Community midwives views of postnatal care in the UK; A descriptive qualitative study

Objective: To explore views and experiences of community midwives delivering postnatal care. Design: A descriptive qualitative study design undertaking focus groups with community midwives and community midwifery team leaders. Setting: All focus groups were carried out in community midwifery care settings, across four hospitals in two NHS organisations, April to June 2018 in the West Midlands, UK. Participants: 47 midwives: 34 community midwives and 13 community midwifery team leaders took part in 7 focus groups. Findings: Inductive framework analysis of data led to the development of themes and sub-themes relating to factors influencing discharge from hospital, strategies to address increases in discharge and the broader challenges to providing care. Conditions on the postnatal ward and women's experiences of care in the hospital were factors influencing timing of discharge from hospital that resulted in community midwives managing women and babies with more complex needs. In order to manage increased workloads, there was growing but varied use of flexible approaches to providing care such as telephone consultations, postnatal clinics, and maternity support workers. Key conclusions and implications for practice: In a context of short postnatal hospital stays, community midwives appear to be responding to women's needs and service pressures in the postnatal period. Wider implementation of specific strategies to organise and deliver support to women and babies may further improve care and outcomes.