Tailor-made Care for New Mothers

New mothers are to be given personalised “baby plans” under NHS guidelines announced yesterday. The guidance, issued by the National Institute for Health and Clinical Excellence (Nice), and the first to set out national standards of postnatal care for new mothers, applies to women in England and Wales. Hospitals and primary care trusts (PCTs) will need to comply with it or risk a drop in their performance ratings.

Under the guidelines women will work out their individual requirements in the run-up or immediate aftermath of their baby’s birth and receive detailed information on what they can expect from their midwife or health visitor.

Each mother can expect to see a health professional up to five times in the first eight weeks after birth. But those who need more support will be given individual treatment.

Nice, which studies the clinical and cost-effectiveness of treatment, insists that the baby packs will save the NHS £1m a year by 2012 and that the scheme will cost £6.8m a year initially. But the figures fail to take into account the cost of extra health visitors and midwives or the fact that 10,000 more midwives are needed.

Cheryll Adams, a member of the committee which set up the guidelines, said: “You could argue more midwives need to be in place to meet the standards. We have got to have an appropriate workforce.”

The Royal College of Nursing said in a climate of job cuts and deficits, it would be difficult for the standards to be implemented. The guidelines provide a timetable of appointments, including giving the baby a thorough examination within 72 hours, something which has to occur by law but which Nice believes is done insufficiently. Dr David Elliman, consultant paediatrician at Great Ormond Street hospital and member of the guideline committee, said: “In some areas the quality isn’t very good. The training isn’t as good as it might be.”

Great emphasis is placed on breastfeeding in the guidelines. At present, only 22% of mothers still breastfeed by six months, but encouraging the practice would reduce respiratory problems and gastroenteritis among babies.

Advice is also given on how to reduce the risk of cot deaths. Parents are advised never to sleep with their child on a chair or sofa, and not to “co-sleep” in a bed before 11 weeks.

Rona McCandlish, chairwoman of the group that set out the guidelines, said: “This guideline recognises that women, babies and families deserve highest quality care after birth.”

But Carolyn Basak, midwifery and womens’ health adviser at the Royal College of Nursing, said it would be difficult to implement the guidelines in the “current economic climate”.

Dame Karlene Davis, general secretary of the Royal College of Midwives, welcomed the guidance and said she hoped it would serve as a “a constructive start to proper funding” for midwifery.

At present, there are the equivalent of 24,808 full-time midwives, but the RCM says an extra 10,000 are needed.

What they’ll be told

  • Parents should never sleep with their child on a chair or sofa

  • They should not “co-sleep” in a bed before 11 weeks

  • Within 24 hours, mothers should be provided with an opportunity to talk about the birth

  • Within two to six weeks, women should be asked about resumption of sexual intercourse and whether they still have the baby blues

  • Baby’s hearing checks should occur within four to five weeks