In this two-part blog, Katie Daly compares her experience of maternity care last September to another Mum, Jen*, who had her baby in March this year. In Part 1 we started with Katie’s story and in this, Part 2, we follow Jen’s story.
I spoke to Jen* whose postnatal care coincided with the COVID-19 pandemic, and our conversation showed what a different and challenging experience she had. It appears to be her postnatal care that was most affected by COVID-19.
Jen was 40 weeks pregnant when she gave birth to her first baby in March. She had planned to give birth at a midwife-led birthing centre, but due to complications, was advised to have her baby in a hospital.
The COVID-19 situation in the UK was becoming more serious at the time she went into labour, but staff she saw did not appear too worried about the situation. Jen says that if she had not experienced complications, she would have been able to have her baby at the birthing centre as planned.
Jen saw the same midwife during antenatal and postnatal care at home but had different midwives in hospital during labour. She was advised her regular midwife would come by if she was in the hospital. Unfortunately, she wasn’t around at the time.
Before and during labour in hospital, she felt safe and supported even though she was seeing new midwives and other staff. Staff introduced themselves and explained what was going on. Her husband was allowed to stay with her – she gave birth a week before the restrictions around visitors came into place.
She was left alone with her husband during non-active stages of labour, but she felt safe and able to access help if she needed. She was never left alone during active labour. She felt involved in the majority of decisions, with the exception of the decision to have an emergency caesarean. Staff checked that she knew what a caesarean was but at this point didn’t give information on the aftercare or what to expect straight after giving birth this way.
Having not planned to have a caesarean birth, she was given very little information about what to expect for recovery. During her short stay, staff often didn’t introduce themselves and were not caring towards her. She was not given the opportunity to ask many questions she had about aftercare and how she was feeling.
She was discharged 24 hours after her surgery and was told to manage the pain with paracetamol and ibuprofen. This is actually standard practise if mother and baby are doing well, though the average stay after a caesarean is three to five days. However, she felt that she was left with very little support. Jen was told her discharge was faster than expected due to a shortage of beds because other maternity services were being closed due to the pandemic.
As with all new mothers she was offered a birthing debrief, but this was delayed due to staffing issues caused by the pandemic. It’s now ten weeks since she had her baby and Jen is still waiting to hear back about this.
Jen had around four face-to-face midwife appointments between the birth and ten weeks postpartum but was expecting around eight. I lost count of how many times I had seen a midwife or health visitor in those early days, but whether at home or at the clinic, it is definitely well into double figures. She says the reduction in appointments was due to staffing issues caused by the pandemic.
While her midwives have been very supportive, the majority of her interactions with them and her GP have been via phone. She had the six-week review and many other appointments via phone where she had to report the health of her baby by answering questions on her visual appearance. As a new mother, this has caused a lot of concern that she may have missed something important. She has had to buy home scales and has weighed her baby at home. I know that for me the weighing clinics were a valuable time where you were able to ask midwives and health visitors about all those little worries you have as a mother: all the little weird things babies go through such as rashes, sleep patterns and poo (oh, the obsession new mothers have with what is a normal poo!).
Some services of additional support have been cut due to the pandemic, such as the breastfeeding clinic. Jen has paid privately to gain support from a lactation specialist, as breastfeeding has been a difficult journey for her.
All in all, myself and Jen share concerns that after the pandemic, some little nuanced parts of postnatal care will not go back to what they were before. This could be due to a greater emphasis on infection control, requiring clinicians, patients, and families alike to be extra cautious. Also, cynically, postnatal care being moved to a telephone service would save resource and money.
However, I feel there is a desperate need for Trusts to keep measuring how new mothers feel about these changes and to continue tailoring care based on the individual. There is so much talk about our birth plan during pregnancy. For myself and Jen, the birth of our babies was ultimately a time where we felt cared for, supported and grateful. But it’s hard to overstate the importance to mothers of having good experiences of maternal care.
For many mothers, postnatal care is where we need the most support. No matter what your experience is for birthing your baby, what your body goes through is brutal, scary, and weird. You need those medical professionals to tell you that it is okay and it will return to some kind of new normal afterwards. You need a friendly midwife to see your tired face, tell you how well you are doing as they change a nappy for you while you sit on your sofa in your nightie. You need someone to tell you why four days after giving birth you will cry because you don’t actually want spaghetti for dinner. You need health visitors to bring you a cup of tea as you sit in a circle and tearfully share your feeding woes.
Postnatal care is not just crucial physical checks for mother and baby; it is also vital mental health support for new families. Without postnatal visits, early signs of issues can’t be easily detected and managed. Providing mothers with home visits from healthcare professionals supports them with their own health and enables them to raise healthy, happy children. The benefits of a good start in life are a long-term investment in our future and it is vital for all concerned that Trusts take time to hear about how well they are supporting new mothers in these early days.
*Jen’s name has been changed to protect her identity.
items marked with * are required