Postnatal Notes Field Trial
This evaluation was a joint project between the Perinatal Institute and the Mid-Staffs NHS Trust, Maternity Department of Stafford District General Hospital and community areas of Rugeley and Cannock.

Aim
The aim of the field trial was to assess the 'user friendliness' of the new Postnatal Notes for Mother and Baby, for both mothers and health professionals.

Methods
50 sets of notes were audited, 50 mother and 50 baby of the first 50 consecutive women to deliver a live baby booked by the Chase Team from commencement of the evaluation. 80 midwives altogether used the documentation, 67 hospital based midwives and 13 community based midwives.

Results
33% of the midwives who used the Notes responded to the questionnaire.

Delivery Suite Midwives
Initially they found the notes time consuming and some sections repetitive. They found that the birth summary and postnatal checks were good, but would find navigation easier if they were on the front page. The tick boxes in these sections were not popular as the midwives preferred to make notes. In the ‘Information for Mothers’ section, they liked the documentation on mothers’ emotions but felt they did not and would not get a positive response to the section on contraception. In the ‘Examination of the Newborn’ section they did not have enough space to document abnormalities. They also felt that 10 days was not long enough for mothers to read through the information.

Team Co-ordinator, Community
The team felt they had to navigate through the notes to find the information they were looking for. When completing the postnatal discussion some mothers used the opportunity to complain about waiting times and meals etc and this then created more problems. The postnatal checks were not consecutive which meant flicking through the notes. There was positive feedback on the breastfeeding information and the idea of both the GP and health visitor having a copy of the discharge letter, although this could also be time consuming. Overall they would prefer one set of notes and the mothers to keep the information sections.

Community Midwife
The community midwives found that the notes were initially time consuming but became better with experience. They liked the information within the notes and thought that it would be good for fathers to read and know what was going on. Space to document what advice and information they give the mothers, to allow effective communication of information to other carers would have been preferred.

Mothers
The majority of the mothers wanted a ‘great deal’ or ‘quite a lot’ of information during the postnatal period. 80% of the mothers read the information in the notes and all understood the content and were happy with the amount of detail. They all thought the information given was relevant, with some wanting more information in certain areas, especially neonatal screening.

Conclusions
The results of the field trial significantly influenced the development of these notes and the notes now include less repitition and a more logical flow. The field trial demonstrated that as the midwives became more experienced with the layout of the notes they found them easier to use. This increased knowledge highlighted areas for further development.

The mothers found the notes informative and easy to understand.

Acknowledgements
We would firstly like to thank the women who agreed to participate in the use of the notes during the postnatal period and completed questionnaires to aid our evaluation.

We are also grateful to the hospital midwives of the Stafford District General hospital and community midwives of the Chase Team, Cannock, for their participation and cooperation in the field trial of the Notes.