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Table 3 Evidence Concerning Use of Post-Birth Care Plans

From: Policy, evidence and practice for post-birth care plans: a scoping review

Document, Author and Year Location Method and Participants Main aims/ objectives/purpose Main findings
Left to your own devices: The postnatal care experiences of 1260 first-time Mothers Newburn and Bhavnani, (NCT) 2010 UK Findings of a survey carried out with 1260 first-time mothers - largely NCT members - who had given birth to their first baby during 2008–2009. To investigate the post-birth experiences of women, the quality of support in the first few weeks after giving birth. Considered the extent to which the NICE recommendations on the use of individualised post-birth care plans had been implemented. 96% of women stated that they had not been not involved in developing a post-birth care plan as recommended by NICE.
Many women reported poor co-ordination and planning of care they received and a lack of continuity of carer.
Pressure Points Campaign – ‘Postnatal Care Planning’ Royal College of Midwives (RCM) 2014 UK In 2013, the RCM surveyed midwives, maternity support workers and student midwife members from across the UK. They also asked women for their experiences of post-birth care. To investigate the extent to which post-birth care plans are used, barriers to use and experiences, from the perspective of women and professionals. There’s a significant gap between what women should be receiving in terms of post-birth care planning and what they are getting. Almost half of the women could not recall discussing a post-birth care plan before the birth and 2/3 had not discussed it afterwards. A lack of resources and lack of professional awareness of the NICE guidance was identified as the main reasons for this. Reiterates the importance of continuity of care and individualised care.
Safely delivered – a national survey of women’s experience of maternity care 2014
Redshaw, M. & Henderson, J. National Perinatal Epidemiology Unit (NPEU) 2014
England Based on a survey of 4571 women, who gave birth during a 2 week period in 2014. Set out to investigate women’s experiences of their maternity care, including post-birth care. The participants were not asked whether they had completed a post-birth care plan. Consideration of individualised care and continuity of carer.
Whilst most women were satisfied with their care received at all stages, lesser levels of satisfaction were evident in relation to post-birth care.
Individualised, flexible postnatal care: a feasibility study for a randomised controlled trial Forster, D. et al. 2014 Australia 109 women approached during pregnancy, were sent a postal survey 8 weeks after giving birth, completed by 67.
Clinical data was collected from medical records.
The study refers to ‘planning in the antenatal period for postnatal care’ and a ‘postnatal care plan’, but the investigation is concerned solely with a new proposed model relating to early hospital discharge. Most women (n = 103) completed a ‘postnatal care plan’ during pregnancy; 17% planned to leave hospital within 12 h after birth and 36% planned to stay 48 h.
The ‘postnatal care plan’ considers the family support system at home.
Having a baby in Scotland 2015: listening to mothers An Official Statistics publication for Scotland Scottish Government 2015 Scotland Survey of 2000 women who gave birth during February and March 2015. The aim of the study was to provide a benchmark for improvement in maternity services and inform a major review of maternity services in Scotland. Very similar to the CQC survey in England. The survey failed to directly ask women whether they had completed a post-birth care plan.
Most women reported a very positive experience of their maternity care.
Post-birth care was viewed as less positive than antenatal and intrapartum care.
Reiterates the importance of continuity of care and carer and the provision of individualised care.
A Survey of Women’s Experiences of Maternity Care in Northern Ireland National Perinatal Epidemiology Unit (NPEU) and the School of Nursing and Midwifery at Queen’s University 2016 Northern Ireland Details the experiences of 2722 women who gave birth between October 2014 and December 2016. Set out to uncover women’s experiences of maternity care in Northern Ireland. There was no question posed around post-birth care plans or broader maternity care planning.
Similar findings to comparative surveys in England and Scotland, though generally the women were more satisfied with their post-birth care than the other countries.
Recognition of the challenges regarding continuity of care.
The importance of providing individualised care is recognised as central.
Support Overdue: women’s experiences of maternity services National Childbirth Trust (NCT) and National Federation of Women’s Institutes (NFWI) 2017 UK Survey of 2500 women who gave birth in England or Wales in 2014, 2015, and 2016. The study set out to investigate women’s experiences of maternity services. States that the NCT endorse the NICE guidelines around developing a post-birth care plan, yet there is no specific question asking whether the women had developed a plan or what it contained.
The report outlines some key areas, including continuity of carer, and personalisation – though the latter is discussed mainly in relation to antenatal care.
A systematic approach towards the development of quality indicators for postnatal care after discharge in Flanders, Belgium Helsloot, et al. 2017 Belguim Involved health care professionals, representatives of health care organisations and policy makers with expertise in the field of post-birth care. Set out to develop a set of quality indicators for post-birth care after hospital discharge, to monitor and improve care provision. Identified a range of ‘quality indicators’.
States that planning for post-birth care should start in pregnancy with an individualised care plan that follows mother and baby throughout the pregnancy, birth and post-birth periods. There is no template of such a plan offered.
Some recognition around the ‘feasibility’ and ‘acceptability’ of such a care plan, but limited elaboration of this.
The importance of continuity of care is emphasised.
Your Birth We Care – a survey exploring women’s experiences in pregnancy and birth in Wales
Welsh Government 2017
Wales The survey was completed by 3968 mothers from all over Wales. It aimed to understand the perception of women about the quality of antenatal care and the capacity of the service to prepare women for labour, birth and also parenting. As this survey was primarily concerned with pregnancy and birth, there was limited mention of post-birth care and needs and no discussion of care planning for either the post-birth period or any other part of the maternity journey.
Emphasised the importance of continuity of care and carer and the challenges in achieving this.
Individualised care was emphasised, but only in terms of antenatal care and birth choices.
Survey of women’s experiences of maternity care
Care Quality Commission 2018
England Large-scale maternity survey based on responses from 18,426 women who gave birth during January–February 2017. It aimed to uncover women’s experiences of their care during labour and birth, as well as the quality of antenatal and post-birth support. Refers to the NICE guidelines on developing a post-birth care plan, but does not ask women whether they had had the opportunity to develop a plan.
Compared to previous surveys, the largest improvements were in post-birth care - though this was still viewed less positively than other aspects of maternity care.
The importance or continuity of care and individualised care is recognised.
Planning for your Postnatal Care Needs
Personal Care Plans – for mums and families
North-West London Sustainability and Transformation Plans (STP) 2018
England An initial consultation with women from the North-West London area. Development of a postnatal care plan tool in line with the NICE guidelines. Subsequent pilot phase and evaluation of this tool by 27 women and 4 midwives via a survey and several others in small focus groups, resulting in the reworking of the tool and development of a maternity care planner. Setout to develop ways in which local post-birth care service provision could be improved, in terms of information needs, and promoting continuity of care and personalised care.
The pilot sought to address: the feasibility of using the too; its usefulness in signposting women to relevant information; and its effectiveness in preparing women for parenthood.
In terms of the findings: the majority of the women felt that the plan: had been introduced at the right time; had helped to prepare for post-birth needs, requires to be addressed through face-to-face conversations with their midwife.
The midwife feedback was generally positive. The tool was viewed as helpful in planning for post-birth care and particularly for first-time mothers, but seen as creating additional time pressures and training needs.