Today, we’re speaking to Dr Clare Macdonald, an Academic Clinical Lecturer in General Practice based at the University of Birmingham.

Title of paper: Complex social needs and maternal postnatal care: what can primary care do?

Available at: https://doi.org/10.3399/BJGP.2026.0069

Throughout the discussion we use the terms ‘woman’ and ‘women’, but we know that not all those who give birth will identify as women and intend this to mean all those who give birth.

Transcript

This transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.

Speaker A

00:00:00.480 - 00:00:51.740

Hello and welcome to BJ GP Interviews. I'm Nada Khan and I'm one of the Associate Editors of the Journal. Thanks for listening to this podcast today.

In today's episode, we're speaking to Dr. Claire MacDonald. Claire is an academic clinical lecturer in general practice, and she's based at the University of Birmingham.

We're here today to talk about the editorial she's just published in the May issue of the bjgp, and it's titled Complex Social Needs and Maternal Postnatal Care. What Can Primary Care Do?

So, hi, Clare, it's lovely to meet you and to talk about this brilliant editorial, but before we get into the editorial itself, I wonder if you can just talk us through what you actually mean by complex social needs in the context of postnatal care.

Speaker B

00:00:51.980 - 00:02:21.290

Yeah.

So I think when we talk about social complexity in the postnatal population, we're talking about women who have multiple factors that might be influencing how they can access care or influencing the clinical and social risks that they have. So for most people, the time after they've had a baby results in some social change.

Even in the most straightforward, most brilliantly supported, most physically well person, there are big social changes. And that is a period of a complex time to navigate and finding your way and your identity as a family with a new baby and so on.

When we talk about complex social needs, we're talking about women who face other aspects of adversity.

So it might be that they have housing instability, it might be that they have experienced domestic abuse or they continue to experience domestic abuse, that they have a history of safeguarding issues, safeguarding for themselves or safeguarding concern, concerns about other children or other family members.

And when we see women who have overlapping social risk factors that produces this kind of network of complexity that puts them at compounded additional risk and they need additional help in navigating their health needs in that time.

Speaker A

00:02:21.450 - 00:02:47.310

And I wonder why you felt that this was an important issue to highlight right now. So is there anything in particular that makes you think that this is the right time to sort of look into this?

I know that there's a complex picture in terms of sort of maternal care, and if we look at things like the cost of living crisis, which is compounding a lot of the pressures that people are facing. But talk me through what your impetus was in thinking about this as a now issue.

Speaker B

00:02:48.110 - 00:05:26.470

Yeah, that's right.

So maternity services are really high profile in the news a lot at the moment, but from a secondary care perspective, and quite rightly, there's a spotlight on the poor care that some women and their families and their babies receive from secondary care. And there are, you know, huge pieces of work being done to improve that, to improve outcomes and to improve people's experiences.

But that focus tends to be on intrapartum care.

So the care that people receive in hospital around the time of birth, sometimes there's a little bit of focus on antenatal care as well and reducing risk during pregnancy, there's a lot less focus on what looks like the less exciting time of preconception care and then postnatal care. So after women get discharged from maternity services, we know that they're often left feeling a little bit isolated in the healthcare context.

Some qualitative research that we've done in the past, looking at women's experiences of postnatal care, women told us that they were surprised about they'd had so many appointments during pregnancy and then so much healthcare retention in the first few days after birth, and then they were just surprised. No, you know, they had a baby and no one was really interested in their health anymore. And that genuinely came as a surprise to them.

We know that maternal mortality in the uk, which, thankfully, in absolute numbers, is. Is quite small, but it's certainly higher than it could be and maybe should be, particularly compared to other kind of similar European countries.

And there are actually more maternal deaths postnatally, so in the sort of later postnatal period, six weeks to a year after birth, than there are in that sort of antenatal, intrapartum and early postnatal period. And all of the political drive tends to be about reducing maternal mortality in its traditional definition of being up to six weeks after birth.

But as GPs, where we can really have an impact is in those late maternal deaths.

And of course, very few of us, thankfully, will be involved in the care of a woman who dies in that period, because they are small in absolute numbers. But there are all the women who do not die, but have those risk factors and have that complexity.

And the longer they live with those sort of adverse health conditions and adverse social conditions, that is dramatically reducing their quality life course health. And we can really step in, in that postnatal period to look at how we can influence that.

Speaker A

00:05:26.870 - 00:05:49.080

Yeah, and you've mentioned about the kind of care that women get in during their pregnancy. And sometimes, I'm sure for some women, the postnatal period can feel already pretty fragmented for those reasons.

But how do you think that that fragmentation can become amplified for women with complex social needs? Do you have any thoughts about that?

Speaker B

00:05:50.280 - 00:08:25.320

Absolutely. So a Lot of people will know how to contact their gp, right?

I think if you ask people, most people have probably got that number saved in their phone or they know where their GP practice is.

But after you have a baby, women are then given all these kind of new healthcare professionals who are interested and involved and it's impossible to know how that all fits together.

So the midwife will typically follow women up for that kind of, you know, 10 to 14 days postnatally, usually just at the time the midwife is giving you the final sign off appointment. Within a day or two, you have an appointment with the health visitor, which again is somebody new, and then you might have a follow up.

For example, if a woman's had a third degree tear or is having some additional hospital follow up because of hypertension or gestational diabetes, then the hospital are involved and then they come back to the GP.

And I often feel like, for us as GPs, women, as soon as they're pregnant, they can generally self refer to the midwife and they get kind of lifted out of the primary care system to an extent.

We might not see them through their whole pregnancy, then they have a baby, we might or might not get a discharge summary that gives us some details about the birth and then we invite them for their postnatal consultation and in that time, you know, they've had an entire pregnancy, a huge life changing event, and then we get to see them for this one appointment. And it's so complicated.

Often for women who are not sure where they're going to get their next meal from, how can they be giving any kind of cognitive time to figuring out if the midwife told the health visitor and if the health visitor told the GP and if they're worried that their bleeding's gone on for a bit too long, do they try and phone the woman who came on Thursday or the woman who came on Monday, or do they come back to their gp?

We're asking a lot and we also place a lot of burden on women to retell their story because information transfer is not always timely, it's not always sufficiently detailed.

And again, for women who are living in more precarious social situations, that burden then of having to, you know, they're juggling and the, you know, the mental load of everything they're trying to figure out. And then we're asking them, can you remember if your blood pressure was high during your pregnancy?

Whereas we should know that we should have that information from those other services. So that fragmentation in services really means that the burden is unduly placed on women to kind of patch that up.

And we need to find a better way of dealing with that.

Speaker A

00:08:25.640 - 00:08:38.260

One of the things I think that comes through really strongly is that some of the women with the greatest needs often face the biggest barriers, care. And what kind of barriers are we talking about here that these women are facing?

Speaker B

00:08:38.980 - 00:10:06.270

The Embrace report, which is well, well worth a look at at least their infographics, I think for every gp, it's just a couple of minutes to read. Actually, their infographics are really excellent. So.

So this is the annual report that's produced called Mothers and Babies Reducing Risk through audits and confidential inquiries across the uk. So Embrace Talk about this notion of a constant isolation of biases.

So in all of the cases that they reviewed and reported on in their most recent study, they found that 91% of them faced multiple interrelated challenges. So the women who died tended not to just have maybe one big risk factor.

Lots of them had multiple interrelated challenges, and these were factors like being overweight or obese, being known to use substances, having had experience of domestic abuse. Ethnic minority groups as well, and migrant women particularly, face substantial barriers to accessing good maternity care.

And language barriers are really critical.

And I think we can do quite a good job of that in primary care, because our appointments, particularly the postnatal consultation, tend to be pre booked and pre planned.

And that's somewhere where we can really make sure that we're providing those interpreter services and giving women that kind of culturally supportive access to healthcare and then.

Speaker A

00:10:06.270 - 00:10:26.270

Thinking more about the role of general practice. And I wonder what you think.

I mean, you've given us some pointers about, you know, that postnatal check and things, but what do you think in terms of the role that general practice can actually realistically play in improving postnatal care for women facing social disadvantage? Do you have any ideas about that?

Speaker B

00:10:26.270 - 00:14:44.070

There are lots of practical, innovative things that can be done at practice level, and they are things about, principally about access to care. And there are tools and resources to help with this. So NHS England produced a document which is a guideline intended for icbs.

Actually, it's a toolkit rather than a guideline called Improving Postnatal Care that gives some really specific pointers about the groups who are at particular risk and the groups who have more adverse outcomes. So at practice level, it would be quite straightforward to look at, you know, who are we providing postnatal consultations to?

We know from past research that nationally, younger mothers and ethnic minority mothers are less likely to have postnatal consultations compared with others. So at practice level, it's possible to look and say, hang on, are we reaching those women who stand to gain the most from postnatal consultations?

So using resources like that to see what's happening. Some people have looked at how their invitations to postnatal consultations are working. So there's confusion amongst women.

And this is probably understandable because every practice does it a little bit differently. So women tend not to know, am I going to get sent an appointment? Do I need to make an appointment for myself?

And there's vast majority variation and that's fine because different practices know their populations and they can do it whichever way works. But I think that's the key. It has to work and it has to be really clear.

So it might be that when we get the birth discharge summary, is there a standard text message we could send out saying, we are going to invite you for this appointment, but if you need us before that, please contact as usual, kind of giving permission and inviting that contact if it's needed. Which helps women to kind of understand and navigate their way through.

We talk in the editorial as well about utilisation of other members of the primary care team. So social prescribers, for example, are quite underutilised in this population.

And although they absolutely have the skill set, could social prescribers maybe have a role in connecting women with groups? You know, if it's your first baby, particularly how do you know where the local baby group is?

Do you know if there's kind of baby yoga class on this day or, you know, postnatal exercise class or whatever it is you might be interested in, Social prescribers would be really, you know, excellent professionals to help connect women.

And then it can be a two way thing because if they maybe pick up from a woman who they're supporting that her mood seems lower this time than it did last time, they have this bidirectional ability to be able to contact back the GP and say, I'm a bit worried about this woman, maybe you need to ask the health to see her, maybe you need, maybe she needs a GP follow up. Her mood seemed a bit lower, whatever it might be. So I think there's definitely some practical things we can do.

There are moving beyond a practice level. There are things that kind of PCN level and beyond.

So there's a PCN in Leeds who are kind of recognizing this social need for women in the postnatal period and they are providing a sort of a drop in session.

So like a session that's like a two hour monthly session led by PCM care coordinators and supported, I think, by a third sector organization as well, to bring together a whole range of health services so that women can meet, they can be with their babies, they can have that community support, but also potentially access to sexual health services and signposting and they can be self referred or they can be referred by their gp. So it's about knowing your population and looking for those little innovative ways.

A practice that I worked at a long time ago used to have like a stay and play baby session during the immunization clinic. And that was an opportunity, you know, it was very little for the practice to do in terms of organization.

It's a few toys and I think some of the receptionists used to be on, on hand. But it was a really great kind of innovative project to just give women the chance to meet each other for a little bit of informal peer support.

Speaker A

00:14:44.710 - 00:15:10.660

Yeah.

And I think that goes to show that, you know, maybe current models of postnatal care, either at a higher level, at a PCN practice level, aren't necessarily always at the moment designed around the needs of women most at risk, but these sort of small, innovative practices could actually help, especially with connecting women across different services, because I think that's often quite difficult to do in general practice, across maternity, mental health and community services as well.

Speaker B

00:15:11.700 - 00:16:30.900

And it's hard for GPs to know who and where to refer women to. So we found this in some research that we did around GPs doing postnatal consultations.

It was really common that GPs said they wanted better referral pathways, they needed to understand. So if you don't know what you're going to do when you find a problem, you're less likely to inquire about it as a gp.

So, for example, take pelvic health. If you don't know what to do if a woman reports a problem, you're probably not going to be so inclined to directly inquire about it.

And we know that for intimate problems like that, disclosure is increased when direct questions are asked. So a woman might not feel able to raise it herself, but if the GP can sensitively directly inquire about it, she's more likely to, to raise it.

It can then be addressed. But is the GP going to ask if they're thinking, well, I don't know where to refer it to?

So that kind of local knowledge of pathways and for women who are the most vulnerable and the most socially complex, the chances of them being at your postnatal consultation in the first place are less. And then if you don't know what the appropriate referral pathways are, you're less likely to inquire about it.

And it's just these kind of stepward missed opportunities that we see most in those who are more vulnerable.

Speaker A

00:16:31.620 - 00:16:46.580

I think that's a really good point about just asking those very direct questions.

And I wanted to know, just from your perspective for gps listening to this, do you think that there are any small changes that could make the biggest difference for women with complex social needs after giving birth?

Speaker B

00:16:47.300 - 00:18:56.370

I think what would make a difference in primary care is women being able to access care and women being heard. And sometimes that might mean we have to go to them. We need ways in our practices of identifying them.

So there needs to be a stratified way of when a woman has a baby, you know, if there are a certain number of risk factors that gets flagged and they somehow get like a different level of invite. We also need to, to think about those who are more vulnerable because they've not got their baby with them, for example.

Hello and welcome to BJ GP Interviews.

I'm Nada Khan and I'm one of the Associate Editors of the Journal.

Thanks for listening to this podcast today.

In today's episode, we're speaking to Dr. Claire MacDonald.

Claire is an academic clinical lecturer in general practice, and she's based at the University of Birmingham.

We're here today to talk about the editorial she's just published in the May issue of the bjgp, and it's titled Complex Social Needs and Maternal Postnatal Care.

What Can Primary Care Do?

So, hi, Clare, it's lovely to meet you and to talk about this brilliant editorial, but before we get into the editorial itself, I wonder if you can just talk us through what you actually mean by complex social needs in the context of postnatal care.

Yeah.

So I think when we talk about social complexity in the postnatal population, we're talking about women who have multiple factors that might be influencing how they can access care or influencing the clinical and social risks that they have.

So for most people, the time after they've had a baby results in some social change.

Even in the most straightforward, most brilliantly supported, most physically well person, there are big social changes.

And that is a period of a complex time to navigate and finding your way and your identity as a family with a new baby and so on.

When we talk about complex social needs, we're talking about women who face other aspects of adversity.

So it might be that they have housing instability, it might be that they have experienced domestic abuse or they continue to experience domestic abuse, that they have a history of safeguarding issues, safeguarding for themselves or safeguarding concern, concerns about other children or other family members.

And when we see women who have overlapping social risk factors that produces this kind of network of complexity that puts them at compounded additional risk and they need additional help in navigating their health needs in that time.

And I wonder why you felt that this was an important issue to highlight right now.

So is there anything in particular that makes you think that this is the right time to sort of look into this?

I know that there's a complex picture in terms of sort of maternal care, and if we look at things like the cost of living crisis, which is compounding a lot of the pressures that people are facing.

But talk me through what your impetus was in thinking about this as a now issue.

Yeah, that's right.

So maternity services are really high profile in the news a lot at the moment, but from a secondary care perspective, and quite rightly, there's a spotlight on the poor care that some women and their families and their babies receive from secondary care.

And there are, you know, huge pieces of work being done to improve that, to improve outcomes and to improve people's experiences.

But that focus tends to be on intrapartum care.

So the care that people receive in hospital around the time of birth, sometimes there's a little bit of focus on antenatal care as well and reducing risk during pregnancy, there's a lot less focus on what looks like the less exciting time of preconception care and then postnatal care.

So after women get discharged from maternity services, we know that they're often left feeling a little bit isolated in the healthcare context.

Some qualitative research that we've done in the past, looking at women's experiences of postnatal care, women told us that they were surprised about they'd had so many appointments during pregnancy and then so much healthcare retention in the first few days after birth, and then they were just surprised.

No, you know, they had a baby and no one was really interested in their health anymore.

And that genuinely came as a surprise to them.

We know that maternal mortality in the uk, which, thankfully, in absolute numbers, is.

Is quite small, but it's certainly higher than it could be and maybe should be, particularly compared to other kind of similar European countries.

And there are actually more maternal deaths postnatally, so in the sort of later postnatal period, six weeks to a year after birth, than there are in that sort of antenatal, intrapartum and early postnatal period.

And all of the political drive tends to be about reducing maternal mortality in its traditional definition of being up to six weeks after birth.

But as GPs, where we can really have an impact is in those late maternal deaths.

And of course, very few of us, thankfully, will be involved in the care of a woman who dies in that period, because they are small in absolute numbers.

But there are all the women who do not die, but have those risk factors and have that complexity.

And the longer they live with those sort of adverse health conditions and adverse social conditions, that is dramatically reducing their quality life course health.

And we can really step in, in that postnatal period to look at how we can influence that.

Yeah, and you've mentioned about the kind of care that women get in during their pregnancy.

And sometimes, I'm sure for some women, the postnatal period can feel already pretty fragmented for those reasons.

But how do you think that that fragmentation can become amplified for women with complex social needs?

Do you have any thoughts about that?

Absolutely.

So a Lot of people will know how to contact their gp, right?

I think if you ask people, most people have probably got that number saved in their phone or they know where their GP practice is.

But after you have a baby, women are then given all these kind of new healthcare professionals who are interested and involved and it's impossible to know how that all fits together.

So the midwife will typically follow women up for that kind of, you know, 10 to 14 days postnatally, usually just at the time the midwife is giving you the final sign off appointment.

Within a day or two, you have an appointment with the health visitor, which again is somebody new, and then you might have a follow up.

For example, if a woman's had a third degree tear or is having some additional hospital follow up because of hypertension or gestational diabetes, then the hospital are involved and then they come back to the GP.

And I often feel like, for us as GPs, women, as soon as they're pregnant, they can generally self refer to the midwife and they get kind of lifted out of the primary care system to an extent.

We might not see them through their whole pregnancy, then they have a baby, we might or might not get a discharge summary that gives us some details about the birth and then we invite them for their postnatal consultation and in that time, you know, they've had an entire pregnancy, a huge life changing event, and then we get to see them for this one appointment.

And it's so complicated.

Often for women who are not sure where they're going to get their next meal from, how can they be giving any kind of cognitive time to figuring out if the midwife told the health visitor and if the health visitor told the GP and if they're worried that their bleeding's gone on for a bit too long, do they try and phone the woman who came on Thursday or the woman who came on Monday, or do they come back to their gp?

We're asking a lot and we also place a lot of burden on women to retell their story because information transfer is not always timely, it's not always sufficiently detailed.

And again, for women who are living in more precarious social situations, that burden then of having to, you know, they're juggling and the, you know, the mental load of everything they're trying to figure out.

And then we're asking them, can you remember if your blood pressure was high during your pregnancy?

Whereas we should know that we should have that information from those other services.

So that fragmentation in services really means that the burden is unduly placed on women to kind of patch that up.

And we need to find a better way of dealing with that.

One of the things I think that comes through really strongly is that some of the women with the greatest needs often face the biggest barriers, care.

And what kind of barriers are we talking about here that these women are facing?

The Embrace report, which is well, well worth a look at at least their infographics, I think for every gp, it's just a couple of minutes to read.

Actually, their infographics are really excellent.

So.

So this is the annual report that's produced called Mothers and Babies Reducing Risk through audits and confidential inquiries across the uk.

So Embrace Talk about this notion of a constant isolation of biases.

So in all of the cases that they reviewed and reported on in their most recent study, they found that 91% of them faced multiple interrelated challenges.

So the women who died tended not to just have maybe one big risk factor.

Lots of them had multiple interrelated challenges, and these were factors like being overweight or obese, being known to use substances, having had experience of domestic abuse.

Ethnic minority groups as well, and migrant women particularly, face substantial barriers to accessing good maternity care.

And language barriers are really critical.

And I think we can do quite a good job of that in primary care, because our appointments, particularly the postnatal consultation, tend to be pre booked and pre planned.

And that's somewhere where we can really make sure that we're providing those interpreter services and giving women that kind of culturally supportive access to healthcare and then.

Thinking more about the role of general practice.

And I wonder what you think.

I mean, you've given us some pointers about, you know, that postnatal check and things, but what do you think in terms of the role that general practice can actually realistically play in improving postnatal care for women facing social disadvantage?

Do you have any ideas about that?

There are lots of practical, innovative things that can be done at practice level, and they are things about, principally about access to care.

And there are tools and resources to help with this.

So NHS England produced a document which is a guideline intended for icbs.

Actually, it's a toolkit rather than a guideline called Improving Postnatal Care that gives some really specific pointers about the groups who are at particular risk and the groups who have more adverse outcomes.

So at practice level, it would be quite straightforward to look at, you know, who are we providing postnatal consultations to?

We know from past research that nationally, younger mothers and ethnic minority mothers are less likely to have postnatal consultations compared with others.

So at practice level, it's possible to look and say, hang on, are we reaching those women who stand to gain the most from postnatal consultations?

So using resources like that to see what's happening.

Some people have looked at how their invitations to postnatal consultations are working.

So there's confusion amongst women.

And this is probably understandable because every practice does it a little bit differently.

So women tend not to know, am I going to get sent an appointment?

Do I need to make an appointment for myself?

And there's vast majority variation and that's fine because different practices know their populations and they can do it whichever way works.

But I think that's the key.

It has to work and it has to be really clear.

So it might be that when we get the birth discharge summary, is there a standard text message we could send out saying, we are going to invite you for this appointment, but if you need us before that, please contact as usual, kind of giving permission and inviting that contact if it's needed.

Which helps women to kind of understand and navigate their way through.

We talk in the editorial as well about utilisation of other members of the primary care team.

So social prescribers, for example, are quite underutilised in this population.

And although they absolutely have the skill set, could social prescribers maybe have a role in connecting women with groups?

You know, if it's your first baby, particularly how do you know where the local baby group is?

Do you know if there's kind of baby yoga class on this day or, you know, postnatal exercise class or whatever it is you might be interested in, Social prescribers would be really, you know, excellent professionals to help connect women.

And then it can be a two way thing because if they maybe pick up from a woman who they're supporting that her mood seems lower this time than it did last time, they have this bidirectional ability to be able to contact back the GP and say, I'm a bit worried about this woman, maybe you need to ask the health to see her, maybe you need, maybe she needs a GP follow up.

Her mood seemed a bit lower, whatever it might be.

So I think there's definitely some practical things we can do.

There are moving beyond a practice level.

There are things that kind of PCN level and beyond.

So there's a PCN in Leeds who are kind of recognizing this social need for women in the postnatal period and they are providing a sort of a drop in session.

So like a session that's like a two hour monthly session led by PCM care coordinators and supported, I think, by a third sector organization as well, to bring together a whole range of health services so that women can meet, they can be with their babies, they can have that community support, but also potentially access to sexual health services and signposting and they can be self referred or they can be referred by their gp.

So it's about knowing your population and looking for those little innovative ways.

A practice that I worked at a long time ago used to have like a stay and play baby session during the immunization clinic.

And that was an opportunity, you know, it was very little for the practice to do in terms of organization.

It's a few toys and I think some of the receptionists used to be on, on hand.

But it was a really great kind of innovative project to just give women the chance to meet each other for a little bit of informal peer support.

Yeah.

And I think that goes to show that, you know, maybe current models of postnatal care, either at a higher level, at a PCN practice level, aren't necessarily always at the moment designed around the needs of women most at risk, but these sort of small, innovative practices could actually help, especially with connecting women across different services, because I think that's often quite difficult to do in general practice, across maternity, mental health and community services as well.

And it's hard for GPs to know who and where to refer women to.

So we found this in some research that we did around GPs doing postnatal consultations.

It was really common that GPs said they wanted better referral pathways, they needed to understand.

So if you don't know what you're going to do when you find a problem, you're less likely to inquire about it as a gp.

So, for example, take pelvic health.

If you don't know what to do if a woman reports a problem, you're probably not going to be so inclined to directly inquire about it.

And we know that for intimate problems like that, disclosure is increased when direct questions are asked.

So a woman might not feel able to raise it herself, but if the GP can sensitively directly inquire about it, she's more likely to, to raise it.

It can then be addressed.

But is the GP going to ask if they're thinking, well, I don't know where to refer it to?

So that kind of local knowledge of pathways and for women who are the most vulnerable and the most socially complex, the chances of them being at your postnatal consultation in the first place are less.

And then if you don't know what the appropriate referral pathways are, you're less likely to inquire about it.

And it's just these kind of stepward missed opportunities that we see most in those who are more vulnerable.

I think that's a really good point about just asking those very direct questions.

And I wanted to know, just from your perspective for gps listening to this, do you think that there are any small changes that could make the biggest difference for women with complex social needs after giving birth?

I think what would make a difference in primary care is women being able to access care and women being heard.

And sometimes that might mean we have to go to them.

We need ways in our practices of identifying them.

So there needs to be a stratified way of when a woman has a baby, you know, if there are a certain number of risk factors that gets flagged and they somehow get like a different level of invite.

We also need to, to think about those who are more vulnerable because they've not got their baby with them, for example.

So women whose babies have died.

But thinking about the sort of socially complex women whose babies have been removed into local authority care, if you're a practice who does their postnatal checks all in one clinic, that's not going to be the right waiting room environment to invite a woman who doesn't have a baby with us.

So it's about making sure that for those rare but really important, important circumstances, your practice has got a setup and a pathway that correctly identifies and deals with them.

These women are probably going to need more of our time, and that opens a whole can of worms about funding and remuneration and all of those things.

However, we need to make sure that we're given time and that we're following people up.

I think when we see women for a postnatal consultation, because it's often referred to as a postnatal check, that can become in our minds a bit like, okay, it's a checklist.

I have to check certain things and then it's done.

We need to reframe that and see it like any other consultation.

So, sure, there are certain things that need to be done in that, but we may well need to follow up like we would from any other consultation.

Just because it's seen as a routine check, it doesn't mean that there's no follow up.

And if we can't address everything, if they need reflection, referral to social prescribing, if they need some support, you know, accessing the food bank if you need a conversation with the health visitor, if you need to go back to secondary care and say, I need some more information, I need to speak to the midwife, what happened?

That's going to need more of our time because, you know, we can't just magic that time out of nowhere.

Yeah.

Any final thoughts about sort of your thoughts around this area or anything that you want to mention?

I think my take home point would be that we are really expert at understanding our patients needs.

And because of this notion that maternity is not much to do with general practice anymore, it can be really easy to start to feel like that's not our problem.

But I think as gps we can really take ownership of that postnatal period where when it comes to identifying social risk factors like domestic abuse and so on, we're really, really good at that.

So we can also be really good at that in the postnatal period addressing sort of cardiometabolic risk factors.

The postnatal period is a really prime time for us to harness that opportunity and do it.

And it's some of the places where we can have the biggest potential gains in terms of improving people's long term health.

And when we improve the long term health of a woman who's just had a baby, we improve the outcomes for her infant as well.

So it really is like a win win because if we can address mental health problems in the woman, she's going to be able to have a better relationship and a happier, more fulfilling time for that baby who's going to be more well as a result.

So I think it's about us taking ownership, knowing our local populations, which we know we're really good at.

But there's probably some little tweaks that every individual probably practice can make that just nudge our ability to harness the power of our primary care teams and identify these, you know, socially complex women and give them the care that they are really, really in need of.

I think that's a really optimistic message actually.

It's sort of, to me it feels like this is a time that we have the opportunity to make a difference and I think that that really comes through very clearly in the editorial.

So yeah, I'd recommend anyone to go back and have a read through through it.

But it's just as you say, it's a really good thing to highlight and we are, you know, we are involved in these women's care after they come back to us from being in the maternity sort of bubble as almost as such with midwives and maternity care and I think it's really a chance to embrace that care and sort of think forward and how we can really optimise that.

So, yeah, brilliant, brilliant editorial.

But I think that's probably a great place to wrap things up.

Up.

And I just wanted to say thanks very much for your time.

Brilliant.

Thank you.

It's a pleasure.

And thank you all very much for your time and for listening to this BJGP podcast.

Claire's editorial can be found on bjgp.org and in the May issue of the Journal.

And the show notes and podcast audio [email protected] thanks again and bye.