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The new Postnatal Notes for Mother are
to be used in conjunction with Postnatal
Notes for Baby. The dual documents ensure
support of the mother-baby dyad whilst
acknowledging that mother and baby are
individuals. When
a mother has been bereaved, the mother’s
booklet is a stand alone document containing
minimal references to baby care in general,
whilst promoting sensitive, individualised
care. Where the baby is with carers other
than the mother, the Postnatal Notes for
Baby booklet stays with the baby. At the
end of the period of midwifery care, both
booklets are returned to the unit for filing.
The new Postnatal Notes intend to facilitate
delivery of an improved standard for
postnatal care tailored to the individual
needs of the woman, the baby and the
family. They reflect the NHS Agenda around
public health offering an equitable service
which is accessible, flexible, and culturally
sensitive. Evidence based information
is provided to enable mothers and their
families to make informed choices, allowing
them to engage in their plan of care
based on:
1. The Guideline for Routine Postnatal
Care which is evidence based and supports
the need for change to ensure that women
report their problems and health professionals
ask the appropriate questions [1, 2].
This requires:
- Effective transfer of information and communication at significant times
[3]
- Increased awareness of risk [4, 5]
- A reduction of poor postnatal outcomes and conflicting advice [2, 3]
2. The Children’s NSF which promotes
individualised, multi-disciplinary management
with midwifery and obstetric care based
on providing good clinical and psychological
outcomes for the woman and baby, while
putting equal emphasis on helping new
parents prepare for parenthood [3]. This
requires:
- Care that identifies and responds in a systematic way to women's health
needs based on best evidence
- A multi-disciplinary team-based approach
- Enhanced and extended post birth care with improved access and flexibility
for all
- Extended service provision with local options for care
3. ‘Why Mothers Die’ findings
highlight the importance of risk assessment:
- In determining morbidity particularly in vulnerable women and those experiencing
domestic violence and mental health problems [3].
- Targeting ‘at risk’ groups, particularly the prevention of
second pregnancies in teenage years [4].
The postnatal notes provide prompts
for identification of risk factors to
enable action to be taken by appropriate
personnel, which can be communicated
effectively, supported by efficient documentation
of the management process [5].
The new Postnatal Notes for Mother contain:
• Explanatory notes on ‘what to expect’. Mothers want ‘information
that is up-to-date and evidence based, answers common problems, discuss options
and offers practical advice’; socially disadvantaged mothers want at least
as much information as other groups [6].
• Prompts for midwives to discuss various public health issues which are
relevant during the postnatal period – e.g. risks of developing complications,
emotional support, domestic violence [4], and smoking cessation [7].
• Further prompts to discuss individual needs and access to services.
• Information on postnatal screening tests consistent with aims of the
National Screening Committee [9]; prompts to confirm that information has been
given to allow informed choice.
References
1. Guideline for Routine Postnatal Care (NICE, February 2006), www.nice.org.uk
2. Bick, Macarthur and Knowles et al. Postnatal Care. Evidence and Guidelines
for Management. 2002
3. National Service Framework for Children, Young People and Maternity services.
Standard 11, Maternity Services. www.dh.gov.uk/childrensnsf
4. Confidential Enquiry into Maternal Deaths in the UK - 6th Report (2004)
CEMACH, RCOG, London. www.cemach.org.uk
5. Confidential Enquiry into Stillbirths and Death in Infancy – 8th
Annual Report (2001) CESDI, London. www.cemach.org.uk
6. Singh D & Newburn M. 2000. Access to Maternity Information and Support.
Experiences and needs of women before and after giving birth. National Childbirth
Trust, London.
7. ‘Smoking Kills’ Executive Summary, DOH: www.dh.gov.uk
8. National Screening Committee - www.nsc.nhs.uk
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Page
1: Lists personal
details, lead professional
and place of birth,
which might be different
to the booked maternity unit.
All routine and emergency contact
numbers are listed
here.
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Page
2: Previous
history is recorded
to promote effective transfer
of risk information. In line
with NHS Information Authority
guidance on patient data
collection, space is included
to record that discussion
has taken place. Smoking
details are recorded to facilitate
effective management of individualised
smoking cessation plans and
also for data collection
purposes. Space is provided
to record investigations
including prompts to ensure
that various tests have been
discussed with the mother,
and whether she agrees to
have them. Blood tests which
are normally done antenatally,
but completed postnatally
are documented here and a
summary of all tests recorded
on the discharge letter (page
20).
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Page 3:
Mother alerts are
listed and any which apply
to the mother are ringed. These
are then transferred to the key
to risk highlighting
the need for vigilance, further
investigations, treatment or
referral. |
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Page
4: Provides space
to record clinical findings
from the first postnatal
assessment after
a home birth or prior to
early transfer home or after
admission to the postnatal
ward. If the mother is remaining
as an in-paitent, 'orientation
to the ward' details are
documented.
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Page 5: Management
Plan provides space
to document specific care requirements,
based on the mother’s needs,
identified by her history,
the maternal alerts and key
to risk. Follow-on sheets with
a gummed strip are available,
to be attached on top, so that
the most recent documentation
is always on display. |
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| Pages 6: The
nature of postnatal care is
outlined, including an explanation
of some of the more common postnatal
complications. These can be referred
to as and when necessary, so
that the mother has some information
to keep after it has been explained. |
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Pages 7: Provide
space to record clinical findings
from postnatal assessments
of maternal well-being. Free
text can also be documented in
the tables. |
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8: The
nature of postnatal
care is outlined,
including an explanation of
some of the more common postnatal
complications. These can be
referred to as and when necessary,
so that the mother has some
information to keep after it
has been explained. Information
about the pelvic floor and
how to perform pelvic
floor exercises are
described. |
Pages
8 & 9
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Page
9: Provide space to
record clinical findings from postnatal
assessments of maternal well-being. Free
text can also be documented
in the tables. |
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| Page 10: Provide
space to record clinical findings
from postnatal assessments
of maternal well-being. Free
text can also be documented in
the tables. |
Pages
10 & 11
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Page 11: Provide
space to record clinical findings
from postnatal assessments
of maternal well-being. Free
text can also be documented in
the tables. |
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| Page 12: Provide
space to record clinical findings
from postnatal assessments
of maternal well-being. Free
text can also be documented in
the tables. |
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Page 13: Provide
space to record clinical findings
from postnatal assessments
of maternal well-being. Free
text can also be documented in
the tables. |
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| Page 14: Provide
space to record clinical findings
from postnatal assessments
of maternal well-being. Free
text can also be documented in
the tables. Follow-on sheets
with a gummed strip are available,
to be attached on top of page
14, so that the most recent documentation
is always on display. |
Pages
14 & 15
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Page 15:
Free text pages for
all professionals providing
care to document chronologically
the care during the postnatal
period, over and above the
space on the assessment of
maternal well-being pages. |
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| Page 16:
Free text pages for
all professionals providing
care to document chronologically
the care during the postnatal
period, over and above the
space on the assessment of
maternal well-being pages. |
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Page 17: Free
text pages for all
professionals providing care
to document chronologically
the care during the postnatal
period, over and above the
space on the assessment of
maternal well-being pages.
Follow-on sheets with a gummed
strip are available, to be
attached on top of page 17,
so that the most recent documentation
is always on display. Page
17 also has an important Special
Features box for key
points relating to risk factors.
Detailed action plans as a
result of problems can be recorded
on the management plan (page
5). |
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Page 18: The Mothers
page provides
space for the mother to
write comments and questions.
Any reflections on the
mother’s birth experience
can be documented by the
midwife, not as a formal
debrief but as an opportunity
to promote discussion.
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Page
19: Information
is provided on emotional
wellbeing with prompts
to help mother’s recognise
and respond to problems.
The family planning text
encourages mothers to seek
further information about
contraception and pre-conceptual
care for the next pregnancy.
Contraception choices can
be recorded on the discharge
summary (page 20).
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| Page 20: Throw-out
page - Discharge summary:
the first half of the page
is the labour summary and the
second half the postnatal progress
up to discharge, to facilitate
effective handover of information
to health visitor and GP. |
Page 20 & 21
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Page 21:
Includes an explanation of
some of the more common postnatal
complications and
important symptoms including
warning signs (vaginal haemorrhage,
infection, headaches, etc).
This text can be accessed as
and when necessary, so that
the mother has information
to refer to after explanations
have been given. General postnatal
information and public health
messages - diet, domestic violence,
work and benefits etc provide
prompts for discussion between
midwife and mother.
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| Page 22: A checklist
for transfer of care to community
midwife, which is
completed before the midwife
leaves the mother after a home
birth or prior to the mother
leaving hospital, ensures important
information is given and documented,
such as how to contact the
midwifery team and SIDS prevention.
There is space to document appointments and
why they have been arranged;
with a section for recording signatures of
every professional who writes
in these notes; and a list
of support groups,
with space to add more. |
Page 22
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NOTE: Frequent
reference is made to the web
address, www.preg.info where mothers and professionals
are able to gather further information.
It also has a link to the DOH
website, allowing mothers to
view the Birth to Five Book using
a search engine to access individual
topics. For professionals, there
are references and links to evidence
and guidelines to support the
statements made in the Notes. |
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