Quality Standards
Issued: July 2013
QS37

Postnatal care

Introduction

This quality standard covers postnatal care, which includes the core care and support that every woman, their baby and if appropriate, their partner and family should receive during the postnatal period. This includes recognising women and babies with additional care needs and referring them to specialist services. For more information see the scope for this quality standard.

Why this quality standard is needed

Postnatal care is the individualised care provided to meet the needs of a mother and her baby following childbirth. Although the postnatal period is uncomplicated for most women and babies, care during this period needs to address any variation from expected recovery after birth. For the majority of women, babies and families, the postnatal period ends 6–8 weeks after the birth. However for some women and babies, the postnatal period should be extended in order to meet their needs. This is particularly important where a woman or baby has developed complications and remains vulnerable to adverse outcomes. For example, this could include women who have poor support networks, have developed a postnatal infection or other health problem that is continuing to impact on their daily lives, or women who are at risk of mental health problems or infant attachment problems.

How this quality standard supports delivery of outcome frameworks

NICE quality standards describe high-priority areas for quality improvement in a defined care or service area. Each standard consists of a prioritised set of specific, concise and measurable statements. They draw on existing guidance, which provides an underpinning, comprehensive set of recommendations, and are designed to support the measurement of improvement. This quality standard, in conjunction with the guidance on which it is based, should contribute to the improvements outlined in the following 2 outcomes frameworks published by the Department of Health:

Tables 1 and 2 show the outcomes, overarching indicators and improvement areas from the frameworks that the quality standard could contribute to achieving.

Table 1 NHS Outcomes Framework 2013/14

Domain

Overarching indicators and improvement areas

1 Preventing people from dying prematurely

Overarching indicator

1a Potential years of life lost (PYLL) from causes considered amenable to healthcare

Improvement area

Reducing deaths in babies and young children

1.6i Infant mortality*

1.6ii Neonatal mortality and stillbirths

4 Ensuring that people have a positive experience of care

Overarching indicator

4a Patient experience of primary care

4c Friends and family test (placeholder)

Improvement area

Improving women and their families' experience of maternity services

4.5 Women's experience of maternity services

5 Treating and caring for people in a safe environment and protecting them from avoidable harm

Improvement areas

Reducing the incidence of avoidable harm

5.1 Incidence of hospital-related venous thromboembolism (VTE)

Improving the safety of maternity services

5.5 Admission of full-term babies to neonatal care

Alignment across the health and social care system

* Indicator shared with Public Health Outcomes Framework (PHOF)

Table 2 Public health outcomes framework for England, 2013-2016

Domain

Objectives and indicators

2 Health improvement

Objective

People are helped to live healthy lifestyles, make healthy choices and reduce health inequalities

Indicators

2.2 Breastfeeding

2.5 Child development at 2–2.5 years (Placeholder)

2.11 Diet

2.12 Excess weight in adults

2.13 Proportion of physically active and inactive adults

4 Healthcare public health and preventing premature mortality

Objective

Reduced numbers of people living with preventable ill health and people dying prematurely, while reducing the gap between communities

Indicators

4.1 Infant mortality*

4.3 Mortality from causes considered preventable**

Alignment across the health and social care system

* Indicator shared with NHS Outcomes Framework

** Indicator complementary with NHS Outcomes Framework

Coordinated services

The quality standard for postnatal care specifies that services should be commissioned from and coordinated across all relevant agencies encompassing the postnatal component of the maternity care pathway. A person-centred, integrated approach to providing services is fundamental to delivering high-quality care to women, babies, partners and other family members.

The Health and Social Care Act 2012 sets out a clear expectation that the care system should consider NICE quality standards in planning and delivering services, as part of a general duty to secure continuous improvement in quality. Commissioners and providers of health and social care should refer to the library of NICE quality standards when designing high-quality services. Other quality standards that should also be considered when choosing, commissioning or providing a high-quality postnatal care service are listed in Related quality standards.

Training and competencies

The quality standard should be read in the context of national and local guidelines on training and competencies. All health and social care practitioners involved in assessing and caring for women and babies should have sufficient and appropriate training and competencies to deliver the actions and interventions described in the quality standard.