Midwife and Health Visitor Visits After Birth

The published timings

First midwife visit. NICE NG194 is specific: "Ensure that the first postnatal visit by a midwife takes place within 36 hours after transfer of care from the place of birth or after a home birth. The visit should be face-to-face and usually at the woman's home, depending on her circumstances and preferences."

Two things to notice. Thirty-six hours is a maximum, not a target. And "face-to-face" is written into the recommendation, so a phone call is not a substitute for the first visit.

How long midwife visits continue. The NHS says midwives "will agree a plan with you for visits at home or at a children's centre until your baby is around 10 days old. This is to check that you and your baby are well and support you in these first few days."

First health visitor visit. NG194 says to "consider arranging the first postnatal health visitor home visit to take place between 7 and 14 days after transfer of care from midwifery care so that the timing of postnatal contacts is evenly spread out." The NHS puts it as "when your baby is around 10 to 14 days old."

NG194 adds a provision people rarely know about: "If a woman did not receive an antenatal health visitor visit, consider arranging an additional early postnatal health visitor visit."

The handover, and why it should not be silent

NICE NG194 requires that "the transfer of care from midwife to health visitor is clearly communicated between healthcare professionals and the woman or the parents are informed about the transfer of care from midwife to health visitor."

If your midwife visits simply stop and nothing happens for a fortnight, that is a gap worth chasing. Ring your GP surgery or the health visiting team and say your midwife discharged you on such a date and you have not heard from a health visitor.

What they are actually checking on you

NG194 lists what the midwife should assess at each contact, for all women:

• symptoms and signs of infection;
• pain;
• vaginal discharge and bleeding;
• bladder function;
• bowel function;
• nipple and breast discomfort and symptoms of inflammation;
• symptoms and signs of thromboembolism;
• symptoms and signs of anaemia;
• symptoms and signs of pre-eclampsia.

For a vaginal birth, perineal healing is added. For a caesarean, wound healing and signs of wound infection.

NG194 also requires that "At each postnatal contact, assess the woman's psychological and emotional wellbeing," with further assessment and follow-up arranged if there are concerns. And it asks that at each contact you are given "the opportunity to talk about her birth experience," with information about birth reflection services where appropriate.

That list is the answer to "what am I allowed to bring up?" All of it. None of it is off-topic.

What they check on your baby

The NHS describes the early checks: a newborn physical examination offered within 72 hours; checks for jaundice, infection of the umbilical cord or eyes, and thrush in the mouth; and temperature, weight and reflexes. "On day 5 after the birth, or sometimes a few days later, you'll be offered the newborn blood spot (heel prick) test," and a newborn hearing screening test before your baby is four weeks old.

The health visitor takes over growth and development, recording it in the personal child health record — the red book. The NHS says "A health visitor will do a new baby review within 10 to 14 days of the birth," covering safe sleeping, vaccinations, feeding, adjusting to life as a new parent, and your baby's development.

The next scheduled review is at six to eight weeks: a thorough physical examination usually done by a GP, and, in the NHS's words, "They'll also ask you how you've been feeling emotionally and physically since the birth of your baby."

The check that is about you, not the baby

The 6 to 8 week postnatal check is yours. The NHS says: "Your GP surgery should offer and provide you with a postnatal check. You can request an appointment for a check yourself, especially if you have any concerns. It's a good idea to make a list of questions to take along with you."

It can be done immediately before or after your baby's 6 to 8 week check, or separately if you would prefer — and asking for it separately is worth knowing about, because a combined appointment tends to become entirely about the baby.

The HSE describes its equivalent postnatal check-up in similar terms.

Getting more contact than the schedule offers

There is no fixed number of visits, and NG194's framing is about need rather than quota. Reasons that justify asking for more contact include feeding that is not established, wound concerns, low mood, a previous mental health problem, a difficult birth, no support at home, or a baby who is not gaining weight.

NICE CG192 is relevant here too: it says clinicians should consider asking the depression identification questions "During the past month, have you often been bothered by feeling down, depressed or hopeless?" and "During the past month, have you often been bothered by having little interest or pleasure in doing things?" during the early postnatal period. If nobody has asked, you can start that conversation yourself.

If nobody comes

Ring the maternity unit if the first midwife visit has not happened within 36 hours of you leaving. Ring your GP surgery or the health visiting team if you have heard nothing by two weeks. NG194 says "All healthcare professionals should ensure appropriate referral if there are concerns about the woman's health," and the pathway only works if someone knows you are in it.