Investigation of postnatal experience and care in Grampian
Patients and staff who participate in PNC were surveyed by postal questionnaires and interviews to obtain a complete picture of the structures, processes and experiences which comprise it. 1249 newly delivered mothers and 648 health professional staff involved in PNC responded to the surveys (response rates 90.2% and 83.4% respectively). Maternal morbidity was reported by 85% of women in hospital, 87% at home in the first two months and 76% subsequently. Excess anxiety affected up to 27% of women, and depression occurred in around 16%. These factors influenced parental attitudes to their babies, as did aspects of babies' behaviour. 3% of women were readmitted to hospital for puerperal complications within the first two months, and 5% subsequently. At least one health problem occurred in 76% of babies in hospital, 82% in the first two months at home and 88% in the year thereafter, and the proportion treated increased with time. Readmission was necessary for 4% of babies in the first two months and 15% subsequently. Problems in PNC identified by respondents included lack of staff time, lack of continuity of care (resulting in conflicting advice), unrecognised maternal morbidity and need for support, high (and increasing) use of NHS services by babies, care focused on physical health problems rather than psychological and emotional ones, and deficiency in the quality of care after the first two months. Reorganisation of PNC so that the care of the patients (mother and baby) was its focus might enable the delivery of more effective and efficient care. A redefinition of the role of the midwife, greater autonomy and better professional recognition would increase job satisfaction and improve care. Forms of care which have been shown to be ineffective or harmful should be discontinued, and those which improve postnatal outcomes should be promoted.