A mixed methods study of the postnatal care journey from birth to discharge in a maternity service in New South Wales, Australia

Background: Service gaps continue in hospital and community-based postnatal care despite a high prevalence of physical and mental health concerns reported by women following birth. The aim of this study was to describe the postnatal journey and the care provided to women and their babies who were at low risk for health complications from birth to discharge from the maternity service. Methods: A mixed methods design was used to map the postnatal journey, for the woman and baby, from birth to discharge from the maternity service. Data were collected through activity diaries completed by 15 women and telephone interviews with the women two weeks after birth. Results: The average hospital postnatal stay was 70 h and, in this time, the women received on average, a total of 3 h of direct care from a health professional. That is, 4.3% of the in-hospital postnatal stay was spent interacting with a health professional. Approximately 53 min of care in the postnatal unit was directed at the mother's health, 50 min on the baby's health needs, 43 min supporting breastfeeding and 20 min on discharge information. Most reported that hospital based postnatal care was helpful, although they reported that staff on the postnatal unit were rushed and mostly the midwife caring for them was unfamiliar to them. Breastfeeding support in the first 12-24 h was limited, with women wanting more one-on-one access to midwives. Some women received home-based midwifery care, and on average each home visit by a midwife was 29 min. Women who received home-based midwifery care reported that this care was very helpful. Women reported that home-based midwives were more likely to engage women in conversations about their social and emotional needs than hospital-based midwives. All mothers were offered a home visit from a child and family health nurse and most visited a general practitioner in the first week. Conclusions: Women often experience limited time in direct interaction with midwives in the postnatal unit in hospital. Those who received midwifery care at home were more satisfied with this care, Women are requesting more support from professionals in the early postnatal period.