Maternity services. Volume II, Minutes of evidence.

  • Great Britain. Parliament. House of Commons. Health Committee
Date:
1992
Catalogue details

Licence: Open Government Licence

Credit: Maternity services. Volume II, Minutes of evidence. Source: Wellcome Collection.

    49/320 (page 381)
    13 November 1991] [Continued the lay organisations such as the NCT through which women have access 24 hours a day to a single breastfeeding counsellor who nas herself breastfed and who gives a consistent message. Recommendations Hospitals should strive for a consistent approach towards instruction in and assistance with infant feeding. Most women have decided well before delivery, even before pregnancy, how they wish to feed their baby. it is unrealistic to believe that the incidence of breast-feeding can be dramatically increased by intervention during the post partum period. Attention should be focused on discussing antenatally relevant and real problems such as feeding, crying and getting the baby to sleep and on supporting women who are keen to breast-feed. Mothers who do not wish to breast-feed or who are unable to do so should not be made to feel guilty or inadequate. Consideration should be given to the wider use of breast-feeding counsellors from lay organisations in hospitals since midwives have insufficient time to handle women struggling with infant feeding. 211 Contraception Flessig (5) reported recently that 31 per cent of pregnancies ending in childbirth in England and Wales were the result of unintended conceptions. Particularly likely to have been unplanned are pregnancies occurring at short intervals (6). For a couple preoccupied with a new baby decisions about contraception are frequently postponed. Decisions about infant feeding are relevant to contraceptive choice and a change from breast to bottle may render the chosen method less appropriate or even less effective. Again a large number of professionals may give advice, none of them with a particular expertise in family planning, and usually too little time is spent discussing past experience. General practitioners are good at remembering to discuss contraception at the post-natal visit (2) “‘possibly encouraged by the early opportunity to claim an item of service fee” but in over 85 per cent of cases they advise the pill. Recommendations Doctors with an interest and expertise in contraception should be involved in establishing a consistent hospital policy with regard to post partum contraception and policies should be made known to the community teams. Discussion about contraception should not be left to ill-informed junior medical and nursing staff. In large maternity hospitals a doctor or nurse trained in family planning should be available to visit post-natal wards daily to discuss contraception. 2iii Perinatal Bereavement Attitudes to perinatal bereavement have changed profoundly over the past 25 years (8). Despite this, stillbirth and neonatal death is often handled extremely badly in hospital. Staff are often ill-informed of the legal requirements and local arrangements for registration of the birth; disposal of the body or remains; funeral or burial; post mortems; the availability within the hospital of immediate support from the hospital chaplain. Support from the post-natal team in the community is often better but relies on good communication between members of the team. Recently the RCOG has distributed to all maternity units a copy of the Stillbirth and Neonatal Death Society’s publication “Miscarriage, stillbirth and neonatal death; guidelines for professionals” London: SANDS 1991. Recommendations Hospitals should have clear and consistent guidelines about the management of perinatal bereavement easily available to all staff. The use of checklistst for management such as that available in the RCOG working party report on the management of pernatal deaths should be encouraged. Written information about statutory requirements and local arrangements should be available to all bereaved parents. Where possible accommodation in single rooms with opportunities for the partner to stay should be made available together with a time for parents to be alone for as long as they wish with the dead baby. Post-natal checks should be undertaken by the obstetrician at a time when all post mortem, infection screen reports etc. can be guaranteed to be available. Aclear and consistent policy must be made within the community and in the event of a stillbirth or neonatal death, communication between all members of the team is of paramount importance. Information about voluntary support organisations such as the Stillbirth and Neonatal Death Society should be made available in all practices. 2iv Post-natal depression Depending on the exact definition used (and excluding puerperal psychosis) severe post-natal depression occurs in between 15 per cent and 40 per cent of mothers. The main failing of the medical services lies in identifying post-natal depression but it is difficult to do so as mothers often try to hide it.