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Postnatal care up to 8 weeks after birth [CG37]

Measuring the use of this guidance

Recommendation: 1.1.4

Women should be offered an opportunity to talk about their birth experiences and to ask questions about the care they received during labour.

What was measured: Proprtion of Trusts offering a formal or informal afterbirth/listening service.
Data collection end: December 2017
100%
Number that met the criteria: 54 / 54
Area covered: England
Source: Thomson, Gill; Garrett, Charlotte, Afterbirth support provision for women following a traumatic/distressing birth: Survey of NHS hospital trusts in England, Midwifery, 71, 63-70, 2019. DOI: 10.1016/j.midw.2019.01.004


Recommendation: 1.2.4

Women should be offered information and reassurance on: the physiological process of recovery after birth (within the first 24 hours) normal patterns of emotional changes in the postnatal period and that these usually resolve within 10–14 days of giving birth (within 3 days) common health concerns as appropriate (weeks 2–8).

What was measured: The proportion of women who answered 'yes, definitely' to the question 'Were you given enough information about your own physical recovery after the birth?'
Data collection end: February 2015
57%
Data collection end: February 2017
57%
Data collection end: February 2018
53%
Area covered: England
Source: Care Quality Commission. Survey of women's experiences of maternity care.

What was measured: The proportion of women who answered 'yes, definitely' to the question 'Were you given enough information about any emotional changes you might experience after the birth?'
Data collection end: February 2015
57%
Data collection end: February 2017
59%
Data collection end: February 2018
56%
Area covered: England
Source: Care Quality Commission. Survey of women's experiences of maternity care.


Recommendation: 1.2.22

At each postnatal contact, women should be asked about their emotional wellbeing, what family and social support they have and their usual coping strategies for dealing with day‑to‑day matters. Women and their families/partners should be encouraged to tell their healthcare professional about any changes in mood, emotional state and behaviour that are outside of the woman's normal pattern.

What was measured: The proportion of women who answered 'yes' to the question 'After the birth of your baby, did a midwife or health visitor ask you how you were feeling emotionally?'
Data collection end: February 2015
97%
Data collection end: February 2017
98%
Data collection end: February 2018
98%
Area covered: England
Source: Care Quality Commission. Survey of women's experiences of maternity care.

What was measured: The proportion of women who answered 'yes' to the question 'Were you told who you could contact if you needed advice about any emotional changes you might experience after the birth?'
Data collection end: February 2015
75%
Data collection end: February 2017
78%
Data collection end: February 2018
56%
Area covered: England
Source: Care Quality Commission. Survey of women's experiences of maternity care.


Recommendation: 1.2.23

Formal debriefing of the birth experience is not recommended.

What was measured: Proprtion of Trusts offering an informal afterbirth/listening service.
Data collection end: December 2017
14.8%
Number that met the criteria: 8 / 54
Area covered: England
Source: Thomson, Gill; Garrett, Charlotte, Afterbirth support provision for women following a traumatic/distressing birth: Survey of NHS hospital trusts in England, Midwifery, 71, 63-70, 2019. DOI: 10.1016/j.midw.2019.01.004


Recommendation: 1.2.58

Methods and timing of resumption of contraception should be discussed within the first week of the birth.

What was measured: The proportion of women who answered 'yes' to the question 'Were you given information or offered advice from a health professional about contraception?'
Data collection end: February 2015
92%
Data collection end: February 2017
89%
Data collection end: February 2018
88%
Area covered: England
Source: Care Quality Commission. Survey of women's experiences of maternity care.


Recommendation: 1.3.4

Healthcare professionals should have sufficient time, as a priority, to give support to a woman and baby during initiation and continuation of breastfeeding.

What was measured: The proportion of women who answered 'yes' to the question 'Did you feel that midwives and other health professionals gave you active support and encouragement about feeding your baby?'
Data collection end: February 2015
63%
Area covered: England
Source: Care Quality Commission. Survey of women's experiences of maternity care.

What was measured: The proportion of women who answered 'yes, always' to the question 'Did you feel that midwives and other health professionals gave you active support and encouragement about feeding your baby?'
Data collection end: February 2017
64%
Area covered: England
Source: Care Quality Commission. Survey of women's experiences of maternity care.

What was measured: The proportion of women who answered 'yes, always' to the question 'Did you feel that midwives and other health professionals gave you active support and encouragement about feeding your baby?'
Data collection end: February 2018
63%
Area covered: England
Source: Care Quality Commission. Survey of women's experiences of maternity care.


Recommendation: 1.3.17

Unrestricted breastfeeding frequency and duration should be encouraged.

What was measured: Public Health Outcomes Framework indicator 2.02ii: Proportion of all infants due a 6-8 week check that are totally or partially breastfed.
Data collection end: March 2014
45.8%
Data collection end: March 2015
43.8%
Data collection end: March 2016
43.2%
Data collection end: March 2017
44.4%
Data collection end: March 2018
42.7%
Area covered: England
Source: Public Health England. Public Health Outcomes Framework


Recommendation: 1.4.11

A complete examination of the baby should take place within 72 hours of birth. This examination should incorporate a review of parental concerns and the baby's medical history should also be reviewed including: family, maternal, antenatal and perinatal history; fetal, neonatal and infant history including any previously plotted birth‑weight and head circumference; whether the baby has passed meconium and urine (and urine stream in a boy). Appropriate recommendations made by the UK National Screening Committee should also be carried out. A physical examination should also be carried out. This should include checking the baby's: appearance including colour, breathing, behaviour, activity and posture head (including fontanelles), face, nose, mouth including palate, ears, neck and general symmetry of head and facial features. Measure and plot head circumference eyes; check opacities and red reflex neck and clavicles, limbs, hands, feet and digits; assess proportions and symmetry heart; check position, heart rate, rhythm and sounds, murmurs and femoral pulse volume lungs; check effort, rate and lung sounds abdomen; check shape and palpate to identify any organomegaly; also check condition of umbilical cord genitalia and anus; check for completeness and patency and undescended testes in males spine; inspect and palpate bony structures and check integrity of the skin skin; note colour and texture as well as any birthmarks or rashes central nervous system; observe tone, behaviour, movements and posture. Elicit newborn reflexes only if concerned hips; check symmetry of the limbs and skin folds (perform Barlow and Ortolani's manoeuvres) cry; note sound weight; measure and plot. [2006]

What was measured: The proportion of babies eligible for the newborn clinical physical examination who were tested within 72 hours of birth.
Data collection end: December 2015
93.3%
Number that met the criteria: 126338 / 135400
Data collection end: December 2016
94.9%
Number that met the criteria: 259900 / 311904
Data collection end: July 2017
93.5%
Number that met the criteria: 518595 / 554848
Data collection end: March 2018
95.2%
Number that met the criteria: 595343 / 625368
Area covered: England
Source: Public Health England: National Screening Programme Key Performance Indicators.


Recommendation: 1.4.12

The newborn blood spot test should be offered to parents when their baby is 5‑8 days old.

What was measured: The proportion of babies who are eligible for newborn blood spot (NBS) screening and have a conclusive result recorded on the child health information system by 17 days of age.
Data collection end: March 2018
96.7%
Number that met the criteria: 573645 / 593257
Area covered: England
Source: Public Health England: National Screening Programme Key Performance Indicators.


Recommendation: 1.4.14

A hearing screen should be completed before discharge from hospital or by week 4 in the hospital programme or by week 5 in the community programme.

What was measured: The proportion of babies eligible for newborn hearing screening for whom the screening process is complete by 4 weeks corrected age (hospital programmes-well babies, NICU babies) or by 5 weeks corrected age (community programmes-well babies).
Data collection end: December 2014
97.8%
Number that met the criteria: 606333 / 620128
Data collection end: December 2015
98%
Number that met the criteria: 609298 / 621697
Data collection end: December 2016
98.2%
Number that met the criteria: 620676 / 632189
Data collection end: March 2017
98.4%
Number that met the criteria: 643657 / 654016
Data collection end: March 2018
98.5%
Number that met the criteria: 627458 / 636835
Area covered: England
Source: Public Health England: National Screening Programme Key Performance Indicators.



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