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Your entitlements when you give birth

Every new parent knows that those first few hours and days are extreme in every way. Not only are you coping with the physical after-effects of the birth, you are managing hormonal ups and downs, learning to connect with this amazing little human who has joined your family, and learning how to parent in a hurry.

If it is your first baby, you will likely have many questions and anxieties. What does it mean when your baby pulls a face, how do you differentiate one cry from another, how often do you have to change the nappy… and why did no one tell you babies were so slippery and wriggly when you try to bathe them and change their clothes!

Breastfeeding comes easily to some, but certainly not to all mums. Those first few days are crucial times to get breastfeeding well established and for mum to feel comfortable when feeding. The support and advice from a trained lactation consultant can be invaluable at this time.

Even if you have given birth before, you will still need guidance and reassurance as every baby is different. And you need to rest, because when you go home, there will be the other family members to tend to and reassure that they are still as important as they were before the new baby arrived.

And rest… it is not called labour for nothing. Giving birth is extremely hard work and mothers need to be able to rest and recover after the birth before they take up the reins again of their new normal lives.

In New Zealand, women are fully funded for 48 hours of postnatal care at the facility of their choice – but not all mothers realise this, and many end up going home from hospital before they are ready. In some maternity wards, new mums are pressured to go home early because they are told there are not enough beds for the number of women giving birth. This results in mums leaving hospital sometimes only hours after having had their baby when they are still recovering after the delivery and they are left floundering in their new role.

So, what makes the first 48 hours so important?

Whether it’s your first, second or third time, becoming a parent is a big transition and those early hours and days are crucial for establishing a close bond between baby and parents.Giving parents the tools to make the right decisions and the opportunity to form a loving, nurturing attachment with their baby is at the heart of postnatal care. The first 48 hours after birth often sets a pattern of interaction that will serve the child and parent for a lifetime. Without a good, loving bond or attachment, children are less likely to grow up to become happy, independent and resilient adults.

When I left the hospital [five hours after giving birth], I felt unimportant, a burden to the system, an inconvenience. I was exhausted, confused, and in shock. We felt like we didn’t have a choice about going home. And ultimately my family and I felt that the system took advantage of our forgiving, tolerant, and accommodating nature.

New mum, Helen

An impaired parent-child relationship can contribute to the development of behavioural, social or learning difficulties in children and make it more difficult for them to fulfil their full potential and become resilient in the face of life’s challenges.

Many first-time parents are left floundering with no social support and little idea of how to cope with the practicalities of having a new baby – bathing, changing, feeding, loads of washing – all on top of minimal sleep plus coping with the after-effects of the birth. Parents often complain that there is a lot of focus on the birth, but not always a lot of information about what to do with a new baby.

While birth is a defining moment, it’s also an emotionally tumultuous time, as many women are vulnerable to mental health problems including anxiety, depression and adjustment disorders. Dads and partners are also affected and need additional support at this time.

There is an idealistic expectation that a woman knows what to do when she becomes a mum, and she has an innate knowledge on how to be a parent. Many women experience the ‘baby blues’, a perfectly normal feeling triggered by physical changes and emotional factors – the transition from mum-to-be to actual mum requires a special type of care and support from trained, dedicated professionals.

Most women who give birth in New Zealand experience no significant medical issues. However, some mothers can experience complications that can have a long-term negative impact on them, their baby and whānau. Receiving the appropriate postnatal care, support and management in a dedicated maternal facility can alleviate and even prevent many treatable conditions that can arise from giving birth.

Three-day bill offers more choices to families

National MP Louise Upston is proposing the New Zealand Public Health and Disability (3 Day Postnatal Stay) Amendment Bill, which would entitle new mums to a minimum of three days of hospital care after the birth of each child, an additional day to the 48 hours currently contracted. The bill would also allow mums to stay longer than 72 hours if needed, and would require the midwife, obstetrician or GP to make sure the mother knows her entitlements.

“I believe mums should have a choice in the kind of care that they opt for, whether that’s in a hospital or at a community or private facility – or at home. I would like to see community care available to all women, no matter where they choose to give birth,” Louise says.

That extra day in a birthing facility could make the world of difference to a new family adjusting to the realities of feeding, bathing, changing and learning to read their new baby’s cues. Louise says the policy is estimated to cost an additional $16–$20 million and would be ring-fenced to prevent health boards putting the money into other areas. This relatively small investment in the welfare of families would seem to be money well spent.

Louise is a passionate advocate for new mothers and their families. Her own first birth was stressful. “I was a solo mum,” Louise recalls, “and the prescribed medication I was taking meant that the risk of fetal abnormality was very high. Doctors recommended a termination and I was under a lot of pressure. I decided to listen to my baby and go ahead with the pregnancy, but it was a stressful time.

“When I went into labour, my father dropped me at the hospital and I was left alone – my mother had passed away and my extended family lived elsewhere so there was no one to support me during the birth. I was fearful. After my baby was born – thankfully healthy – I struggled to breastfeed. I was bloody-minded and refused to go home until I felt I could manage, but it was hard. I just knew I had to stay – but it didn’t need to be so hard.”

When Louise was approached by Mothers Matter, who outlined their work to make sure that women knew they were entitled to 48 hours postnatal care, she took up the cause at a political level and prepared her private member’s three-day bill.

“There is broad cross-party support for improved perinatal care,” Louise says. “I believe we all need to work together – government, NGOs, communities and healthcare professionals – to make the first three days a safe space for mothers and babies.

“I don’t want any mum to go home with their baby without feeling confident.”

Mothers Matter

Mothers Matter is a collaboration of individuals, health professionals and parents who want to ensure all women:

  • Know why postnatal care is important;
  • Understand they are entitled to receive up to 48 hours of funded inpatient postnatal care regardless of the type of birth; and
  • Can choose where they receive that care.

In order to provide optimal maternity care, they are requesting the Government establish a ring-fenced national fund, managed by the Ministry of Health, to support a mother’s right to receive the clinically and psychologically appropriate amount of time (up to 48 hours or longer if clinically indicated) of postnatal care and support at the primary maternity facility of her choice, no matter what kind of birth she has had – whether this is at a hospital, primary maternity centre, or community birthing facility.

They also believe that for women and their families to make an informed choice about postnatal care, they need to know what their entitlement is, and what the benefits are from receiving the right level of postnatal care in the right place.

Leigh Bredenkamp

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