Postnatal Care, Going, Going…

Postnatal care has long been known as the Cinderella of maternity services and now it seems to be dwindling further away. Bearing the brunt of financial cuts, postnatal visits have become less frequent and, in many areas, have moved away from the community and into hospitals and children’s centres. In some areas postnatal care is on the verge of disappearing completely.

Today we have a new norm. Many families may receive a phone call instead of a home visit, are often required to take their baby to the children’s centre for the heel prick test and other screening tests and are being discharged from maternity services by the Health Visitor. Does this represent progress? Is this disjointed service what women want or need when their lives are so busy? Or have we got it wrong and made cuts for financial and staffing reasons, leaving women and babies without care that they desperately want and need?

So, what is postnatal care? Well call me old fashioned (and I certainly am) but I like to carry out some basic observations of mothers and newborns. A physical check for baby includes top to toe observations, checking for rashes and jaundice, normal reactions, pulse and breathing rhythms, oxygen saturations, feeding patterns and noting nappies (what’s in them and how often!). For new mothers, pulse, blood pressure, temperature, checking for involution of the uterus, healing of the perineum and the nature of lochia, observing legs, feet and fingers for swelling. But, often more importantly than the physical checks, time to talk with and listen to mum, how she is coping, what does she need help with? Advice on feeding, sleeping, child development, what’s normal and what’s not, self-care and the transition to parenthood.

Maybe we’ve simply devolved these roles. Breastfeeding counsellors, children’s nurses and health care assistants are all very capable of picking up some of these tasks but what of continuity? What of knowing women so well that they feel able tell you if they have problems rather than a cursory “Hi, how are you?”, “Fine.” Perhaps we’re all so reliant on “Dr Google” that we no longer need health care professionals or have lost faith and confidence in them, but although the internet has a place it should not be used as excuse to replace the role of an experienced midwife.

Perhaps the label “The Cinderella Service” has stuck because postnatal care appears less glamorous than the work of the labour ward or antenatal clinic (although in some areas the latter has taken quite a hit too). But the truth is that families need midwives at this time just as much as in pregnancy or labour. The days with a newborn are long, sleep is short, and post-partum healing takes time. This is not a time to abandon women, it is a time to support them, to care for them and to build a strong foundation on which they might build new lives with new possibilities.

Is the NHS so short of midwives now that they are unable to provide even a basic level of service? Personally, I feel that there are so many specialists and extended roles that midwives and resources are spread too thin. However, the signs of leading causes of maternal mortality (sepsis, maternal mental health, VTE and eclampsia) are unlikely to be discovered remotely and the key to their detection both antenatally and postnatally is continuity of care by one trusted midwife.

This unfortunate situation is being addressed in small ways by independent midwives, small hospital teams and home birth groups. However, we can clearly see an example of the Inverse Care Law emerging, where the women who most need postnatal support are often receiving the least care. Allocating money and services to postnatal care will reduce illness and even death associated with the postnatal period, improve child health and breast-feeding rates and empower families as they start a new journey with their baby.

Can we sit back and watch as postnatal care disappears completely from our services, or is it time to rethink the situation and take a stand before it’s finally…

…Gone.