title: Redesigning postnatal care: exploring the views and experiences of midwives.
abstract: OBJECTIVE
  women have consistently rated postnatal care less favourably than other episodes of maternity care. Midwives have also reported concerns with postnatal care, with challenges related to workloads, busy environments and lack of staff. Given these concerns, a regional hospital in Victoria, Australia redesigned its postnatal care provision. The changes included cessation of routine postnatal observations and the use of clinical pathways for women who gave birth vaginally; promotion of rest through minimal disturbances before 9 am; discouraging the use of the call bell system except in emergency situations; introduction of 'one-to-one' time with women; and promotion of normalcy and independence. This paper examines midwives' views of the changes and their impressions of the effects of the changes on women and their infants.
  
  
  METHODS
  cross-sectional surveys of midwives were conducted six months after the changes to postnatal care were introduced then again, two years later. Midwives' views and experiences of the changes; the impact of the changes on confidence and autonomy of practice; views regarding the effect on women's satisfaction with care; and the perceived safety of the changes were explored.
  
  
  METHODS
  a regional hospital in Victoria, Australia where approximately 2,000 births occur each year.
  
  
  METHODS
  permanent part-time and full-time midwives.
  
  
  RESULTS
  response rates were 64% (50/78) at baseline and 60% (50/84) two years later. Overall, midwives were supportive of, and complied with, the changes to postnatal care. They agreed that change was needed and believed that the new way of providing care would be better for women and increase individualised care. Midwives also agreed that the changes would facilitate rest for women, believed that removal of routine observations for women after a vaginal birth was safe and that it would allow more time with women. Over time, midwives were more likely to feel autonomous when providing postnatal care. However, some concerns were raised, mostly in relation to the challenges around postnatal documentation, care provision without the guidance of a care/clinical pathway, and about limiting the use of the call bell to only emergency situations. Midwives were not confident that the changes would necessarily translate to a measurable increase in women's satisfaction with care, and were not confident that the changes translated into more time to spend listening and providing support to women.
  
  
  CONCLUSIONS
  overall, midwives were supportive of the changes and agreed that change to postnatal care was needed. Challenges remain around the most effective method of communication and documentation of postnatal care. It is important that when major changes to care provision are implemented that care providers' views and experiences are explored given their crucial role in the introduction and maintenance of changes and the potential impact on them as care providers.
authors.affiliation: School of Nursing and Midwifery, Australian Catholic University, 115 Victoria Parade, Fitzroy, Australia. jane.morrow@acu.edu.au
authors.forename: Jane
authors.initials: J
authors.lastname: Morrow
authors.forename: Helen
authors.initials: H
authors.lastname: McLachlan
authors.forename: Della
authors.initials: D
authors.lastname: Forster
authors.forename: Mary-Ann
authors.initials: MA
authors.lastname: Davey
authors.forename: Michelle
authors.initials: M
authors.lastname: Newton
mesh_terms: D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D009721:Nurse Midwives / Q000523:psychology*; D009775:Obstetrics and Gynecology Department, Hospital / Q000458:organization & administration / Q000639:trends; D009936:Organizational Innovation; D057240:Patient Preference; D011181:Postnatal Care / Q000379:methods*; D011247:Pregnancy; D058996:Quality Improvement; D014739:Victoria