I vividly remember starting many postnatal shifts by taking a sheet of A4 paper and folding it into squares, one for each woman and her baby.
As the shift went on each square would fill up with maternal and newborn observations, feeding plans, medicines, jaundice checks and notes on anything I needed to follow up.
At the time, it felt like a practical way to stay organised. It was only much later that I realised what that piece of paper was telling me. Every square held two patients, not one: a woman recovering from birth and a baby who needed their own assessment, monitoring and care. A ward caring for six women and six babies isn’t caring for six patients – it’s caring for twelve. I suspect many midwives reading this will recognise that experience.
I started my midwifery training in 2009 and had the privilege of learning from some phenomenal postnatal midwives. Their commitment to women, babies and families shaped my understanding of what good care looks like.
Some of my greatest job satisfaction came from helping families through the transition to parenthood, which included supporting feeding decisions, offering reassurance, spotting early concerns, or simply making time to listen.
As a newly qualified midwife, I even considered applying for a permanent postnatal role on nights. If I am honest, part of the appeal was that the workload often felt slightly more manageable, with fewer visitors, fewer interruptions and fewer competing demands.
Looking back, I realise that what I perceived as a more manageable workload was often simply a relative reduction in pressure, rather than genuinely safe staffing.
That comparison says a lot. Postnatal wards have carried such a heavy workload for so many years that “slightly less busy” had started to feel manageable. The question we should be asking is how that became normal and why we have accepted it for so long?
Maternity care today has changed and women are more clinically complex. More babies who need extra monitoring and support are now cared for on postnatal wards through transitional care, rather than on neonatal units. Midwives have expanded responsibilities, yet discussions about safe staffing continue to focus largely on labour wards, theatre activity and triage. Postnatal care matters too.
Labour care has a recognised one-to-one standard and neonatal units work to defined ratios. Postnatal wards have no equivalent standard. Babies are factored into workforce planning tools such as Birthrate Plus, but it is rarely clear to the midwives delivering care, or to the women and families receiving it, how that care is reflected in actual staffing numbers.
The RCM’s safe staffing position statement is an important step forward. It states that babies must be accounted for within care provision and recognised as individuals requiring assessment, monitoring and clinical care in their own right. The next step is making sure that principle is visible in how postnatal wards are actually staffed.
Since writing about this issue earlier this year, I have spoken with colleagues, maternity leaders and policymakers. What has struck me most is how many people immediately recognise the problem. They do not need convincing that postnatal care is busy. They have lived it.
If you recognise these challenges in your own service, I would encourage you to join the conversation. Speak to your local leaders. Get involved with your RCM branch and share your experiences. Help ensure that postnatal care has a voice in discussions about maternity safety and workforce planning.
Because unless we start talking about postnatal staffing, it is unlikely to change. And if babies are patients, then surely they should count.
Count the babies. Protect postnatal care.
