Women who gave birth in New South Wales public hospitals found postnatal care the least satisfactory part of their experience, the first detailed survey of its kind has found.
Experts say the findings reflect the importance of continuity of care, including having one midwife or obstetrician working with women from pregnancy through to the weeks after birth.
The Bureau of Health Information developed the survey in conjunction with the Kolling Institute, and received responses from 4,739 women – almost one in 20 of those who gave birth in NSW public hospitals in 2015.
Most women reported a positive experience, the survey found, with 79% of respondents saying they would speak highly about the hospital where they had their baby.
But women responded more positively about their experiences during labour and birth, and less positively about postnatal hospital care, a finding consistent with surveys in other jurisdictions and around the world.
About one-third of women said that after giving birth, they received conflicting advice about feeding their baby (32%) or about caring for themselves or their baby (32%).
Women who gave birth to their first baby and women who had a caesarean section responded to many survey questions less positively. Of first-time mothers, 76% said postnatal hospital care was “very good”, compared with 81% of women who had given birth before. And just 54% of new mothers felt they had been given complete information about how to care for themselves and their baby before leaving hospital.
Most survey respondents (80%) said their length of stay in hospital was “about right” compared with 13% who felt their stay was “too short”. Almost 30% of women said they were not given advice during antenatal visits about healthy weight gain, and about one in 10 said they were not told about the risks of alcohol consumption or exposure to tobacco smoke.
Responses from women who gave birth in southern NSW were significantly more positive than the overall state results. At a hospital level, responses were most positive for Ryde hospital in Sydney and Wyong hospital on the central coast. Responses were least positive for Fairfield in western Sydney.
The chief executive of the Bureau of Health Information, Dr Jean-Frederic Levesque, said the survey was conducted to establish whether the maternity care received by women in public hospitals was in line with their expectations so that hospitals could improve.
“We wanted to give women a voice and to see how engaged they felt with their own care,” he said.
While some of the more poorly rated hospitals saw higher proportions of women from diverse cultural backgrounds, including women who spoke English as a second language, as well as higher proportions of women from lower socioeconomic areas, others with a similar demographic of patients, such as Ryde, performed exceptionally well.
“What we see is that there are hospitals providing excellent care to women regardless of their cultural background or socioeconomic status,” Levesque said.
But the head of the Australian Medical Association, obstetrician Dr Michael Gannon, said there might be some bias in the survey towards women with English as a first language because they would have been more likely to have responded to the survey.
But he said it was a nonetheless a strong survey that highlighted the importance of continuity of care, with those hospitals offering such care rated more highly across all categories, including postnatal care.
“Whether that continuity comes from having the same obstetrician or the same midwife, it is extremely important to women and it makes them feel safer and more comfortable,” Gannon said.
“Midwives are very effective at looking after women with high risk of complications at birth, so long as hospitals with midwife-led models of care understand that a low-risk birth can turn into high-risk birth very quickly. So there must be very clear referral guidelines in place to get women to emergency and an obstetrician if something goes wrong.”
A professor of midwifery at Western Sydney University, Hannah Dahlen, said the lack of satisfaction with postnatal care reflected international findings.
Few women had access to continuity of care models despite findings that it led to more positive experiences throughout and after pregnancy, she said.
“What clearly jumps out from the findings of this survey are Ryde and Wyong hospitals, where women are overwhelmingly more satisfied,” she said. “It is no coincidence that both have 100% continuity of midwife care, from pregnancy through to after birth,” Dahlen said.
“That should be a clear message to governments, hospitals and health districts that these models work and must be supported.”
