Clinicians

Why is what comes after birth an afterthought? Time to give postnatal care the spotlight

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Author: Hegenberger Medical

Author: Marie Louise, Founder of the Modern Midwife and a UK Midwife since 2012 and Senior Midwife in Australia (2013-15)

Antenatal vs Postnatal care – mind the gap!

Growing and giving birth to another human being requires a lot of nutrition, energy and physiological changes. This includes changes to the cardiovascular system, blood volume increasing by 50%, the lungs changing shape and the loosening of ligaments leading to supported fetal growth, to name just a few. Mums are often left with some form of wound either due to a c-section or trauma to the perineum. Yet rarely do we prepare mums for this or talk about wound care afterbirth. Why is this?

If a mum goes on to breastfeed she needs to continue to share her body in many ways and makes around 600ml – 1200ml milk every 24 hours for her baby. Breastfeeding maybe a natural process but it does not come naturally to many mums as all maternity care providers know, mums need support, realistic expectations and a good understanding of normal newborn behaviour. Why isn’t more education and support provided?

What comes afterbirth often remains an afterthought. During pregnancy the focus is often on fetal surveillance, the pregnancy and birth preparation. Lots of mums are left wondering, why wasn’t I prepared for this? Sadly postnatal care is the aspect of maternity care that women in England are least satisfied with1. Likely this will not come as a surprise for every clinician reading this, we have long been aware of the differences in antenatal and postnatal care. 

Postnatal care internationally – how do approaches differ?

The approach to postnatal care differs widely throughout the world by both country and culture. Let’s explore some examples.

In Malysia, there’s real focus on the first six weeks following birth and nourishing the mum to support her healing and recovery.

Nearby in China there is something known as ‘the one month sitting’ where new mums aren’t expected to get out of bed and everything is done for them. Some clinicians would argue this is not ideal due to the risk of blood clots and that movement promotes healing, yet it’s interesting that postpartum care is embedded so firmly into the nation’s tradition and consciousness.

The ancient practice of Ayurveda in India is the world’s oldest holistic healing system and includes an approach for new mothers. The practice recognises the stress that birth can have on mums’ bodies and seeks to harmonise their vata energy with rest, warmth, food for their digestive system and nourishment.

Closer to home, mums in the Netherlands are given access to a Kraamzorg which is a unique form of postnatal care where a professional supports a new mum with daily recovery checks, a daily review of the baby (checking weight, temperature, etc.), supports (if necessary) with breastfeeding and teaches both parents about basic childcare. A Kraamverzorgende will even help with light household work such as laundry and cleaning of the household including the bathroom, toilet and mother and baby’s rooms to ensure a clean environment for the family and their newborn.

So what learnings can we take for the UK? 

It’s important to consider different international practices and how they are supporting new mums when considering our approach to postpartum care in the UK.

Postnatal care has an important role in enabling a safe and positive transition to parenthood, especially for first time parents2. The consequences of poor postnatal care may be especially problematic for first-time mothers, who need to develop parental confidence, new skills understanding of their body and their babies3. Research by Jenny McLeish revealed first-time mothers’ satisfaction with postnatal care and their confidence as new mothers were primarily influenced not by the extent to which their expectations were met but the varied extent to which their postnatal needs were met’1.

Ultimately, McLeish concludes that rapid and responsive assessment of needs both antenatally and postnatally is the best possible course of action for mum and baby alike. Raising concerns with our senior colleagues and questioning processes that may not supporting mums is important. Our voices matter and we have a profound impact on new mothers’ lives.

As care providers we need to bring focus back to postnatal care, to offer solutions and push to promote and define postnatal care pathways. Let’s start here in the UK and put postnatal care back into the spotlight where it belongs.

References 

  1. First-Time Mothers’ Expectations and Experiences of Postnatal Care in England, Jenny McLeishMerryl HarveyMaggie Redshaw, … First Published September 17, 2020 Research Article in PubMed https://doi.org/10.1177/1049732320944141
  2. Demott, K., Bick, D., Norman, R., Ritchie, G., Turnbull, N., Adams, C., Barry, C., Byrom, S., Elliman, D., Marchant, S., Mccandlish, R., Mellows, H., Neale, C., Parkar, M., Tait, P., Taylor, C. (Eds.). (2006). Clinical guidelines and evidence review for postnatal care: Routine postnatal care of recently delivered women and their babies. National Collaborating Centre for Primary Care and Royal College of General Practitioners.
  3. Barclay, L., Everitt, L., Rogan, F., Schmied, V., Wyllie, A. (1997). Becoming a mother— An analysis of women’s experience of early motherhood. Journal of Advanced Nursing, 25(4), 719–728. https://doi.org/10.1046/j.1365-2648.1997.t01-1-1997025719.x

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