Postnatal Notes for Mother 10.1M

Home

About the Notes

Postnatal Notes Survey

Results of the Field Trial

View the Pages for Mother

View the Pages for Baby

Information for Professionals

Training Information

Birth to Five Book

Costs and Ordering

Consent Protocol

Feedback

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

	Page 1	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.

Page 2: Key points in the mother’s previous history are recorded here. There is space to sign that the conversation has taken place about confidentiality and data collection. DH smoking statistics can be collected and it also acts as a prompt to discuss smoking cessation. There is space to document any investigations / immunisations and a prompt to check that antenatal serology has been done.	Pages 2 & 3	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. There is a box to tick if no alerts are identified.

Page 4: Provides space to record clinical findings from the first postnatal assessment after a home birth or prior to early transfer home or on admission to the postnatal ward. If the mother is remaining as an in-patient, ‘orientation to the ward’ details are documented.	Pages 4 & 5	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.

Page 6: Provides written information for the mother about postnatal care, including an explanation about common postnatal complications and caesarean section. Information about the pelvic floor and pelvic floor exercises are described.	Pages 6 & 7	Page 7: Provide space to record clinical findings on the postnatal assessments of maternal well-being stickers. Free text can also be documented contemporaneously.

Page 8: Provide space to record clinical findings on the postnatal assessments of maternal well-being stickers. Free text can also be documented contemporaneously.	Pages 8 & 9	Page 9: Provide space to record clinical findings on the postnatal assessments of maternal well-being stickers. Free text can also be documented contemporaneously.

Page 10: Provide space to record clinical findings on the postnatal assessments of maternal well-being stickers. Free text can also be documented contemporaneously.	Pages 10 & 11	Page 11: Provide space to record clinical findings on the postnatal assessments of maternal well-being stickers. Free text can also be documented contemporaneously.

Page 12: Provide space to record clinical findings on the postnatal assessments of maternal well-being stickers. Free text can also be documented contemporaneously.	Pages 12 & 13	Page 13: Provides written information for the mother about postnatal care, including an explanation about common postnatal complications and caesarean section. Information about the pelvic floor and pelvic floor exercises are described.

Page 14: 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	Pages 14 & 15	Page 15: Provides a special feature section for the most pertinent points to be documented so they can be seen at a glance when the throw out page is opened. It includes an explanation of important symptoms and warning signs. The family planning text encourages discussion around contraceptive choices and pre-conceptual care for the next pregnancy. Contraceptive choices can be recorded on (page 16).

Page 16: 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.	Pages 16 & 17	Page 17: Information is provided on emotional wellbeing with prompts to help mother’s recognise and respond to problems. General postnatal information and public health messages provide prompts for discussion between midwife and mother.

Page 18: Provides a checklist for transfer of care to community midwife, ensuring important information is given and documented, such as how to contact the midwifery team. There is space to document appointments and a section for recording the signature of every professional who writes in the notes; and a list of support groups, with space to add more.	Page 18	Additional pages are available for page 5 and 12 that can be added using a gum strip to facilitate chronological record keeping. 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.

Stickers have been developed to record assessments of maternal well being. This is to support a more chronological flow of documentation and reduce duplication. These should be added to the notes on pages 7-12, and then documentation from the post natal check should be recorded on the sticker. Post natal day number and where the woman has been seen should be recorded on the sticker. Space to document any referral to additional support has been included in the assessment. Prompts are included to review key to risk and management plan.