title: An evaluation of strategies to improve the quality and content of hospital-based postnatal care in a metropolitan Australian hospital.
abstract: OBJECTIVE
  This study aimed to design, implement and evaluate strategies to improve the quality and content of hospital-based postnatal care.
  
  
  BACKGROUND
  Following birth, women report physical health problems, difficulties with breastfeeding, a lack of parenting self-efficacy and there is high occurrence of postnatal distress and depression. Despite these significant needs, women are frequently dissatisfied with the advice and support they receive from hospital-based postnatal care.
  
  
  METHODS
  A pre/post test design compared the effect of multifaceted strategies on perceptions of quality and content of postnatal care, knowledge and experience of postnatal problems, parenting self-efficacy and breastfeeding outcomes. The key strategy, 'one-to-one time', focused on providing women an uninterrupted period of time each day when a midwife would be available to discuss women's concerns about their health and that of their baby.
  
  
  METHODS
  A convenience sample of 146 women at baseline and 148 women postintervention completed a postal self-report questionnaire between 2-4 weeks postpartum.
  
  
  RESULTS
  There were no significant differences between baseline and postintervention groups in perceived quality of care, breastfeeding outcomes and maternal self-efficacy. Women experiencing health issues, including insufficient milk supply, backache, abnormal bleeding and urinary incontinence, were more likely to report that they received good or excellent care and advice in the postintervention group. Strategies to increase rest appeared effective with women less likely to report excessive tiredness postintervention. The key strategy, 'one-to-one time' was not consistently implemented, 57% of women reported they received 10 minutes or less of uninterrupted time with a midwife and only 11% reported that they were provided with 20 minutes or more.
  
  
  CONCLUSIONS
  There is the potential for individualised care to impact on outcomes for women but established routines and institutional priorities are difficult to change.
  
  
  CONCLUSIONS
  Midwives require both skill development and time to be able to sensitively listen to women's needs in the hospital postnatal setting.
authors.affiliation: School of Nursing and Midwifery, University of Western Sydney, Building ER, Parramatta Campus, Penrith South DC 1797, Penrith, NSW, Australia. v.schmied@uws.edu.au
authors.forename: Virginia
authors.initials: V
authors.lastname: Schmied
authors.forename: Margaret
authors.initials: M
authors.lastname: Cooke
authors.forename: Rosalind
authors.initials: R
authors.lastname: Gutwein
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Steinlein
authors.forename: Caroline
authors.initials: C
authors.lastname: Homer
mesh_terms: D005260:Female; D006761:Hospitals; D006801:Humans; D009517:New South Wales; D049590:Postpartum Period; D011247:Pregnancy; D011787:Quality of Health Care