Standardising postnatal care for mothers and babies

Ensuring mothers are aware of the health benefits of breastfeeding, reducing the risk sudden of death syndrome, and assessing women for postnatal depression are among measures services can take to improve the quality of postnatal care, according to NICE.

Postnatal care aims to meet the various needs that a mother and her baby might have following childbirth. For most mothers and babies, the postnatal period ends between 6 and 8 weeks after birth, and tends to be free from complications.

However, complications do occur and certain women, such as those with poor support networks or those who have developed a postnatal health problem, may be vulnerable to harmful outcomes.

While many first-time mothers report benefitting from good-quality postnatal care, research from the National Childbirth Trust shows that this can vary widely.

Around one in eight report being highly critical of the care they received, and cite insensitivity, inconsistent care and lack of emotional support due to too few home visits as reasons.

To standardise and improve the quality of care provided, NICE has produced a postnatal care quality standard, which contains 11 statements to support the measurable improvement of services.

Among these, is a statement to measure whether safer infant sleeping is discussed with women, their partner or main carer at each postnatal contact.

This statement aims to help reduce sudden infant death syndrome, which is the sudden and unexplained death of an apparently well baby. More than 300 babies die of this syndrome each year, with certain behaviours increasing the risk of this.

NICE says that providing the mother, her partner or the main carer with the opportunity to regularly discuss infant sleeping practices can help to identify and support them and the wider family in establishing safer infant sleeping habits, and in reducing the baby's risk of sudden infant death syndrome.

Most women who experience emotional changes in the immediate postnatal period find these resolve up to two weeks after birth. However, some women may still feel low, or anxious and experience negative thoughts following this, which may lead to an increased risk of mental health problems.

To tackle this, the quality standard also includes a statement to measure whether women who have transient psychological symptoms - or ‘baby blues' - that have not resolved at 10-14 days after birth, are assessed for mental health problems.

The quality standard also includes a statement measuring women who receive breastfeeding support from a service that uses an evaluated, structured programme.

NICE says that breastfeeding contributes to the health of both mother and child in the short and longer term. Consequently, women should be made aware of these benefits and those who choose to breastfeed should be supported by a service that is evidence-based and delivers an externally audited, structured programme. In addition, delivery of breastfeeding support should be coordinated across the different sectors.

The quality standard contains a statement to measure whether information about bottle feeding is discussed with women or main carers of formula-fed babies, in order to prevent any of the potentially serious infections that babies can develop if their formula milk is not prepared safely.

Also included is a statement to measure whether women have their emotional wellbeing, which includes their emotional attachment to their baby, assessed at each postnatal contact.

This to help with the baby's social and emotional development, and with the woman's ability to provide a nurturing relationship, as this is partly dependent on her own emotional wellbeing.

Professor Gillian Leng, Deputy Chief Executive and Director of Health and Social Care at NICE said:

"The period immediately following the birth of a new baby is an exciting, life-changing time, both for the mother, her partner and their family.

"However, such great changes can sometimes feel overwhelming for the mother, so it is important that there are standards in place that outline clear, sensible ways to support and care for women during this hugely significant time in their lives.

She added:

"I am sure this new quality standard issued by NICE will be welcomed by both parents and healthcare professionals alike."

Jane Munro, quality and audit development advisor at the Royal College of Midwives, which endorsed the quality standard said:

"The publication of this quality standard gives commissioners and providers of services important benchmarks to measure their performance against, and sets out the levels of care women should expect.

"We particularly welcome the statements recognising the importance of emotional well-being and maternal mental health - as care in this area has often been under-resourced."

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