New mothers should be given a longer “settling in” period at home, as very early visits from midwives could lead to unfair assessments, warns new guidance by the National Institute for Health and Care Excellence (NICE).
Parents should be allowed at least 12 hours alone with their baby after they leave hospital to ensure risk assessments carried out by midwives during the first postnatal visit accurately reflect their living situation, the independent body recommends.
Without this “period of adjustment and settling in”, mothers may appear less capable at looking after their baby than if they had been given longer to find their feet, according to the guidance.
“The committee discussed the benefit of waiting at least 12 hours after transfer to home care before conducting the first postnatal visit as there should be a period of adjustment and settling in and a risk that the assessment may not be reflective of the situation if conducted earlier,” it states.
There is currently no firm rule as to when the first postnatal visit should take place. However, it could be as soon as a few hours after the mother is discharged from the hospital.
Allowing between 12 and 36 hours for parents to get their bearings is one of NICE’s recommendations in their updated guidance on the care of mothers and babies in the period from birth up to eight weeks after delivery.
Sarah McMullen, director of impact and engagement at the National Childbirth Trust, said: ‘’A midwife’s first home visit is really important to assess the physical and mental wellbeing of both mother and baby. Having enough time to settle back in at home, with a few cycles of feeding and some rest if possible, may give midwives a more realistic assessment of welfare and support needs.
“However, new mums and partners should also be informed of what to look out for, for example heavy blood loss or persistent headache, and have a number to call in case of any urgent problems before the midwife’s visit.”
NICE’s guidance, which was last updated in 2006, aims to “improve consistency of care across the country”. It is based on evidence gathered before the Covid-19 pandemic took hold.
It emphasises the need to “tailor” birthing and recovery plans around each mother’s “needs and preferences”.
Among NICE’s new recommendations is that the mother’s bladder function should be one of the health checks carried out before she and her baby are discharged from hospital. It warns that “undetected or unmanaged urinary retention can lead to serious long-term consequences such as urinary incontinence”.
The guidance also recommends checking that the mother is able to feed her baby successfully before going home.
NICE also emphasises the importance of supporting new mothers in developing an emotional attachment to their baby.
It recommends considering how the woman is recovering physically and emotionally from the birth, and whether there were any birthing traumas or complications.