A major new survey has found that while most women are satisfied with the standard of care they receive in Irish hospitals when having a baby, their satisfaction with the level of care they get once they have given birth drops significantly.

AIMS Ireland (Association for Improvements in Maternity Services) which carried out the survey among 367 mothers who had had a baby in the past four hears, says the results show that the postnatal period is the "weak underbelly" of maternity care in Ireland.

The survey, according to Krysia Lynch of AIMS, has identified some dissatisfaction among mothers with postnatal care in the community, with one-fifth of women rating the support they receive from public health nurses to be poor and 17% finding the care they received at the six-week check-up (mostly carried out by GPs) also to be poor.

Of particular concern to AIMS was that over one third of women (37%) said they were not asked about their psychological well-being at the six-week check. This is worrying, in view of the fact that nearly one-fifth of women surveyed said they had suffered from postnatal depression.

Ms Lynch says that while quite rightly there is a focus on the helath of the baby at the six-week check, queries about the health of the mother tend to concentrate on her physical, rather than her mental well-being, thereby potentially missing cases of postnatal depression.

While the standard of hospital care pre-birth and during labour comes out well in the survey, which is perhaps surprising considering the pressure on resources and facilities in many units, hospitals fare poorly in terms of the support provided for breastfeeding.

One-third of the women polled said breastfeeding support while in the maternity unit was poor, and Krysia Lynch said this is a significant finding in terms of our low breastfeeding rates.

According to Krysia Lynch, women are often emotionally vulnerable after having given birth, but are often faced with cramped and understaffed postnatal units. Moreover, the trend towards shorter hospital stays places a greater onus on adequate community support for mothers; but this, she says is still sadly lacking for many women.

The results show that 52% of the women opted for combined GP-hospital care while 22% went for consultant-led hospital care only and 10% had combined GP-hospital midwife-managed care.

Some respondents, however, remarked on the shortage of midwives and consultants in some areas affecting services available and maternity care choices for women. Only a small number of respondents understood they had access to alternative care options such as home births, domino care or midwifery-led units.

Out of the women surveyed, nearly 84% rated the care they received during their pregnancy, in hospital and in the community, as either excellent or good. However, nearly 35% felt the information given to them throughout their pregnancy was average or poor.

AIMS says there is clearly room for improvement in terms of information provided. It says with nearly half of women who attended antenatal classes rating them as average or poor, this raises questions about how these classes can be improved. In addition, there are accessibility issues raised by the fact that 35% of women did not attend classes at all.

As for the labour itself, nearly 81% rated the care they were given during labour as either excellent or good,with 8% rating care as poor.  Most of the births were in hospital, with only around 8% of women having home births.

Fifteen per cent said information provided to them during labour was poor, which AIMS says indicates that many women in labour are not adequately communicated with by carers.

Nealy 80% of women reported a positive experience in relation to birth partners being present, although around one in five said the partners were treated with indifference or excluded.

AIMS says care after birth fared the worst in the survey and is in most in need of improvement.

Forty-five per cent of those surveyed said the care/support they received after the baby was born, that is postnatal care up to six weeks after birth, was either average or poor, with nearly half of respondents receiving inadequate information.

However, just over 80% said the care their newborns received was either excellent or good.

Also, 45% of women said care/support provided by the public health nurse service at home or in health centres was average or poor.

Most women attended their GP or consultant for the routine six-week check for themselves and their babies; however 41% rated this care as either average or poor, with 17% rating it as poor.

AIMS says there is a need for greater continuity of care in the community, and the roles of the GP and public health nurse need to be supported in order to maximise the provision of quality services.

It says that while it is important to acknowledge the good and often excellent care experienced by many women using maternity services, it is critical that where issues of concern are highlighted that they too are acknowledged and addressed in a practical manner.

The recommendations arising from the AIMS survey include:

*The Government and HSE must address the shortage of midwives and in some cases shortage of access to consultants for women in Ireland and should consider extending options such as home births and midwife units to all women.

* A major review of antental education is needed.

* Maternity units should review the implementation of evidence-based practices and procedures in support of normal birth, with AIMS claiming that some interventional procedures serve to perpetuate intervention in normal birth and increase the cost and complexity of care

* Breastfeeding support must be improved.

* Resources available to public health nurses should be improved to allow them to increase their contact with mothers and the requirements of the six-week check should be reviewed to ensure consistency and quality.

See also www.aimsireland.com

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