We need to improve postnatal care, starting with the maternal six week postnatal checkBMJ 2020; 368 doi: https://doi.org/10.1136/bmj.m252 (Published 24 January 2020) Cite this as: BMJ 2020;368:m252
- Judy Shakespeare, retired general practitioner1,
- Cheryll Adams, executive director2,
- Stephanie deGiorgio, portfolio GP3,
- Elizabeth Duff, senior policy adviser4,
- Sarah Hillman, academic clinical fellow5,
- Judith Stephenson, professor6
- 1Oxford OX2 7AG, UK
- 2Institute of Health Visiting, London, UK
- 3Dover, UK
- 4NCT, London, UK
- 5University of Warwick, Coventry, UK
- 6Elizabeth Garrett Anderson Institute for Women’s Health, University College London, London, UK
Jakes and colleagues’ paper on the maternal six week postnatal check is timely but anachronistic.1 Although not stated, this is aimed at general practitioners. A letter to the Guardian from four royal colleges2 and the Royal College of Obstetricians and Gynaecologists’ publication Better for Women also emphasise the need to improve care at this check.3 This is against a background of lack of investment and fragmentation of postnatal care.
A maternal postnatal check is not currently included in the NHS GP contract, which defines the “postnatal period” as lasting until only day 14.4 This aspect of the contract is being re-negotiated currently, but we do not know the outcome.
In 2017 the Royal College of General Practitioners agreed a position statement saying that GPs were now unskilled for their role in maternity care.5 GPs need to be trained to provide safe care. NHS England does not consider GPs to be part of either maternity or mental health workforces, although they clearly provide care to women after birth. In addition, Health Education England does not fund GP education beyond core training.
Health visitors are also concerned with postnatal care, after discharge from midwifery care at 10-12 days. They are now employed in cash strapped local authority services, often unable to meet their mandated roles.
In 2014 one of us (JS) co-wrote a chapter on post-pregnancy care for the chief medical officer’s annual review, which concluded that postnatal care was “not fit for purpose.”6 Since then, care has been further fragmented; only the service available for women with severe mental illness has improved (about 5% of postnatal women).
A group of senior interested parties met recently to debate why postnatal care is such a low priority for NHS England.7 We plan to lobby for better postnatal care. Funding and training for the maternal six week check, as described in this paper, would be a start.
Competing interests: None declared.
Full response at: https://www.bmj.com/content/367/bmj.l6482/rr-0.