Stopping maternity care for mothers six weeks after giving birth is unrealistic

8 December 2016

Professor Cecily Begley, is principal investigator of MAMMI and Chair of Nursing and Midwifery in the School of Nursing and Midwifery and Dr Deirdre Daly is Assistant Professor in Midwifery.

The MAMMI study (Maternal health And Maternal Morbidity in Ireland) was inspired by one woman, back in 2010, who told a midwife, now one of the MAMMI research team, that she leaked urine, could not control when she passed wind, and leaked faeces. This had been happening to her since she gave birth to her first child two years previously. Telling her story wasn’t easy, and it didn’t happen the first time she met this midwife, who was a complete stranger to her. It took a second and third visit, and importantly, time – time for the woman to develop trust in the midwife, and time during the visit for the woman to tell her story. The extent of this woman’s misery was plain to see and painful to listen to as she sobbed her heart out, spilling out the misery she had endured in silence for the previous two years.

Every part of this woman’s life had been made miserable by these health problems. At work she was afraid she would ‘get caught out’ or ‘caught short’, and at home she found her relationship with her partner was changing for the worse due to her fear of telling him or having an accident during intimate times. She had tried to talk to a health professional once but didn’t try again because she was told that ‘these things happen’. She was worn down and out by it, physically and mentally, and found herself withdrawing from her partner, friends and social life. There was nothing extraordinary about this midwife – she just happened to be working in a midwife-led service that could offer women a 20 minute visit, and that was all the time this woman needed.

That was six years ago, and that one woman was the inspiration behind the MAMMI study which has shown us that she was far from being alone and sadly that nothing has changed for thousands of new mothers since. Three-quarters of women birthing in Ireland are not being asked about their own health issues after becoming mothers, and the lack of information and lack of discussion about these issues means women stay quiet, because they feel embarrassed and believe they are alone in experiencing these problems. Most women change their lives to fit in with the health limitation rather than seeking help to fix the problem. For example, many women stop exercising or do less exercise because they are afraid they will leak urine.

After women become mothers, it seems as if maternity services have no time for them and no time to listen to women. Perhaps this is because the health problems women experience after the birth are, generally, non-life threatening and are thus viewed as being of less importance than more serious health conditions. But these problems, acute and temporary initially, go on in some instances to become chronic, debilitating conditions that weigh women down, affecting their lives and the lives of their children and partners. All postnatal health problems are treatable and curable, often with conservative and non-invasive treatments, but not asking women about them compounds the silence, and makes it too hard for women to divulge their difficulties.

The take home message for women is - health problems such as leaking urine, faeces, having pain in the pelvic area, being anxious, down or depressed, are not normal, and can be treated.

The message for healthcare professionals is – take time to listen to women. If time is short, find ways of making sure women are told about postnatal problems and are given time to tell their story. Every woman should be offered the opportunity to complete a self-assessment check-list on health and well-being after motherhood.

The message for policy makers is – stopping maternity care at six weeks postpartum is far too early and is unrealistic. Women have barely had a chance to settle into motherhood, have spent the weeks since the birth trying to mother their baby as best they can with little sleep, and have had no time to think about themselves. Follow-up visits, three months after becoming a mother, should be an essential part of our maternity services and has been recommended in the National Maternity Strategy 2016. Data should be recorded electronically so, as a nation, we know about women’s health problems, and can link these back to her maternity care. The maternity services is the ideal place to introduce the individual health identifier that was legislated for in 2014.

And one final plea, as services undergo the much needed redesign, change the title of the community postnatal services from being ‘Child health surveillance services’ to ‘Woman, child and family services’. In other words, put women first, foremost and central. If women are well, babies and families will be well.

First published as an opinion piece in the Irish Independent: Stopping maternity care for mothers six weeks after giving birth is unrealistic

Professor Cecily Begley, is principal investigator of MAMMI and Chair of Nursing and Midwifery in the School of Nursing and Midwifery and Dr Deirdre Daly is Assistant Professor in Midwifery.

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