Exploring the care we provide to new mothers
Additional Document Info
Women have consistently rated the care they receive following childbirth, less favourably than the care they receive during pregnancy and birth (Brown, Davey et al. 2005; Newburn and Bhavnani 2010). Midwives have also reported that although they are generally positive about the care they provide to women in hospital after childbirth , there are many barriers to care such as heavy workloads, busy environments and lack of staff (Cattrell, Lavender et al. 2005; Rayner, Forster et al. 2008). Postnatal documentation has all been reported to be problematic with significant levels of duplication and contradictory and sometimes incorrect information (Savage 2008).
In response to these issues, the Royal Women’s Hospital (the Women’s) implemented and evaluated changes to how postnatal care was provided. The changes included removal of postnatal care maps; introduction of new, streamlined postnatal documentation (e.g. redesigned maternal and infant observation and infant feeding charts); introduction of a new “guide to postnatal care” which included normal postnatal observation and documentation requirements; and the introduction of an educational tool for new mothers to ascertain women’s individual needs in the postnatal period. The overall aim of the changes was to increase women’s satisfaction with postnatal care by tailoring care to women’s individual needs and to streamline postnatal documentation.
A before-and-after design was used to evaluate the changes to postnatal care at the Women’s. Mother and Child Health (MCHR), La Trobe University, in collaboration with the Women’s undertook the evaluation which specifically aimed to explore the views, experiences and health outcomes of women who gave birth at the Women’s following the implementation of changes to postnatal care and compare these to the views, experiences and health outcomes of women who gave birth prior to the changes.
Women were sent a survey at two time points; immediately prior to the postnatal changes and to women who gave birth nine months after the changes. Surveys were sent to women when their baby was four months old.
In total, 350 women responded to survey one (prior the postnatal changes) and 352 to survey two (after the changes). Overall, following the changes, women’s ratings of hospital postnatal care improved in a range of ways. On a scale of 1-7 where ‘1’ was very poor and ‘7 ‘ was very good, 76% of women rated their postnatal care as a ‘6’ or ‘7’ following the changes, compared with 68% before the changes. Following the changes, improvements were also seen in women’s ratings of a number of specific aspects of postnatal care including: being given an active say in decisions about the care of themselves and their baby; feeling that care was provided in a competent way; and that midwives discussed their information and education needs according to their needs.
In response to a question about what women were “particularly happy with”, the most common response related to midwives attitude and behaviour such as “caring”, “helpful”, “nurturing”, “supportive”, “encouraging”, “friendly” and “approachable”. Women appreciated help with breastfeeding and care given to themselves and their baby. The physical space (such as privacy provided in single rooms) was also positively received by women.
Some aspects of care showed little or no improvement however. Only 52% of women before the changes, and 58% of women after the changes, reported that they were given the advice they needed about how to handle, settle or look after their baby. Approximately one third of women both before and after the changes would have like more advice about the baby’s health and more advice about their own health and recovery after the birth. Following the changes, 57% of women responded ‘6’ or ‘7’ on the seven point scale that midwives had spent enough time with them in hospital after the birth and 58% agreed that midwives had enough time to assist them with feeding the baby.
In response to a question about what women were “particularly unhappy with”, most pertained to waiting for assistance from midwives, lack of help generally and conflicting advice. Women also would have liked the option of having their partner stay with them overnight. Environmental issues (such as visitors and room sharing) were issues also mentioned by some women.
Women’s care at home following discharge from hospital was also explored. The majority (approximately 95%) of women received at least one visit from a midwife following discharge. Prior to the changes 20% of women having their first baby had only one visit compared with only 11% following the changes. Primiparous women were more likely to receive a third visit following the changes (21% compared 35%). Overall, women were very satisfied with care received at home with higher ratings of care following the postnatal changes (78% of women scored ‘6’ or ‘7’ before the changes compared with 84% after).
There was no change in the proportion of women giving their infants any breast milk at the time of the survey, but the rates were high in both groups; 78% had fed their infant any breast milk in the last 24 hours at time point one and 77% had done so at time point two
Conclusion and recommendations
Following the changes to postnatal care at the Women’s, improvements were seen in a number of specific aspects of postnatal care and in women’s overall ratings of postnatal care both in hospital and at home. However, some aspects of hospital postnatal care remained less than satisfying for women; specifically regarding the time midwives spent with them on the postnatal ward, and how much support midwives provided to women and their babies. The Women’s should continue with the changes implemented however further initiatives aimed at increasing the support provided to new mothers on the postnatal ward should be implemented and evaluated.