Having a baby in Scotland 2013: Women's experiences of maternity care

4. Chapter 4: Care after Birth in Hospital and at Home: Postnatal Care

Summary of key results

• Length of time in hospital after the birth - 77% of women said that the length of time they spent in hospital after the birth of their baby was about right.
• Information and explanation - 61% of women were always given the information and explanations they needed while in hospital after the birth of their baby.
• 28% of women said they were only sometimes and 5% said they were not treated with kindness and understanding.
• Cleanliness - 69% reported that their postnatal ward and 60% that their toilet facilities were very clean.
• Infant feeding - 63% of women said that midwives and other health professionals always gave them active support and encouragement about feeding their baby and 57% said that they always received consistent feeding advice.
• Continuity of care - 98% of women saw a midwife for their postnatal care at home, 51% of these women saw the same midwife for all, or most of their postnatal care at home. 44% of women said that they saw the same midwife for antenatal and postnatal care either all or most of the time.
• Listening to women - 78% of women said that they always felt listened to and that their personal circumstances were always taken into account.
• Information - 64% said that they were definitely were given enough information about their own recovery after birth.
• Thinking of the six weeks following birth - 78% of women said that they definitely received help and advice about their baby's health and progress.
• Emotional changes - 59% said that they were given enough information about the emotional changes they might experience.
• How women rated the care they received after the birth of their baby; 52% of women rated the care they received in hospital as excellent and 31% as good. 58% of women rated the care they received at home as excellent and 33% as good.

Postnatal care

4.1. The early postnatal period is the time when most women are recovering from birth and getting to know their new baby. While women have very different care needs all women need care and support in the early days and weeks after giving birth to assist them in their recovery, to develop or renew confidence in their parenting skills and to establish infant feeding. This is essential if babies are to get the best possible start to their lives.³⁴ To do this all new mothers need appropriate and timely advice tailored to their own needs as well as support and kindness from staff. Other surveys have found that during the postnatal period of maternity care some women may experience conflicting advice and lack of continuity of care and social support.^{12, 35} A Refreshed Framework for Maternity Care in Scotland⁶ identifies key principles for high quality postnatal care recommending that postnatal care, both in hospital and at home, should be tailored to women's individual needs and that all women should receive timely and consistent advice. Women should be given the information they need about the physiological and emotional changes that they may experience as well as advice about their own wellbeing and about their babies' health.

Postnatal care in hospital - Length of stay in hospital after the birth

4.2. The length of time that women in Scotland remain in hospital after giving birth has decreased by around one day on average, over the last ten years (http://www.isdscotland.org/Health-Topics/Maternity-and-Births/Births/). The length of postnatal hospital stay will be affected by factors such as the type of birth women experience (i.e. caesarean section or normal vaginal birth), women's choice and hospital policy. Women were asked how long they remained in hospital following the birth of their baby and whether they felt this was too long, too short or about right for them.

4.3. The survey found that 27% per cent of women reported that they left the hospital within 24 hours of giving birth with a further 36% reporting that they remained in hospital for one or two days (Table 23).

4.4. There was wide variation between health boards and between mainland and island boards for length of postnatal hospital stay. NHS Fife had the highest rate of women who left hospital within 24 hours (48%) compared to NHS Greater Glasgow and Clyde where 21% of women reported leaving hospital within 24 hours of birth. Although there was wide variation in length of hospital stay, the majority of women (77%) said that the length of time they spent in hospital after the birth of their baby was about right (Table 23).

Table 23: Length of stay in hospital after birth

Question: How long did you stay in hospital after your baby was born?
	Per cent	Frequency (n=2,311)	Confidence interval (%)
Up to 12 hours	11	250	9.6	11.7
More than 12 hours but less than 24 hours	16	384	15.1	17.7
1 to 2 days	36	845	34.7	38.2
3 to 4 days	25	566	23.4	26.5
5 or more days	12	266	10.4	12.7
Question: Looking back, do you feel that the length of your stay in hospital after the birth was...
	Per cent	Frequency (n=2,261)	Confidence interval (%)
About right	77	1,743	75.2	78.3
Too long	14	294	12.4	15.0
Too short	10	224	8.5	10.6

Care, information and advice

4.5. The survey found that over 50% of women remain in hospital for less than three days after the birth. During this short period mothers and their babies will receive essential assessments of their health and wellbeing and mothers should receive the information, support and advice that they require to care for themselves and their babies when they return home. Women were asked whether they were given the information and explanations that they needed and if they were always treated with kindness and understanding while in hospital after the birth of their baby.

4.6. The survey results suggest that some women are not always receiving the support and advice that they needed at this time. Only 61% of women said they were always given the information and explanations they needed (Table 24) ranging from 55% of women in NHS Grampian to 74% of women in NHS Fife and 88% of women resident in the Western Isles. Sixty-seven per cent of women said that they were always treated with kindness and understanding. However 28% said sometimes and 5% said that they were not (Table 24).

Table 24: Care, information and advice

Question: Thinking about the care you received in hospital after the birth of your baby, were you given the information or explanations you needed?
	Per cent	Frequency (n=2,311)	Confidence interval (%)
Yes, always	61	1,436	59.4	62.9
Yes, sometimes	30	684	28.6	31.9
No	9	191	7.5	9.6
Question: Thinking about the care you received in hospital after the birth of your baby, were you treated with kindness and understanding?
	Per cent	Frequency (n=2,316)	Confidence intervals (%)
Yes, always	67	1,580	65.4	68.8
Yes, sometimes	28	630	26.4	29.7
No	5	106	4.0	5.6

Hospital environment

4.7. Postnatal care within the maternity unit should always be provided in a safe and clean environment. Women were asked to rate the cleanliness of their hospital room/ ward and bathroom and toilet facilities. Almost all women (97%) reported that their room or ward was either very clean or fairly clean and 94% said the toilets and bathrooms they used were either very or fairly clean (Table 25).

4.8. For mainland boards women in NHS Fife were more likely to report that their hospital room/ward was very clean (89%) and that the toilet and bathroom facilities were very clean (86%) compared to 58% and 47% respectively for women in NHS Grampian. All the women in NHS Western Isles reported that the hospital room/ward was very clean (100%) and 88% that toilet and bathroom facilities in the hospital were very clean.

Table 25: Hospital environment

Question: Thinking about your stay in hospital, how clean was the hospital room or ward you were in?
	Per cent	Frequency (n=2,307)	Confidence interval (%)
Very clean	69	1,626	67.6	70.9
Fairly clean	28	624	26.7	29.9
Not very clean	2	46	1.5	2.5
Not at all clean	1	11	0.2	0.8
Question: Thinking about your stay in hospital, how clean were the toilets and bathrooms you used?
	Per cent	Frequency (n=2,301)	Confidence interval (%)
Very clean	60	1,426	58.4	61.8
Fairly clean	34	744	32.1	35.5
Not very clean	5	100	3.8	5.4
Not at all clean	2	31	1.0	2.0

How women rated their postnatal care in hospital

4.9. Overall 83% of women rated the care they received in hospital after the birth of their baby as either excellent or good (Figure 6) ranging from 77% in NHS Greater Glasgow and Clyde and NHS Grampian to 93% in NHS Borders.

Figure 6: Overall rating of postnatal care in hospital

Infant feeding

4.10. Establishing competence and confidence in infant feeding is a key element of parenting in the earliest days and weeks following birth. The rate of breastfeeding in Scotland has remained below recommended levels,³⁶ and improving the rate of successful breastfeeding across Scotland is a key target for health improvement. Previous research suggests that women often report receiving conflicting advice and lack of support to assist them to establish infant feeding³⁵ and this may apply to women who have chosen formula feeding as well as those who wish to breastfeed their baby. All women should receive the information, support and advice that they need to establish their choice of infant feeding whether they are breast or formula feeding their baby.¹⁶

4.11. The survey asked women whether they felt that they had received relevant information about feeding their baby from midwives or their midwifery team (this could have included midwives and maternity support workers), before they gave birth. The majority of women (68%) reported that they definitely had (Table 26) ranging from 62% in NHS Lothian to 82% in NHS Dumfries and Galloway and 83% in NHS Western Isles. However, 32% of women overall, said no, or only to some extent.

Table 26: Antenatal information about infant feeding

Question: During your pregnancy did midwives or the midwifery team provide relevant information about feeding your baby?
	Per cent	Frequency (n=2,212)	Confidence interval (%)
Yes, definitely	68	1,528	66.7	70.2
Yes, to some extent	26	573	24.6	28.0
No	5	111	4.4	6.1

4.12. Women were asked how their baby was fed in the first few days after birth. Almost half of women reported that their baby had been fed breast milk only during the first few days (Table 27). For mainland boards this ranged from 40% in NHS Forth Valley to 61% in NHS Highland, for island health boards the range was 65% for women resident in Western Isles to 87% for women in Shetland.

4.13. Women who said that their baby was formula fed were asked whether they had put their baby to the breast on even one occasion. Of these women only 23% said that they had ever put their baby to the breast.

Table 27: Infant feeding

Question: In the first few days after the birth how was your baby fed?
	Per cent	Frequency (n=2,340)	Confidence interval (%)
Breast milk (or expressed breast milk) only	49	1,176	46.8	50.4
Both breast and formula (bottle) milk	21	475	19.4	22.3
Formula (bottle) milk only	30	669	28.1	31.4
Other	1	19	0.5	1.1
Not sure	0	1	0.0	0.1
Question: Did you ever put your baby to the breast (even if it was only once)?
	Per cent	Frequency (n=687)	Confidence interval (%)
Yes	23	152	19.3	25.8
No	77	535	74.2	80.7

Infant feeding - support and advice

4.14. Women were asked whether they felt that their feeding decisions were respected by staff and whether they always received the active support and encouragement that they required about feeding their baby. Finally, they were asked whether they felt that they were always given consistent advice about infant feeding. These questions referred to women's experience of care both in hospital and at home following the birth.

4.15. While the majority of women (82%) reported that their feeding decisions were always respected by staff, women were not so positive about feeding support and advice received. Thirty-seven per cent of women said that they felt that they either only sometimes, or did not receive support and encouragement about feeding their baby (Table 28).

4.16. Only 57% of women reported always receiving consistent advice about feeding their baby. Twenty-seven per cent reported only sometimes, and 16% said that they did not receive consistent feeding advice (Table 28). For mainland boards the proportion of women reporting always receiving consistent advice ranged from 51% in NHS Lothian to 70% in NHS Fife. For women resident in island health board areas this ranged from 52% in NHS Shetland to 77% in NHS Western Isles.

Table 28: Were your feeding decisions respected by staff?

Question: Were your decisions about how you wanted to feed your baby respected by staff?
	Per cent	Frequency (n=2,314)	Confidence interval (%)
Yes, always	82	1,902	80.5	83.3
Yes, sometimes	15	339	13.6	16.1
No	3	73	2.6	3.9
Question: Did you feel that midwives and other health professionals gave you active support and encouragement about feeding your baby?
	Per cent	Frequency (n=2,186)	Confidence interval (%)
Yes, always	63	1,397	61.0	64.7
Yes, sometimes	26	568	24.8	28.1
No	11	221	9.5	11.9
Question: Did you feel that midwives and other health professionals gave you consistent advice about feeding your baby?
	Per cent	Frequency (n=2,141)	Confidence interval (%)
Yes, always	57	1,228	55.0	58.8
Yes, sometimes	27	581	25.6	29.0
No	16	332	14.4	17.2

Care at home after the birth

Continuity of care

4.17. Current maternity care guidance advises that following discharge from hospital women will continue to receive care from a midwife or midwifery team until at least ten days following the birth and for as long as necessary thereafter.⁸ During this time most women will receive three or four home visits from a midwife. After around ten days the midwife will usually transfer responsibility for care of the mother and baby to a health visitor who may visit or provide health advice and information via a local clinic.

4.18. Continuity of midwifery care is key element of high quality maternity care and an aspect of care that is as important in postnatal care as at other stages of a woman's maternity care journey. Scottish Government maternity care policy⁶ recommends that during their postnatal care at home women should receive continuity of care, ideally from their named midwife.

4.19. Almost all women said that they had been visited at home by a midwife following the birth of their baby (98%; Table 29); this ranged from 94% to 99% of women in the mainland boards .

4.20. Women who said that they were visited by a midwife were then asked to recall roughly how many times they saw a midwife after they went home. About half of the women were visited three to four times by the midwife (50%; Table 29). These women were asked whether they saw the same midwife at every visit, and whether this was their named midwife. Fifty-one per cent said that they saw the same midwife at all or most visits. In NHS Tayside 41% of women said they saw the same midwife at all or most visits compared to 70% in NHS Fife. Overall 47% of women said this was their named midwife ranging from 25% in NHS Tayside to 63% in NHS Fife (Table 29).

4.21. Women were also asked whether they saw the same midwife for both antenatal and postnatal care; 44% of women said that they did either all or most of the time ranging from 27% in NHS Tayside to 58% in NHS Fife. Twenty-eight per cent of women did not see the same midwife for their care before and after birth, but would have liked to have done while 28% said that they did not mind not seeing the same midwife for both antenatal and postnatal care (Table 29).

4.22. Finally women were asked whether they would have liked to have seen a midwife more or less often. While the majority of women said that they saw a midwife as much as they wanted, 16% said that they would have liked to have seen a midwife more often. Only 3% of the women would have liked to see the midwife less often (Table 30).

Table 29: Continuity of care: Postnatal care by midwife/midwifery team

Question: Since your baby's birth have you been visited at home by a midwife?
	Per cent	Frequency (n=2,341)	Confidence interval (%)
Yes	97	2,269	96.4	97.6
Yes, but I had to contact them to ask them to visit	1	22	0.6	1.4
No, I visited the midwife or saw a midwife in a clinic	<0.5	7	0.1	0.4
No, I was not offered a visit	<0.5	1	0.0	0.1
No, I was visiting or staying near my baby in a neonatal unit (NNU, NICU, SCBU)	1	37	1.0	1.9
No, for another reason	<0.5	5	0.1	0.4
Question: How many times in total did you see a midwife after you went home?
	Per cent	Frequency (n=2268)	Confidence interval (%)
1 to 2	9	208	8.2	10.4
3 to 4	50	1,104	48.1	51.8
5 to 6	26	614	24.8	28.0
7 times or more	14	342	13.1	15.6
Question: If you saw a midwife for your care at home after birth, did you see the same one every time?
	Per cent	Frequency (n=2,254)	Confidence interval (%)
Yes, every time	17	378	15.8	18.6
Yes, most of the time	34	763	32.3	35.8
No	49	1,113	46.9	50.6
Question
Question: Was this your named midwife?
	Per cent	Frequency (n=1,646)	Confidence interval (%)
Yes	47	761	44.7	49.1
No	53	885	50.9	55.3
Question: Did you see the same midwife for both your antenatal and postnatal care?
	Per cent	Frequency (n=2,308)	Confidence interval (%)
Yes, always	10	218	8.6	10.8
Yes, most of the time	34	793	32.6	36.1
No, but I would have liked to	28	632	26.4	29.7
No, but I did not mind	28	665	26.3	29.6

Table 30: How often would you have liked to see a midwife?

Question: Would you have liked to have seen a midwife...
	Per cent	Frequency (n=2,331)	Confidence interval (%)
More often	16	351	14.3	16.9
Less often	3	81	2.8	4.1
I saw a midwife as much as I wanted	81	1,899	79.5	82.4

Accessibility of services

4.23. At home following the birth of their baby all women need to have timely access to maternity care services if they need advice or support. Women were asked whether they had a telephone number for a midwife or midwifery team that they could contact when they were at home after the birth of their baby. Women who said that they had tried to contact a midwife or midwifery team were then asked whether they were given the help that they needed.

4.24. Almost all women reported that they did have a telephone contact number (98%) and this was the case across all health board areas. The majority of women who used this number reported that they were always given the help that they needed (86%; Table 31).

Table 31: Accessibility of services at home following the birth of a baby

Question: When you were at home after the birth of your baby, did you have a telephone number for a midwife or midwifery team that you could contact?
	Per cent	Frequency (n=2,318)	Confidence interval (%)
Yes	98	2,273	97.6	98.6
No	2	45	1.4	2.4
Question: If you contacted a midwife or midwifery team were you given the help you needed?
	Per cent	Frequency (n=1,418)	Confidence interval (%)
Yes, always	86	1,225	84.5	87.9
Yes, sometimes	10	138	8.4	11.4
No	2	31	1.5	2.9
No as I was not able to contact a midwife	2	24	1.0	2.3

Woman centred care

4.25. Patient centred care is one of the key indicators of care quality care described in the Scottish Government Healthcare Quality Strategy.²⁰ All women have different needs for care, advice and support following the birth of their baby and some of these may only become apparent after the mother and baby return home. It is important that the care women receive at this time is tailored to their own needs (i.e. women centred). In this section of the report aspects of women centred care included; being listened to, having personal circumstances taken into account in being given advice, and being asked about emotional and physical wellbeing and recovery. Women were asked if they felt that the midwife or midwives that they saw always listened to them and if they felt that they took their personal circumstances into account when giving advice.

4.26. Overall 78% of women said that they always felt listened to (Table 32) although there was some variation between health boards, with 66% of women in NHS Borders reporting always feeling listened to compared to 89% in NHS Highland. Seventy-eight per cent of women said that their personal circumstances were always taken into account when being given advice and this was fairly consistent across mainland boards, ranging from 72% in NHS Borders to 88% in NHS Fife and NHS Western Isles.

Table 32: Women centred care - being listened to

Question: Did you feel that the midwife or midwives that you saw always listened to you?
	Per cent	Frequency (n=2,323)	Confidence interval (%)
Yes, always	78	1,814	76.5	79.5
Yes, sometimes	19	440	17.6	20.4
No	3	69	2.4	3.7
Question: Did the midwife or midwives that you saw take your personal circumstances into account when giving you advice?
	Per cent	Frequency (n=2,052)	Confidence interval (%)
Yes, always	78	1,613	76.6	79.9
Yes, sometimes	19	377	17.1	20.2
No	3	62	2.4	3.8

4.27. Almost all women (96%) said that a midwife or health visitor asked how they were feeling emotionally (Table 33) and this this was consistently the case across all health boards. However, when asked if they were given enough information about their own recovery after the birth only 64% said that they were definitely given enough information, with wide variation between health boards (53% of women in NHS Borders to 75% in NHS Highland and 81% in NHS Western Isles). Overall, 28% of women said only to some extent and 8% said no (Table 33). Almost all women reported that they were told that they would need to arrange a postnatal check-up of their own health (Table 33).

Table 33: Advice and support from midwifes/heath visitors about women's health after the birth of their baby

Question: Did a midwife or health visitor ask you how you were feeling emotionally?
	Per cent	Frequency (n=2,274)	Confidence interval (%)
Yes	96	2,176	94.8	96.4
No	4	98	3.6	5.2
Question: Were you given enough information about your own recovery after the birth?
	Per cent	Frequency (n=2,299)	Confidence interval (%)
Yes, definitely	64	1,480	62.5	66.0
Yes, to some extent	28	646	26.5	29.7
No	8	173	6.6	8.6
Question: Did a midwife tell you that you would need to arrange a postnatal check-up of your own health? (Around 4-8 weeks after the birth)
	Per cent	Frequency (n=2,260)	Confidence interval (%)
Yes	93	2,094	91.7	93.7
No	7	166	6.3	8.3

4.28. Women were asked if they had trust and confidence in the midwives and midwifery team that they saw after they went home and while the majority of women (78%) reported always having trust and confidence, ranging from 70% in NHS Lanarkshire to 87% in NHS Highland and 91% in NHS Shetland. It is concerning that 19% of women overall, said that they only sometimes did, while 3% of women said no (Table 34).

Table 34: Confidence and trust in midwives/midwifery team after going home

Question: Did you have confidence and trust in the midwives and midwifery team you saw after going home?
	Per cent	Frequency (n=2,315)	Confidence interval (%)
Yes, always	78	1,813	76.3	79.3
Yes, sometimes	19	428	17.5	20.4
No	3	74	2.6	3.9

In the six weeks after birth…

4.29. The survey asked women about their experience of care in the six weeks following the birth of their baby. During this time the responsibility for care and support for the majority of women will have been transferred from the midwife to the woman's health visitor and to the continuing care of the GP.⁸

4.30. Women were asked whether during the six weeks following the birth of their baby they received help and advice about feeding their baby and about their baby's health and progress. They were asked whether they were given enough information about emotional changes that they might experience and if they were offered advice about contraception.

4.31. The survey found that there was considerable variation in the advice and support women received. While most (78%) said that they definitely received help and advice about their babies health and progress, less said that they definitely received advice and help about feeding their baby (67%). While almost all women said that they received contraceptive advice (92%), only 59% said that they were given enough information about the emotional changes they might experience, 30% of women said that they only received this information to some extent, and 11% reported that they did not receive this important information (Table 35).

Table 35: Help and advice in the six weeks after the birth

Question: In the six weeks after the birth of your baby did you receive help and advice from a midwife or health visitor about feeding your baby?
	Per cent	Frequency (n=2,000)	Confidence interval (%)
Yes, definitely	67	1,353	65.5	69.3
Yes, to some extent	26	509	24.0	27.5
No	7	138	5.8	7.8
Question: In the six weeks after the birth of your baby did you receive help and advice from health professionals about your baby's health and progress?
	Per cent	Frequency (n=2,241)	Confidence interval (%)
Yes, definitely	78	1,758	76.4	79.5
Yes, to some extent	20	438	18.5	21.6
No	2	45	1.5	2.5
Question: Were you given enough information about any emotional changes you might experience after the birth?
	Per cent	Frequency (n=2,197)	Confidence interval
Yes, definitely	59	1,308	57.1	60.8
Yes, to some extent	30	660	28.5	31.9
No	11	229	9.6	12.0
Question: Were you given information or offered advice from a health professional about contraception?
	Per cent	Frequency (n=2,295)	Confidence interval (%)
Yes	92	2,124	91.5	93.4
No	8	171	6.6	8.5

Overall rating of care at home after the birth

4.32. Asked to rate the care that they received at home after the birth of their baby, 58% of women rated their care as excellent and 33% said their care was good (Figure 7). When comparing the mainland boards 97% of the women in NHS Dumfries and Galloway described their care at home after their birth as excellent or good, compared to 86% of the women in the NHS Borders and NHS Lanarkshire. Of the island boards women in NHS Shetland were more likely to report their care at home after the birth of their baby as excellent or good (94%), compared to 88% of the women in NHS Western Isles and NHS Orkney.

Figure 7: Overall rating of care at home after birth

Conclusions Postnatal care

4.33. Care in hospital after the birth was rated lower than the other stages of maternity care. This is a similar finding to other surveys that have reported women as less satisfied with postnatal care.^{12, 35} This survey focussed on three main aspects of postnatal care in hospital; cleanliness, information and advice, and kindness and understanding. The findings of the survey do not provide an explanation of which particular aspects of maternity care in hospital contributed to the overall lower rating of care and other factors may have been involved. However, almost 40% of women said that they were not always given the information and explanations they needed and one third felt that they were only sometimes or that they were not, treated with kindness and understanding. Postnatal care in hospital is generally provided in a context of time and workload pressure. The survey found that 27% of women were discharged home less than 24 hrs and over 60% within 48 hours of giving birth. This rapid turnover means that it is likely that admission and discharge procedures will take up much of the staff time available. During the short postnatal hospital stay a considerable volume of health assessments, advice and education have to be delivered by a range of care staff who may then have little time available to fully answer questions or to provide women centred care. The first few days following childbirth are crucial in promoting mothers parenting confidence, bonding and physical recovery. Scottish Government Health Policy has prioritised health and social care in the early years through the policy Getting it Right for Every Child,⁹ it is essential that maternity care in the earliest days following birth is also given the high priority and staffing resource that it merits if women's experience is to be improved.

4.34. These results do not make a distinction between mothers who chose to breast or formula feed their infants. A secondary analysis will produce data for these subgroups of mothers. Nevertheless, all mothers should receive support and encouragement, and consistent advice about infant feeding. Over a third of women felt that this was not always their experience; lack of advice about infant feeding was reported by almost one third of women up to six weeks after birth.

4.35. Continuity of care has been a key element of Scottish Government maternity care policy for over 20 years. It is an encouraging finding of this survey that around half of women responding said that they saw the same midwife for postnatal visits all or most of the time and that for 44% of women this was a midwife who had also provided antenatal care. However, conversely around 50% of women did not receive continuity of care. Recent research on continuity of midwifery care¹⁸ has focussed on antenatal care and care in labour, there is less evidence for benefit in postnatal care. However, seeing the same person for care will reduce the need for women to repeat information or concerns and provide more opportunity for staff to identify emerging problems over a series of visits and to provide consistent advice. It is interesting that the health board in which the highest proportion of women reported seeing the same midwife for all or most of postnatal care at home (NHS Fife - 70%), and women who reported seeing the same midwife for antenatal and postnatal care (58%) also achieved the highest proportion of women who reported always receiving consistent feeding advice (70%) and always having personal circumstances taken into account (88%).

4.36. The findings suggest that women felt they received sufficient information about their baby's wellbeing and about practical aspects such as arranging a postnatal health check and contraception. However, more information and advice is required on aspects of women's own recovery and wellbeing. Over 40% of women felt they did not get enough information about potential emotional changes and 36% did not get enough information about their own recovery. Other research² has found that as many as 19% of women will experience postnatal depression and many women experience enduring physical problems following birth.³⁷ It is therefore essential that women are given appropriate and timely advice about their own recovery and emotional wellbeing so that they are equipped to recognise potential health problems and seek help promptly.