Evidence
Alert

First-time mothers need clear and consistent information about the care they can expect after giving birth

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.

What’s new?

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.

What’s next?

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.

Commentaries

Study author

We were surprised at the consistency of these findings coming from women of diverse backgrounds. We thought there might be differences depending on a woman’s age, ethnicity, socio-economic status, migration status, and living in an urban or rural area, but there were no patterns. In particular, the hopes and fears about staff attitudes and their own confidence were similar for older mothers worried about losing status and role identity, and younger mothers worried about age discrimination and child protection proceedings.

Jenny McLeish, Health Services Researcher, National Perinatal Epidemiology Unit (NPEU), University of Oxford

Lived experience

On reflection, I wish I had received more information in advance, particularly on expressing breast milk. Initiatives that could help parents – especially taking into consideration current COVID restrictions – would be online antenatal classes to include postnatal information, and online postnatal-specific information on hospital websites.

One of my concerns was that I would be judged if I struggled emotionally. An increased focus on parents’ mental health and wellbeing would help to ensure they are signposted to available support.

The continuity of carer teams are being rolled-out nationwide. This will help stop service users from slipping through the net as midwifery staff will have developed a working relationship with their families.

COVID has heightened anxiety for many people, especially those currently accessing maternity services. Restrictions and service availability has been changing constantly. This has affected postnatal care in some locations, as all face-to-face visits were moved to phone or virtual appointments during the peaks of the pandemic.

Kelly Phizacklea, Public contributor, Cambridge

Researcher

This paper provides rich insights into first-time mother’s expectations, ideal and real, of postnatal care. It demonstrates the anxieties that some women have about postnatal care and the absence of joined-up information. Women in the study were largely reliant on piecing together information from informal sources such as other mother’s experiences. This unsatisfactory approach could set up a feedback loop of negative experiences.

The findings should serve as an incentive to develop clear, comprehensive information for midwives to provide to pregnant women. It needs to set out the timing, location, content and purpose of postnatal care, to be accessible at any stage of pregnancy and tailored to reach a wide range of socio-demographics.

Lisa Hinton, Senior Research Associate, The Healthcare Improvement Studies (THIS) Institute, University of Cambridge