Postnatal care, the ‘Cinderella’ of NHS maternity services, is often undervalued and in the shadow of its bigger siblings, antenatal and intrapartum care. The women of North West London told us that their postnatal care was not always consistent, and that the messages they received were sometimes conflicting and confusing. In short, they wanted continuity and personalised care. We listened, and set about devising ways in which we could improve and transform the way local postnatal care was delivered.
The population of North West London is socially and culturally diverse, with complex needs, both physical and emotional. More than 100 languages are spoken across our boroughs, and women and families often access care across our geographical boundaries, challenging continuity of care, information and services. The confines of the NHS can make these barriers somewhat overwhelming, particularly when there are fierce competing demands and priorities. As a midwife, I have experience in providing postnatal care in a variety of settings. Embarking on a transformation project for the first time, with the chance to pursue significant changes, seemed too good an opportunity to miss.
We conducted a review of the postnatal information provided to women at each of our six maternity hospitals, which revealed huge variation in the quality, quantity and evidence-based accuracy from one provider to another. This is where our work began, to create a multidisciplinary, expert booklet that would collate the ‘need-to-know’ facts, information, guidance and links to support our women and families in one, easy to read and accessible resource. High on the agenda was improving safety, ensuring that women knew what to look out for and who to contact in the event that either their own or their baby's health began to deviate from the norm. This booklet replaces the ‘photocopies of photocopies’ from leaflets published some years ago, which lack visual appeal, factual and evidence-based accuracy. And so, the After Your Baby's Birth (North West London Collaboration of Clinical Commissioning Groups, 2018) booklet was born.
We wanted to champion collaborative and cohesive work, not only with our wider maternity team, but also with women and their families. Service users were fundamental in helping guide the content and layout of the booklet, offering support and excitement at ‘finally having everything we need to know in one place.’
With the 40-page booklet now circulating through the postnatal wards, birth centres and community hubs, the initial response from women and midwives has been hugely enthusiastic and positive. To increase accessibility, the booklet will be integrated into the North West London maternity app, due to launch in summer 2018. The booklet has been translated into the top two languages spoken in our boroughs, Arabic and Guajarati, and it is hoped that more translations will come in the near future. The booklet has also been presented to the London Maternity Strategic Clinical Leadership team, with a view of expanding it to reach women beyond North West London.
Improving postnatal care is tough, but helping women to prepare for what lies ahead and signposting them to the many supporting organisations available is undoubtedly a move in the right direction. High on both the local and national agenda is the requirement to ensure care is personalised, and despite recommendations from the National Institute for Health and Care Excellence (NICE) (2015) that ‘a documented, individualised postnatal care plan should be developed with the woman, ideally in the antenatal period or as soon as possible after birth’, many maternity services simply are not putting this valuable tool into practice.
The ‘personalised postnatal care plan’, developed by a multidisciplinary team of clinicians has been trialled by a community team from each Trust, and evaluation of the content and format is now taking place. This small booklet is designed to be completed by mother-to-be and midwife during pregnancy and after birth—preparing her for her personal journey into parenthood in a holistic and family-centred way. Carving out ever-precious midwifery time to use this tool effectively poses a challenge, but finding innovative and new ways of providing care is not impossible.
We therefore continue to grow our vision to transform postnatal care in North West London, by taking small steps and by keeping women and their newborn babies at the centre of everything we do.