6-8 weeks after the birth, will include feeding issues, mental health, physical recovery, pelvic health and support with any problems that arose during pregnancy such as diabetes and high blood pressure.
This initiative was initially introduced in response to an increase in the number of new mothers suffering from post-natal depression. The new NHS guidance asks GPs to provide personalised postnatal care for the physical and mental health of mothers.
Women have always been offered a newborn check as well as a 6-8 week check. But the new guidance to GPs states that the consultation must be a separate appointment from the baby check and in the invitation to attend, women should be sent an outline of what to expect and what will be discussed. The invitation should be tailored to women’s circumstances to include whether there has been a bereavement/stillbirth.
While investigating medical negligence cases, we know that postnatal care can impact maternal and infant health. Being reminded of the signs and symptoms of newborn illnesses, early reporting of issues with a baby not taking to feeding all leads to avoidable long-term problems.
We also deal with many cases regarding maternal injuries after childbirth with women reporting bleeding, difficulties with bowel and bladder movements as well as pain. Many mothers feel embarrassed to report such symptoms or feel that many are a 'normal' consequence of childbirth. Having the opportunity for a structured consultation with the GP will hopefully provide mothers with the time and opportunity to discuss those issues.
Data from MBRRACE (Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK) shows that maternal deaths are higher in the postnatal period. This is largely because there are now a larger number of women with more complex pregnancies due to pre-existing issues and so this postnatal GP contact provides the opportunity to monitor and provide support and treatment for the women that need it.
A good example of practical ways in which this might help is the guidance reference to postpartum bleeding. Women will have been told that bleeding vaginally is normal after birth but the guidance states that by the time of the postnatal consultation the bleeding should have stopped and if it hasn’t, GPs are to consider this in more detail and if there is heavy bleeding this might suggest retained products of conception which may require a specialist referral.
Given this can lead to medical issues it is important that it is dealt with – we have dealt with cases involving the failure to consider retained products of conception leading to infection, blood loss and surgery. Dealing with something avoidable like this, together with everything having a newborn baby entails is very difficult and also contributes to the increase in levels of post-natal depression for new mothers.
Mental Health has a big focus in the guidance, asking GP to 'Ask about mental health problems. Ask every woman, every time about her mental health. Never assume someone else has already asked her'.
future pregnancies and how best to space these making them feel more able to make decisions for themselves and their families.
All in all the very comprehensive guidance is a hugely positive step – indeed the guidance is titled 'GP six to eight week maternal postnatal consultation – what good looks like' and sets a standard for the care women can expect to receive in those precious early months.
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