The first six to eight weeks after giving birth is an important time in a woman’s transition into motherhood. But currently little is known about what pregnant women expect, or how well informed they feel in advance about the care they will receive during this postnatal period.
The current national guidance in England covers the routine postnatal care that women and babies should receive, but this is not consistently followed.
This study was set up to explore what first-time mothers expect from postnatal care while they are pregnant, what they would ideally like, where they get their information on postnatal care, and whether they feel the information they have is sufficient.
It concludes that all pregnant women need clear and comprehensive information on what they can expect from postnatal care as a standard part of their preparation for parenthood. It should specifically address any fears they might have about being judged for seeking support and reassurance after giving birth.
The research could prompt maternity professionals to ensure that women have all the information they need on the postnatal care available in their local area.
What’s the issue?
Postnatal care is important for helping new parents have a safe and confident start to family life. Current NICE guidance recommends that each woman should have a postnatal care plan that considers their individual needs and preferences. Ideally, it should be drawn up in pregnancy and regularly reviewed.
However, not much is known about what support pregnant women expect after birth or where they get their information about postnatal care.
A recent national survey of maternity care highlighted that women were less satisfied with their postnatal care than with care during pregnancy, labour and birth. This could be because they did not receive good care – or because it did not match up to what they were expecting. Understanding what first-time pregnant women expect to happen – and what they ideally would like to happen – will identify new ways to improve the information they receive about the postnatal care available to them.
The new study was set up to explore pregnant women’s expectations about their postnatal care. Between October 2017 and March 2018, in-depth interviews were carried out with 40 first-time mothers from diverse backgrounds across England. Six themes emerged from the interviews
1. Women received snippets of information from different sources
None had been given comprehensive information about postnatal care. Instead, they had pieced together information from multiple sources including other mothers’ stories, the internet, and limited information from health professionals and classes during pregnancy.
2. Some planned ahead, others went with the flow
Many were unclear about the different professionals involved and when, where and why they might see them. Some said that not knowing about postnatal care was a source of stress and having a clear structure for what support to expect would help them through the uncertainty of becoming a mother for the first time. Most wanted this information to be easily accessible in pregnancy, although a quarter said they were more likely to look at it after birth.
3. Would they receive judgement or reassurance?
There was a gap between what women expected or feared would happen in their postnatal care, and what they wanted or hoped for. They wanted non-judgmental advice, reassurance about what is normal for a baby, and backing from kind and empathetic health professionals who understood the unique vulnerability of the first-time mother. Their strongest fear was that they would be judged and seen as inadequate parents if they asked for help.
4. Where would the focus of care be?
Women wanted their own physical and emotional wellbeing to be a key focus of postnatal care, but generally expected that the focus would be on physical checks for the baby and breastfeeding.
5. A system under pressure
They expected that health professionals would be under pressure, that postnatal wards would be busy, and that the onus would be on them to ask for help and advice if they needed it. Ideally, they wanted the NHS to provide clear, authoritative, consistent information about looking after a baby, answering questions that first-time parents could not foresee.
6. Who would decide about discharge?
Some worried they would be asked to leave hospital before they felt ready. Other women worried that they would have to stay in hospital longer than they wanted. Ideally, they wanted more control over the length of hospital stay, and to make a joint decision with staff.
Why is this important?
NICE guidance on postnatal care is currently being revised. The results of this study show that women need more information about what care they can expect in the postnatal period.
The researchers recommend changes to the delivery and content of information on postnatal care. They say that information should:
- be clear and comprehensive, and provided to all women as a standard part of preparation for parenthood
- take a parent-centred perspective and cover all settings (hospital, birth centre, home, community). It should include the content, purpose, timing and location of postnatal care, and the roles and responsibilities of all professionals who may be involved
- specifically address women’s fears, particularly about being judged as incompetent or over-anxious if they seek professional advice and reassurance
- be provided in ways that are accessible at any stage of pregnancy or the postnatal period, since not all women will engage with this information before giving birth.
This evidence invites maternity professionals to take responsibility for giving mothers clear and comprehensive information about all the postnatal care they can expect in their local area and to ensure that women have a better experience than many currently fear.
One of the obstacles is that postnatal care is complicated and fragmented: not only is it different in different areas but within individual areas, it is delivered by multiple professionals working within a complex system. Despite this, new parents need to understand and experience their postnatal care as positive, safe and joined-up. Maternity professionals could begin by ensuring that they themselves understand the full detail of the postnatal care offered, and can describe it to all pregnant women.
Future research should explore the potential for local and national sources of postnatal care information to be available for pregnant women. It could explore the most acceptable and helpful formats for delivering information. Research could also consider fathers’ and co-parents’ expectations and information needs about postnatal care.
You may be interested to read
The full paper: McLeish J, and others. “Reassurance that you’re doing okay, or guidance if you’re not”: A qualitative descriptive study of pregnant first time mothers’ expectations and information needs about postnatal care in England. Midwifery. 2020;89:102813
A paper examining the same mothers’ actual postnatal care experiences with a particular focus on their interactions with health professionals: McLeish J, and others. A qualitative study of first time mothers’ experiences of postnatal social support from health professionals in England. Women and Birth. 2020. doi: 10.1016/j.wombi.2020.10.012 (NB article currently in press)
A paper reporting on the connections between mothers’ expectations, experiences, satisfaction with their care and parenting confidence: McLeish J, and others. First-Time Mothers’ Expectations and Experiences of Postnatal Care in England. Qualitative Health Research. 2020;30:1876-1887
NICE guidance: Postnatal care up to 8 weeks after birth [CG37] (2006, last updated 2015)
Funding: This research was commissioned by the NIHR Policy Research Programme through the Policy Research Unit in Maternal and Neonatal Health and Care.
Conflicts of Interest: The study authors declare no conflicts of interest.
Disclaimer: NIHR Alerts are not a substitute for professional medical advice. They provide information about research which is funded or supported by the NIHR. Please note that views expressed in NIHR Alerts are those of the author(s) and reviewer(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.