Maternity services review - HOME • DORSET'S VISION · in the last 2-5 years (50%). Responses were also received by mothers or partners who had their baby in the last 1-2 years (28%),

Maternity services review

Consultation resultsAugust 2017

Public ConsultationResults

WorkshopEvents

Prepared by the Market Research Group at Bournemouth University

StaffEvents

Prepared by the Market Research Group

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WorkshopEvents

StaffEvents

Introduction ...........................................................................................................3Summary Findings ..................................................................................................7Methodology ........................................................................................................10Main Findings .......................................................................................................11

Consultation respondents ............................................................................................................. 11

Improvements to personalised care planning ............................................................................... 20

Preferred location of care .............................................................................................................. 26

Satisfaction with personal care planning ....................................................................................... 27

Postnatal Care ............................................................................................................................... 28

Satisfaction with postnatal care .................................................................................................... 28

Ideas for improvement for postnatal care ..................................................................................... 34

Maternity Information ................................................................................................................... 40

Suggested improvements for information during pregnancy ........................................................ 47

Information after birth ................................................................................................................. 53

Suggested improvements for information after birth ................................................................... 57

Other comments and suggestions ................................................................................................. 63

Workshops ...........................................................................................................69Engagement events ....................................................................................................................... 69

Dorchester Workshop, 21 attendees ............................................................................................ 69

Wimborne Workshop, 16 attendees ............................................................................................. 74

Bournemouth Workshop, 20 attendees ........................................................................................ 78

Workshop summary ...................................................................................................................... 81

Staff Survey ..........................................................................................................83Personalised Care Planning ........................................................................................................... 83

Postnatal Care ............................................................................................................................... 87

Information during pregnancy ....................................................................................................... 91

Information after birth .................................................................................................................. 94

Further Comments ........................................................................................................................ 97

Conclusions ........................................................................................................ 100

Contents

3Prepared by the Market Research Group


WorkshopEvents

StaffEvents

IntroductionA Five Year Forward View for maternity care was launched in 2016 to improve outcomes of maternity services in England. A key recommendation of the national maternity review and the published ‘Better Births’ report was that NHS England should seek volunteer localities to act as early adopters to harness enthusiasm for change and test the model of care described in the report. Through a network of support coordinated by the Maternity Transformation Programme (MTP), the Early Adopters are now taking forward the implementation of the vision in Better Births, going further and faster, and will share the learning from their experiences.

As part of the Better Births project, the Early Adopters play a key role delivering action and improvement quickly and their experiences will pave the way for national roll-out of initiatives that deliver safer, more personalised care for all women and every baby, improve outcomes, and reduce inequalities. Seven Early Adopter sites were identified, following a competitive selection process supported by Members of the MTP Board of which Dorset was one.

In Dorset there are approximately 7,000 births a year. Dorset’s maternity services are provided by three main acute providers that offer access to a variety of birthplace options, including Consultant Led Units, alongside Midwifery Led Unit, standalone Midwifery Led Unit and homebirth teams to enable women to have their babies at home. Women already have access to good services in Dorset; however there is still variation of care and inequity of services provided across the county.

The focus of the current review was on personalised care planning, postnatal care and care for vulnerable and high risk women. Providing better personalised care planning will support and empower women to develop personalised care plans, supported jointly with their midwife, and any other professionals involved in their maternity care, ensuring care is wrapped around women, with the required support, to meet their own needs, as well as the needs of their baby, partner and family. Improving postnatal care will develop arrangements to ensure smooth transition between midwife, obstetric and neonatal care, and as well as ongoing care in the community from their GP and health visitor.

The vision is to improve outcomes for mother and baby by providing better personalised care planning, improved postnatal care and provide better support to vulnerable and high risk women and families in Dorset.

Better Births Project Aims

The aims of the Better Births project are:

• Make measurable improvements in safety outcomes for women, their babies and families by delivering safer care across Dorset

• To enable more women to be offered informed choice through to access unbiased information and advice, including their evidence based risk assessment of their needs

• To increase the number of women who feel their care needs have been met through their personalised care plan

• To ensure women feel supported adequately through the postnatal phase and have a positive experience

• To ensure services will be high quality, evidence based and safe; delivered at the right time, in the right place, by a properly planned, educated and trained workforce

• Greater focus on prevention at scale and early targeting to reduce long term need on healthcare

• To improve health and wellbeing of mother and baby reducing need to access health services in the future


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• To enable integrated service provision to meet the varying and different needs of every woman, pregnancy, baby and family

• To ensure consistent models of care are provided to women, babies and their families

• To ensure evidenced based and consistent healthcare standards that is applicable to all providers

The services included within this review are:

• Maternity Providers: (Dorset County Hospital, Poole Hospital Trust, Royal Bournemouth Community Hospital)

• Health Visiting

• Primary Care

• Independent Midwives

• Children’s Centres

• Health services in children’s centres

• Family and Babies (FAB) breastfeeding support

• Specialist community perinatal mental health team

• Perinatal mental health inpatient unit

• Specialist services in Long Term conditions

• Specialist drug and alcohol services

• Live well Dorset

• Neonatal services

• Counselling support services

• Shine Bereavement Charity

Better Births Project Stages

The key deliverables and timeframe planned for the Better Births in Dorset project can be seen below.

KEY DELIVERABLES COMPLETION DATELocal needs assessment, benchmarking and gap analysis August 2017Co-production design and modelling which includes a number of stakeholder events October-December 2017Models of care piloted January-December 2018Evaluate success of the project December 2018

Communication and engagement

The objective of the communication and engagement stage were to ensure:

• Engagement activity and communication reflect the values and principles of NHS Dorset CCG: honest, responsive, courageous, responsible, collaborative, caring;

• Wide ranging promotion and advertising of the view seeking phase through targeted and segmented communications;

• A variety of view seeking methodologies offered to ensure that all communities are given opportunities to share their views: online survey, paper questionnaire, attending a workshop;


• Mothers, partners, staff and wider public receive clear and timely information on the project, how they can be involved and opportunities to share their views;

• To ensure mothers and partners feel safe and supported to engage and offer views;

• Monitoring and evaluation of whether the engagement achieves its purposes, is representative of the local population and/or identifies any additional work required;

• Compliance with legislation including engagement and consultation with Health Overview and Scrutiny Committees;

• Equal recognition and value given to mothers, partners, staff and clinical views and experiences;

• Co-production approach throughout between mothers, partners and professionals to ensure best possible outcomes and suitability for users.

Core Statutory Duties

All engagement and communication throughout this review has ensured that Dorset CCG’s and the Local Authorities legal requirements to consult about any proposed changes to health care are followed. The duties particularly focus on:

• Consulting and engaging patients and the public;

• Consulting the local authorities Overview and Scrutiny Committee.

Compliance is required with The Health and Social Care Act 2012 (‘the Act’) and amends to the Local Government and Public Involvement in Health Act 2007 (’the 2007 Act’). From Section 242(1B) of the National Health Service (NHS) Act 2006, NHS Dorset CCG will ensure this review consults on:

• The planning of the provision of those services;

• The development and consideration of proposals for changes in the way those services are provided;

• Decisions to be made by the body affecting the operation of those services.

To ensure compliance with Section 234 of the 2007 Act, this review will report on:

• The consultation carried out (or proposed to be carried out) before making any commissioning decisions;

• The influence that results of the consultation have on commissioning decisions.

As part of section 244 of the NHS Act 2006, NHS Dorset CCG will keep the local authority Health Overview and Scrutiny Committees well informed and allow opportunity to review and feedback on the review proposals.

Equality Act

The Equality Act 2010 requires public bodies to consider how the decisions they make, and the services they deliver, affect people who share protected characteristics and to publish information evidencing how this has been done. An ‘Equality Impact Assessment’ and ‘Privacy Impact Assessment’ have both been completed.


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Next Steps

This report will be presented to the Maternity Early Adopter Project Board in September 2017 to assist them in the decision making process. Once the report has been approved by the Project Board, this will then inform the remodelling and redesign phase of the project. Copies of this report will be available on www.dorsetccg.nhs.uk.

Implementation to test the co-produced models of care will begin in January 2018, concluding in December 2018, when all findings will be reported back to NHS England for evaluation and to support other Sustainability and Transformation Plans in delivery of the Maternity Transformation Programme.

The Market Research Group

NHS Dorset CCG commissioned the Market Research Group to assist with the analysis and reporting process. The Market Research Group (MRG) is an independent market research agency based within Bournemouth University.

MRG are a full service agency, with the capability to carry out bespoke data collection and analysis for clients in need of qualitative, quantitative or desk-based research. MRG specialise in providing market and social research intelligence services for healthcare organisations, local government, heritage, tourism, arts and academic sectors and have accumulated over twenty years’ worth of experience working within the public sector in particular.

MRG work in partnership with their clients and focus on adding value at every stage of the research process, whilst providing a flexible, personalised and cost-effective service.


Summary FindingsThere were a total of 427 responses to the Better Births in Dorset questionnaire. There were 69 individual responses to the staff questionnaire, and 57 attendees to the three workshop events held by NHS Dorset CCG.

Consultation Respondents

The majority of respondents were aged 31-35 (37%), 26-30 (26%) or 36-40 (22%). One out of ten respondents was aged over 41 (10%), while 6% were aged between 18 and 25.

Postcodes provided by respondents were allocated to one of 14 districts; the districts with the highest number of respondents were Bournemouth (23%), Poole (18%), West Dorset (18%), Weymouth and Portland (9%) and East Dorset (8%).

The majority of respondents had received, or were currently receiving maternity care in Dorset (97%).

Half of the responses to the survey were from either a mother or partner who had had their baby in the last 2-5 years (50%). Responses were also received by mothers or partners who had their baby in the last 1-2 years (28%), mothers or partners who had their baby in the last 6 months (25%), mothers or partners who had their baby in the last 6-12 months (16%) and expectant mothers or partners (5%).

Personalised care planning

Nearly three quarters of respondents felt that they had the opportunity to develop a personalised care plan (73%).

The majority of respondents had been offered a hospital birth (85%), just less than half were offered a home birth (48%) and 29% were offered a midwife led only unit. 15% of respondents indicated that they had not been offered a choice of birthplace.

Aspects of personalised care planning that worked well for respondents included the relationships that were formed with professionals and their support and advice, the information they received, the home birth teams, feeling in control, their personalised care and support, continuity and appointments. However, some respondents commented that there was a lack of planning for them, they had limited choice or their planning did not go well.

Improvements suggested for personalised care planning included better continuity, more information to help prepare people for the birth or after birth and about the options available to them, professionals allocating more time to make a plan and consultants who listen and explain things more. Other suggested improvements included plans to be considered more and notes read, better communication among staff, flexibility with appointments, more choice and more control over choices, more consideration of history and health conditions, having a plan and more equipment, staff and facilities to enable real choice. A number of comments were made by respondents who suggested nothing needs to be improved.

The most popular locations to receive care during and after pregnancy were people’s own home (142 comments), a local hospital or maternity unit (82 comments) and a local clinic or GP surgery (77 comments).

Just less than two-thirds of respondents were either very satisfied or satisfied with their personalised care planning (64%). On the other hand 16% of respondents were dissatisfied or very dissatisfied with their care planning.


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Postnatal care

More than three fifths of respondents were satisfied or very satisfied with their experience of postnatal care (62%). However, 18% of respondents were dissatisfied or very dissatisfied with their postnatal care.

During postnatal care respondents particularly liked the help they had received from midwives, their home visits, support they had received from health visitors, help they had on the wards and help with breastfeeding. Other things that worked well for respondents was having flexibility over when they could go home, the children’s centres and drop in clinics available, the home birth teams and support from consultants. Some respondents however, commented on what had not worked well for them during postnatal care.

The ideas for improvement that were suggested for postnatal care were mostly related to the hospital wards and staff, breastfeeding help and support, home visits, support from midwives and health visitors and more continuity. Other suggestions included more practical support, more consideration of mothers’ mental health and emotional wellbeing, better experience of being discharged, better communication among services and better accessibility to children centres. However, many comments were made by respondents who suggested nothing about postnatal care needs to be improved.

Maternity information

The majority of respondents felt that they did have good quality information and advice throughout their maternity care (72%).

Classes and online maternity websites were considered to be the most important methods of information provision, meanwhile text and apps were considered to be the least important.

Information during pregnancy

The information sources respondents felt were particularly good during pregnancy included midwives, antenatal classes, leaflets, other sources, other healthcare professionals, their own research, NCT, unit tour, home birthing group and the NHS website. Other comments were related to the type of information that was particularly good which included information on breastfeeding, all of the information and pain relief. Some respondents commented that they had received limited information during pregnancy or that it needs to be better.

Respondents suggested that during pregnancy they would have liked more information about antenatal classes, the birth, feeding, how to care for their baby, how to care for themselves, health conditions, apps and websites available and maternity groups. Respondents also suggested that there were too many leaflets that are too generic, information from midwives and consultants could be better, information needs to be more consistent and needs to be less risk based.

Information after birth

The comments on the information that respondents had received after birth were mostly related to a source or type of information they thought was particularly good. The information sources that respondents valued were midwives, health visitors, leaflets and bounty packs, hospital ward staff, websites and apps, and their peers. The types of information respondents thought were particularly good included information about breastfeeding, how to care for their baby, about local children’s centres and groups and how to care for themselves.

For the information that is received after birth, the majority of the suggested improvements were related to things that they would like more or better information on. Aspects respondents wanted more information on included breastfeeding, mother’s health and wellbeing, how to care for their baby, local groups and classes, complications and bottle feeding. Some respondents suggested the information provided by midwives, leaflets and health visitors after birth could be improved.


Further comments

Further comments provided by respondents were mostly related to the need for more information and classes, hospital units and wards, continuity of care, the need for more funding and staff, proposed closures to maternity units, breastfeeding advice and support, midwives, experience of labour and postnatal care and communication.

Whose Shoes? Workshops

Three workshops were held by NHS Dorset CCG and discussed maternity information, personalised care planning and postnatal care. The most common suggestions for how to improve maternity information were to improve the way in which it is communicated, provide more consistent information and more sources of information. Discussions on personalised care planning were mostly related to communication, the way mothers are made to feel, support, choice and control, information, individuality and diversity, and more time to develop plans. Common themes related to postnatal care included support, information and advice, communication, choice and control, and hospital environments.

Staff Survey

Staff were asked to provide their job title and where they work. 52 respondents indicated that they were a midwife (including Community/ Community homebirth/ Homebirth/ Lead/ Safeguarding/ Senior/ Smoking in pregnancy midwives), while 6 indicated that they were a maternity support worker, 3 were a consultant, 4 were in another medical professional role, and 4 were either management or administration/support staff.

18 staff indicated that they work at Bournemouth, Bournemouth Birth Centre, or RBCH. 27 staff work at Poole, Poole Hospital, Poole Maternity Unit, or the Haven Birthing Suite. 11 staff work at Dorchester or DCH, while 7 staff work in either ANDA, ANC, CDS, Labour Ward, PNW or TCU.

Staff commented that personalised care planning works well when there is continuity, when extra appointments are offered, care is personalised to the individual and enough time is allocated so they can build a relationship with parents. However, staff also suggested all of these could still be improved, for example that there needs to be more continuity, more time allocated to appointments, and a more personalised and flexible approach to care.

During postnatal care staff felt that breastfeeding help, midwife support, home visits and hospital care worked well. On the other hand, suggested ideas to improve postnatal care included to offer more home appointments, improve communication among maternity services and provide more practical support.

Staff suggested midwives, antenatal classes and leaflets were valuable sources of information that were particularly good during pregnancy. However, information during pregnancy could be improved by allowing midwives to spend more time with women during appointments and making information more available on apps and websites.

Similarly the information provided postnatally that staff commented works well included information from midwives, leaflets and bounty packs, and websites and apps, as well as information about breastfeeding and how to care for their baby. Suggestions to improve postnatal information included providing consistent and personalised information, and providing more information on mothers’ health and how to care for their baby.

Further comments related to what works well with maternity services in Dorset were related to community midwives, continuity of care, home visits, breastfeeding support and home births. Further suggestions for how to improve maternity services in Dorset were related to the need for more staff, continuity of care, more localised services, better communication and additional breastfeeding support.


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MethodologySurvey design

NHS Dorset CCG designed and distributed the survey. The online survey web link was promoted by NHS Dorset CCG on their Twitter account, the Dorset Maternity Voices Facebook page and on wards at Dorset County Hospital, Poole Hospital and Royal Bournemouth and Christchurch Hospital. Paper versions of the survey were available on request. A separate version of the survey was designed by NHS Dorset CCG, which staff across various locations, job roles and departments were invited to complete.

Data analysis and reporting

The online responses were recorded anonymously and collated into one spreadsheet by NHS Dorset CCG. The data set was then provided to The Market Research Group for analysis and reporting. Quantitative data analysis was performed using SPSS statistical software. The qualitative data was thematically analysed independently by The Market Research Group and the most common themes that emerged are highlighted throughout this report. It is worth noting that some respondents provided comments to open ended questions that were not directly related to the question asked. These comments have still been analysed and are reported on throughout.

Sample size and statistical validity

There were a total of 427 individual responses to the consultation questionnaire.

A sample size of 427 indicates that the results are representative of the Dorset population to within ±4.74% at the 95% confidence level. One can therefore assert with 95% confidence that the margin of error contained within the results is not greater than ±4.74%.

57 respondents in total took part in the workshops and 69 staff replied to the staff survey.

Engagement events

Throughout the consultation period a team from NHS Dorset CCG delivered and facilitated three workshops across Dorset. The workshops were supported by New Possibilities who created a picture board during each workshop which visualised the key themes that emerged throughout discussions.

The four hour events followed a similar format which included a brief welcome and introduction to give an overview of the Better Births project followed by the ‘Whose Shoes?’ board game. The ‘Whose Shoes?’ board game uses 200 scenarios which help share good practice and challenge attitudes and assumptions. Through the medium of play the game encouraged commissioners, health professionals and members of the public to discuss maternity experiences in Dorset.

At every workshop the team ensured a relaxed, informal and welcoming atmosphere and approach so participants felt supported and encouraged in sharing their opinions.

The comments from the workshops were collated by NHS Dorset CCG and provided to MRG for analysis and reporting, along with the picture boards created by New Possibilities.


Main Findings

Consultation respondents

There were a total of 427 individual responses to the consultation questionnaire.

About You

Age

Respondents were asked how old they were. For the purpose of further analysis when interpreting the responses to the consultation, ages were allocated to one of five age groups. The majority of respondents were aged 31-35 (37%), 26-30 (26%) or 36-40 (22%). One out of ten respondents was aged over 41 (10%), while 6% were aged between 18 and 25.

31-35

26-30

36-40

Age

10%

22%

37%

26%

6%18-25

41+

Base: 422


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Locality

Respondents were asked to provide the first part of their postcode to understand views in different areas. There were a total of 43 postcode districts provided by those who responded to this question. The most common postcodes provided were DT1 (8%), BH21 (7%), BH12 (7%), DT2 (6%), BH9 (6%), DT3 (6%) and DT4 (5%).

For the purpose of further analysis when interpreting the responses to the consultation, postcodes were allocated to one of 14 districts. Caution should be taken when interpreting district analysis however, due to the fact that some postcodes cross the boundary for multiple districts. The most common districts were Bournemouth (23%), Poole (18%), West Dorset (18%), Weymouth and Portland (9%) and East Dorset (8%). There were also 3 responses from South Somerset, Burnley and Teignbridge.

Bournemouth

Poole

West Dorset

District

Weymouth & Portland or West Dorset

East Dorset

23%

Weymouth & Portland

North Dorset

Christchurch

Purbeck, Poole or East Dorset

Purbeck

Base: 423

18%18%

9%8%

6%6%

4%4%

3%New Forest 1%

Maternity care in Dorset

The majority of respondents indicated that they (or their partner) was receiving or had received maternity care in Dorset (97%).

Yes

Are you (or your partner) receiving or have received maternity care in Dorset?

97%

Base: 424

3%No


Parenthood

Respondents were asked to indicate the capacity in which they were responding to the survey. Half of respondents to the survey were either a mother or partner with a baby in the last 2-5 years (50%). More than one quarter were a mother/ partner with a baby in the last 1-2 years (28%), meanwhile a further one quarter of respondents were a mum/ partner with a baby in the last 6 months (25%). 16% of respondents were a mum/ partner with a baby in the last 6-12 months and 5% were an expectant mum/ partner.

Mum/partner with baby in last 2-5 years

Mum/partner with baby in last 1-2 years

Mum/partner with baby in last 6 months

Capacity responding to survey

50%

28%

25%

16%

5%Expectant mum/partner

Mum/partner with baby in last 6-12 months

Base: 420

Personalised Care Planning

Care plan development

Respondents were asked to indicate if they felt they, or their partner, had the opportunity to develop a care plan in order to meet their individual needs. 312 respondents (73%) provided a response to this question. Of those who responded, just less than three-quarters indicated that they felt they did have the opportunity to develop a care plan in order to meet their individual needs (73%).

Yes

Do you feel you had the opportunity to develop a care plan to meet your individual needs?

73%

Base: 312

27%No


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Further comparisons were made to identify respondents more likely to feel they had the opportunity to develop a care plan to meet their individual needs. There were no significant differences when comparing this across capacity responding to the survey, district or age group.

Birthplace choices

Respondents were asked to indicate the choices of birthplace they, or their partner, had been offered. The majority of respondents had been offered a hospital birth (85%), meanwhile just less than half had been offered a home birth (48%) and just less than one third had been offered the choice of a midwife led only unit (29%). 15% of respondents indicated that they had not been offered a choice of birthplace.

Hospital Birth

Home Birth

Midwife led only unit

Please tick the choices of birthplace that you (your partner) were offered

85%

Base: 314

48%

29%

15%No Choice offered

Further comparisons were made to identify respondents more likely to have been offered different choices of birthplace. Respondents who indicated that they had the opportunity to develop a care plan to meet their individual needs were significantly more likely to have indicated that they were offered a hospital birth, home birth and midwife led only unit than those who did not feel they had the opportunity to develop a personalised care plan.

Respondents who had their baby in the last 12 months were significantly more likely to have been offered the option to have their baby in a midwife led only unit than those who had their baby 2-5 years ago.

In addition to this, respondents who live in Bournemouth, Poole, Christchurch and Purbeck, Poole or East Dorset were significantly more likely to have been offered a midwife led only unit than West Dorset and Weymouth and Portland respondents.

Respondents aged over 41 were significantly less likely to have been offered a home birth or midwife led only unit than those aged 26 to 30 or 36-40.


What worked well

Respondents were asked to comment on what has worked well for them about their personalised care planning. 238 respondents answered the question giving 279 comments. However, it should be noted that 61 of these comments referred to things that did not go well with the personalised care planning. These comments are discussed at the end of this section.

Relationships/ communication/ support/ given choices

Information

Home birth

When thinking about your (your partner's) personalised care planning, what has worked well for you?

Limited choice

Lack of plan

60

Control

Personalised care and support

Continuity

Appointments

What did not go well

Base: 238

19

16

20

30

44

29

22

28

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Many comments were related to the relationships that are formed with professionals, especially midwives and consultants (60 comments). Respondents liked the support and advice that they received during discussions with their midwives and consultants. In particular, respondents felt listened to and that they had the flexibility to make their own decisions with full support.

“The midwives were very flexible, supportive, caring and sensitive to my concerns.”

(Had a baby in the last 6-12 months, 41+, DT3)

“I was given a choice at every part of my pregnancy. Very personalised. I was talked through all options and given sound advice.”

(Had a baby in the last 6 months, 31-35, BH11)

“Midwife 1:1 sessions at home to discuss my birth plan. Chatting to midwife weekly about options… Second time around (baby 2), still really valuable to chat about all my options with both midwife session at home and a number of consultant appointments spread over time. The consultant and midwives were more than happy for me to try for VBAC but also respected my wishes that I didn't want induced VBAC so we booked in a date for 41 weeks in the hope I would labour first. This was SO reassuring to know and that the staff backed me 100%.”

(Had a baby in the last 1-2 years, had a baby in the last 2-5 years, 31-35, BH16)


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In addition to this, some respondents commented that continuity of staff had a positive impact on their experience of maternity care in Dorset (19 comments). Respondents felt that seeing the same midwife throughout appointments during their pregnancy helped build a trusting relationship.

“I liked having the same midwife throughout pregnancy this time whereas with my first I would see 4 different ones at my prenatal appointments – all lovely just preferred the continuity this time.”

(Had a baby in the last 6 months, had a baby in the last 2-5 years, 31-35, DT2)

“In 2016 I was looked after mainly by one midwife. It made a huge difference. I really felt she knew me and cared. She even popped in to meet the baby, once arrived! In 2014 I saw a variety of midwives, felt like whoever was available, had to keep explaining everything from the start, and didn’t feel valued.”

(Had a baby in the last 1-2 years, had a baby in the last 2-5 years, 31-35, DT4)

“Having the same midwife at every appointment – continuity of care is so important.”

(First time expectant mum, 31-35, BH14)

Respondents also commented that the appointments with midwives and consultants had worked well for them during pregnancy (16 comments). These respondents felt appointments were convenient and flexible, they had a good outcome and appreciated being able to have extra appointments if they asked for them.

“This time around I felt it was easy to change midwife to make appointments easier for me to attend by fitting around days off. I think the move to having antenatal appointments at children's centre instead of doctors surgery was a good one and when it turned out my midwife could not see me at the CC on my days off and I asked not to have to go to hospital instead I was promptly passed to a different midwife who could see me at home which has been very convenient.”

(Expectant mum, had a baby in the last 2-5 years, 31-35, BH10)

“I appreciated the extra appointments I was offered the second time (e.g. late scans) due to the complications on my first delivery.”

(Partner of someone who has had a baby in the last 2-5 years, 31-35, DT4)

“The flexibility of having my appointments at home and fitting them in around my family commitments.”

(Had a baby in the last 1-2 years, 31-35, DT2)


Some respondents praised the personalised care and support they received, particularly if things were not straightforward with their pregnancy and birth, for example if they had complications with previous pregnancies or had health issues (20 comments).

“We were under the care of the consultant from the beginning due to previous complications. Luckily we have had the same consultant with each pregnancy and this has helped as we are comfortable with our team. We respect the advice of the consultant and whilst she respects our wishes, we try and compromise to a safe conclusion.”

(Had a baby in the last 6-12 months, had a baby in the last 2-5 years, 31-35, DT3)

“My difficult pregnancy was taken into account by my midwife and consultant. Options were given to me according to what was right given my circumstances and my own personal choices.”

(Had a baby in the last 6-12 months, 31-35, BH18)

“We knew we had to have a hospital birth due to pregnancy diabetes but it was explained why and was happy as we knew we would be in the best possible place.”


A number of comments were related to home births, respondents were happy with the advice and support in their homebirth meetings (30 comments). Some of these respondents commented on the support they received from specific home birth teams, including the Cygnet, Eden and Christchurch home birth teams.

“Getting the opportunity to meet midwives when I registered with them and they told me I could have a home birth which I hadn't even considered before. Then we met someone from the cygnet Homebirth team who was really inspiring and we realised this was the best choice for us.”

(Had a baby in the last 6 months, 31-35, DT6)

“The Eden home birth team go above and beyond to help provide personalised care.”


“My home birth plan was considered by a senior midwife and with support from the home birth group, it led to a great home birth that felt natural and like I was in control of my body at all times.”



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Many respondents appreciated the amount of information they had received from a number of sources, including midwives, consultants, antenatal classes, tours, talking to others and doing their own research (44 comments).

“Being well informed by the midwives, but also through our own research and speaking to other parents who had used the services. It helped me gain an idea of what I did and didn't want as part of my individual care plan.”


“The antenatal appointments and classes were really informative and helpful.”


“I did a lot of research myself using the NHS website and blogs/books. I then discussed things with the midwife but I felt supported and confident.”


As a result of being informed, a number of respondents felt in control and able to have the birth that they wanted, including where they gave birth and type of birth (29 comments).

“Having a plan gives you time to think about what you really hope to happen. I personally feel that we had explored all the options and we were well prepared.”


“I got exactly what I wanted - a hospital birth at Dorchester both times.”


“Asked for a pool birth and was luckily able to have one.”

(Had a baby in the last 2-5 years, 18-25, BH22)

On the other hand, there were some respondents who felt they had very limited choice over their birthing options, and their planning was not personalised as a result (22 comments). Moreover, this was often due to complications or other circumstances, for example if they had complications during a previous birth or they were considered high risk.

“Unfortunately due to an early emergency birth of my first child I didn't get a chance to have much planning and for my second child I was midwife and consultant led and a hospital birth was planned from the beginning.”


“We didn't have a chance to have a plan as such, as our baby was breeched this was only picked up on a growth scan. We were sent to see a consultant shoved 4 pieces of paper one on turning and the other on C-section.”

(Had a baby in the last 6-12 months, 26-30, DT10)

“It's hard to comment as I had twins and had very limited options.”



A number of respondents suggested that there was a lack of personalised care planning during their pregnancy (28 comments). Some commented that they were not offered this or that it felt like it was a tick box exercise already set out with no option for personal choice, while others commented that there was no plan but this was because it is not possible to plan a birth.

“It didn't feel individual; more that I was following a set guide that had already been assigned to me.”


“My plan was to have no plan as you never know what may or may not happen.”


“I haven't really yet been offered any options. I'm currently 22 weeks. My midwife has refused to give me her number, so I don't really feel I've had much of an opportunity to talk to her much about my care or concerns as they arise.”

(First time expectant mum, 26-30, BH8)

Finally, a few respondents discussed what did not work well for them in their personalised care planning (11 comments).

“My care plan was central to my labour and the birth of my daughter, but there were certain health professionals who were unwilling to listen to me or my husband and our wishes or views.”


“I wasn't listened to.”

(Had a baby in the last 6-12 months, 41+, BH21)

“Nothing... I didn't get to do what I wanted.”



20

Improvements to personalised care planning

Respondents were asked to suggest ideas for how their personalised care planning could be improved. There were a total of 278 comments made by respondents.

Nothing / positive comments

Continuity

More info in order to prepare for birth/ after birth

When thinking about your personalised care planning, whatdo you think could be better?

Consultants listening/ explaining things

More time and discussion when making plan

60

More info about options available

Plan considered/ notes read

Better communication between midwives/staff

Flexibility - personalised, appointments etc.

More choice

Base: 408

3424

119

189

151414

Control - choices not questioned

Support & consideration of history/ health conditions

A better plan

Control - if no equipment, staff etc.

Birth experience

Other question

38911

4

17

The most common suggestion from respondents was that nothing about personalised care planning could have been better (60 comments).

“I couldn't fault it, I was happy with all my care planning.”


“Nothing, midwife listened well and agreed with our decisions.”


“Very happy with everything, nothing.”



A number of respondents would have liked more information during pregnancy in order to feel more prepared, in particular information about what to expect during the birth itself and afterwards especially if anything goes wrong or the plan changes (34 comments).

“I don't think we were given enough information about what would happen if things went wrong (which they did). There was no information about how our care plan could be adapted if things didn't go to plan.”


“We did not have any classes that really prepared us for the actual birth. No breathing classes for example, something which we expected to have… No one really tells you or prepares you for all the things that can go wrong. It is supposed to be a wonderful experience, and it is, until something goes wrong (with hormones and tiredness) and can be really stressful.”


“More information about preparing for the birth and afterbirth i.e. not in Q&A format with midwife, but more a ‘reminder’ type of conversation regarding iron intake, how to push, posture throughout pregnancy, relaxation, breathing techniques, hypnobirthing, tips and tricks for a shorter labour etc…”

(Had a baby in the last 6 months, had a baby in the last 2-5 years, 31-35, BH1)

In addition to this, many respondents would have liked more information on the different birthing options that are available to them earlier on in pregnancy, especially home births (24 comments).

“I think options could have been explained more. I don't feel like I was given any information or choice regarding the type of birth I could have or where I could have it.”


“At the booking appointment more information should have been given about home births, it was mentioned and I declined – I did my own research afterwards, I then contacted the midwives and asked to switch to the home birth team – I think more people would opt for it if more information was given at the beginning.”


“More information from the midwives about what type of birth I could have and if I had wanted a birth at home, what I could expect to receive. Personally I like to have honest advice (even if I may not like it) rather than being told what I'd like to hear.”



22

Some respondents also felt that they would like more choice over choices surrounding the birth, often due to complications, which became stressful for mothers and their partners (11 comments).

“The birth plan was due to be completed with my midwife at 36 weeks but I ended up seeing a consultant at 36 weeks (my baby was breech) so this wasn't done. My midwife was planning to do it at my 38 week appointment but I had my baby before the appointment.”


“I had an elective C-section with my first child three and a half years ago as he was breech. I really did not want a C-section then, and I certainly didn't want one now. I found being considered as high risk on the fact I had a C-section alone without taking all other things into consideration as well e.g. time elapsed since surgery, the reason for it, and the fact that both my pregnancies have been healthy and straight forward, very frustrating and a bit unfair.”

(Expectant mum, had a baby in the last 2-5 years, 31-35, BH10)

“Until placenta praevia was confirmed it was very up in the air and that caused anxiety. Initially they expected the placenta to move and they kept pushing for a natural birth. I found this stressful.”

(Had a baby in the last 2-5 years, 41+, BH8)

Furthermore, some respondents commented that they would like a better plan or to be offered a plan because they either did not have a birth plan at all (9 comments).

“My birth plan was blank and no one actually asked me what I wanted until I was in labour, by then it was too late.”


“There was no birthing plan done at all from Milborne St. Andrew midwife. More back up from them would have been nice to put my wife's mind at ease.”

(Partner of someone who has had a baby in the last 6 months, partner of someone who has had a baby in the last 2-5 years, 36-40, DT11)

“I asked my midwife about making a birth plan and was told that they don't do that anymore, despite my friend (who lives in Poole) having an hour long appointment with her midwife to make her birth plan.”


Respondents suggested there should be more time and discussion with midwives when creating the birth plan (18 comments). These included comments from respondents who suggested midwives should be more thoughtful and supportive towards the wishes of both mothers and their partners.

“Longer time needs to be spent on plan. I was given half an hour and at no point did anyone check that I was still happy with it or if there was anything else I wanted to adapt or change.”


“The personalised care plan didn't really seem that personalised and I don't remember having much discussion about what I wanted or was best for me.”


“Including the birth partner more. They play a huge role in the run up, the birth and after.”



Further to this, respondents suggested mothers and partners should be able to have more control over their birth plan without their choices being questioned or feeling pushed into other choices (9 comments).

“My birth plan choices were questioned repeatedly.”


“On some occasions I did feel pressured to do things against my wishes.”


“Pressure placed on the worst case scenario near the end of my pregnancy made me feel as though I little scope for having my voice heard.”


It was also suggested that consultants could be more sympathetic towards mothers by spending more time with them, listen to exactly what they want and explain things more (15 comments).

“If consultants/registrars had taken the time to explain risks/benefits and allowed me time to think to weigh up options. Appointments were rushed and I didn't feel fully informed or free to make choices.”


“During my pregnancy it was quite distressing to have a consultant suggest my child may have Downs and was swaying to the higher probability that it was, and to consider ‘options’.”

(Had a baby in the last 2-5 years, 41+, DT5)

“Consultants need to have time for mothers, especially when there's an issue.”


Some comments were related to the communication amongst midwives and other staff members, suggesting that this could be better (14 comments).

“More effective communication between the centralised care in Poole/Bournemouth and the community midwives.”


“When I first found out I found it hard to see the correct person, my doctor was in Westbourne and somehow forgot to refer me. When I telephoned nobody knew where I should be going, Bournemouth or Poole… I spent many hours on the phone and it seemed like no one wanted me or could decide where I should have my care!”


“On our arrival at the hospital there was some confusion as to which department were to receive me so it took an hour for me to be admitted into Haven birth centre.”



24

Some respondents felt that they would like their birth plan to be considered or their notes to be read by maternity staff (14 comments).

“I feel that my wishes of a more natural/active labour could have been more considered or accommodated.”


“When going into labour it would have been nice if my care plan had verbally been acknowledged, even if I couldn't stick to it.”


“For my first baby my birth plan was not followed; it was only read after baby was born.”


Furthermore, many respondents suggested they would have liked more continuity of care (38 comments). Respondents suggested being able to see the same midwife throughout their pregnancy and birth would have meant not having to repeat things and possibly that their birth plan and wishes would have been considered more during the birth.

“Having the same midwife throughout would have made a huge difference instead of having to explain our situation at every appointment!”


“More consistency. I rarely saw the same midwife during antenatal care and during birth I had 3 separate teams, none of which were involved in postnatal care, so no continuity of care.”


“Seeing the same midwife more often so that there was more continuity in planning/ not having to explain things over and over to different people.”


Nine respondents suggested that practitioners could have been more considerate about previous health conditions when discussing plans, for example anxiety. Some respondents also felt they could have been more supportive of other issues that arise during pregnancy and more knowledgeable about the right course of action for these.

“Taken anxieties about childbirth more seriously, I have an irrational fear and nobody took me seriously. It ended up in a traumatic labour and birth experience. It clearly stated on my medical history that I have historically suffered anxiety.”


“First time round I had many midwives due to some being part-time etc. My anxiety wasn't dealt with which eventually led me to being overdue and terrified and demanding a section.”

(Had a baby in the last 6-12 months, had a baby in the last 2-5 years, 36-40, BH17)

“Midwife seemed very busy and distracted. Wasn't easy to get hold of and felt like I was taking her time up. Had very bad ongoing sickness while pregnant and was repeatedly told 'that’s normal'. I have since found out most people with my level of sickness were treated in hospital.”



Some respondents also suggested there could have been more flexibility during their personalised care planning, particularly with arranging appointments with midwives or consultants in terms of times, dates and location (11 comments).

“I was simply told to book appointments and had to go with what was convenient to the system, not what was convenient for me.”


“More appointments at my local hospital and not having to travel miles across town.”


“I work full time and there didn't seem to be any understanding that I needed a choice of appointments rather than being told a date and time.”


Four respondents suggested there should be more equipment, facilities and staff available to enable real choice and ensure it is possible to follow the birth plan.

“I wanted the option of a VBAC with potential for a water birth/ part in the water during the labour purely for pain relief and/or active labour, however I was concerned that there were only a couple of wireless devices for monitoring at the hospital and they couldn't guarantee I would be able to use one.”


“I couldn't have an epidural during my second labour as the anaesthetist was with someone else. I was expected to be understanding about this when in fact I felt that my experience was being invalidated and that if I needed additional support the ward was understaffed.”


Finally, eight comments were related to the actual birth experience or how postnatal care could be improved, as opposed to their personalised care planning.

“I wanted help with breastfeeding after birth but none was given.”


“I was left longer than expected after birth before someone returned to say all was well and I could start getting cleaned up. But this was my third baby so maybe I could have made this decision.”



26

Preferred location of care

Respondents were asked to give their preferred location of care and services received during and after pregnancy. A total of 354 comments were made by 255 respondents to this question. For the purpose of analysis these comments were coded into main locations.

The most popular locations to receive care during and after pregnancy were respondents’ own home (142 comments), a local hospital or maternity unit (82 comments) and a local clinic or GP surgery (77 comments). Other respondents commented that they would prefer to access care locally to them (19 comments), in a local children’s centre (15 comments) or from their community midwife (5 comments). A few respondents did not mind where they went to access care, or were unsure (9 comments).

Home

Local hospital/ unit

Local maternity clinic or GP surgery

Where would you prefer to access the care and services you receive during and after pregnancy?

Other (don't mind, not sure or wherever is best)

Local children centre

142

Locally to me

Community midwife

Other (related to other question)

Base: 255

82

77

19

15

9

5

5


Satisfaction with personal care planning

Respondents were asked to indicate their level of satisfaction with their, or their partner’s, personal care planning. More than one third of respondents indicated that they were very satisfied (35%), while just less than one third were satisfied with their personal care planning (29%). One fifth responded ok (21%), meanwhile 8% were very dissatisfied and a further 8% were dissatisfied with their personal care planning.

Very satisfied

Satisfied

Ok

On a scale of 1 to 5, how satisfied were you with your (your partner's) personal care planning?

35%

Base: 304

29%

21%

8%

8%Very dissatisfied

Dissatisfied

Further comparisons were made to identify respondents more likely to be satisfied, or dissatisfied with their personal care planning. Respondents who indicated that they did not have the opportunity to develop a care plan to meet their individual needs were significantly more likely to be very dissatisfied or dissatisfied with their personal care planning, while respondents who did feel that they had this opportunity were significantly more likely to be very satisfied or satisfied with their personal care planning.

Those who had their baby in the last 6 months were significantly more likely to be very satisfied with their personal care planning than respondents who had their baby more than 1 year ago.

Furthermore, respondents from West Dorset or Weymouth and Portland were significantly more likely to be very satisfied with their personal care planning than those from Bournemouth.

No significant differences were identified when satisfaction was compared across age groups.


28

Postnatal Care

Satisfaction with postnatal care

Respondents were asked to indicate their level of satisfaction with their postnatal care. More than one third of respondents indicated that they were very satisfied with their postnatal care (36%), and just more than one quarter were satisfied (26%), Just less than one fifth indicated that they were ok with their postnatal care (18%), 9% were dissatisfied while a further 9% were very dissatisfied with their postnatal care.

Very satisfied

Satisfied

Ok

On a scale of 1 to 5, how satisfied were you with your (your partner's) postnatal care?

36%

Base: 272

26%

18%

9%

9%Very dissatisfied

Dissatisfied

No significant differences were identified when satisfaction with postnatal care was compared across capacity responding to the survey, district or age group.


What worked well

Respondents were asked to comment on aspects of postnatal care that worked well for them. 230 respondents answered the question giving 376 comments. However, it should be noted that 27 of these comments referred to things that did not go well with their postnatal care. These comments are discussed at the end of this section.

The majority of comments which discussed what works well in postnatal care were related to support from midwives (85 comments) and home visits (81 comments). The remainder of comments were related to support from health visitors (47 comments), support from staff on hospital wards (43 comments), help with breastfeeding (33 comments), what does not work well (27 comments), flexibility over when to go home (15 comments), children centres and drop in clinics (11 comments), the home birth team (10 comments), support from consultants (8 comments), everything (7 comments) and other help provided (6 comments).

Midwife help

Home visits

HV help

When thinking about postnatal care, what has workedwell for you (your partner)?

What did not go well

Breastfeeding help

85

Ward help

Children centres / drop in clinics

Not being rushed home

Home birth team

Consultant help

Base: 230

8147

4333

27

105

1110

Everything

Other help

Being able to go home ASAP

Other

876

3


30

Many respondents appreciated the support, advice and help that they had received from midwives after birth (85 comments). Some respondents commented on the continuity of care from seeing the same midwife.

“The midwives were all fantastic. Very supportive of our difficult labour, debriefing me and partner, phoning to check if I was ok in the days between home visits. Couldn't fault them at all.”


“The midwife care afterwards was amazing; they made me feel at ease and made me feel completely confident I was getting the best care.”

(Had a baby in the last 6-12 months, 31-35)

“Having the same 2-3 midwives come to visit you postnatally for continuity of care. I had some problems postnatally both times (including mastitis). It was great to have someone who 'knows your story' without having to explain background to your feelings etc. For my most recent birth, I had the midwives who looked after me both prenatally and postnatally first time round and that was amazing.”


Further to this, many comments were related to home visits straight after birth from different healthcare professionals (81 comments). Respondents liked being visited at home because it is convenient and provides reassurance, especially for new mums. Some of these respondents also commented that they appreciated when a specific time had been given for these visits.

“It was wonderful having midwives and health visitors visit me at home post birth. I also saw the infant feeding team at home. I was quite fragile post birth and had a lot of trouble feeding so home visits were essential.”


“Regular home visits were helpful rather than travelling with a new-born.”

(Had a baby in the last 6-12 months, had a baby in the last 2-5 years, 41+, BH6)

“Home visits and having a text from the community midwife with a window time slot when she would arrive.”


A number of comments were related to the help, support and advice received from health visitors after birth (47 comments).

“I was very happy with my health visitor and I have had the same one for both my children allowing me to build a relationship with them.”


“I suffered with PND after my second baby and found my health visitor very helpful in getting me some counselling and coming to see me fortnightly to see how we were doing.”


“The health visitors were exceptionally supportive. Home visits helped immensely and my concerns for my baby were always listened to.”



In addition to this, a number of respondents praised the help they had received from staff and practitioners on hospital wards, including the NICU (43 comments).

“It was amazing at the hospital to know that you and baby were checked on regularly, and the midwife and care assistants had all the time for you that you needed.”


“Even though it was traumatic going straight to surgery after giving birth and then staying in hospital for a long time, every member of the postnatal team made sure I was so well looked after. I really admire them and the amazing job they do.”


“The care in hospital was excellent. Discharge planning meeting in hospital was very informative.”


Comments were also related to help with breastfeeding (33 comments). Respondents appreciated being offered help when there were problems with breastfeeding but also not feeling pressured to breastfeed.

“We were given loads of support around breastfeeding and some days had professionals come to our home twice a day. Our little girl wasn't feeding properly so having that extra support was incredible.”


“Having the option to contact the breastfeeding helpline/ buddies was invaluable, their support and advice was incredibly beneficial.”


“My midwife seemed genuinely concerned about my issues with breastfeeding, and although she encouraged me to try it to begin with she did not judge me for choosing to switch to formula.”


On the other hand, some respondents shared their experience of when the postnatal care they had received did not work well for them (27 comments).

“I did feel disappointed in my postnatal care, I really struggled to breastfeed, at no point was I offered the chance to see a baby feeding helper. It was only when talking to other mum later in my postnatal care was I aware I could have seen someone about this.”


“Nothing, it was a truly horrible time.”


“My son was born at 36 weeks and we had a few issues associated with this. I felt once home we were 'dropped' far too quickly by the midwives considering my son was premature.”



32

Some respondents valued having flexibility over when they could go home after birth (15 comments). These comments included respondents who appreciated being able to stay longer in hospital to have additional help and support before feeling confident enough to go home (10 comments), meanwhile others liked being able to go home as soon as possible and not having to stay in hospital (5 comments).

“After both labours, there was no rush to send me home until I was ready. Even though the midwives were clearly stretched, I was made to feel secure and that if I had a problem they would be there for me, which they were.”


“Being allowed to stay in for 4 days after birth to allow C-section to settle down and get confident/ better at feeding.”


“Being able to go home 24 hours after elective caesarean section with good variety of pain relief.”


Some comments were related to the children centres and drop in clinics that are available during postnatal care (11 comments). Respondents particularly appreciated the convenience of being able to turn up at any time if they had any problems or wanted to ask questions.

“I also find the health visitor clinics very helpful in that you turn up when it’s convenient for you, and with a young baby trying to stick to a time is impossible it seems, and you chat with other mums whilst waiting your turn.”


“Local children's centre groups to talk to other mums.”


Ten respondents commented on their home birth team and that the visits from the CYGNET and EDEN teams after birth had worked well for them.

“Having plenty of home visits from Cygnet home birth team were amazing, they made us feel completely comfortable.”


“The Eden team spent time getting to know me and my family before baby was born which meant we already had a great relationship to promote trust in a relaxed environment for my post natal care at home.”



Eight comments related to the help, support and advice received from consultants and GPs.

“After our second child my wife had a haemorrhage and they were very good at arranging a consultant appointment to explain what had happened.”

(Partner of someone who has had a baby in the last 6 months, partner of someone who has had a baby in the last 2-5 years, 26-30, BH8)

“…After this our pregnancies have all been consultant led and we can’t fault the care we have received.”


Seven respondents commented that everything worked well for them during postnatal care.

“All of the support provided after both of my children was excellent.”


“All was good!”


Finally, a few appreciated the support that was provided by other services (6 comments). For example, these respondents praised the 24/7 phone line service and the option for birth counselling if necessary.

“Phone line to call about any problems in the early days.”


“First time around, option to attend birth counselling.”



34

Ideas for improvement for postnatal care

There were a total of 295 comments which suggested ideas for how postnatal care could have been better. The main topics for improvements were those who suggested nothing needed to be improved (53 comments), improvements to hospital wards and ward staff (49 comments) and breastfeeding help and support (46 comments). Other ideas for improvement were related to home visits (30 comments), midwives (20 comments), health visitors (19 comments), continuity of care (19 comments), practical support (17 comments), mental health and wellbeing (14 comments), discharge from hospital (9 comments), communication (8 comments), children centres and clinics (6 comments) and other improvements (5 comments).

Nothing

Hospital wards / ward staff

Breastfeeding help

When thinking about your (your partner's) postnatal care, what do you think could have been better?

HV help

Midwife help

53

Home visits

Continuity

Practical support

Isolation, mental health & wellbeing

Communication

Base: 228

4946

30201919

1714

7Discharge

Children centres, baby clinic etc.

Other improvements

Being able to go home ASAP 28

65

The most comments for how postnatal care could have been better were made by respondents who felt everything went well with their postnatal care that they received and nothing needed to be improved (53 comments).

“I found the postnatal care to be excellent… I honestly can’t fault anything.”


“Nothing, I cannot fault the care I have received and the support I was given, and still receive.”


“I was happy with the care I received.”



However, many respondents commented that improvements were needed to hospital wards and their staff (49 comments). These comments included the need for more staff on wards; staff need to be more helpful and understanding with new mothers as well as allowing dads to stay in hospital.

“My partner was left with my literally new born baby for two and a half hours straight after I'd given birth as I had to go for surgery to repair a tear. My baby screamed for most of it and he was left with no support for him or the baby, and as first time parents he found that really hard to deal with. I completely understand that the unit was busy but just a friendly face to talk to him to reassure him that things would be ok with me and how to care for our baby, and also to provide him with somewhere to sit.”


“At the hospital, the staff were extremely busy and they were understaffed. I felt they couldn't spend the time they wanted with patients.”


“Husband should have certainly been allowed to stay in postnatal. After becoming a new mum and to twins, C-section and normal vaginal delivery on the same day, I simply needed his support around the clock. But he was asked to leave at 8pm and couldn't re-enter until 8am, leaving me feeling very isolated, afraid and completely exhausted.”


A number of new mothers also felt additional help and support with breastfeeding would have improved their experience with postnatal care (46 comments). It was suggested that there needed to be more consistent advice on breastfeeding from professionals and a change in attitudes from staff so that they were more open and less judgemental about switching to formula in order to make mothers feel less pressured to breastfeed.

“I felt that the breastfeeding support both in hospital and postnatally could have been much better. I witnessed many new mums in hospital in tears because they were desperate to breastfeed and couldn't do it and didn't seem to be getting much help. Once I was gone from hospital I was disappointed at the level of breastfeeding support I received and felt this was a contributing factor in me stopping earlier than I would have liked.”


“I had to remain in hospital with my baby for a week and a couple of the midwives were very pushy with feeding and I felt under a lot of pressure instead of feeling able to bond with my baby and breastfeed at my own pace. There was also a lot of conflicting advice from professionals and I feel had I been left alone, breastfeeding would have been more successful.”(Had a baby in the last 1-2 years, 41+, BH11)

“Support for breastfeeding and not just pressure. I found the pressure overwhelming, even though I couldn't physically do it… I became depressed over breastfeeding and carried immense guilt for not being able to breastfeed. It's a shame that these reasons are not looked into at the time of the issue. To date, I still feel guilty getting a bottle of formula out in public because of how I was made to feel in the hospital with the feeding team. When I requested formula in the hospital the reaction of the midwife was something that I reflected on for some time with my guilt, with the words ‘they won't like me doing this’.”



36

Home visits from professionals also needs improving according to many respondents (30 comments). In particular, it was strongly suggested that health visitors and midwives should give an indication of time for home appointments to ensure people do not have to wait at home all day.

“It would have been useful to know approximately when the midwife was going to visit at home, not being given a time means a lot of waiting.”


“Although I welcomed the midwife visits after birth I would have preferred to be given a time when they were coming rather than having to be in all day or in my case trying to stay awake so I wouldn't miss them.”


“It would have been helpful, especially as a first time mum, to have had more visits at home. I know lots of other mums locally who had home visits from their health visitor for 10 months whereas I was expected to take my baby to the children's centre at 4 weeks old.”


Respondents felt midwives could be more supportive, sensitive and knowledgeable during postnatal care (20 comments).

“Same midwives for the maternity care would be fantastic however just having kind ones who like their job would be just as good. I don't need to know if the midwife has 78p in her bank account as one told me. I don't need my first one messing up my notes, forgetting to put down that I have a leaky heart valve which is serious for me. Eating chewing gum during my first appointment is not professional at all. She barely spoke to me and she gave the impression she didn't want to be there. If she didn't then she should have found someone else to see me or cancelled.”


“Not sure how the care after the death of our baby boy could be different but some midwives may need training on how to talk to grieving parents.”


“Upon coming home we had a nice midwife but she wasn't very helpful, she didn't know very much about problems specific to twins.”



In addition to this, respondents felt health visitors could also be more supportive, sensitive and knowledgeable (19 comments).

“I feel my health visitor could have been more sensitive, she made me worry about things that I really need not have worried about and left me feeling criticised and patronised.”


“The health visitor care was poor. I had a new health visitor who had no experience with the problems I was having and a narrow viewpoint. She didn't approve of me co sleeping. Many of my friends lied to the health visitors about how they parented just to avoid the lecture.”


“Health visitors have been late, failed to show and even failed to book one appointment, clearly overstretched.”


There were also suggestions that more continuity of care would improve people’s experience of postnatal care in Dorset (19 comments). Respondents felt they would have had a better experience if they hadn’t had to see different practitioners each time and retell their story or if there had been more consistency with the advice they had received from different practitioners.

“My postnatal midwife care could have been better as we saw a different midwife at every appointment after my baby was born. It would have been nice to have kept some consistency.”


“It would be nice to have the same midwife all the way through so that you build a rapport and trust. Mine changed three times with my second pregnancy.”


“The staff were trying their best but we were seen by so many different members of staff, and each staff member gave different advice in terms of how best to care for and feed my baby. This left me feeling very confused and unconfident as a first time mum.”(Had a baby in the last 6-12 months, 31-35, BH20)


38

It was also suggested that there needs to be more practical support after birth (17 comments). Respondents suggested mothers should not be left alone to cope and need more information from professionals about their own physical recovery as well as what to do and where to go for support.

“Postnatal pelvic health could be better explained and checked. People constantly ask if my stomach muscles have been checked by a medical professional. I didn't even know this was an option!! I believe that concentrating more on a woman's postnatal health will help in later life.”


“We were sent home without even knowing how to change a nappy as my midwife didn't get me booked on to antenatal classes in time, a run through would have been helpful.”


“Nobody has checked my recovery or given me advice on what to expect in terms of my physical recovery. I still feel like my body has a long way to go 6 months on but have no idea if my experience is normal or not.”

(Had a baby in the last 6 months, 41+, BH9)

Some respondents suggested there needed to be more consideration for new mothers’ mental health and wellbeing after birth, including ensuring new mothers are aware of the option for birth counselling (14 comments).

“I could have benefitted from someone to talk to, like the psychologist in NICU, when I was at that stage, in postnatal with no access to my baby as I was recovering from a C-section and facing going home without him.”


“Emotional support – I was in a very vulnerable state post birth and at the time was suffering from PTSD and anxiety following a traumatic shoulder dystocia birth, my son was in NICU for 5 days and then when we came home the midwife visited for nearly 4 weeks due to his weight loss (he took 4 weeks to regain his birth weight) but although his care was great, I struggled hugely with my emotional and psychological health… I believe the emotional support should be more thorough for cases like mine, are midwives able to give this support? Do they have time? I needed someone to tell me to talk about what happened. I needed someone to tell me what I had been through was terrible and it’s okay to feel like this, you will feel better, keep talking about it – that’s what got me through that difficult time, it was talking about what happened but having the time to do this is not something a midwife probably has.”


“The 6 week check up at the doctors wasn't very worthwhile. I didn't feel like there was much consideration for how I felt. My doctor did the necessary checks on my baby and didn't ask much about my recovery or how I was at all.”



Nine respondents suggested their experience of being discharged from hospital could have been better by being more flexible. These mostly came from respondents who felt they should not have been rushed home when they needed to stay longer to recover and build up their confidence before going home, while two commented that they should have been able to go home sooner as they desired.

“I felt I got rushed out of hospital before I was fit to go.”


“Discharge from hospital took a ridiculous length of time both times. It was annoying having to go to the hospital for postnatal care after having just given birth.”


It was also suggested communication among maternity services needs to be improved (8 comments). Respondents identified that there could be better communication between staff for more joined up services, as well as better communication between staff and parents.

“I had my little one at Poole hospital even though my postcode should have possibly meant a Bournemouth birth. I feel the communication doesn't always get relayed between them well. Also their style of paperwork was different which confused one of the midwives.”


“I had my baby at Poole Maternity Unit and there seemed to be confusion regarding the first post birth home visit as Bournemouth Hospital team wasn't informed I'd been discharged. I ended up having to chase.”


Six suggested improvements could be made to children centres and baby clinics, in particular respondents commented on the inconvenience of having to get to these.

“It's not always convenient to attend the well-baby clinic at the children's centre (home visits are easier), and I didn't find my 6 week check very thorough.”


“The insistence that I make appointments straight after a C-section at the local health centre when I could barely sit in a car due to discomfort.”


Other suggestions for improvement included being able to receive more postnatal care from home birth teams and offering more holistic approaches to care (5 comments).

“Care carried out by home birth team.”


“A few more holistic approaches on offer.”



40

Maternity Information

Quality of information

265 respondents (62%) answered the question “do you feel you had good quality information and advice”. Of those respondents, the majority felt they did have good quality information and advice (72%). 17% did not feel that they had good quality information and advice, while one out of ten respondents were not sure (11%).

Yes

No

Do you feel you had good quality information and advice?

72%

Base: 265

17%

11%Not sure

When making comparisons across districts, respondents from Weymouth and Portland were significantly more likely to feel like they did have good quality information and advice than those from Purbeck, Poole or East Dorset.

There were no significant differences when comparing respondents who felt that they had received good quality information and advice across capacity responding to the survey or age group.


Method of information provision

Respondents were asked to indicate how important different methods of information provision were, including leaflets/ flyers, classes, text, apps and online maternity websites.

Classes and online maternity websites were considered the most important methods of information provision by respondents. These two methods had the highest percentage of respondents who indicated these were very important, as well as the lowest percentage for those who thought these were unimportant. Half of respondents indicated classes were very important (50%), while 36% thought online maternity websites were very important. In addition to this, only one in ten respondents indicated that classes (12%) and online maternity websites (11%) were unimportant.

The methods of information provision which were considered the least important to respondents were text and apps. Both of these methods had the highest percentage of people who indicated these were unimportant as well as the lowest percentage for respondents who considered them very important in comparison to the other methods. 43% of respondents indicated that text was unimportant, while one third of respondents considered apps unimportant (33%). Furthermore, only 15% of respondents indicated that texts were very important while 24% thought apps were very important.

Leaflets/Flyers

Classes

Text

How important is it to you to receive information in the following ways?

19%

12%

43%

33%

11%

52%

39%

42%

44%

54%

30%

Base: 260

50%

15%

24%

36%Online Maternity Website

Apps

Very Important Important Unimportant


Respondents were asked to comment on the information that they had received during pregnancy that they found particularly good. A total of 268 comments were made related to what had worked well for them.

These comments were mostly related to information provided by midwives (47 comments), antenatal classes (46 comments), leaflets (44 comments) and other information sources (24 comments). Comments were also related to suggestions that there was limited information or the information provided should be better (19 comments), information on breastfeeding (13 comments),


42

all the information received was good (13 comments), own research (11 comments), information provided by other healthcare professionals (11 comments), NCT classes and website (9 comments), unit tour (8 comments), home birthing group (7 comments), information on pain relief (6 comments) and the NHS website (6 comments).

Info from midwives

Antenatal class

Leaflets

Thinking about the information you received during pregnancy, what do you think was particularly good?

Breastfeeding

No / limited info

47

Other

All

Own research / classes i arranged myself

NCT class / website

Unit tour

Base: 209

4644

2414

1313

11

98

Info should be better

Info from HVs

Unrelated

After birth info

Info from consultants

Home birthing group

Info on pain & pain relief

NHS website

8

7

6

2

6

2

3

5

Many respondents commented that the information and advice received from midwives was particularly good (47 comments).

“The midwife in both my live births was great, had all the information I needed, and was easy to contact.”


“One particular Midwife at our scans at DCH was outstanding, we were never rushed and reassured at every scan, we were lucky enough to have her each time (many scans throughout) and she was amazing. She spoke through each stage and explained what was happening and why, this was by far the best source of information we had.”


“How helpful the community midwives were. They answered all my questions about pregnancy.”



Many respondents also liked the information they had received in their antenatal classes (46 comments).

“The antenatal classes were invaluable as a first time mum.”


“The NHS antenatal classes were really good. The midwife who took the class managed to give a great deal of information within a short space of time which was easy to understand and delivered in an entertaining way.”


“Generally very good antenatal classes delivery by NHS.”


A number of comments were also related to the leaflets that are provided (44 comments). Leaflets mentioned include count the kicks, the preparation pack, bounty book and leaflet about screening.

“The information from the bounty book on what was needed in my hospital bag.”


“Count the kicks leaflet about monitoring baby's movements.”


“All information packs and leaflets were brilliant with many contact numbers email addresses etc.”


Other sources of information that respondents felt worked well for them included apps, the labour line, breathing and relaxation classes, speaking to other people, discharge talk and yoga (24 comments).

“An app I downloaded myself to show me how my baby was developing.”


“Labour line was very useful for me when I suffered from severe abdominal pain.”


“Talking to people who had experienced what I had.”



44

However, some respondents suggested there was limited or no information given to them or that the information that was provided should have been better (19 comments).

“I only remember getting information leaflets at my first scan and check in appointment with midwife. Very much felt like if I didn't ask I wouldn't have got the info.”


“I didn't receive any info. No classes were discussed or offered to me.”


“I wish all the information had been enclosed in one booklet. Like the red baby book. It all seemed jumbled together. Every midwife seemed to have to sift through loads of pages to find what she needed.”


Comments were also related to the information and advice received about breastfeeding or at the breastfeeding classes (13 comments).

“Information on breastfeeding was very in depth.”


“Lots of support regarding breastfeeding.”


“Breastfeeding – no pressure to do it. Everything was well explained.”


Some respondents suggested all the information they had received during pregnancy was good (13 comments).

“I felt I had all the information I needed and more.”


“Everything was great!”


“It covered what I needed as a second time round mum.”



Some respondents had done their own research or found and arranged classes for themselves which they had found particularly useful (11 comments).

“I knew where to look and liked to do my research so I was well informed.”


“The best was the private pregnancy yoga lessons I attended.”


“Reading I did myself.”


Respondents also appreciated the information and advice they had received from other healthcare professionals (11 comments). These comments were mostly related to the information provided by consultants (8 comments), while a few commented on health visitors (3 comments).

“As soon as I was under consultant care we were provided with as much information as possible on a regular basis.”


“Consultants keeping me well informed as to what was happening.”


“The advice regarding the peep course from the health visitor was invaluable.”


Nine commented that the information provided by the NCT was particularly good, either through their classes or website.

“Privately funded NCT antenatal classes.”


“Recommendation for NCT classes.”


Eight respondents thought that the unit tour they had during their pregnancy was particularly good.

“The visit to the maternity unit.”


“Once it was established that my baby would be born prematurely, we had a tour of NICU and a consultant paediatrician speak to us – all very good.”



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A few comments were related to the information received about the option for a home birth from the home birthing group (7 comments).

“Home birthing group was brilliant. My husband wasn't keen on a home birth until he attended the group.”


“The meet the midwife session at the children's centre from the Eden team.”


A few respondents suggested the information they had received about pain and pain relief was useful (6 comments).

“I was shown a chart detailing the levels of pain I would experience during the various stages of labour, which I found very helpful as I could visualise where the increasing pain was leading.”


“Ways to deal with labour and pain, and ways to help your body along the process of labour i.e. positive affirmation, breathing techniques and hypnobirthing methods.”


Finally, six respondents suggested the NHS website was a good source of information during pregnancy.

“The NHS website was good for any additional questions I had between appointments.”


“NHS choices website was excellent for support information.”



Suggested improvements for information during pregnancy

There were 213 suggestions for how the information provided during pregnancy can be improved. The majority of these comments were related to aspects that respondents felt they needed more information on (123 comments), while others commented on what could have been better about the information that was provided (53 comments) and other comments (37 comments).

Antenatal classes

About the birth

Care of baby

Thinking about information you received during pregnancy, what do you think could have been better?

More info about health conditions

Care of mother

25

Breastfeeding

Apps and websites

Bottle feeding

Groups

Home birth

Base: 186

2113

617

139

74

3

Info is fragmented - needs to be consistent

Less risk based info

Everything

Irrelevant

Nothing

More scans, info on procedures etc.

Peer support

Info for dads

Too many lefleats / needs to be personalised

Communication with midwives / consultants

32

18

13

11

17

225

13

OtherImprovement of information givenMore information needed

The aspects that respondents felt they needed more information on were antenatal classes (25 comments), the birth (21 comments), feeding (19 comments), how to care for their baby (17 comments) and care of the mother (13 comments). Other comments were related to more information about health conditions (9 comments), apps and websites (7 comments), maternity groups and peer support (7 comments) and other additional information (5 comments).


48

Many respondents suggested that antenatal classes could be improved (25 comments). These included comments suggesting there should be more information about booking antenatal classes, more information should be provided during the classes, there should be more of them available and they should be more accessible.

“Could have been told about booking antenatal classes as I wasn't told so I missed out.”


“I really wanted to go to antenatal classes but there were none available on the NHS. I found this deeply disappointing. First time mums need this support as I didn't get all the information I wanted and had to rely on things I could find on the internet which are not always helpful or accurate.”


“Antenatal classes in evening and more local.”


A number of comments were related to information about the birth (21 comments). These included comments from respondents who would like more information about different birthing options, how to cope with the birth and what to expect, particularly if things go wrong.

“More preparation for labour and when it goes a bit wrong. My waters broke before contractions and ended up having to be induced by hormone drip, felt unprepared, as it seemed to be quite the opposite to everything we had been told.”


“More about other birthing methods, water births, and more about C-sections.”


“Being given a variety of information instead of this is best, like natural birth, hypnobirthing, how to prepare for labour with exercise etc.”


Respondents also suggested that they would have liked more information about feeding (19 comments). These mostly related to breastfeeding in particular (13 comments) although six commented that they would have liked more information about bottle feeding.

“More awareness of breastfeeding and what to do if it doesn't happen straight away. Making this feel a normal and relaxed process rather than forced and unforgiving.”


“More detailed information on preparing to breastfeed and on your baby's nutritional needs.”


“It would have been nice to have information about combining breast and bottle in the leaflets to give a true reflection of all the choices available.”



A number of comments were related to the need for more information about how to care for their baby after the birth (17 comments).

“There was no real preparation on how to look after a baby. Lots on birth and breastfeeding, but nothing on bathing, keeping babies warm/cool enough, colic, sleeping, common illnesses.”


“I think in our first pregnancy it would have been useful to know what to expect in the first few weeks when we came home with the baby.”


“If they offered a class on caring for a new born, that would be much appreciated!”


In addition to this, respondents would have liked more information for mothers about how to care for themselves, for example, information on safe foods during pregnancy or their own recovery after the birth (13 comments).

“Perhaps the reasons why certain foods should be avoided when pregnant – the information is quite confusing.”


“Info about protecting your abdominal muscles during pregnancy, childbirth and post birth, as well as your pelvic floor (which is given) would have been valuable and would save a lot of problems down the line for a large number of women.”


“Possibly more information from the community midwife about the birth and your after care.”


Nine respondents suggested that more specific information about health conditions, complications and twin pregnancies could be provided.

“More information should be available on Hyperemesis Gravidarum and GP's should have an understanding of this illness.”


“More twin specific information.”



50

Some respondents suggested there should be more information provided on apps and websites (7 comments).

“More dedicated online resourcing perhaps… I think it would save the NHS a lot of money as well as improving the birth experience for a lot of women.”


“I wasn't directed to anything online. I think this is the best way to inform and educate rather than leaflets.”


Seven respondents suggested that there should be more information about maternity groups and peer support that are available.

“Being given knowledge of forums such as Baby Centre where you can join your birth month group and have peer support.”


“Option of a mentor/buddy would be great, particularly for those with no family around to help.”


Other improvements that were suggested were the need for more information about home births (3 comments) and more information for fathers about what to expect (2 comments).

“Better home birth prep advice – a checklist of things to have ready, and how the home system worked once in labour etc.”


“More information for the dads on what to expect during labour, my partner is a first time dad and didn't have a clue what was needed.”


Suggested improvements for the information that was provided were related to there being too many leaflets that are not personalised (18 comments), information from midwives and consultants (17 comments), information needs to be more consistent (13 comments) and to have less risk based information (5 comments).


A number of respondents suggested that there are too many leaflets that are too marketed with not enough personalised information provided to mothers (18 comments).

“Too many leaflets. They should consolidate things down into one place – a handbook. Tons of paper must be wasted on unnecessary leaflets.”


“There's a lot of standard information made for every pregnant person. I feel there should be a more personal side to it, especially for first time mums. Like I said, I felt like a number more than a person.”


“The amount of leaflets you are given at your first booking appointment can be very overwhelming.”


The information from midwives and consultants, as well as the way it is communicated, needs improving according to respondents (17 comments).

“Midwife able to provide better answers to the questions I had, she was generally unable to answer questions and I was left to find out for myself.”


“When I mentioned I had SPD, the consultant who looked after me did not mention there was help for it until I found out from my midwife. I wish I had known sooner there was support available.”


“I thought I was going to a routine appointment, didn't realise I was under consultant care as it was my first (clueless) pregnancy! The consultant scared me when she said she was seeing if I could carry the baby to term.”


Some respondents also suggested the information that is provided is too fragmented and needs to be more consistent between sources or needs to come from one source, for example all information to be delivered from one person or one booklet (13 comments).

“The information received varies from one care provider to another and can be confusing.”


“Info was disjointed and contradictory depending on who was talking.”


“Having one midwife deliver it all.”



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A few comments were related to the need to have less risk based information that scares people (5 comments).

“The tone of some of the leaflets could cause concern. I understand that you have to detail the risks etc., but perhaps look at how it is written.”


“The way my age was approached and the probability of things going wrong was upsetting.”


Other suggestions for improvement were from respondents who suggested nothing needed to be improved (22 comments), the need for more scans or more help in postnatal period (11 comments) and few suggested that everything needed to be improved (3 comments).

A number of respondents suggested that all the information provided was fine and that nothing needs to be improved (22 comments).

“I wouldn't expect any more than what I was receiving, it was fab.”


“Nothing – all informative.”


“Nothing, every bit of advice was perfect. I could not ask for more.”


Other comments were made by respondents who would like more scans, better access to help after the birth or more information on procedures (11 comments).

“A scan between the 20 weeks and end of term. We paid for a private scan but feel it should be offered to all women, especially first time mums, to settle any anxiety they may have.”


“Open access to help in the postnatal period.”


“Options/Pros/Cons for procedures like a ‘sweep’ (didn't end up needing one – but it was talked about as the expected option after a certain date).”


Three respondents suggested that everything about the information that is provided during pregnancy needs to be improved.

“Everything. Advice sheet, local antenatal groups, exercise classes etc. Had to find them all off my own back. Didn't even realise what an NCT class was until I’d had my baby and it was too late. Awful service.”




Respondents were asked about the information they received after their baby was born. A total of 215 comments were made related to what worked well; 93 comments were related to the source of information, 76 were related to the type of information while 46 were general comments.

Source - midwives

Source - HV

Source - packs, leaflets etc.

Thinking about information you received after your baby was born, what do you think was particularly good?

Source - peer support

Source - websites and apps

42

Source - staff in hospital ward

Type - breastfeeding

Type - care of baby

Type - childrens centres, baby groups

Type - care of mother

Base: 188

1515

135

341

1611

6Type - bottle feeding

No information

General positive comments

All

Nothing

218

119

8

General commentsType of informationSource of information

The source of information comments were related to midwives (42 comments), health visitors (15 comments), leaflets and bounty packs (15 comments), hospital ward staff (13 comments), websites and apps (5 comments) and their peers (3 comments).

Just less than half of the respondents who commented on sources of information suggested midwives were a particularly good source of information after their baby was born (42 comments).

“Info given from midwives in visits following births.”


“Student midwife helped me to learn how to latch my baby on during breastfeeding and helped with positions. This took a long time but she was very patient and stayed with me.”


“The help and advice given by my midwife.”



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In addition to this, some respondents felt health visitors were a good source of information (15 comments).

“Health visitor's knowledge on baby health was very valuable.”


“Health visitors were very helpful at visits and clinic in terms of advice.”


“My health visitor was really helpful in explaining all the growth charts, and as I had experienced some antenatal anxiety she gave me lots of information about how to access help if I needed it.”


Some comments were related to the information that was provided on leaflets and in bounty packs (15 comments).

“I was given another copy of the vaccine booklet and the breastfeeding booklet, also a leaflet on lochia and postnatal bleeding which was very useful.”


“There were a lot of leaflets on a lot of topics, perfect for flicking through at your own pace.”


“Again the written literature to refer back to.”


Thirteen respondents commented that the staff on hospital wards were particularly good at giving them information after birth.

“NICU was outstanding for advice etc., which continued once at home if we had any questions. Obstetrician followed up to talk everything through.”


“Discharge planning meeting in hospital.”


“Advice and reassurance provided by midwives and maternity team at DCH.”



Other sources of information that respondents felt were particularly good were websites and apps, for example the Kelly Mom website (5 comments) and their peers (3 comments).

“ABM and Kelly Mom info online about cluster feeding, skin-to-skin and responsive breastfeeding.”

(Had a baby in the last 6-12 months, had a baby in the last 2-5 years, 41+, DT1)

“Meeting with other mum's was helpful.”


The comments which discussed the type of information received after birth were related to breastfeeding (41 comments), how to care for their baby (16 comments), children’s centres and baby groups (11 comments), care for mothers (6 comments) and bottle feeding (2 comments).

More than half of the comments for the type of information that respondents thought were particularly good were related to breastfeeding (41 comments).

“Breastfeeding help from trained HCSW. Without them I may not have been able to breastfeed.”

(Had a baby in the last 1-2 years, had a baby in the last 2-5 years, 41+, DT1)

“Breastfeeding guide on latching with photographs on what a good latch looks like.”


“Breast feeding clinic content and support was fantastic.”


Some respondents liked the information they received about how to care for their baby, including things such as vaccinations, weaning and sleeping (16 comments).

“Information about the vaccinations available was good and information about co sleeping.”


“I liked the baby-led weaning info plus clear info on vaccinations etc.”


“Good advice about sleeping positions and do's and don'ts.”


Eleven comments were related to information about the children’s centres and baby groups that are in their local area and the support they provide.

“Information on baby groups in the area to help you socialise (first time parent).”


“Information on mum and baby groups/children's centres.”



56

Other types of information that respondents received that they thought were particularly good was about care for mothers (6 comments) and bottle feeding (2 comments).

“Lots of information regarding postnatal depression and warning signs.”


“Bottle feeding advice (rare but very helpful).”


Other comments included respondents who did not receive any information (18 comments), general positive comments (11 comments), those who said nothing was particularly good (9 comments) and those who said everything was good (8 comments).

A number of respondents suggested they did not receive any information after their baby was born (18 comments) or that nothing about the information that they had received was good (9 comments).

“I don't recall receiving any after.”


“I don't recall receiving much at all postnatally.”


“Nothing – seriously nothing.”


On the other hand, some respondents were generally positive about the information they had received after the birth (11 comments) or were happy with all the information they received (8 comments).

“Kept informed about everything at every stage.”

(Partner of someone who has had a baby in the last 6 months, partner of someone who has had a baby in the last 2-5 years, 26-30, BH8)

“I'm only a week post-partum so early days. So far it's been fine.”


“All of it was great.”



Suggested improvements for information after birth

There were 195 suggested improvements for the information that is provided after birth. These comments were mostly made by respondents who would like more or better information on different aspects after they have had their baby (119 comments). Comments were also related to the source of information (27 comments) and other general comments (49 comments).

Midwives

Leaflets

Health visitors

Thinking about information you received after your baby was born, what do you think could have been better?

How to care for baby/ development

Mothers health and wellbeing

10

Breast feeding advice

Groups/ centres/ clinics

Info/ support when complications

Personalised/ easy to handle/ sensitive info

Bottle feeding advice

Base: 177

107

2826

1711

99

8

All was good - nothing to improve

Received no info

Everything needs to be better

Other

Classes

More about online info

More info generally

Other (info for dads)

3

42

2

2

34

40

OtherSource of information Better information

The most common types of information that respondents suggested needs to be better or have more of included breastfeeding advice (28 comments), mothers health and wellbeing (26 comments), how to care for their baby (17 comments) and about local groups, classes and centres (14 comments). Other comments were related to the information received when there are complications or problems (9 comments), a more personalised and sensitive approach (9 comments), bottle feeding advice (8 comments), information that is available online (4 comments), more information generally (2 comments) and other (2 comments).


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A number of respondents suggested they would have liked to have received better information and advice about breastfeeding (28 comments).

“I struggled to access breastfeeding support after leaving Poole hospital. I was in pain, and by 5 weeks I tried to access help but was told individual breastfeeding support was only available for the first 28 days. After that I had to go to breastfeeding support group, which was closed for two weeks over the Easter holidays.”


“Information on feeding and not being pressured to breastfeed if it's not working as you feel like a failure.”

(Expectant mum, had a baby in the last 2-5 years, 31-35, DT1)

“Breastfeeding advice. It’s a bit annoying to be told (whilst in agony) that breastfeeding shouldn't be painful if the positioning is right whilst also being told that the positioning looks ok. There was also some incorrect advice given by one individual.”


In addition to this, respondents would have liked more information on a mother’s health and wellbeing after they have given birth (26 comments). In particular, it was commonly suggested that there should be more information about postnatal depression and the physical recovery following childbirth and C-sections.

“More information about/support for PND, as a new mum I was very confused on what the range of emotions were and didn't feel like I could talk to anybody about it.”


“Advice on HOW to protect your muscles as they heal, especially after a C-section... Prevention would go a long way and I'm sure training health visitors and midwives in just a couple of things in this to give advice would be very cost effective in preventing issues in many women as these kind of non-medical but life-impacting conditions can have a real impact on both physical and mental health and quality of life.”


“Caesarean info. I didn't feel I'd been told what I could/couldn't do, caring for wound etc. A caesarean briefing, leaflet or web link could have helped me feel more informed.”



Some comments suggested there could have been more information about how to care for their baby, what to expect in the first few weeks after going home with their baby and the stages of a baby’s development (17 comments).

“Definitely more help on caring for a baby.”


“I really feel that a talk/session on baby care before the baby is born would have been so helpful e.g. how to change a nappy, what baby needs to wear in what temperatures, sleep environments, about establishing a good routine (not necessarily one from a book but whatever routine the baby gets into), good sleep associations or signs to look out for in terms of sleep needs, what to do if baby doesn't settle, how to wash a baby and that using a sling to get them to sleep is normal! I literally walked into motherhood unprepared because everyone told me ‘it will come naturally’ which it didn't, mainly because baby was unsettled because breastfeeding wasn't going very well.”


“Information about different developmental stages would have been good; what to expect or encourage.”


More information about groups, classes and centres that are available in local areas was also suggested by some respondents (14 comments).

“Some kind of booklet with all the local services, clubs, baby groups etc. in. Felt very lonely and had no idea where to go.”


“More information on mother and baby activities in the community. There are lots but there doesn't seem to be a comprehensive list, I had to find out from friends, neighbours and social media instead.”


“Would have been good to have a 'what's on locally' for mother and baby app, which would ping up an hour before a class or group were due to start.”



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Nine respondents suggested that there needs to be more information given by healthcare professionals when things do not go well or there are complications, about what is happening and what to expect.

“Community nurse (baby was on home oxygen), was not very understanding and didn't seem to have read notes on my baby.”


“More information on the behaviours of a baby born via C-section, for example mucus getting stuck in baby's throat.”


“The doctors didn’t have time for us and made me feel like I was an inconvenience. My baby was having strange spasms which concerned the midwives but one doctor said 'I don’t know why he’s doing it but I wouldn't worry about it' but I was worrying about it.”


In addition to this, some suggested that the information could be relayed in a more personalised and sensitive way to mothers that is easy to handle, taking into consideration that they have just given birth and might need a bit more time with midwives or health visitors to understand (9 comments).

“Just explaining clearly without rushing would be good. After having a baby, women are pretty tired and their hormones are going down so sometimes just going slower helps. Everything is done in such a rush.”


“SIDS advice can be terrifying! It should be handled very sensitively otherwise you can feel like your baby is constantly in grave danger despite your best efforts.”


“More personalised information.”


Eight respondents suggested that the information and advice about bottle feeding could be improved.

“More information on formula feeding. As soon as you say you are formula feeding it's like midwives want to avoid any conversation with you!”


“Bottle feeding! I had no idea what I was doing, what he needed...”


“Have some information on safely sterilising bottles if you do choose to formula feed (when I made a decision to use formula, as a first time mum I didn't have a clue where to start).”



Other respondents suggested that there should be more advice about what information is available online, for example by providing links or recommending online groups (4 comments), that there should be more information in general (2 comments) or there should be other information provided, for example specific information for fathers (2 comments).

“Links to recommended websites.”


“Lack of information, more information would have been helpful.”


“Information hub for dads.”


The sources of the information that respondents suggested could be better included midwives (10 comments), leaflets (10 comments) and health visitors (7 comments).

Some of the respondents felt they needed to spend more time with midwives after birth to get more information and advice as well as consistency of the information being provided by different midwives (10 comments).

“The poor midwives were rushed off their feet and never stayed longer than to cast a quick eye on me and my son. If they had more time it would have been nice to chat to them about worries or questions...”


“Midwives just concerned with box checking and writing in notes. Always seen by different person.”


“Where I saw someone everyday it was rarely the same person (understandably) but the problem was each midwife gave me different answers to questions, or had different ways of doing things.”


Other respondents suggested there were too many leaflets to read after giving birth and this would be better received in one pack (10 comments).

“So many leaflets from midwives when you have no time to read and are so sleep deprived nothing sinks in.”


“Not giving me a pile of outdated photo copied leaflets.”


“Too many leaflets were given to me. It would have been better to have one leaflet that summarised the relevant information, and possibly a website or app with further information.”



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Seven commented that the information and advice they received from their health visitors could have been better, in particular that this could have been more consistent.

“Health visitor advice needs to be consistent!!”


“Some information from health visitors has been confusing. More breastfeeding knowledge among health visitors would be preferable.”


“Health visitors I personally find a complete waste of time and money, they showed up and gave us no support.”


The majority of the other general comments were made by respondents who thought all the information they received after their baby was born was good and that nothing needed to be improved (40 comments).

“Happy with information provided.”


“Nothing more could have been given.”


“It excelled, nothing could have been better.”


On the other hand, four suggested that they did not receive any information at all, meanwhile three suggested everything about the information that they received after they have had their baby needs to be better.

“Everything.”


“Not really been given any information especially as we are new to the area of Blandford.”



Other comments and suggestions

Respondents were asked to provide any further ideas about how maternity services in Dorset could be improved. There were a total of 285 comments which suggested ideas.

The most common themes that emerged were more information and classes (38 comments), hospital units and wards (33 comments), continuity of care (33 comments) and the need for more funding and staff (27 comments). Other themes included suggestions to keep local maternity units open (24 comments), compliments (24 comments), breastfeeding advice and support (20 comments), midwives (19 comments), experience of labour and postnatal care (16 comments), improve communication (15 comments), home births (14 comments), handling of complications or twin pregnancies (10 comments), more localised services (6 comments), health visitors (4 comments) and other (2 comments).

More information and classes

Continuity of care

Units and wards

Do you have any ideas on what we could do to improve maternity services in Dorset?

Compliments

Keep maternity unit open

38

More funding/ more staff

Breastfeeding

Midwives

Labour and postnatal care

Better communication

Base: 209

3333

272424

2019

1615

Home birth

Improve handling of complications & twins

More localised services

Other

Health visitors

1410

64

2


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The most common suggestion for how maternity services could be improved was to provide more information and classes (38 comments). This included respondents who would have liked more holistic antenatal classes which provide more information about different birthing options, for example natural birth, C-section and hypnobirthing, and also how to care for their baby. Respondents also suggested it would be good to have more information on what networking groups are available locally and online.

“More information, support and provision for more holistic antenatal classes such as active or hypnobirthing.”


“For me it's very much around the info given out post C-section, particularly in emergency C-section cases like mine. I had no idea what to expect, how to move around, exercise etc.”


“More networking of parents, and made into a normal thing.”

(DT3)

Many comments were also related to how hospital units and wards can be improved generally, by improving the environment, facilities and the care that is received, for example respondents suggested having more private rooms, more beds and making sure staff provide sufficient support (33 comments).

“More private rooms, even if they are smaller. That's the only thing I really worried about; I couldn't relax in the shared rooms at all.”


“Make sure ALL delivery rooms have equipment to support mobility during labour (i.e. mats/cushions for floor, birth ball).”


“Hospital care needs to be better. I felt neglected and that no one listened to me or even cared.”


A number of respondents also suggested there needs to be more continuity of care (33 comments). Comments reflected the importance of seeing the same midwife, where possible, as well as having consistency in the care and advice provided by different units.

“Try to ensure wherever possible that expectant mothers have consistency in their midwife. It makes a huge difference if you can form a rapport with your midwife, even more so if that midwife is available for the birth.”


“Try to have the same people looking after you during antenatal and postnatal care.”


“Continuity of care between different trusts should be improved e.g. between Bournemouth and Poole.”



It was suggested that there should be more funding allocated to maternity services to be able to have more staff, especially midwives, so they are not overstretched and can provide better care (27 comments).

“Invest in better services and more midwives and health visitors. Poole is overcrowded; although staff are highly trained it is like a conveyor belt which is unacceptable for women's care, mental health and birth experience.”


“More midwife assistants to allow more 1:1 time and discussions, to help both in the community and in hospital, and to take the pressure away from the midwives in busy units.”(Had a baby in the last 1-2 years, had a baby in the last 2-5 years, 31-35, BH16)

“Increase staffing on shifts. We waited 2 hours for my emergency C-section as staff told me that to undertake it at the end of a night shift with short staffing would be dangerous so it was best to wait until 9am if possible. Result – I lost a lot of blood.”


In addition to this, a number of respondents suggested that their local maternity unit should remain open; in particular respondents did not want the changes to the services provided by units in Poole and Dorchester (24 comments).

“Don't move the maternity services from Dorchester!!”


“Keep Poole maternity open.”


“Keep the units as they are so that there's not the scary aspect of travelling over an hour to receive labour care!”

(First time expectant mum, 26-30, DT5)

There were also a number of comments which complimented maternity services in Dorset and suggested there wasn’t anything which could be improved (24 comments).

“I personally cannot fault the maternity services I received through all my pregnancies and births.”


“Personally I had a positive experience right from the start, and had the right support when needed through my pregnancy care. Even my husband felt supported by all staff during the pregnancy.”


“Continue what you are doing. I have had three complicated births at DCH and I cannot praise the midwives and team enough to ensure I have delivered healthy babies, and my after care was second to none.”



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Some respondents suggested better support and advice on breastfeeding would improve maternity services (20 comments).

“Provide extra breastfeeding support, both at the hospital and after discharge.”


“More funding to support breastfeeding, FAB is a great service, but surely with the evidence to support breastfeeding more of a priority ought to be put on this.”


“Extra time needs spending on supporting breastfeeding as not all professionals were properly trained in breastfeeding.”


Comments were also related to care from midwives (19 comments). This included suggestions that there should be more midwife led units, all midwives should use and understand the same paperwork, appointments should be more flexible, more time should be spent with midwives in appointments and that midwives could be more understanding to the fact that all women are different and respect their wishes.

“All maternity teams to be using generic paperwork as Poole team were using some paperwork that they knew nothing about in the Blandford area. Should be the same across the country. Even in Poole hospital some of the midwives were from different hospitals and were saying how machines were different than they were used to, paperwork structure was different even catheters were different.”


“Allow midwives to have more time with their couples – they have great knowledge and information to give.”


“Work with the mother at an early stage on birth plans and respect mothers’ wishes. Also some midwives should appreciate that different women have different pain thresholds and listen to what the mother is saying.”


There were suggestions that experiences of labour and postnatal care for both mothers and babies could be improved, particularly for first time mothers in terms of helping them to understand what to expect, reassurance and support (16 comments).

“A little more respect to the mother’s privacy and dignity should be given during labour.”


“All I can say is please ensure that mum's who have had a difficult/traumatic birth (especially first time mums) are given plenty of reassurance after the birth and checked on regularly.”


“Better aftercare and basic help for first time mums. Explanation of what had happened if it was particularly difficult, as that helps to work through things emotionally.”



Some respondents suggested there should be better communication in order to improve maternity services, both among practitioners themselves as well as from practitioners towards mothers and partners (15 comments).

“Communication between consultants could be better; we had wasted appointments as no one knew what the other was doing.”


“Consultants who listen and are willing to accept natural choices.”


“Listen to what mothers want.”(Had a baby in the last 2-5 years, 41+, BH9)

Some comments were related to how services can be improved for those who choose to have a home birth (14 comments). These comments included that parents should not have to bring their baby to be checked in hospital after a home birth, more money should be invested in home birth teams and more information should be available on home birth as an option at an earlier stage in pregnancy.

“Actually the only thing that could be better is when you have a home birth, going up to Dorchester hospital the very next day with your baby to have him/her checked over was pretty rubbish! So maybe having that done at home would be much better in the future.”


“Promote home birth even more strongly. Care from Cygnet team is second to none.”


“Let mothers know how wonderful a home birth can be and how safe it is for your baby and how being in a relaxed environment means your birth can be less complicated. Some mums don't know much about it or realise it's an option.”


Ten respondents suggested the way healthcare professionals handle complications or twin pregnancies could be improved.

“Doctors not to be so quick to intervene with suction cups, forceps, caesarean and anything else invasive. Have faith doctors!”


“The worst aspect for me personally was the approach to the Downs test and my age which made me very uncertain.”


“Ensure midwives know about multiple pregnancy needs and birth or have a dedicated twin midwife.”



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It was also suggested that providing more localised services would improve experience (6 comments).

“More availability to have appointments locally.”


“It would be better to have more accessible services at the local GP instead of having to visit the hospital and pay expensive parking fees all the time.”


“It is vital that all women can access a unit relatively close to home. I was in for 4 days post birth and it would have felt very isolated if it was far from home.”


Finally, four respondents suggested that the advice and support from health visitors could be improved.

“More practical advice available from health visitors.”


“Health visitors who actually support parents and babies, actually turn up to visits and give the correct information.”



Workshops

Engagement events

There were three workshop events held throughout the county, with a total of 57 attendees. The table on the next page shows where these workshops were held and the number of attendees at each.

Table 1: Workshop events attendances

Workshop No. of members of the public

No. of CCG members

No. of health professionals

Total no. of attendees

Dorchester 4 6 11 21Wimborne 2 4 10 16Bournemouth 5 3 12 20Total no. of attendees 11 13 33 57

NHS Dorset CCG held three workshop events to discuss maternity services in Dorset. These workshops gave participants information about the purpose of the review and then participants were given the opportunity to discuss specific issues related to maternity information, personalised care planning and postnatal care.

Whilst common themes emerged from the three workshops, different experiences and suggestions were discussed in each; therefore findings from the three workshops are reported individually, followed by a summary.

Dorchester Workshop, 21 attendees


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One of the main themes that emerged from discussions around maternity information was the importance of the way in which it is communicated. In particular, the discussion focused on ways of making the information easier to understand and more user friendly, in terms of the language that is used and making information available in different formats. It was suggested that professionals should use simpler language, without abbreviations and medical jargon when talking to parents to help them understand.

“Communicate in a way the mother understands.”

“Language - doctors need to explain/speak in basic terms. Need to inform patients, not scare them.”

“Using a balance of right language - user friendly.”

In addition to this, people suggested information needs to be made available in different formats. Suggestions included utilising technology to provide different platforms online, for example providing antenatal classes’ online, social media, online forums and apps, as well as providing more opportunities to get the information during other informal sessions outside of midwife appointments and antenatal classes, such as drop in sessions, information roadshows, coffee mornings and facilitated buddy up schemes.

“Should antenatal classes be online? Not to replace but enhance current service.”

“RELIABLE well administered Facebook/online community.”

“Help people more vulnerable to buddy up - not necessarily at a group, perhaps at home/café.”

“Information roadshow, informal, relaxed, regular.”

Other discussions emphasised the importance of educating mothers effectively by providing all of the information that is needed as soon as possible during pregnancy. In particular some suggested that they would like to receive more information on the options available, for example home births, and risks to them, as well as details of real experiences from other mothers, so they can make their own informed choices. An important aspect of this is to ensure the information that is provided is consistent and accurate so mothers are not left feeling confused.

“I knew home birth was an option but it was never brought up.”

“Pre conception education needed early on - information for accurate understanding as opposed to perceptions.”

“A range of conflicting information/advice - consistency of information advice is key.”

“Need to check information as well as giving information.”



One of the most important things people discussed was to feel supported during their personalised care planning. Mothers emphasised the importance of being able to build a trusting relationship so they feel supported and are able to co-produce plans. Continuity, dignity and feeling valued are all important aspects that were identified which help build trusting relationships that make mothers feel supported.

“Building relationships - time to communicate.”

“Continuity of care is key to personalised care planning.”

“I had a midwife with me and when the doctor came in I met her from between my legs - that's not normally how I greet people.”

In relation to this, the way professionals communicate during personalised care planning was discussed. Parents particularly disliked the use of abbreviations and medical terminology during discussions and suggested these need explaining properly to ensure understanding. In addition to this, parents disagreed with labels or categories such as high risk, and felt these could be communicated and explained more effectively in a way that provides more reassurance.

“Jargon needs explaining and open - important for understanding.”

“We hate T.L.As - Three Letter Acronyms.”

“Communicate 'high risk' without raising anxiety too much but making me aware of the need.”

“Could 'high risk' be renamed as 'enhanced care' with an explanation of why.”

Furthermore, the importance of choice and feeling in control of their pregnancy and birth was discussed. Through the support and advice of professionals, mothers should be made aware of all of the options that are available to them and should feel supported to be able to make their own informed choices so they are in control. Although professionals were cautious that there needs to be a balance between empowering women to make personal choices while also mitigating risk.

“Other options need to be promoted - hypnobirthing, home birth, and water birth.”

“Everyone should know home birth is available.”

“Women need to be in control of their pregnancy.”

“How to manage the balance between accepting a women's autonomy and our knowledge of the risks she might be exposing herself to?”

It was also suggested professionals could be more considerate and supportive of individuality and diversity during personalised care planning, for example by having support workers who speak different languages or understand different cultures.

“How do we get respect for our individuality?”

“Contact churches, mosques etc., must respect their culture. Involve them all.”

“Peer supporters who speak others language and understand their culture.”

“Ask people about cultural differences.”


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Postnatal care

Support was central to the discussion about postnatal care. Mothers felt like there should be more opportunities for them to talk about how they are feeling and coping after birth, and without judgement. This includes allowing mothers to stay in hospital after birth to be around professionals and feel confident before going home, if necessary.

“Opportunity to debrief/counselling/early parenting skills etc.”

“Women feel things just happened to them - want/need to talk about experiences. Opportunity to just talk and not be judged for how they feel.”

“Time in hospital is important for some and needs to be available if needed (afterbirth).”

An important part of postnatal support that was raised is that it needs to be ongoing, and continue even between appointments with midwives or health visitors.

“Feeling lost between appointments - access to local trusted information.”

“Health visitor appointments are too far apart. My depression escalated between visits…”

“Continued support throughout the whole journey.”

People appreciated sources of support such as baby massage courses, antenatal classes, doulas, children’s centres, health visitors, midwives and other mothers. However, there were also suggestions for how to encourage people to use these services more for support or make them more widely available, particularly for more vulnerable people. Suggestions included giving people a reason to attend groups, having doulas from different communities, having access to midwives or classes online or providing opportunities for women to talk and share their experiences.

“Give women who do not feel comfortable attending groups a reason to attend e.g. weighing, massage etc.”

“Doula from other communities to support people.”

“Access to midwives online e.g. IM/ emails Skype /Chatroom.”

“Support vulnerable nervous people to take steps to build relationships.”

The discussion also reflected the importance of education and information, and the way this is communicated to parents by professionals during postnatal care.

“More info given postnatally.”

“How you say things.”


In particular, mothers suggested there needs to be better information and advice about their own emotional wellbeing and mental health.

“Better links with mental health support/guidance - not all mums suffer from post natal depression but do suffer from anxiety.”

“My depression escalated between visits 4 months then 10 months, I had to find help for myself.”

“Mum's need better info regarding postnatal depression & anxiety. Health visitors are too stretched to help.”


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Wimborne Workshop, 16 attendees


The second workshop discussed the information that is provided during and after pregnancy, and suggested this could be simpler, by limiting the use of medical terms and abbreviations, to make it easier for parents to understand. It was also suggested creating an app where all the information is in one place would be of benefit for parents.

“Abbreviations - too many, keep it simple please.”

“Could we have a red book app - always have my phone on me. Could have reminders.”

“Right information, at the right time, in the right format.”


One of the main themes that emerged from discussions about personalised care planning was the way mothers are made to feel during discussions with professionals. A significant part of this is the way professionals communicate with mothers, it is important for them to listen to mothers, and to not be dismissive or patronising towards what they are saying. It was also suggested professionals should use appropriate language that can be fully understood, and will not cause confusion or worry.

“Felt talked down to – tone and language needs to be considered so that they feel heard and not dismissed.”

“Don’t dismiss me with your power.”

“I am a person. I have many jobs, currently I’m making another person in my body. Am I amazing? Can you see that? Do you hear me? Work with me, I’m a person… like you!”

“Language used is so key - e.g. 'you've got a good sized baby!!' What does that mean? How will I get it out?!”


On the other hand, some commented that they felt reassured and put at ease by professionals, in particular during visits to the unit and by being able to meet the team before the birth, or if they were made aware of what to expect if everything doesn’t go according to their plan.

“Meeting the team and a sense of continuity is so reassuring.”

“Good to visit where you want to have birth but also good to have an awareness of where you might go - e.g. choose Bournemouth but need to go to Poole, home birth but end up in hospital.”

In addition, mothers like to feel empowered and in control. In particular, parents would like some reassurance that if plans have to change, the things that are important to them will still be considered.

“Help people to not feel restricted if things change - can't their plans change too, so that they have a wish for each birth option?”

“When things change, please respect the things that are important to me.”

In relation to this, another theme raised during the discussion was the importance of personal choice and preferences for the birth. Parents want to feel that they have free choice over their birthing options, and provision of quality information is vital for enabling parents to make informed decisions that are right for them. Some were grateful for the opportunity to make their own choices, however others felt their wishes were not listened to or a lack of information about things such as home births, risks and pain relief often limited their choices.

“I typed up a loose birth plan (my choices) and colour coded it - things I did not want in dark blue, positive things brighter colours- encourage this, easily seen, clearer.”

“Normalise home birth, encourage women to feel it is normal - does not feel it is equitable across the country.”

“Education, education, education, then let mum decide.”

Finally, some people suggested care planning should be prioritised by professionals, and more time spent on these to ensure personalised choices.

“Prioritise time for care planning to improve personalised choices.”

“Take time to notice the small things!”


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Postnatal care

One of the main themes that emerged from the workshop discussion was that postnatal support available to both mothers and fathers needs to be improved. Mothers emphasised that they need ongoing support, even after they have had their baby; this includes not feeling rushed to leave hospital. As well as mothers, it was suggested there could be greater support offered to dads after their baby has been born.

“Need to support mums post birth - they still matter, they still have choices and still need info.”

“Do not rush mums out of post natal ward if they feel they need to establish breastfeeding.”

“Support for dads - support for dads who take the burden and support the mums struggling.”

The support available for parents who have lost their baby was also discussed. People emphasised the importance of continuing support for the whole family. Suggestions for how services can be more supportive towards these families included having dedicated areas, specialist team for care, ongoing support for siblings, personalised choices, and more joined up services.

“When stillbirth happens can the service be joined up e.g. midwives speak to the health visitors.”

“Loss of a baby – nothing can prepare you, care has to be individualised, all their choice - what the family and parents wanted.”

“Dedicated area – not having to see other people's babies, separate entrance.”

Improvements to the information that is provided to parents about what to expect after birth have also been suggested. Mothers particularly wanted more information that is consistent about what to expect during and after birth, in terms of their own physical recovery as well as how to care for their baby. One suggestion was to have parents attend antenatal classes who can give an insight into their own real experience; meanwhile others suggested that classes specifically for dads would be beneficial.

“Have parents in antenatal classes - tell me how it really is.”

“Antenatal/parenting classes for men, delivered by men.”

“Consistency of message from each sector, midwives, health visitors.”

In addition to this, the approach of some professionals for how they communicate with parents and the language they use could be improved. In particular, how changes to plans are communicated and the use of the word ‘plan’ related to giving birth was discussed.

“How messages are communicated if plans have to change is key - explain why something has to happen.”

“Birth plan - change to birth hopes.”


Comments were also related to choice. Parents wanted to feel confident they can ask for a different health professional if they wish, meanwhile professionals commented that they want mothers to understand that they do have a choice and move away from the assumption that professionals have to give permission for different options.

“Choice of health professional - confidence to ask for a different person if they do not connect.”

“We want people to believe in their choices, their care, to realise they can choose.”

Improvements to the hospital environment were also suggested, including improved cleanliness of wards, involve women when designing new facilities so they are suitable and creating a comfortable environment to allow people to sleep.

“Important to remember that small details make a BIG difference - cleanliness for example.”

“The hospital wants the curtains open but I just want some sleep. There is such a quick turnover I'm not going to be making and friends here anyway, so let me sleep in peace!”


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Bournemouth Workshop, 20 attendees


It was suggested there could be improvements to the information that is provided during and after pregnancy. In particular, it was suggested there is a lack of consistency with the information that is provided by different healthcare professionals. In addition to this, the way in which information is communicated, often through the use of abbreviations and medical terminology, can sometimes cause confusion for mothers and partners who are left to try and understand all of the information. People would benefit from professionals explaining things to them more clearly and slowly so they are able to understand.

“I would sit trying to translate my notes using google - too much use of 3 letter acronyms.”

“Communication methods - won't engage with the methods used by health professionals but will watch every episode on 'one born every minute'.”



Discussions about personalised care planning were centred on communication, how people are made to feel, choice, consistency of information and partnership.

Firstly, it was suggested that communication in maternity services could be more effective, both among healthcare professionals as well as the way in which they communicate with parents. It was suggested that professionals should explain things clearly and ensure parents fully understand and know what to expect, as well as making it comfortable for parents to feel able to ask any questions. Better communication between staff would also make it easier for parents so they do not have to repeat their story to different individuals. As a result of poor communication some discussed the way they are made to feel. In particular, it was suggested staff could listen more without judgement and be more approachable. As well as this, people felt that during their personalised care planning they should be made fully aware of what to expect during labour and after birth, for example labour ward rounds or the possibility of not being able to give birth in the hospital they had planned to.

“Be clear in what you say and check my understanding - being induced at 37 weeks, is that on the day or during the week of?”

“My birth was ok but it was the events surrounding it that were traumatic - I had to repeatedly tell my story to new people.”

“Do not judge - make yourself accessible and approachable.”

In relation to this, some commented on how important it is for them to feel like they have a free choice during their personalised care planning. Attendees wanted to be able to make informed decisions once they were aware of all of the options, recommendations and risks but often felt there was limited choice or that they were pressured into certain choices by professionals. It was also suggested information that is more consistent and communicated more effectively would help these decisions.

“It's not choice if you're only allowed to choose what they want you to do, you get choice when you put your foot down.”

“Making choices as informed decisions - recommendations, listen and weigh up risks, then make decision.”

Furthermore, it is also important that plans are developed in partnership, taking into consideration the opinions of staff, mothers and their partners, in order to create a plan that is personalised and about the individual rather than to comply with set guidelines.

“Develop birth plans together.”

“Partner gets left out. All questions and responses to mum, dad does not get heard or seen.”


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Postnatal care

Discussions about postnatal care in workshop 3 were related to support and advice, flexibility, continuity of care, postnatal ward environment and communication.

One of the main themes that emerged from the workshop discussion was the importance of support and advice from others. Sources of support that mothers find particularly useful include classes and groups, children centres, online groups, home birth teams, midwives and support workers.

“Postnatal groups help you network and build lasting, supportive networks.”

“Children centres are there for everyone.”

“Home birth service fantastic - felt well supported…”

“She sat and really listened. It still makes me emotional to talk about that because it made me feel so supported for the first time (10 days post birth).”

People particularly appreciated the advice they had received on how to care for their baby and breastfeeding.

“Postnatal advice on basic care of looking after a new-born - hints/tips for happy changing, feeding, crying etc.”

“Breast feeding support Dorset on Facebook – information is really useful at 3am in the morning.”

“Breast feeding support at home is a huge help as it can be challenging.”

However, despite the positives many also had criticisms of the postnatal support and advice they had received. A lack of consistency in the advice received from different networks or advice that is not explained clearly causes confusion for parents, meanwhile others felt postnatal services could be more accessible, health visitors could be more supportive or better diversity of staff to support all mothers. Furthermore, the discussion emphasised that support and advice is just as important for fathers/ partners as it is for mothers.

“Do midwives get the same information that mums/dads get in the classes? Seem to have very different ideas at times!”

“Access to services and help in postnatal period needs to be better.”

“Health visitors need to respect others ideas and wishes - mums are very informed and know what they want!”

“How do we empower dads? How do we make sure they are ok after a traumatic birth? Maternity Support workers are really valuable in this role.”


In addition to this, discussions reflected the importance of continuity of care; some relayed positive experiences where they had a dedicated midwife or team whereas others suggested being able to see the same midwife or better handovers between staff would improve continuity and prevent mothers from having to repeat themselves to different people.

“Discharge with named midwife is great for continuity and debrief.”

“The continuity was great in pregnancy but I needed my own midwife postnatally.”

“Document in my notes if you had a conversation and record the details - saves me having to repeat myself.”

“Smaller teams to enable continuity of care.”

Some suggested giving mothers more control over when they and their babies can be discharged from hospital would improve experience of postnatal care. Some wanted to be able to stay in hospital longer allowing them enough time to feel confident before going home; meanwhile others would have liked the option to be transferred elsewhere.

“Don’t send mums home too quickly! It’s scary having a baby to care for. More postnatal beds are needed.”

“Should have the option to transfer elsewhere and out of acute - this would benefit all - free up beds and give those women who need it support.”

Others suggested improvements to the hospital ward environment would better their experience of postnatal care. Suggestions included noise levels, provide more space and privacy, and space for partners to be able to stay.

“Noisy postnatal ward - staff need to be aware that conversations are overheard.”

“Post Natal Ward - Need more space and privacy. Allow dads to stay - change layout to facilitate.”

Workshop summary

The workshops covered a wide range of topics related to maternity information, personalised care planning and postnatal care. Participants provided various examples of what has worked well for them during their own experiences and suggested many ideas for how maternity services can be improved. It should be noted that themes are not exclusive and that all comments from the workshops should be considered.

The most common themes that emerged from discussions about maternity information included communication, consistency and information sources. In all three workshops people commented that the way information is communicated to parents is vital. It was suggested professionals should use simple language, without abbreviations, which is easy for parents to understand. In addition to this, discussions from two of the workshops suggested to improve parents’ understanding, information should be more consistent. Additional information sources, such as apps, social media and informal sessions were also suggested in two of the workshops.

Workshop discussions on personalised care planning were mostly related to communication, the way mothers are made to feel, support, choice and control, information, individuality and diversity, and more time to develop plans. Communication between staff and parents was discussed in all


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of the workshops; all suggesting professionals should listen more and clearly explain things without using medical jargon to ensure parents understand. In relation to this, people in two of the workshops relayed their own experiences of the way they have been made to feel by professionals, while the other workshop discussed the support they had received from professionals, suggesting this could be improved. The importance of choice and control was also discussed in all three of the workshops. It was suggested more could be done by professionals to ensure parents are given accurate and consistent information on all their options and to ensure parents feel fully supported to make their own choices, without feeling pressured into certain options. A discussion from one workshop suggested professionals should be more considerate of individuality and diversity during care planning; meanwhile another workshop suggested parents would benefit from professionals allocating more time to their care planning.

Common themes from the workshop discussions about postnatal care included support, information and advice, communication, choice and control, and hospital environments. People in all of the workshops appreciated the support networks that are currently available to mothers; however they all also suggested improvements. Ideas that were suggested included improving accessibility to postnatal support services, providing continuous support, better support for dads and more support for families who have experienced a loss. Improvements were also suggested for the information and advice that is given to parents by the discussions in all three of the workshops. In particular, people would like better or more information about mental health support, what to expect during labour and after the baby has been born, how to care for their baby and information specifically for dads. Furthermore, two of the workshop discussions suggested the way this information is communicated to parents is just as important, commenting that this needs to be simple and consistent for parents. People in two of the workshops also suggested that they would like more control over things such as how long they can stay in hospital for and what professional they see, meanwhile others in these two workshops suggested improvements to the hospital environment itself, for example restricting noise levels and extra space.


Staff Survey

There were a total of 69 individual responses to the staff version of the questionnaire.

Job Title and Location

Staff were asked to provide their job title and where they work. 52 respondents indicated that they were a midwife (including Community/ Community homebirth/ Homebirth/ Lead/ Safeguarding/ Senior/ Smoking in pregnancy midwives), while 6 indicated that they were a maternity support worker, 3 were a consultant, 4 were in another medical professional role, and 4 were either management or administration/support staff.

18 staff indicated that they work at Bournemouth, Bournemouth Birth Centre, or RBCH. 27 staff work at Poole, Poole Hospital, Poole Maternity Unit, or the Haven Birthing Suite. 11 staff work at Dorchester or DCH, while 7 staff work in either ANDA, ANC, CDS, Labour Ward, PNW or TCU.

Personalised Care Planning

There were a total of 87 comments made by staff in relation to personalised care planning. Of these comments, 47 were related to what works well for them and 40 were suggestions for how personalised care planning can be improved.

The comments for what works well for staff during personalised care planning were related to continuity (13 comments), appointments (11 comments), personalised care and support (7 comments), taking the time to build relationships (6 comments), information (3 comments), home births (3 comments), control (2 comments) and what does not work well for them in personalised care planning (2 comments).


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Staff commented that personalised care planning works well when there is continuity during antenatal care; this is because it allows midwives to build a trusting relationship in order to understand parents’ needs.

“Continuity of care is very important in the antenatal period.”

“Having continuity of midwife throughout the pregnancy so that time can be taken to build a relationship to enable the midwife to understand the patient’s needs.”

Related to this, six members of staff commented that they like to spend time with parents to build that relationship and understand their individual needs.

“Time is paramount – they need to spend time to get to know the client and the needs of her and her family.”

Some members of staff commented on appointments with parents, in particular staff commented on extra appointments to suit individual need and the appointment at 36 weeks (11 comments).

“In an ideal world it should be about personalised care planning and time to meet the women for their 36 week appointment and do a birth plan etc. is a good opportunity to discuss this.”

“Extra antenatal and postnatal appointments to suit individual needs.”

Staff also discussed providing personalised care and support, for example when a woman is considered high risk or additional support with smoking cessation (7 comments).

“Individualised high risk cases being dealt with, plan made following discussion with the Consultant Midwife.”

“Good smoke stop support.”

Other comments for what works well during personalised care planning were related to the information and antenatal classes offered (3 comments), the care provided by the home birthing teams (3 comments) and women being in control of their choices (2 comments).

“All women are offered antenatal classes to opt in to.”

“As a homebirth team midwife I am able to get to know women and have the time to fully explain information to allow them to make informed decisions. I feel the midwife client relationship is better and that women trust me. I am very flexible in regards to timing and days of appointments so women can generally meet me at a time which suits them and their family.”

“A woman can choose her place of birth.”


Suggested ideas to improve personalised care planning were related to continuity (8 comments), allocating more time and discussion to care planning (8 comments), adopting a more personalised approach to accommodate individual needs (7 comments), more information prior to birth to prepare plan (6 comments), better communication (5 comments), consultant care (2 comments), having more staff (1 comment), more choices (1 comment) and more support for those with previous health conditions (1 comment).

Staff suggested there needs to be more continuity during personalised care planning (8 comments).

“Community midwifery care works well when there is continuity of care.”

“Have the same midwife so women are able to build a relationship which enables trust in the service.”

In addition to this, staff would like to spend more time with expectant mothers allowing more discussion to create a suitable plan (8 comments).

“Allow more time to discuss a care plan and birth outcome that's individualised.”

“Time! There is never enough. Women are rushed through appointments with Drs and midwives as services are so stretched.”


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It was also suggested care planning would be improved by adopting a more personalised and flexible approach, including more flexibility with appointments and accommodating for the needs of people who speak different languages (7 comments).

“Some women require longer appointments than others due to complex needs/concerns. It would be beneficial to have extra time with these women. GP surgeries and Children's centres run to fix appointment schedules. To have a little more flexibility, e.g. to add 5 minutes occasionally, will allow for enough time for these families.”

“Better support groups/services for women and families who do not speak English as a first language. Bournemouth is becoming increasingly diverse with a range of ethnicities and social backgrounds.”

Five members of staff suggested that communication between service providers could be improved so that services are more joined up.

“Communication and planning between Bournemouth and Poole could be better.”

“Complete mismatch with service provided in RBH where there seems less accountability for decisions, less consistency and incomplete records (at least for us). This matters as most of the women deliver here and we don't have a good work up of their needs when they come in.”

Other suggestions from staff to improve personalised care planning included better consultant led care (2 comments), more staff to ensure women have real choice (1 comment), offer more choices to women (1 comment) and provide better support for women with previous health conditions (1 comment).

“Clearer support structure for individualised complex care planning. I am generally well supported as a homebirth midwife, but many of my general caseload find their 'consultant led' approach leaves them dissatisfied and asking questions.”

“We need more community staff to enable flexibility for women's choice of place and time of antenatal care.”


Postnatal Care

A total of 89 comments were made by staff in relation to postnatal care. Of these comments, 46 discussed what works well for them while 43 suggested ideas for how postnatal care can be improved.

The staff comments on what works well during postnatal care were related to help and advice with breastfeeding (14 comments), midwife support (10 comments), home visits (9 comments), hospital care (9 comments), support from health visitors (2 comments), not rushing mothers home (1 comment) and what did not go well (1 comment).

A number of staff praised the breastfeeding support that is provided through support workers and feeding team (14 comments).

“There's a good infant feeding team available for support.”

“Breastfeeding support workers in the community. They take a lot of the midwives 'delegable' workload and provide excellent care for the ladies.”

Staff also suggested that postnatal care works well when there is continuity of care with parents seeing one or few midwives, and when midwife appointments are convenient and flexible in terms of location (10 comments).

“When there is continuity of care from a small number of midwives (2-3) from antenatal to postnatal care.”

“Having appointments at local children's centres works well because women don't need to wait in for a midwife to visit.”


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In addition to this, staff commented that being able to visit parents at their home works well during postnatal care (9 comments).

“Women are seen in their own home and can be supported.”

“There is good care at home for women from community midwives and health visiting.”

Nine members of staff commented that the postnatal care provided by hospital staff on wards and in clinics works well.

“Caring staff on the post natal wards.”

“Weekend postnatal clinics (when women want to come in to hospital for a specific appointment).”

Other comments for what works well during postnatal care were related to the support from health visitors (2 comments), and not rushing women to leave hospital after they have given birth (1 comment).

“When there is good communication with Health Visitor team (best if they are located in same geographical area).”

“We also allow women to stay in hospital for as long as they need (within reason). We allow our mums who have babies on SCBU to stay for up to 28 days free of charge.”


On the other hand there were 43 suggested ideas to improve postnatal care. These were related to home visits (11 comments), communication (7 comments), practical support (6 comments), continuity (5 comments), hospital care (4 comments), midwife support (3 comments), breastfeeding support and advice (2 comments), not rushing mothers home after birth (2 comments), other improvements (2 comments) and support for mothers so they are not isolated (1 comment).

A number of staff commented on the home visits that women receive after birth (11 comments). Staff suggested that postnatal appointments should be at home if needed, that there should be more visits and visits should be tailored to individual need with women able to choose when and where they are seen.

“Women are often given appointments in the community at Children centres. It would be nicer for women to receive visits in their home. Especially those with other children and complex needs. However, due to financial cut backs this would be very difficult to achieve.”

“Return to home visits. I find it appalling that women are "dragged" to postnatal clinics a couple of days after birth - especially after an LSCS or traumatic delivery. They may not have slept. In my opinion this is unkind.”


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Seven members of staff suggested communication between staff needs to be improved to better postnatal care. This included suggestions that providing more staff and resources would lead to more joined up services.

“Our documentation is confusing and overly complex compared to previous trusts I have worked in. Documentation and organisation of postnatal care is very paper based (visit sheets etc.) which means things can easily get lost and is quite inaccessible.”

“Reduce fragmentation caused by staff shortages.”

Others suggested that additional practical support about how to care for their baby could be made available after birth to parents who need it, and not just leave mothers to cope on their own if they are struggling (6 comments).

“Give more information for those who want it during antenatal regarding baby's behaviour and care in the early days.”

“Bring back more practical care i.e. bathing baby.”

Five suggested that more continuity of care, by seeing the same midwife where possible or receiving consistent advice from professionals, would improve experience of postnatal care.

“Further improvement could be made to enhance postnatal continuity, perhaps with a named postnatal midwife to act as a contact point.”

“Consistency - same midwife visiting where possible.”

A few suggested that hospital care could be improved; in particular staff suggested more involvement from consultants, as well as making changes to discharge procedures and the hospital ward environment would better postnatal care.

“Too few doctors review women postnatally as a matter of course, only ever troubleshooting often with delays and inconsistent messages by most junior staff. Daily postnatal round of ill or potentially ill women should be done by LW consultant in the morning as routine.”

“Environment - fan in hot weather, refreshments in room, noise on wards to allow people to rest.”

Three suggested that midwives are overstretched and postnatal care and support can sometimes suffer as a result of this.

“Sometimes clinical concerns get missed because MCAs (who are amazing, I must add) do many visits and may not pick up on cues or realise the significance of certain things.”

“NIPEs in the community. They are all being done by community midwives and there are not enough for this workload. Some are being asked to do 6 NIPE examinations in an 8 hour day followed by paperwork all in completely different postcodes. This is too much and a lot of stress for those midwives who have volunteered to do the course.”


Other suggested ideas to improve postnatal care included additional support with breastfeeding (2 comments), more flexibility over when mothers can go home after they have given birth (2 comments), other improvements such as a hub for staff to discuss things (2 comments) and offering additional support to ensure mothers are not isolated (1 comment).

“Breastfeeding support should be more available in the community by way of maternity support workers who train in this area of care.”

“Some women need to spend more time in the unit with support than others, system should give that flexibility.”

“Changing expectations - having women supporting each other more - in a class postnatally or a drop in rather than being isolated.”


Staff were asked to comment on the information that they provide during pregnancy. A total of 48 comments were made. These consisted of 24 comments related to what works well about the information they provide during pregnancy, meanwhile there were 24 suggested ideas for how this information could be improved.

The sources of information that work well during pregnancy according to staff are midwives (8 comments), antenatal classes (8 comments), leaflets (6 comments), home birthing group (1 comment) and mothers doing their own research (1 comment).

Staff felt that the information and advice provided by midwives during pregnancy was particularly good, including the way midwives communicate this information (8 comments).

“When the woman is interested in the subject and the information is given in a manner that she relates to it. I always try to explain the whys of whatever.”

“Discussion face to face with a midwife.”


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Antenatal classes are also a good source of information during pregnancy according to staff (8 comments).

“Classes are offered for preparing for labour, birth and infant feeding, and also specialist classes for teenage/young parents via a specialist midwife.”

“Antenatal classes - lots of info given by midwife - group setting so more topics are discussed as varied group of people etc.”

Six commented that leaflets work well during pregnancy, as long as there are not too many, because these can be referred back to if necessary or can cover things that are missed during appointments.

“There are many leaflets available to women. Ensuring advice is consistent and nothing gets missed in the short appointment times.”

“Some leaflets to jog memory.”

Staff also commented that the home birthing group is a good source of information (1 comments), and also that it is good to encourage mothers to do their own research and provide good sources for this (1 comment).

“I am able to communicate to women that I understand they will access most info themselves on the internet and direct them to legitimate sources of information.”


There were 24 suggested ideas for how to improve the information that is provided during pregnancy. The sources of information staff suggested could be improved included midwives (8 comments), apps and websites (7 comments) and antenatal classes (2 comments). Comments were also related to how the information can be improved; suggestions included provide more consistent information (2 comments), provide less information (2 comments), additional information about complications (2 comments) and more information on how mothers can care for themselves (1 comment).

It was suggested that midwives need to be able to spend more time with women during appointments so they are able to provide more information and discuss this properly (8 comments).

“Difficult to provide all necessary information during antenatal appointments due to short duration, therefore difficult to have a meaningful discussion about topics such as infant feeding. Longer antenatal appointments could be useful e.g. For 36 week birth plan discussion and infant feeding discussion.”

“A bit more time at appointments – there is so much information to give now that 20 minutes is not long enough – maybe have 30 minutes for some antenatal appointments.”

In addition to this, a number of staff suggested providing quality apps and websites with all the information needed during pregnancy would be beneficial (7 comments).

“I think we could have an app with lots of practical information or really good internet links that the woman could access and when she wanted she could have time to discuss her questions with me.”

“In our digital age I think a lot of information is found on the internet so maternity websites/ forums would be a good idea.”


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Two respondents suggested improvements to the antenatal classes that are offered.

“Antenatal classes being part of the children’s centre and working with health visitors to facilitate pre-birth and parenting.”

“I think there is scope to have a parent education midwife or even a parent education support worker to run the classes. As currently we all share and not everyone is passionate about education or good at it.”

Other suggestions were related to how the information itself can be improved. These suggestions included provide more consistent information or have information delivered by one source (2 comments), provide less information (2 comments), provide additional information about complications (2 comments) and more information on how mothers can care for themselves (1 comment).

“I think it would be improved if one person coordinated it with a couple of helpers.”

“Encourage women to view pregnancy as a natural process as sometime s too much information can medicalise the process and increase anxiety.”

“Early pregnancy info re supplements diet etc. as women are not booked until 8-11 weeks and sometimes do not know.”


Respondents to the staff survey were also asked to comment on the information that is provided postnatally. There were a total of 35 comments made by staff; 18 comments were related to what works well and 17 comments were suggestions for how postnatal information can be improved.


The sources of information that staff think works well for mothers postnatally include midwives (6 comments), leaflets and bounty packs (3 comments), websites and apps (2 comments) and peer support (1 comment).

“I have time to ensure women understand info I provide.”

“As above we hand out some fantastic leaflets ensuring consistent advice.”

“Development of ‘padlet’ so women are given consistent information.”

The types of information that staff commented works well after birth include information on breastfeeding (3 comments) and how to care for their baby (2 comments).

“A breast feeding course is offered to all women in pregnancy and the feedback I hear post birth is very positive.”

“I think the information I give regarding baby care and breastfeeding works well.”

There were 17 suggested ideas for how the information that is provided postnatally can be improved. Suggestions to improve postnatal information included providing more personalised and consistent information (7 comments), other suggestions (3 comments), more information on mothers’ own health (2 comments), more information on how to care for their baby (2 comments), midwives (1 comment), publications (1 comment) and online information (1 comment).


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Some staff suggested that continuity is important to ensure parents are receiving consistent information. In addition to this, more personalised information central to the mother would be beneficial (7 comments).

“Continuity could be improved, which would help information to be provided more consistently.”

“Women don't take it all in they just want relevant information to them at the time they need it – you can’t do this unless you see them regularly.”

There were also suggestions that there needs to be more information provided postnatally on mothers’ own physical health and wellbeing (2 comments), how to care for their baby (2 comments) and other aspects, for example smoking cessation (3 comments).

“I believe the information we give re pelvic floor exercise could be better as it seems to me that women are so tired and preoccupied with other things that they neglect this aspect which is so important to their health in the future.”

“I feel more hands-on practical information could be offered. Women go home very early now and they miss out on some essential practical skills from breastfeeding to changing a nappy.”

“We need postnatal smoke stop support as many women go back to smoking.”

A few suggested improvements were related to different sources of information. These comments included information that is provided by midwives (1 comment), written publications such as leaflets or booklets (1 comment) and online sources (1 comment).

“NNEX - copy of NIPE in notes and or red book completed + stats recorded on labour page with time too.”

“Ensure all those women who do not have access to IT are given written information where staff discuss information with them.”


Further Comments

Respondents to the staff questionnaire were asked to indicate what is particularly good about maternity services in Dorset. A total of 39 comments were made by staff. These comments were related to community midwives (17 comments), continuity of care (9 comments), home visits (6 comments), breastfeeding support (4 comments) and home births (3 comments).

Many of the staff who responded to this question praised the work of the community midwives; in particular comments were related to midwives being supportive, experienced and work effectively together as a team (17 comments).

“Midwives are very supportive and will go above and beyond to help women out.”

“Everyone works well together; we have a good friendly team which means happy midwives.”

“The midwives and support workers are working tirelessly with passion and commitment.”

Some staff also felt that continuity of care is particularly good in Dorset, with women often being given a named midwife who they can contact and see regularly, throughout antenatal and postnatal care if possible (9 comments).

“Continuity of care is very good in this area.”

“Continuity of midwife antenatally and ensuring their antenatal midwife sees them once postnatally if feasible.”

Six commented that the home visits are particularly good for women in Dorset.

“Excellent support and time allocated for each visit.”

“Home visits for bookings.”


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Other comments for what staff felt worked particularly well in Dorset were related to the provision of breastfeeding support (4 comments) and the care provided by the home birth teams (3 comments).

“The ability to offer daily contact/visits for those in need of care/support e.g. Breastfeeding support.”

“The existence of the homebirth team service gives women a legitimate choice to homebirth. They generally know the midwife who attends them and appear very satisfied with the service. The homebirth team gives me excellent job satisfaction.”

Respondents were asked to suggest ideas for how maternity services in Dorset could be improved. A total of 30 ideas for improvement were suggested. Suggested ideas included more funding and more staff (7 comments), continuity of care (6 comments), more localised services (6 comments), improve communication (4 comments), additional breastfeeding support (2 comments), midwife support (1 comment), home birth teams (1 comment), more postnatal support (1 comment), more information that is easily accessible (1 comment) and other (1 comment).

Staff suggested that more staff are required in order to provide better maternity care across Dorset. In particular, staff commented that more midwives would mean they are not as overstretched and are able to spend more time with mothers during visits and appointments (7 comments).

“Need more staff to accommodate the women. Women expect a good service but are often rushed by overstretched midwives.”

“More community staff, and not being pulled in to work on the unit when they are short staffed.”


Six suggested that more efforts to ensure continuity of care would improve maternity services.

“Better continuity e.g. via a named postnatal midwife.”

“More attention on improving continuity of the carer.”

It was also suggested that maternity care would improve if services were provided more locally to make them easier to access for parents (6 comments).

“Clinics in more accessible places postnatally.”

“Better use of Children's Centres. More time to spend with women… but still local for women.”

Four members of staff suggested that communication could be improved, both among maternity service providers themselves as well as with mothers.

“Less paper based, use an efficient user-friendly computer based system (which I know we are moving towards). Easier access to guidelines, be able to request scans and lab tests from community. More communication between hospital, ANC and community e.g. notified when someone attends ANDA, outcome of scan or clinic appointment.”

“Text message for women who fail to attend.”

Other suggested ideas for how maternity services in Dorset could be improved included providing additional breastfeeding support (2 comments), improving midwife support by allowing them to spend more time with mothers (1 comment), improve home births (1 comment), better postnatal support (1 comment) and provide more information that is more easily accessible (1 comment).

“More staff to monitor and provide care in the early days to initiate and support breastfeeding.”

“More time allocated to midwives to spend with women.”

“Ready access to advice if concerned.”


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Conclusions

The findings within this report offer a comprehensive overview and analysis of the Better Births in Dorset consultation. The consultation gave people who have experienced maternity services within the last five years in Dorset the opportunity to provide their views on the services they have received or are currently receiving.

Overall, the majority of people felt like they had the opportunity to develop a care plan to meet their individual needs and were satisfied with their experience of this. Most respondents were offered a hospital birth, where others were offered a home birth or maternity led only unit. However, 15% of respondents were not offered a choice of birthplace at all.

Parents were generally appreciative of the relationships they had formed and the support they had received from healthcare professionals during their personalised care planning, particularly the home birth teams. However, better continuity of staff and having professionals who allocate more time to care planning discussions to fully explain things and listen to parents would help form better relationships and make parents feel more supported. Results from the staff survey support the need for more continuity and allocating more time to care planning discussions. Although many respondents were satisfied with the information they had received during their care planning, there are particular areas that parents still felt they needed more information on in order to feel more prepared, including about the options available to them, about the birth itself and what happens after birth. It is also important to parents to be able to make their own choices that are right for them with the support of professionals but without feeling pressured, and to feel in control of their pregnancy and birth.

The majority of respondents were satisfied with their postnatal care. Respondents particularly liked the help and support they had received from midwives and health visitors during their postnatal care, especially during home visits. Staff also indicated that midwife support and home visits work well during postnatal care, as well as support with breastfeeding. However, many mothers felt that additional help and support with breastfeeding would be beneficial, as well as their own mental health and emotional wellbeing. In addition to this, mothers and staff felt that experience of postnatal care would benefit from additional staff on hospital wards or throughout maternity services, who are more understanding to new mothers.

Finally, the majority of respondents felt they had received good quality information and advice throughout their care from maternity services. The most important sources of information to respondents were classes and online maternity websites, meanwhile texts and apps were the least important. During pregnancy the information that both parents and staff find particularly good include the information that is provided by midwives, in antenatal classes and on leaflets. However, parents suggested this information could be improved by making antenatal classes more accessible and available, and by providing more information about the birth itself, how to care for the baby and breastfeeding. After their baby is born parents value the information they receive from midwives and health visitors, particularly about breastfeeding and bottle feeding and how to care for their baby. However, more information on all of these, as well as mothers’ mental health and emotional wellbeing would be useful for parents.

NHS Dorset CCG should consider the views expressed throughout the report in the next stage of service development.


The Market Research GroupFern Barrow Talbot CampusPooleDorsetBH12 5BBUK

t +44 (0)1202 961377e [email protected]

Documents

Maternity services review - HOME • DORSET'S VISION · in the last 2-5 years (50%). Responses were also received by mothers or partners who had their baby in the last 1-2 years (28%),