The postnatal period is a crucial time for women as they transition to motherhood and can have a lifelong impact on both the mother and baby. High quality care and support can play a significant role during this time. However, there is some evidence to suggest that the quality of postnatal care, historically dubbed the Cinderella service, is not improving and may even be declining, not helped by staff shortages resulting in ever-stretched maternity services. Last year, NICE issued eleven quality standards based on the NICE postnatal pathway, recognising that, “a person-centred, integrated approach to providing services is fundamental to delivering high-quality care to women, babies, partners and other family members”. Nonetheless, the results of a recent Care Quality Commission survey were disappointing, finding that new mothers want “to see a midwife more often and fewer felt they saw a midwife as much as they wanted”.
In response to over-stretched and under-resourced postnatal care services, the Royal College of Midwives launched a campaign, ‘Pressure Points’. So far, two reports, focussing on the experiences of midwives, maternity support workers, student midwives and mothers, have been published as part of the campaign. The first addressed postnatal mental health and the second addressed potentially life-threatening signs in the first 24 hours, with more to follow. I personally would like to see both breastfeeding support as well as community-based care to feature in future reports.
However significant a role they play in improving postnatal care, neither NICE’s quality standards nor the RCM’s Pressure Points campaign will ultimately be the Fairy Godmother that this Cinderella service needs. The introduction of Clinical Commissioning Groups (CCG’s) has provided an opportunity for redesigned and improved postnatal care to be commissioned as part of the maternity pathway. Commissioners could play a vital role in shaping maternity services, including postnatal care, to fit local needs and to radically improve the care women receive. Last year, Oxfordshire CCG put together an innovative business case in which they proposed redesigning the maternity pathway into a ‘mother and baby programme’ to support effective parenting through a flexible approach that would allow local models of care provision as well as partnerships with community and voluntary organisations. In addition, the business case proposed outcomes-based commissioning, taking into account the opinions of women and their partners rather than simply the traditional model measuring volume of activity. Unfortunately, in this instance, these plans were met with resistance from providers. But nonetheless, it shows that CCG’s have the potential to bring about much-needed reforms.
Come on CCG’s – time to wave the magic wand and transform the Cinderella service.