A state-wide review of hospital postnatal care in Victoria, Australia: The views and experiences of midwives

Objective: to describe midwives' views and experiences of the provision and organisation of hospital-based postnatal care. Design: semi-structured interviews with key informants who provide hospital-based postnatal care. Setting: public hospitals in Victoria, Australia. Participants: clinical midwives and midwifery managers (n=33). Findings: midwives remain positive about working in hospital-based postnatal care; however, their satisfaction is influenced by barriers to effective care beyond their control, which specifically limit the time available to spend with women. They described many constraints on their practice, including the length of hospital stay, inadequate midwife-to-woman ratios, the busyness of postnatal units, and the effect of visitors. Midwives viewed the aims of postnatal care to include education and support of women with breastfeeding and parenting skills, and helping in women's physical recovery after pregnancy and birth. Midwives' perceptions of the factors that influence women's satisfaction with postnatal care are consistent with what we know are women's views: continuity of care, individualised unrushed care, and flexibility in routine practices. Key conclusions and implications for practice: midwives' views and experiences of hospital-based postnatal care are in accordance with women's views and experiences. They are less than satisfied with hospital-based postnatal care, and they perceive a need for individualised, unrushed, flexible care. With evidence from both providers and women about the unsatisfactory nature of the current provision and organisation of hospital-based postnatal care, new approaches to this episode of care need to be explored.