Re: Children's National Service Framework

[Guest guest]

Midwives are in short supply. We have local maternity 'birthing centres' (they do very few deliveries in practice) where the staffing is one HCSW overnight, plus a midwife on call from home. Mothers are babies are accomodated for a few days post delivery in the main maternity unit some 10 miles or so away.

To me, this seems a bit like those postop hotels they used a few years ago for patients who had their surgery as day cases and were visited in their hotel rooms by a hospital nurse in the evening. It was designed to avoid the costs of a full inpatient stay. But apart from the accomodation, I find it hard to see the added value for new mums and their babies. Unless we're bringing back the notion of literally 'lying in'?

H

H-----Original Message-----From: junet579@... [mailto:junet579@...] Sent: 29 September 2004 12:58 Subject: Re: Children's National Service Framework

Sorry, I'm just catching up on the debate. I was a bit puzzled by Ann's earlier assertion that having searched the literature she found none to support the new birth visit, and that we need to consider assessments which may be done at any time and should be carried out by a qualified health visitor.

How will we know when it is the right time to assess a family if we don't know them from the new birth at least, and surely we are helping to meet the needs of families by doing a new birth visit? That is usually the time they are at their most vulnerable. Most, in my experience are grateful to see the HV after they have had a new baby, especially a first time mum. Only recently I did a follow up visit to an affluent American mum with a third baby who had several problems. She mentioned that there had been lots of discussions in American magazines about the British system of Midwives and HVs visiting new mums after birth instead of leaving them to get on with it, and how envious they were of this, and wanted it themselves. Perhaps instead of searching the literature for support of the new birth visit we should be asking mums how they feel about it instead?

I also work with a team of nursery nurses who are excellent in lots of ways and who also run some quietCHCs if the HV is not available,and I certainly use them to follow up behaviour problems with toddlers and for teaching mums play skills etc. However, in my experience they just don't usually have the lateral thinking and ability to see further than the immediate presenting problem, that HVs have. For exampe one NN did a visit to talk to the mum about play with her toddler but didn't pick up on the fact that the child had very little speech because that wasn't on her agenda. I'm sure this lack of awareness of the wider agenda could lead to problems being missed at the NBV, and at CHCs however well NN are taught.

Finally, regarding the debate about midwives visiting up to 28 days -haven't we been here before some years ago? Where are all these midwives who are going to visit for 28 days coming from? Certainly where I work, new mums may only get one or two visits from the community midwife in the first 10 days because they are so short staffed, and I have recently had to help 4 breastfeeding mums with latching on and other feeding problems at the NBV, becasue the midwife didn't have time. Only recently too I met a new mum in clinic who was trying to breastfeed but whose baby was given formula in the well known hospital she gave birth in because the midwife told her they were too short staffed to teach her to breastfeed.

June

[Guest guest]

Agree that the 10-14 days guidelines could be more flexible - we now have to state a reason if we're late as part of the PCT's 'standard', but midwives in my neck of the woods are rarely able to visit beyond 11 days. Have also seen a couple of mums from a neighbouring PCT in tears when doing a GP CHC as they have not yet had a NBV by 21 days and are desperate for help and support. Would love to do AN visits but as we currently have 1 full time HV and me officially 2 days a week PT (plus the equivalent of another day's unpaid overtime a week) instead of the 13 HVs we had six years ago, find this impossible.

I understand in Portsmouth AN visits are done and the PCH record book given out then which seems a good idea. By the way, do other HVs find the new PCH record book badly designed, with repetitive paperwork and a nightmare to navigate or is it just me?

June

[Guest guest]

It must be really difficult with so few staff, but I suppose we are all heading that way in some form or other, skill mix etc. Women who are questioned in the name of research on the NBV cannot have a valid view if they have not met their HV yet. I agree that antenatal visiting would be a good answer, but we haven't got the time. It has been suggested that the midwives give out the ph record, but not happening here yet. The books themselves are completely different throughout the land, so an't comment on yours. Kathy Soderquist