult for them to get the help they need. Midwives are primed to look out for developing postnatal depression in very new mothers, but that’s one of many tasks they’re asked to perform. NHS England is currently making some announcements about mental healthcare for perinatal women – we hope this will help to make sure that more new mothers get the care they deserve.
What can we do to encourage new mums to seek out better postnatal care?
In terms of postnatal wards, although it can feel like the last thing you want to do once you get back home, it’s really important to feed back to the hospital on any aspect of your care that concerns you. In our survey, 88% of those who found their overall experience on the ward ‘inadequate’ or ‘terrible’ did NOT complain. It’s understandable – we all see how hard NHS staff work, and most of us are reluctant to criticise, especially if some of your care was brilliant while other bits weren’t so great. But don’t think of it as complaining: think of it as feedback. The best way for hospital managers to become aware of problems is for patients to let them know something has gone wrong – otherwise, human nature and NHS resources being what they are, they tend to assume everyone’s content!
And in terms of long-term recovery from difficult births, birth injuries, things like incontinence and painful sex: there’s no way around it – women need to go to their GPs, be as specific as possible about the symptoms they’re experiencing and how severe they are (don’t underplay it!), and be prepared to ask for a referral to a specialist – don’t be fobbed off. A lot of woman are understandably very embarrassed to do this – 75% of those affected, in our survey, said they hadn’t sought healthcare. Maybe take a friend along for moral support, or make a pact with a friend (online or in ‘real life’) that you’ll both seek help together and support each other through the process. If you’re the kind who likes to do her own research first, have a search online for specialist services in physiotherapy for incontinence, colorectal specialists or gynaecologists specialising in these areas; decide what outcome you want from the GP appointment and make it as easy as possible for them to give you the referral you need. Sites like MASIC and the Bladder and Bowel Community might help, and have a look at https://www.nhs.uk/service-search to find services near you.
And what should our healthcare providers be doing to make sure that women are receiving a good level of postnatal care?
We’ve been working with NHS England on a plan to make things better and we’re looking forward to their report, which should be coming out soon. But on our wishlist, there are a few things. First off, most people would like more resources for the NHS and (in the context of this campaign) for postnatal and maternity services in particular. That aside: different arms of the health service need to communicate a bit better: hospitals, midwives and GP services need to really ensure that information about a woman is passed over so that each professional seeing her knows what she’s been through and what complications she’s experienced or what difficulties she might have had. We’d also like there to be many more ‘touch points’ at which NHS professionals proactively ask postnatal women how they’re doing – not just a couple of days after the birth, but six weeks later, six months later, a year later. For starters it would be great to start paying GPs again to perform the six-week check on the mother. And we think there’s something really important about the NHS deciding to collect much more data about birth and postnatal care. When you dig down into it, there’s a scandalous lack of good-quality data looking at women’s long-term health after birth, and this needs to change.
Are there any countries who offer an excellent level of postnatal care that you look to as the holy grail of postnatal care?
Mumsnet users (and NHS clinicians) talk longingly about the health service in France, where every single new mother gets postnatal physio as standard. And lots of hospitals in other countries throughout the EU and North America have postnatal ‘hotels’, where women are fed and looked after in their own room that’s big enough to accommodate a partner (and visitors) and has en suite washing facilities. On other possible improvements, there are mixed feelings: some Mumsnet users would love to have longer hospital stays, others can’t wait to go home. Some would love postnatal wards to have nurseries where newborns could be taken for a few hours so that their mums can get some rest; others are worried about the impact on breastfeeding, skin-to-skin and mother/baby bonding. One thing we can probably all agree on is that offering women a bit more choice about how they’d like to be cared for would be great – the early days with a newborn are so important, and it’s crucial that new mothers start off life with a new baby as happy and healthy as they can possibly be.
What can my readers do to help support this campaign, how can we get behind it to ensure the campaign objectives are achieved?
We’d love it if you could take a look at our page about the campaign and sign up to Mumsnet to talk to our users about the issues. If you want to be added to our special mailing list of Campaign Champions, please email us on firstname.lastname@example.org with ‘Campaign Champions’ in the subject line (we email about three or four times a year, and only ever about the campaign – this is a no-spam guarantee!).
If there’s only one thing you could say about postnatal care in the UK it would be…
Postnatal care can affect the rest of your life – so let’s get it right first time.
So the question now is – how can you help all mothers and babies get great postnatal care?
If you have 30 seconds…
Please share this on social media using the social media buttons on the sidebar or below.
If you have two minutes…
Please ask your friends on Facebook, Twitter, Instagram, via email (or any other place) what they think can be done to make Wards Fit for Purpose. Feel free to use the suggested copy below:
“Tell Mumsnet how all postnatal wards could be made fit for purpose: add your ideas here #BetterPostnatalCare”
If you have five minutes…
Let Mumsnet know what you think can be done to make postnatal wards in hospitals better for all women. Fridges with sandwiches, fruit and water? Turning off noises on personal devices? Asking visitors to keep the noise down? Maternity care workers to make sure all new mothers get something to eat and drink? You can tweet them @MumsnetTowers with the hashtag #BetterPostnatalCare, post on their Facebook page, or email them at email@example.com.
If you have ten minutes…
Talk to your local candidates about why you think it’s important that women get good postnatal care. You could email them asking them to look at Mumsnet’s campaign; you could tell them about your personal experience, especially if it’s reasonably recent, or the experience of someone you know; you could – if you’re keen – turn up at a hustings in your constituency or write a letter to your local newspaper. If you know who your current MP is, you could email them asking them to take up the cause.
If you have more time…
Would you like to become a campaign champion for our Better Postnatal Care campaign? Being a campaign champion means signing up to go the extra mile – perhaps writing to your MP, talking to your local healthcare trusts about their postnatal care (using information we will give you), making a noise about Mumsnet’s campaign on social media, or drawing other Mumsnet users’ attention to our campaign pages when you see a discussion thread that touches on the issues we’re focusing on. If you’d like to know more, email Mumsnet on firstname.lastname@example.org.
What was your experience of postnatal care? And what do you think needs to change in terms of postnatal care under the NHS? Do leave a comment and have your say.
Picture credit: Designed by Freepik