The Blog

Call the Midwife? It's Time to Up Postnatal Care

Of course, we're told to call a number if we need support or advice. But many women won't. And especially not in the wee small hours of the night. Many will struggle in silence or sink into denial - snapping at a concerned partner or parent that "they're fine".

If you'd asked me a year ago which TV programme I enjoyed watching, I would have said One Born Every Minute. I now cringe at the fact that I ever enjoyed this programme.

As soon as I became pregnant in February 2014 and started on my journey into the realms of labour and birth, I could no longer watch the intervention-fuelled births, the bright clinical environments women were labouring in and the shaking legs hauled up in stirrups. This was far from what I wanted.

Instead, I flicked over to Call the Midwife. A programme that has not only become a nation's favourite (7.1 million of us tuned in for the Christmas Day special), but is also making a profound statement at a time when giving birth at home or in a midwife-led unit, rather than in hospital, is getting positive media attention - thanks to new guidance from NICE.

The invaluable role a midwife plays (or should play) in the care of pregnant women and new mothers within the community is beautifully captured in this BBC drama. But sadly, this is something that has been gradually lost over the decades as births moved into hospitals in the 1970s and away from the community.

Ten weeks ago I gave birth to my beautiful daughter, Molly. I had the birth I wanted and worked for - a calm water birth at my local birthing centre, with no drugs or doctors in sight. Alongside my partner and aunt, who is a midwife and well known advocate for natural birth and who acted as my doula, I was assigned two perfectly lovely midwives.

But neither were 'my' midwife who I saw throughout my pregnancy (when she wasn't on holiday). They knew nothing about my beliefs, values and thoughts surrounding childbirth when I walked through the doors of the birthing centre. I relied on my birth plan, medical notes, my partner and doula to paint the picture... quickly.

This lack of continuity of care, although disappointing, I was prepared for. I knew I couldn't request 'my' midwife to be at my birth. I knew it was highly unlikely that she would be on shift when my time came. I knew I would still receive great midwifery care regardless. But what I didn't know was how little I'd see a midwife in the days and weeks following my baby's birth.

Because I had a straight forward birth, I was lucky to be able to go home the same day as my daughter was born. For me, I was comfortable with this. I had my aunt, with extensive midwifery knowledge, right by my side. But for the average new mother, this can be pretty daunting. You've hardly got to grips with dressing your baby, let alone breastfeeding.

Over the last few decades, the length of time a woman stays in hospital after giving birth has greatly reduced. While to some very welcome (I was more than happy to get home as soon as possible), this change is primarily to reduce costs to the health system - not because of its benefit to mother and baby.

It wasn't uncommon for women who gave birth in the 70s and 80s to stay in hospital for 10 days, with a midwife on call 24 hours a day. Nowadays, women are in and out as quickly as possible. Not always a bad thing, I must stress. But when, in many areas of the country, you only see a midwife three times once you get home - usually day one, day five and day 10 - it can be a very lonely, scary time to many new mothers.

And it's the jump from day one to day five that really shocked me. Day one - the midwife's visit was brief (a midwife I had never seen before - again, no continuity). But actually I was feeling OK, high up on cloud nine and running purely on adrenaline, so I didn't mind that she was in and out quickly. I wanted to snuggle up with my baby. I was in heaven. Utterly shattered but still, in heaven.

As she was leaving, she casually mentioned that someone would be round on Tuesday (four days away). At that point in time, I didn't even blink at this - especially with an experienced midwife for an aunt (and doula) who I had on call night and day. But I now look back on those four long days - when the tiredness creeps in, when your breasts swell, hurt and leak, when the tears flow for no apparent reason, when you have no idea how to soothe this tiny human you're suddenly responsible for - and I'm shocked, actually I'm concerned, that a midwife is nowhere to be seen. Not until day five anyway.

Of course, we're told to call a number if we need support or advice. But many women won't. And especially not in the wee small hours of the night. Many will struggle in silence or sink into denial - snapping at a concerned partner or parent that "they're fine".

They will hit the notorious 'day three blues'. They will sit in tears in a milk-sodden nightie attempting to latch a screaming baby to their tender breast. They will quietly weep, baby in arms, as they pace the floorboards wondering what on earth this baby wants. No wonder so many women give up on breastfeeding or dip into postnatal depression within the first few days after birth. The presence of an experienced, kind, nurturing woman in these times can make a profound difference to a new mother. But many will have to wait four long days.

Looking at the history of midwifery, this hasn't been the case for long. Women I've chatted to from my mother's and grandmother's era recall seeing a midwife every day for numerous days after giving birth, just as you see on Call the Midwife. My aunt told me that when she qualified in 1989, they would visit new mothers twice a day for the first three days and then every day for a week.

I'm aware midwives are currently stretched to their limits. And I can't fault the care and contact I had with any of them. They do an incredible job. It's the system and the model of care that midwifery is currently based on which means many new mothers are left for days unsupported and therefore at risk.

While there is no quick fix solution, I do feel like there needs to be more awareness of this issue. For many women (and men I should add), the days following childbirth are some of the hardest. I was lucky - I had (and still have) a fantastic support circle, access to advice 24/7 and a baby that took to my breast beautifully and had no health problems.

But even a seemingly competent new mother, who smiles and glows, will have wobbles - moments when they doubt themselves, moments when the soreness and tiredness overcomes them - and moments when they simply need a familiar midwife to step through the door with a smile and a hug, and tell them everything is OK.