By Dr Irene Gafson, Trainee Obstetrician for Telegraph UK
Having worked as a trainee obstetrician for six years, I have experienced the delivery of postnatal care across no less than seven different hospitals in London. Sadly I’ve always felt that there is so much room for improvement. I regularly hark back to a short but eye-opening stint I spent working in an Australian hospital in 2007 at the end of medical school. Why was the care so much better there? And more specifically – why was the postnatal ward full of patients who were delighted with their care and staff with a real sense of job satisfaction?
To address these differences, I have chosen to focus my attention on postnatal care where I work. Postnatal difficulties are often the most likely memories to linger and shape opinions about future pregnancies. As a woman working in this field of medicine, friends are often very enthusiastic about sharing their own personal stories with me. Many of my pals blame their ‘poor experiences’ of postnatal care on issues relating to care on the ward and feeling isolated when their partners go home. In fact, where are the partners for 12 hours of each working day on the postnatal ward?
A report jointly published in 2011 by the Royal College of Midwives, the Department of Health, the Royal College of Obstetricians and Gynaecologists and the Fatherhood Institute pointed to this. This document explored many pertinent issues related to men, how to encourage their involvement in maternity care and reduce their feelings of ‘exclusion, fear and uncertainty’. One of its top tips for involving fathers postnatally was to ensure that ‘both parents have knowledge and skills to undertake baby care activities’. It also shared an example of good practice from the Royal United Hospital in Bath that pioneered a ‘Partners Staying Overnight’ pilot. This scheme (which is now being rolled out across the country) was shown to seriously help women who give birth at night or during the early hours of the morning and would benefit from support and care from their partners. It can also have the potential to reduce the workload of the midwives as many of the things patients call a midwife for at night can easily be done by a partner.
As part of my Postnatal Quality Improvement research, I carried out a patient survey of 96 random postnatal women. The majority of these women expressed a desire for partners to be allowed to stay for longer hours. This finding allowed us to swiftly increase the visiting hours but we are still not at a point at which we can allow men to stay overnight. That is because any new policy at a hospital requires significant planning from all the professionals involved.
Clearly in an ideal state, every postnatal woman would be afforded a private room with the possibility of a comfortable place for her partner to be allowed to stay. However, it is completely unrealistic to have large scale whole building re-design across every maternity unit in the country. A more realistic approach to NHS improvement has been demonstrated by Guys and St Thomas’ hospital that launched a scheme for fathers to stay in reclining chairs.
Having dedicated a lot of my free time with the dutiful help of my colleagues to try to improve postnatal care where I work and done significant background reading, I find articles like this very unhelpful. Publishing such a series of skewed points of view without any balance only serves to scare-monger. Where are the opinions of the women who DO want their partners to stay? There were plenty of women with these views in my random survey population. Do they not deserve to be heard or is it considered a weakness to admit that a partner’s help is invaluable at a time like this? Reading this article made me very tempted to go and sit with a woman at 3 in the morning the day after giving birth when she is alone and scared and submit it as an accompanying picture!
Of course I acknowledge that there will be the occasional ‘situation’ created by the presence of a partner staying e.g. snoring or telephone conversations. Problems like this will be rare and with clear rules, it is very easy to exclude individuals who do not adhere to them. Some women may feel that their dignity is challenged by partners staying. Again, ensuring staff adhere to strict policies on maintaining a patient’s dignity through careful closure of the curtains can stop this being a problem.
I clearly understand and accept that not every woman will want their partner to stay but the option should be there. Clearly a good night sleep in bed at home in preparation for the sleepless nights ahead is advantageous but one cannot underestimate the vital role that a partner can play in the immediate postnatal period in the hospital. Many women go home within 24 hours of giving birth today. It is now becoming commonplace to opt for an enhanced recovery and discharge 24 hours even after a planned Caesarean Section. Medical evidence suggests that earlier discharge home increases patient satisfaction which is our main aim. And having a partner around to help support before the discharge home can instill confidence in making the journey home sooner.
People need to remember that unlike other fields of medicine, the workload on maternity wards is relatively consistent both day and night. Casting my mind back to working in Australia, I realise that one of the main reasons things were so different is because the partners were so much more involved. Don’t the women who deliver at night deserve the same opportunities to those who delivered during ‘visiting hours’ in the UK too? Of course they do and I’m happy to report that slowly but surely things are changing, for the better.