Women's views and experiences of postnatal hospital care in the Victorian Survey of Recent Mothers 2000

Summary

Objective

to investigate the views and experiences of postnatal hospital care of a representative sample of Victorian women who gave birth in Victoria, Australia, in 1999.

Design

postal survey sent to women 5–6 months after giving birth.

Setting

Victoria, Australia.

Participants

1616 women who gave birth in Victoria in a 2-week period in September 1999.

Findings

50.8% of women described their postnatal care in hospital as ‘very good’. After adjusting for parity, method of birth, length of stay, model of care and socio-demographic characteristics, specific aspects of care with the greatest negative impact on the overall rating of postnatal care were as follows: midwives perceived as rushed and too busy (adjusted OR=4.59 [95% CI 3.4–6.1]), doctors and midwives perceived as not ‘always’ sensitive and understanding (adjusted OR=3.88 [2.8–5.5]), support and advice about going home not ‘very helpful’ (adjusted OR=3.18 [2.3–4.5]), help and advice about baby feeding not ‘extremely helpful’ (adjusted OR=3.27 [2.1–5.1]), not being given advice about baby feeding (adjusted OR=2.84 [1.2–6.9]). Staying in hospital only 1–2 days (adjusted OR=2.00 [1.2–3.4]), and not knowing any of the midwives in the postnatal ward (adjusted OR=1.80 [1.3–2.4]) were also associated with less positive ratings of postnatal hospital care.

Key conclusions and implications for practice

The 2000 Survey shows that women rate early postnatal care in hospital far less favourably than care in pregnancy, labour and birth. The findings indicate that interactions with caregivers are a major influence on women's overall rating of postnatal hospital care. Acting on these findings requires a greater focus on communication and listening skills, attention to staffing levels, and leadership promoting more women-centred care in postnatal wards.

Introduction

Three population-based surveys of representative samples of women giving birth in the State of Victoria, Australia, have been undertaken over the past decade (Brown and Lumley, 1993; Brown and Lumley, 1997a; Brown et al., 2002). During this time, the provision of postnatal care in Victoria has changed enormously. Between 1989 and 1999, the proportion of women staying in hospital for 5 days or longer after giving birth declined from 76% to 34%. Correspondingly, the proportion of women leaving hospital within the first 48 h increased from 6% to 24% (Riley and Halliday, 2001). The steady decline in postnatal length of hospital stay has been accompanied by recognition of the need for improved discharge planning and stronger links between hospitals and primary-care services. In 1994, the State Health Department advised public maternity hospitals that they were to take responsibility for the provision of postnatal care ‘in the days immediately after the birth, whether this occurs in hospital or in the home’ (Acute Health Services Division, 1994). This was followed in 1998 by a commitment to increased funding of domiciliary midwifery services as part of a 4-year Maternity Services Program (Department of Human Services, Victoria, Maternity Services Program, 2003).

In the context of these changes, one of the main objectives of the Victorian Survey of Recent Mothers 2000 was to explore women's views of postnatal care in hospital and in the first few weeks at home. Another reason for looking closely at women's views and experiences of postnatal care in the 2000 survey stemmed from the poor overall ratings of postnatal care in the previous survey (Brown and Lumley, 1997b).

In Australia, concerns have continued about the possibility of adverse outcomes associated with shorter postnatal length of stay. In the 1989 and 1994 surveys, no evidence was found of a negative effect of shorter length of stay on breast feeding, maternal confidence in the first week at home or depression at 6–7 months postpartum (Small et al., 1992; Brown et al., 1998). Repeating the survey provided an opportunity to assess whether there had been any changes in outcomes associated with the continuing trend towards a greater proportion of women leaving hospital within 2–3 days of the birth. The findings regarding outcomes of shorter postnatal length of stay are reported elsewhere (Brown et al., 2004).

In this paper, we focus on women's views and experiences of postnatal care in hospital in the critical first few days after giving birth. Specific objectives include assessing the views of women enrolled in different models of care (public and private), and identifying organisational and other aspects of care that contribute to women's overall rating and assessment of postnatal care. In particular, we were interested in whether or not continuity of midwife caregiver made a difference to women's experiences of postnatal care.