Postnatal care and attention

The excitement of the birth is done. The mother and baby snuggle close to one another, exploring one another, bonding. The baby may wish to feed or may just want to wallow in that precious first contact, that reassurance of the familiar voice and heartbeat, the gentle arms encircling him. The mother deserves peace, comfort, good food, love and security. The nascent family need time, support, reassurance, love.


Over the following days the parents can get to know their baby, supported if they wish by caring professionals as they increase their confidence. I love the concept of the babymoon where parents are cushioned from the outside world as they wallow in the first few days, doing nothing but rest, attend to their baby and themselves, surrounded by loving support.

But listening to postnatal mums I hear some very sad stories of how uncared for they felt in those precious first few hours and days. If a mum gives birth in hospital she is usually transferred to a postnatal ward and there the problems can start. Mums have told me they were left for hours in dirty bedding, having not been helped to wash after the birth on the birth unit. Some have told me how they needed help, pain killers, reassurance, regular medication.... but had to wait and wait while overworked midwives did their best to care for an unfeasible number of women, at least a quarter of whom were post surgical patients and therefore needed extra nursing care. This isn't universal -some women talk of superb care, staff with endless patience and wonderful support. But I'm sad to say that I hear more bad than good. Many women tell me how frightened and abandoned they felt, their partner sent home while they struggled to learn how to care for their new baby in an alien environment where everyone looked stressed and overworked.

Women may feel they would be better to go home, to be cared for by their families with support from community midwives. One woman I spoke to recently was discharged home one day after a cesarean section -one day after emergency major abdominal surgery. She was visited at home the following day by a rushed community midwife who promised to return on day 5. Is that adequate care? Are we doing enough for these women? This particular woman was readmitted as an emergency on day four as her scar ruptured due to infection -nobody had been checking it with her and she had no idea anything was wrong  Her baby was deeply jaundiced and in need of treatment when they arrived back in hospital -as a mixed race family they had assumed the baby was supposed to be that colour and the mum was so glad he slept all the time as she felt so ill herself. luckily all is well -but that's a near miss.

I hear that in some parts of the country women are having all their postnatal care at a walk in clinic -that home visits have stopped altogether. I am staggered to hear that daily visits up to ten days post birth have been eroded to this in less than 10 years since I became a community midwife. Who is making sure these babies and mums are really living in a safe home environment? What message is this sending to mums -that it's fine to go out on day two? What if she has no transport or support with other children -she just doesn't get seen?

I left my NHS midwifery job 18 months ago as I felt I couldn't keep up the pace and cope with the stress of the job. I took my skills in to the private sector, lost to the NHS except for occasional agency shifts. My sister midwives are doing their utmost to care for families adequately but they often don't have enough colleagues to do their job well enough. Midwives are special women -they have a calling to do right by the families they care for -they are being pushed too hard to reduce and whittle back services. I am angry that they are being put in this appalling position. I feel guilty I'm not there with them.

What can we do? We can fill the gap a little. We can care for and support new parents in our families and communities -giving them the time and space they need to adjust and shift their focus, to rest and recover, to bond.

But we should be protesting -that a vital service is being eroded so quickly without thought for the consequences. We should be standing alongside midwives and saying NO -this isn't OK. Except we can't because the midwives are not fighting this, they are not marching or shouting -because they don't, they are gagged, they fear for their livelihoods.

Answers?




 

Underestimating ourselves

My freind is pregnant and planning to give birth at one of our fab local midwife led units. She has worked and kept active throughout her pregnancy and her baby looks like he is the perfect size for her. He's already lying head down and in the "optimal position" for birth. She's made some good choices to maximise her chances of everything going well on the day -attending classes, learning some self hypnosis techniques. But she told me last week she's worried that everything has gone so well she's bound to need a caesarean or something. It's as if she's saying there is a limited amount of luck and good fortune in the world and she's had her fair share.

This doubt came after a visit to her midwife who made a comment about her stature -she is very small framed. What is going on here? Why did her midwife feel the need to share her own doubt with this woman who now has negative feelings about her beautiful body. This "what if" culture is very damaging as it makes us underestimate our capabilities.

I'm an adult and so I'm not supposed to think like a child. But we all know that children respond really well to praise and encouragemnt -I do too -sorry if that's childish. 

When I was training to be a midwife my mentor, a very expereinced midwife, told me to try to say something complementary or affirming to every woman I met. Sometimes this was a challenge but there was always something to pick out, and I could almost feel the women relaxing and allowing themselves a moment of pride. I don't think there's enough of that going on in the world.

In labour women respond so well to compliments and affirmation too. I often suggest to partners in my classes to tell their woman how beautiful she looks in birth. This is an idea from Ina May Gaskin, american midwife and author -who claims womens cervixes dilate more easily if they are complimented like this. I can believe it -I've tried it and it seems to work to me.

So if my freind is too small framed to birth her baby what will happen?. Her pelvis will open and stretch in a very impressive way. Her baby will be able to mould his head and move in that fantastic birth dance mothers and babies can do. Hopefully her midwife on the day will be wise and help her to use her body optimally, to move and stretch, and circle her hips, relax and let her hormones flow. If she really can't birth her baby with all this going on then her labour will need help and she has doctors who could help her -she will be safe and her baby will be safe. Why don't we all assume that she will be able to do it though -as woman have done for millions of years -a sucessful species hardly on the verge of extinction. 

I also hope her birth midwife will believe in her, will have time to work with her, rubbing her back if she needs it, holding her hand, surrounding her with confidence and care, protecting her from noise and bright lights and intrusion. Midwives in the NHS are amazing women themselves. They have so many responsibilities to juggle and yet many of them still manage to maintain an air of calm, concentration and devotion to the woman they are with. 

I only work for odd days in the NHS. I'm not able to cope with the demands my NHS sisters have on their time, energy and attention. I wonder if her midwife is feeling loved, supported and respected? Somehow I doubt it as I don't think a strong woman could have let a comment like that slip out. Midwives need a culture of positivity building around them so that they can be the best they can be, can enthuse and support and empower.

My freind has started saying a new mantra today. It's from Natal Hypnotherapy -she's been listening to the CDs and it jumped out at her as being particularly relevant this week. She has decided that there is a protective forcefield around her and her baby so that negative thoughts, images and stories simply bounce off, leaving her and her baby unaffected. I like her style.