It was great to see some new faces (adult and baby!) at the meeting today – thanks to all for coming! Thank you very much also to Jodie, who resigned as chair today to focus on her bump! Her hard work over the past year is really appreciated and she has really made a difference to the amount of people we have reached, including those with non-English speaking and difficult to reach groups.

I'll split this update into two - this one on the hospital/midwifery side, and the next one on health visiting and mental health. There are lots of new developments from JPUH:

​​1. There is now a perinatal mental health clinic happening fortnightly, that midwives can refer women to antenatally or postnatally. There is a consultant psychiatrist and obstetrician present, and this means women at this crucial time do not have to wait weeks to be seen. The focus is on women concerned about antenatal/postnatal depression and related issues, and a personal care pathway is made for each woman. They say there is much work still to do, but they are very proud they are making steps in the right direction. We really welcome this, and of course, would love to hear from any women that have used the new service what their experiences were

2. Partners staying: after working with us user reps on this since the start of the year, JPUH is planning to launch a trial scheme from October:​​​

• ​   'Twilight Time' extended visiting hours for birth partners, to 23.30 instead of 9pm currently, at midwife discretion and as long as they agree to the ‘code of conduct’ and are not known to staff for any relevant convictions or abuse concerns
• Also, for women that are transferred onto the Ward in the early hours, partners will be invited onto the ward for a short time, so they can help mum and baby get settled in their new surroundings, and know where to come in the morning, rather than saying goodbye at the ward doors.
•  In certain cases  the birth partners of women that meet certain criteria for extra support may also be able to remain on ward all night but this would be the exception rather than the rule, due to concerns about safeguarding, noise, space, safety, privacy and dignity. Priority factors would include for example Caesarean section, traumatic birth, late evening birth, additional needs etc. 
• We know this solution is not the blanket 'all partners allowed 24/7' that many women called for, so will not please everyone, but as we outlined in our previous blog, it is not really feasible to allow all partners to stay overnight with no restrictions. Hopefully this way forward will allow women more support at this crucial time, while also limiting the potential negative consequences of lots of men being on a women's ward overnight

​​3. Hypnobirthing – some midwives are currently being trained up and this will be offered from around December at around £15 per couple.

4.  Ward tours are now available every Tuesday at 1pm and include Central Delivery Suite, Dolphin Suite, and Ward 11 – which is great as we asked for this at the last meeting :)

5.  Children at scans – Norfolk and Norwich hospital has announced under-12s are not allowed at scans anymore. JPUH is not going down this route, despite some staff concerns. Instead, the wording on the scan letters will be changed to limit the number of children, and make clear that an additional adult should be present to take any disruptive children out if necessary, as sonographers need to be able to concentrate (especially during the anomaly scan), and of course there is also the possibility of bad news, which mums may not wish children to be present for.

6.  Breastfeeding – the hospital was very proud to get accredited for ‘Unicef Babyfriendly Initiative Stage 3’ a couple of year ago but must now apply for re-evaluation to keep that status. The Head of Midwifery feels that this is very expensive at around £9,000 plus a large amount of time by specialist midwives on paperwork for the auditing process. She is concerned this is not the best use of funds and wonders if women would rather that money and time was spent increasing the amount of face-to-face time the specialist infant-feeding midwives can spend with new mums – and hopefully setting up a drop-in breastfeeding clinic (unlike peer-supporters, midwives can refer for tongue-tie etc). She says that the Unicef BFI standards would still be carried on, just without the certificate. What do you think?

Here are the key results of the survey we ran back in March-April this year - we showed the raw data at the June meeting, but its taken a while to write them up here. We have been discussing this issue with JPUH staff over the last six months and there are strong feelings on both sides, both from mums and partners and staff. Clearly, there is no simple answer, and no course of action would please everyone!

The overwhelming response from women is that they feel the need for more support on Ward 11, both practical but especially emotional support. This is especially on the first night postnatal; after a C-section; a first-time mum, or during painful phases of induction. A massive 83% of surveyed women said they wished partners could stay.

However, safeguarding is clearly an issue for the majority  of women, as 60% said partners with certain convictions (eg sex offences) should not be allowed to stay - this would be a large admin responsibility for the ward staff and could be difficult to implement (Eg forcibly remove someone if necessary).

Also, nearly half of women had additional concerns about the impact of partners staying, particularly overcrowding, additional noise (30% of women), privacy and dignity (30%), safety and security (25%) and women not feeling at ease or having lower emotional well-being (13%). The 14% of total respondents who said they were against partners staying or had mixed feelings, also deserve to be listened to as it is not a straightforward vote. 

From the staff point of view, there are serious concerns about the impact on their safety, wellbeing, and workload. We were shocked to hear how often staff are verbally - and even physically - abused on the ward - one said they were literally told to 'F--k off' on a daily basis - which cannot be pleasant, especially when its someone aggressive or of a large size. Some told us that the time taken dealing with awkward birth partners had a significant impact on their care for other women - and security/police have been called numerous times. 

In our survey, we asked how women and partners felt about signing a code of conduct for partners, which is standard at other hospitals. However, only around half of men and women surveyed were happy with the restrictions (eg partner not getting in/on the bed - standard in other wards, for infection control). This would clearly pose a problem for staff, who would have to spend time and energy sorting out these issues. 

So as you can see, there is no simple answer! And no course of action would please everyone!

Our conclusion is: clearly, many women staying overnight on ward 11 in recent years have not felt adequately supported emotionally and/or practically. We therefore have five recommendations for potential courses of action JPUH could take to improve maternity care on ward 11:

1. Have an additional member of staff overnight to minimise waiting times for buzzer presses and ensure all women have enough time with staff to talk through their concerns and feel adequately supported
2. Allow partners to stay for extended hours, but taking into account the concerns raised in our survey, there should not be a total 'free for all' by allowing all birth partners to stay all night. Possible compromise would be extending the hours for women that have one or more of the following: C-section/physical trauma affecting movement; first night postnatal; first baby; additional needs; traumatic birth.
3. If partners are not allowed to stay but mum is transferred onto the ward overnight, we suggest a 'warm handover' is permitted - this means partners can briefly enter the ward, see the new mum settle in, say for 10 minutes, and know where they are, rather than having to say goodbye at the ward door. 
4. Additional staff training to increase awareness of the emotional needs of women in the first night postnatal especially. They need reassurance, comforting and emotional support, as well as not to feel they are being a nuisance if they need to ring the buzzer often - eg if struggling physically or emotionally.
5. More information should be given during pregnancy about the differences between Ward 11 and Central Delivery Suite. Most women otherwise expect to spend the whole time in an individual room with partners 24/7 as they know no different, and it can be quite distressing to find out at short notice (eg induction or staying postnatally due to complications) that they will be on a ward and potentially without partners there.

Phew - long post! If you want to get involved, come along to our quarterly meeting with JPUH staff on Wednesday 11th September at Seagulls Childrens Centre, to hear the latest on a proposed compromise and discuss our next focus topic: improving maternal mental health and detection/care of Postnatal Depression. We hope you appreciate the work we have put in to this research and analysis. It has taken a long time and we desperately need more volunteers to give local women and partners a voice in maternity care. Please get in touch if you can help!

All the best,
Gemma and Jodie