Quality statement 1: Continuity of care

Quality statement

The woman and baby's individualised postnatal care plan is reviewed and documented at each postnatal contact.

Rationale

Postnatal care should be a continuation of the care the woman received during her pregnancy, labour and birth. Planning and regularly reviewing the content and timing of care, for individual women and their babies, and communicating this (to the woman, her family and other relevant postnatal care team members) through a documented care plan can improve continuity of care.

Quality measures

Structure

Evidence of local arrangements to ensure that the woman and her baby's individualised postnatal care plan is reviewed and documented at each postnatal contact.

Data source: Local data collection.

Process

The proportion of women and their babies who have an individualised and documented postnatal care plan, which is reviewed at each postnatal contact.

Numerator – the number of contacts in which the woman and baby's individualised postnatal care plan is reviewed and documented.

Denominator – the number of postnatal contacts.

Data source: Local data collection, for example audit of patient health records.

Outcome

Women's satisfaction with the continuity and content of their postnatal care.

Data source: Local data collection. The Care Quality Commission Maternity services survey 2018 collected information about women's experiences of maternity care.

What the quality statement means for different audiences

Service providers ensure that systems are in place to provide women and their babies with an individualised postnatal care plan, which is reviewed and documented at each postnatal contact.

Healthcare practitioners provide women and their babies with an individualised postnatal care plan, which is reviewed and documented at each postnatal contact.

Commissioners ensure that they commission services in which women are provided with an individualised postnatal care plan, which is reviewed and documented at each postnatal contact.

Women and their babies have an individualised postnatal care plan, which is reviewed and documented at each postnatal contact.

Source guidance

Postnatal care up to 8 weeks after birth (2015) NICE guideline CG37, recommendation 1.1.3 (key priority for implementation)

Definitions of terms used in this quality statement

Postnatal care plan

The individualised postnatal care plan should be documented and developed with the woman, ideally in the antenatal period or as soon as possible after birth. The plan should be comprehensive and include as a minimum:

  • relevant factors from the antenatal, intrapartum and immediate postnatal period

  • details of a named midwife or health visitor, including a 24‑hour telephone number to enable the woman to contact her named healthcare practitioner or an alternative practitioner should he or she not be available

  • details of the healthcare practitioners involved in her care and that of her baby, including roles and contact details

  • plans for the postnatal period including:

    • specific plans for managing pregnancy‑related conditions when they occur, such as gestational hypertension, pre‑eclampsia, thromboembolism, gestational diabetes, postnatal wound care and mental health conditions

    • details about adjustment to motherhood, emotional wellbeing and family support structures

    • plans for feeding, including specific advice about either breastfeeding support or formula feeding

    • plans for contraceptive care.

[Definition adapted with expert group consensus from NICE's guideline on postnatal care up to 8 weeks after birth, recommendation 1.1.3]

Postnatal contact

Women and their babies should receive the number of postnatal contacts appropriate to their care needs. A postnatal contact is a scheduled postnatal appointment which may occur in the woman or baby's home or another setting such as a GP practice or children's centre. Where a woman remains in hospital following delivery, her postnatal care plan should be reviewed on a daily basis until her transfer home and then reviewed at each subsequent contact.

Equality and diversity considerations

Communication and information‑giving between women (and their families) and members of the maternity team is a key aspect of this statement. The individualised postnatal care plan and the information within it should be accessible to women, including women who do not speak or read English and those with additional needs such as physical, sensory or learning disabilities.