THE UK BIRTH CENTRE POSTNATAL EXPERIENCE: ROOM FOR IMPROVEMENT?

Abstract

Introduction: Postnatal care is one of the most neglected areas of maternity care and inadequate postnatal care has consequences for maternal recovery, breastfeeding initiation and continuation, and parent-infant relationships. Little is known about the experience of in-patient postnatal care for those giving birth within an alongside midwife-led unit in the UK. Evolutionary medicine has been used in the past to develop interventions to support evolved maternal-infant biology within clinical postnatal settings. This research aimed to trial an evolutionary-informed intervention (an in-bed bassinet), to improve parent-infant closeness, to facilitate responsive parent-infant care and to understand the experiences of families receiving postnatal care within a UK alongside midwife-led unit.

Methods: Families (n=33) who gave birth to their first infant in an alongside birth centre in the North East of England were randomly allocated either an in-bed bassinet or a standalone bassinet for their in-patient postnatal stay. Video was used to observe caregiver-infant interactions throughout the postnatal stay and assess the influence of bassinet allocation on breastfeeding, parent-infant contact, maternal sleep, and staff presence. Of those who participated, analysable data for 31 participants was collected. Following participation semi-structured interviews were conducted with a subsample of participants (n=25) to understand the acceptability of the bassinet and gather feedback on their postnatal experiences.

Results: There were no statistically significant differences between those allocated an in-bed bassinet versus a standalone bassinet for breastfeeding duration, frequency, or rate per hour. Mothers who were allocated an in-bed bassinet touched their infants significantly more than those allocated a standalone bassinet (p = 0.04), there was no significant difference in maternal or other caregiver holding, maternal sleep or staff presence. Regression analyses indicated that breastfeeding duration throughout the analysed period was associated with time spent in any bassinet (b=-0.213 (95%CI -0.40, -0.03)), prenatal intention to breastfeed (b=39.185 (95% CI 3.158, 75.213)) and maternal education (b=49.757 (95%CI 2.158, 97.357)).
Reponses to the intervention were influenced by families need for rest, recovery, responsiveness, and safety throughout the postnatal period. Both bassinets influenced these themes in different ways, depending on maternal condition following birth and parental values. Overall families appreciated that the in-bed bassinet facilitated responsiveness and allowed them to closely observe their infants. The bassinets did present difficulties with parental rest and unique safety concerns.

Conclusion: The results of this research indicate that the postnatal environment at the study site was hindering maternal postpartum recovery and breastfeeding initiation. Based on the results of the present study this thesis proposes the concept of ‘midwife-led postnatal care’ that upholds the philosophy of midwife-led care throughout the entire peripartum period.