Improving inpatient postnatal services: midwives views and perspectives of engagement in a quality improvement initiative

Abstract

BackgroundDespite major policy initiatives in the United Kingdom to enhance women's experiences of maternity care, improving in-patient postnatal care remains a low priority, although it is an aspect of care consistently rated as poor by women. As part of a systems and process approach to improving care at one maternity unit in the South of England, the views and perspectives of midwives responsible for implementing change were sought.MethodsA Continuous Quality Improvement (CQI) approach was adopted to support a systems and process change to in-patient care and care on transfer home in a large district general hospital with around 6000 births a year. The CQI approach included an initial assessment to identify where revisions to routine systems and processes were required, developing, implementing and evaluating revisions to the content and documentation of care in hospital and on transfer home, and training workshops for midwives and other maternity staff responsible for implementing changes. To assess midwifery views of the quality improvement process and their engagement with this, questionnaires were sent to those who had participated at the outset.ResultsQuestionnaires were received from 68 (46%) of the estimated 149 midwives eligible to complete the questionnaire. All midwives were aware of the revisions introduced, and two-thirds felt these were more appropriate to meet the women's physical and emotional health, information and support needs. Some midwives considered that the introduction of new maternal postnatal records increased their workload, mainly as a consequence of colleagues not completing documentation as required.ConclusionsThis was the first UK study to undertake a review of in-patient postnatal services. Involvement of midwives at the outset was essential to the success of the initiative. Midwives play a lead role in the planning and organisation of in-patient postnatal care and it was important to obtain their feedback on whether revisions were pragmatic and achieved anticipated improvements in care quality. Their initial involvement ensured priority areas for change were identified and implemented. Their subsequent feedback highlighted further important areas to address as part of CQI to ensure best quality care continues to be implemented. Our findings could support other maternity service organisations to optimise in-patient postnatal services.

Experience with and amount of postpartum maternity care: Comparing women who rated the care they received from the maternity care assistant as ‘good’ or ‘less than good care’

“…Internationally, women's evaluation of postpartum care has consistently been more negative than their rating of other episodes of maternity care. Despite such evaluations postpartum care is often given low priority in research and practice (Rudman and Waldenstrom, 2007;Morrow et al, 2013) From the perspective of both postnatal women and care providers increasing concern has been expressed regarding postnatal care provision while at the same time there has been a lack of evidence to guide developments in postpartum care (Rudman and Waldenstrom, 2007;Bick et al 2011;Morrow et al, 2013). The importance of professional postpartum care is described in the World Health Organisation and United Nations Children's Fund (WHO/UNICEF) standard as well as in the National Institute for Health and Care Excellence (NICE) guideline and the NICE quality standard (WHO/UNICEF 2009;NICE, 2013).…”

Severe maternal morbidity and breastfeeding outcomes in the early post‐natal period: a prospective cohort study from one English maternity unit

“…Breastfeeding outcomes were measured by a set of questions validated adapted from the hospital‐to‐home post‐natal study (Bick et al . ). Women were first asked if they had breastfed their babies at any time since they were born.…”

Care of postpartum women following complicated labour and delivery at the University Teaching Hospital, Lusaka, Zambia: Self- reported practices by midwives

“…The aim of this study was to assess the self reported practices of midwives in the postnatal wards at the UTH on the care of postpartum women who experienced complicated labour and delivery from time of admission to the postnatal wards until their discharge from the hospital. Improving health care performance is an increasing challenge globally; high quality service provision and enhanced patient experience are common elements of health care policy in many countries (Bick et al, 2011). Many studies have concentrated on using clients or postpartum women to rate the care they receive from health care providers including midwives, and most often the rating has been very negative.…”

“…Many studies have concentrated on using clients or postpartum women to rate the care they receive from health care providers including midwives, and most often the rating has been very negative. This has often been without consideration of many factors at hand such as staffing levels, availability of materials and equipment among others (Bick et al, 2011;Morrow et al, 2013).…”

“…Furthermore, many studies have focused on the utilisation of postnatal care services and not necessarily on the care midwives deliver to the mothers as seen from the midwives" perspective. Midwives" views on the value and role of the postnatal care they provide have received little attention, despite being a core element of the midwifery role since time in memorial (Bick et al, 2011).…”