Family suite: an innovative method to provide inexpensive postpartum care

A statewide review of postnatal care in private hospitals in Victoria, Australia

BACKGROUND

Concerns have been raised in Australia and internationally regarding the quality and effectiveness of hospital postnatal care, although Australian women receiving postnatal care in the private maternity sector rate their satisfaction with care more highly than women receiving public maternity care. In Victoria, Australia, two-thirds of women receive their maternity care in the public sector and the remainder in private health care sector. A statewide review of public hospital postnatal care in Victoria from the perspective of care providers found many barriers to care provision including the busyness of postnatal wards, inadequate staffing and priority being given to other episodes of care; however the study did not include private hospitals. The aim of this study was replicate the review in the private sector, to explore the structure and organisation of postnatal care in private hospitals and identify those aspects of care potentially impacting on women's experiences and maternal and infant care. This provides a more complete overview of the organisational structures and processes in postnatal care in all Victorian hospitals from the perspective of care providers.

METHODS

A mixed method design was used. A structured postal survey was sent to all Victorian private hospitals (n = 19) and key informant interviews were undertaken with selected clinical midwives, maternity unit managers and obstetricians (n = 11). Survey data were analysed using descriptive statistics and interview data analysed thematically.

RESULTS

Private hospital care providers report that postnatal care is provided in very busy environments, and that meeting the aims of postnatal care (breastfeeding support, education of parents and facilitating rest and recovery for women following birth) was difficult in the context of increased acuity of postnatal care; prioritising of other areas over postnatal care; high midwife-to-woman ratios; and the number and frequency of visitors. These findings were similar to the public review. Organisational differences in postnatal care were found between the two sectors: private hospitals are more likely to have a separate postnatal care unit with single rooms and can accommodate partners' over-night; very few have a policy of infant rooming-in; and most have well-baby nurseries. Private hospitals are also more likely to employ staff other than midwives, have fewer core postnatal staff and have a greater dependence on casual and bank staff to provide postnatal care.

CONCLUSIONS

There are similarities and differences in the organisation and provision of private postnatal care compared to postnatal care in public hospitals. Key differences between the two sectors relate to the organisational and aesthetic aspects of service provision rather than the delivery of postnatal care. The key messages emerging from both reviews is the need to review and monitor the adequacy of staffing levels and to develop alternative approaches to postnatal care to improve this episode of care for women and care providers alike. We also recommend further research to provide a greater evidence-base for postnatal care provision.

Still behind the glass wall? Swedish fathers' satisfaction with postnatal care

OBJECTIVE

To describe new fathers' satisfaction with postnatal care after the introduction of a more family-centered model and to study factors related to fathers' overall satisfaction with postnatal care.

DESIGN

Two cohorts of fathers who had a live-born baby during a 15 weeks period in 2004 and 2006.

SETTING

A Swedish hospital. Postnatal care options were traditional postnatal ward, early discharge, cocare at neonatal ward, and from 2006 a family suite on a hotel ward.

SAMPLE

Two hundred and eighty-four fathers whose babies were born in 2004 and 356 fathers whose babies were born in 2006.

METHODS

Data were collected using a questionnaire and descriptive statistical odds ratios with 95% confidence interval and logistic regression analyses were used.

RESULTS

Six hundred and forty (64%) fathers completed the questionnaire. There was no improvement between the 2 years in satisfaction with the content of postnatal care, although fathers who stayed in the family suite on the hotel ward were more satisfied with the postnatal care over all. The following factors were most significant for predicting dissatisfaction with postnatal care: no support from staff, not being treated nicely, dissatisfaction with the environment, lack of medical check-ups for the mother, and visiting hours.

CONCLUSION

A true family perspective should be applied in postnatal care and the new parents viewed as a family unit, not as medical cases only. Staff working in postnatal wards should be given the opportunity to involve fathers in postnatal care.

Time to listen: strategies to improve hospital-based postnatal care

BACKGROUND

In Australia and internationally, women report high levels of dissatisfaction with hospital-based postnatal care.

AIM

To design and implement strategies to improve hospital-based postnatal care at a Sydney metropolitan hospital.

METHOD

This was an Action Research study. In Phase One, midwives considered the literature and participated in group discussions and interviews to determine their perceptions of postnatal care and the factors that facilitate or hinder the provision of quality care. In Phase Two, midwives participated in 12 working group meetings to design strategies to improve care.

RESULTS

Several important principles of postnatal care were described, including building a relationship with women, meeting their individual needs, being flexible in approach and providing continuity of care. 'Listening to women', 'being there,' and 'normalising experiences and expectations' were believed to be critical to achieving these principles. A key strategy 'One to One Time' was designed to provide women with an uninterrupted period of time each day with a midwife who was available to listen to their needs and concerns and discuss issues related to their health and that of their baby.

CONCLUSION

Midwives designed and implemented strategies that they believed would improve in-hospital postnatal care.

Maternity care options influence readmission of newborns

AIM

To analyse morbidity and mortality in healthy newborn infants in relation to various routines of post-natal follow-up.

DESIGN

cross-sectional study.

SETTING

maternity care in Sweden.

POPULATION

healthy infants born at term between 1999 and 2002 (n = 197,898).

METHODS

Assessment of post-natal follow-up routines after uncomplicated childbirth in 48 hospitals and data collected from the Swedish Medical Birth Register, Hospital Discharge Register and Cause-of-Death Register.

MAIN OUTCOME MEASURE

neonatal mortality and readmission as proxy for morbidity.

RESULTS

During the first 28 days, 2.1% of the infants were readmitted generally because of infections, jaundice and feeding-related problems. Infants born in hospitals with a routine neonatal examination before 48 h and a home care programme had a readmission rate [OR, 1.3 (95% CI, 1.16-1.48)] higher than infants born in hospitals with routine neonatal examination after 48 h and 24-h care. There were 26 neonatal deaths.

CONCLUSION

Post-delivery care options and routines influence neonatal morbidity as measured by hospital readmission rate. A final infant examination at 49-72 h and an active follow-up programme may reduce the risk of readmission.

Comparison of Health Care Utilization of Postnatal Programs in Sweden

OBJECTIVE

To describe the utilization of health care services, based on number of outpatient visits and readmissions, by mothers and newborns following discharge postnatally after having received various types of maternity care.

DESIGN

The design was a cohort of Swedish women giving birth at full term. All together, 773 women and 782 newborns were followed using questionnaires, registry data, and medical chart notes. The information served as a basis for analyzing utilization of health care services during the first 28 days post-delivery.

RESULTS

Of the women, 15% sought medical care and 1.7% were readmitted, whereas 17% of the newborns received medical care and 2.9% were readmitted. At 6 months, about half were exclusively being breastfed. There was no difference in need to seek health care or breastfeeding outcome owing to type of maternity care.

CONCLUSION

Mothers with newborns sought care relatively frequently but rarely needed to be readmitted after discharge from the maternity care. The risk of readmission during the first month after childbirth was not greater for mothers and children who received care through the family suite or early discharge programs.

Postpartum care should provide alternatives to meet parents’ need for safety, active participation, and ‘bonding’

OBJECTIVE

To describe new parents' choice of the type of maternity care they wanted to receive, the family suite (FS) or an early discharge (ED), and to gain a better understanding of parents' experiences of different postnatal care alternatives.

DESIGN

A qualitative study using semi-structured interviews. The interviews were analysed by content analysis.

SETTING AND PARTICIPANTS

Eleven couples and one mother, including both first-time and experienced parents. Six families received care at a FS while the others chose an ED within 24 hours after birth.

MEASUREMENTS AND FINDINGS

The postpartum period was experienced as an unpredictable time for new parents, when the need for safety, participation in decision-making, and 'bonding' was felt to be central and decisive to their choice of care. The type of care that the parents felt best met their needs varied according to the mother's assessment of her own and the baby's health status, the parents' requirements and experience and the way in which they, as parents, handled the opportunities and demands of different environments. However, the opportunities for the parents to choose the form of care they considered best for their family were limited.

PRACTICAL IMPLICATIONS

To best fulfil parents' wishes and needs in postnatal care alternative care forms are needed. Also, a way to treat the family as a whole on an individual family basis must be found and parents of newborn babies should be allowed to choose the form of care they consider best.