Fundamentals of Midwifery: A Textbook for Students (76 page)

The National Service Framework for Children, Young People and Maternity Services (Depart-

ment of Health 2004) recommended all women to receive coordinated postnatal care according to relevant guidelines responsive to the physical, emotional and social needs of the mother and baby. The policy also supported longer duration of midwifery contact for women and families in the postnatal period of up to three months. Maternity Matters (Department of Health 2007) promoted a high quality, accessible maternity service proposing four national choice guaran- tees which included the choice of how and where to access postnatal care. The introduction of the routine postnatal care of women and their babies (NICE 2006) in England and Wales was developed to standardise care and improve outcomes in the postnatal period. The guideline identified the importance of healthcare professionals caring for women and their babies being able to demonstrate relevant core competences. The value of ritualistic intervention that has no proven benefit was revised and a problem-based, systematic approach with emphasis on early detection of physical and psychological health problems and timely, appropriate interven- tion has been endorsed (NICE 2013).

Further reading activity

Read the latest quality standard for postnatal care published by NICE 2013 Information for people

who use NHS postnatal care services [Available online] http://www.nice.org.uk/nicemedia/liv

e/ 14217/64473/64473.pdf

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Despite revision to the content and timing of postnatal care, government policy and national

standards to support evidence-based care, there is evidence to suggest postnatal provision remains the Cinderella of maternity services (Bick 2012). Recent surveys have demonstrated that postnatal care is an area where women still report negative experiences (Bhavnani et al. 2010; Care Quality Commission (CQC) 2013), both in the UK and internationally (Schmied et al. 2008). Consequently, there is an ever increasing demand to provide quality postnatal care. Caring for women with more complex health needs contributes to the pressures in being able to provide woman focused care in the postnatal period. Shorter stays in hospital, a move away from the ‘lying-in’ period and reduced contact with maternity services in the postnatal period has

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changed the emphasis of care. The responsibilities lie more with the mother to self-care and monitor her own recovery from birth (Walsh 2011; Wray and Bick 2012). The changes in the organisation of postnatal care in England have resulted in a gradual shift from the longevity of postnatal home visiting to the introduction of postnatal clinics and reduced number of home visits. Compared to the CQC report of 2010, more women wanted to see a midwife more often and fewer felt they saw a midwife as much as they wanted in the postnatal period (Care Quality Commission 2013).

Postnatal clinics have challenged traditional relationships between women and midwives, albeit implemented in many areas to improve choice and continuity for women and increase the daily efficiency of midwives. The findings of a study designed to illicit the views and experi- ences of women and midwives using postnatal clinics, highlighted that women felt positive about having the choice to access care in a clinic. Many of the women viewed the clinics as being more convenient and flexible; associated with positive feelings of being able to ‘

’ creating independence and motivation, easing the transition to motherhood (Lewis 2009). The community midwives viewed the clinics with optimism due to the efficiency achieved though reduced time spent travelling and parking. The availability of handwashing facilities and the privacy of the clinic environment was also favoured by the midwives (Lewis 2009). Research has indicated that women would prefer to see the midwife for a longer postnatal period (Hunter 2004; Jomeen 2010; CQC 2013). Perhaps the time saved through travelling and increasing daily efficiency of appointments will enable midwives to offer continued care beyond the existing 10–14 days. Currently the system of postnatal provision in England is based on an undefined number of home visits and postnatal contacts; NICE (2006) guidance has not specified the number of postnatal contacts to be offered to women and families.

The number of contacts from the midwife is influenced by a combination of the health pro- fessional’s clinical judgement, the women’s choice and anecdotally workload pressures encour- aging midwives to limit postnatal contact to 10–14 days. Only a quarter of midwives have said postnatal visits were determined most significantly by women’s needs. Nearly two-thirds of the sample of midwives recently surveyed said that the main reason determining the number of postnatal visits was organisational pressures (RCM 2013), implying women and babies are not at the centre of postnatal care provision. Figure 8.2 illustrates a community midwife performing a postnatal home visit.

Activity 8.2

Find out how postnatal care is organised in your area of clinical practice. Think about the different models of care provided and how effective you think they are at meeting the needs of women and families.

The transition to parenthood can have profound effects on the mother and family both physi-

cally and psychologically (Gutteridge 2010; Bastos and McCourt 2010). Providing effective post- natal care can enhance the women’s experiences and health outcomes (MacArthur et al. 2002) and is viewed by mothers as a fundamental aspect of care provision known to increase their satisfaction with childbearing (Jomeen 2010). It is important that midwives demonstrate

Community midwife visiting a woman at home in the postnatal period.

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effective communication skills by listening to women and treating families with kindness, aimed at helping them adapt to their new roles confidently. Giving consistent information that vali- dates the mother and partner’s role, providing care that is culturally sensitive, respecting indi- viduality, choice and additional needs, are also fundamental skills of the midwife. Giving positive verbal feedback to parents about infant care, involving fathers, significant others and providing opportunities for appropriate peer support can enhance maternal self-efficacy and improve the experience and transition to parenthood (Warren and McCarthy 2011). However, Jones et al. (2013) highlighted that peer support may not be of value for all women, particularly for those who feel they cannot talk openly about how they are really feeling, leading to feelings of isola- tion. The midwife can help to build a mother’s confidence in her mothering abilities, promote the development of the mother–infant relationship, parenting competence and self-efficacy (Rowe et al. 2013). However, with reduced midwifery contact in the postnatal period, perhaps there is a danger of pushing mothers too quickly into fostering their own independence rather than allowing them time for replenishing and healing following birth. Midwifery-led units can offer the ideal postnatal environment promoting calmness; a place for the mother to feel nur- tured, the opportunity to restore vitality, learn and gain confidence in her new role supported by the midwives (Smythe et al. 2013). The transfer of care from midwives and effective com- munication with the health visitor and General Practitioner (GP) is a crucial part of the ongoing continuum of postnatal care for the mother and baby.

During the provision of postnatal care, maternity care workers need to be sensitive to the fami-

lies’ needs; whilst much focus is on the woman and baby it is important to acknowledge the fathers’ needs and emotions; to include them in the care. Whilst maternity care providers may

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perceive women to have had a routine normal labour and birth, some partners may find the birth distressing and may manifest symptoms of post-traumatic stress disorder following nega- tive emotional experiences from the birth (White 2007). Partners who have witnessed a trau- matic birth may require de-briefing by maternity care providers whilst in the hospital. It is important that the discussions with the family are reflected in the woman’s maternity records so community staff can offer further support in the postnatal period.