Why does postnatal care only last a few weeks? New data shows that this should be years | Devi Sridhar
bThe first day is usually a time of celebration, recognizing the miracle of life as a child is brought into the world. In Britain, childbirth used to be a much more fraught experience, with a high risk of death for mother and baby. But scientific progress and modern medicine have reduced infant mortality per 1,000 live births, from 31.7 in 1950 to just four in 2020. The number of deaths is relatively higher than Finland and Japan infant mortality rates of about two in a thousand, but much lower than Afghanistan at 103.1.
Once a woman and her baby survive childbirth, several weeks of follow-up is routine in many countries to ensure that any pressing health issues are resolved. This six- to eight-week period is called postnatal care because women are recovering from childbirth, especially if they have had a cesarean section or episiotomy. But what happens to new mothers after those few weeks? They usually disappear from the healthcare system and are left to deal with recovery.
This year is one new scientific review was published in Lancet Global Health, which estimated the extent of long-term postpartum disease by bringing together a number of international studies. The authors estimate that more than a third of women who give birth in a given year suffer from long-term health complications – that’s at least 40 million women worldwide. Even in births without immediate complications, problems can arise later, often after the health system stops monitoring women.
It won’t surprise you to hear that postpartum health issues aren’t easily brought up over dinner because they concern the most private areas of our bodies. These include urinary and anal incontinence, dyspareunia (pain during sex), postpartum depression, tokophobia (fear of childbirth), and chronic pain in the lower back and pelvic area. It is estimated that 43% of women had pain during sex for two to six months after giving birth, 22% for six to 12 months and 40% between 12 and 24 months. Of those who gave birth vaginally, 19% of women suffered from anal incontinence even one year after giving birth.
Postpartum depression has become better recognized in recent years and affects an estimated 11% of women in high-income countries, while secondary infertility (the inability to give birth a second time) is 10.5%. Lower back pain affects an estimated 31.6% of postpartum women, while perineal pain affects 11%.
If you’ve given birth, or been close to someone who has, these circumstances probably resonate. This is talked about behind closed doors, with women often being told to carry on as usual while they care for a new baby. Still, these health challenges aren’t easy for new moms to ignore, given the daily pain they bring just by going to the bathroom, having sex, or just existing. Despite the high prevalence of these conditions, the research shows that no high-quality guidelines for the management of 40% of priority conditions exist in high-income countries, and none have been developed in low- and middle-income countries.
We finally have strong statistics showing the extent of postpartum illness in the long term. These should be used not only to raise awareness, but also to develop solutions. Healthcare systems should consider post-birth support to extend beyond six weeks. This may include routine three-, six-, and 12-month check-ups in women to ensure recovery is on track and to provide care to relieve pain and symptoms. Women should not be left alone and suffer. In addition, we need high-quality international guidelines developed for the 32 most important priority conditions that nurses and doctors can rely on.
Reducing the stigma around long-term health complications after birth is also important: you can do this in your daily life by not only asking about the new baby, but also asking a new mother how she is doing and ensuring that talking about urinary or urinary tract infections, anal incontinence, pain during sex or postpartum depression are not seen as taboo or uncomfortable. So many people experience them that they are in fact commonplace. No one should feel isolated and alone when dealing with these issues.
Last month I wrote about declining fertility in almost all parts of the world. While there are several factors that lead women to choose not to have children, including access to contraception and gender equality, governments must also be aware of what childbirth does to women’s bodies, and the long road to a completely pain-free recovery . There is a clear urgent need to improve maternity care in the NHS, which is in crisis. But another step to make childbirth safer and more feasible would be for healthcare systems to provide services and support to let women know that after six weeks they will not be left alone, but will be supported and cared for – at least for the first two years.