Updated: Apr 8



How I feel about postpartum care in this country is no secret. I strongly believe that we need to make urgent changes to a system which is currently failing both those who work within it and those who birth within it.

Throw. It. In. The. Bin.


But how did this current model come about? And can anything be learnt from past practices which might improve our current system? These are the questions I have been considering and here I will share with you what I have found. (Plus my thoughts on how we can change things for the better...)

 

In the early 20th century, the majority of women birthed at home and the postpartum period was one of care and consideration. The 1902 Midwives Act meant that every birthing person was attended to by a trained midwife (1) and the culture of community back then meant that birthing women were held and helped. Women grew up watching mothers, aunts, sisters and cousins give birth. They were prepared for when their time came and they were surrounded by a village of women who were experienced and could help them.


The loss of population during the First and Second World War lead to an increased concern for infant and maternal health. Creating new life became part of the war effort and midwifery - and pregnant womens bodies - became a political issue. Women began to receive increased antental check-ups and, by the end of the Second World War, more women were birthing in an institution than at home (2).



In 1967 the Maternity and Midwifery Advisory Committee published a report recommending that, for safety reasons, 100% of births should occur in a hospital. Despite offering no evidence or explanation, this lead to a rapid switch from home to hospital birth - jumping from 68.2% in 1963 to 91.4% in 1972. By 1975, over 95% of births occured in a hospital (3). A statistic that would never be reversed. This was the true beginning of what we now see as the increased medicalisation of birth.


With the swap from home to hospital birth, postpartum care had to be adapted. Women were having more complicated procedures and community-based care was no longer seen as enough. There were also huge changes in societal development which left families without their once traditional support systems. During this time, women were routinely kept in hospital for the first two weeks postpartum. They would have enforced bed rest, receive support with caring for their newborn and be taught breathing exercises to recover from childbirth.


The economic struggles of the post-war era placed huge strains on the country. This was the driving force behind reducing the postpartum hospital stay down from two weeks to mere days. This two-week stay had replaced the community-based family and midwifery led care women would have previously experienced. With hospital care also removed, women were simply sent back into the community with little to no specialist support and a mentality of simply 'getting on with it'. A mindset that is sadly still an issue today.


The 1993 'Changing Childbirth' report from the Department of Health truly defined women-centred maternity care with a strong focus on the psychological impacts of childbirth, not just the physical. The report focused on the 'Three C's' - choice, continuity, and control (4). The report was inspirational and saw a huge shift in women having more autonomy over their birthing experience. Yet, almost thirty years later, the 3C's are still just an idyll.




And postpartum provision just kept on dropping. By 2014, 71% of women were sent home before day 3 with only 62% of these receiving three or more home visits following discharge - down from 91% in 2006 (5). Economic and service pressures have severely affected the quality (and length) of service maternity care can provide. Staffing shortages, bed shortages, availability of resources and budget issues all placing limitations on women's care. An increase in maternal age, an increase in the medicalisation of birth - with the c-section rate predicted to rise to almost 30% by 2030 (6) - all placing additional strain on an already struggling service.


The 2016 ‘Better Births’ National Maternity Review comments on the “historic underfunding” of postnatal care. Their 2016 survey showed that many women showed concerns following their care post-birth and that this was one area that showed ‘significant scope for improvement’. For the postpartum period it states that “Postnatal care must be resourced appropriately. Women should have access to their midwife ... as they require after having had their baby. Those requiring longer care should have appropriate provision and follow up in designated clinics.” For those of us who have been through the system - especially in light of the pandemic - know that these important changes have not occurred.

 

So what does postpartum care look like now?


A report in PLOS Medicine back in 2016 showed that UK women have the shortest postpartum hospital stay in the world (7). Most postpartum people are discharged within 24 hours and, for those of us who are onto our second + birth, we can expect to be home within six hours. We get a midwife visit the day after discharge with a second visit at day 5. The majority of people are discharged from specialist, midwifery-based care between day 10 and 14. With around 90% of us requiring stitches of some sort, the large majority of people will not be fully healed at this point. We simply will not know if we are okay. We will not know if we will encounter complications.


And what exactly is the point of the 6 week check???? (If you were lucky enough to actually have one in this post-pandemic era).


All of the reports listed above are great, research into the issue is great but it rarely results in significant change and impact.


The current system is hurting those who serve it as well as those it serves.


 

What should the future look like for postpartum care?


It is hard to view the current overstretched and underappreciated maternity system as capable of providing any more than what is currently on offer.

With Blue Sky Thinking - whilst looking at my baby daughter and considering how I hope the world will look when and if she decides to create life - here are a list of wishes:


Less medicalisation - with birthing people being provided all of the facts available, the benefits and the drawbacks to each choice. All of the statistics, put forward in a non-biased way so they feel empowered to make choices based on their current situation and beliefs. People deserve to understand the difference between perceived risk and actual risk. And they need a health-care team which will support them in their choices, even if it goes against what the team personally believe to be best.


Better in-home care - that supports the postpartum person in their journey of recovery. We need specialist care until we are fully healed and recovered. Anything less is not good enough. We need quick and fast access to gynaecology, to women's health physiotherapists, birth trauma specialists. We need proper rehabilitation for our body. We cannot simply be expected to deal with it. 'You've had a baby, what do you expect?' is not the attitude we need.


Autonomy and trust - a health care team that listens to us, believes us and works with us. That does not normalise or minimise our pain and suffering but works to ease it.


Holistic postpartum education in the antenatal period - teach women and their support network how to look after themselves during this time - How do you care for stitches? How do you return to exercise? What should you be eating to support breastfeeding and recovery? Rest, restore, recover. Figuring these things out when you have a newborn who won't be put down and you are incredibly sleep deprived is not going to work.



 

To share your postpartum story, please email zoe@postpartummatters.co.uk or DM me @postpartum_matters.


I hope that by sharing our stories, we can change the conversation from ' bouncing back' to resting and recovering. And, as a society, we can start caring for and holding space for those who are postpartum.

 

References

  1. Alice Read. (2012) Birth Attendants and Midwifery Practice in Early Twentieth-century Derbyshire. Social History of Medicine, Volume 25, Issue 2, Pages 380–399.

  2. Angela Davis. (2014) Wartime women giving birth: Narratives of pregnancy and childbirth, Britain c. 1939–1960. Studies in History and Philosophy of Science, Vol. 47(B): 257-266.

  3. Angela Davis. (2013) Choice, policy and practice in maternity care since 1948. History & Policy. https://www.historyandpolicy.org/policy-papers/papers/choice-policy-and-practice-in-maternity-care-since-1948

  4. McIntosh & Hunter. (2014) ‘Unfinished business’? Reflections on Changing Childbirth 20 years on. Midwifery Volume 30, Issue 3, Pages 279-281.

  5. Jane Henderson. (2017) Change over time in women's views and experiences of maternity care in England, 1995–2014: A comparison using survey data. Midwifery, 44: 35-40.

  6. Betran AP, Ye J, Moller A, et al. (2021) Trends and projections of caesarean section rates: global and regional estimates. BMJ Global Health 6:e005671.

  7. https://www.theguardian.com/lifeandstyle/2016/mar/09/new-mothers-in-uk-have-shortest-hospital-maternity-stays-research-finds






51 views0 comments

Recent Posts

See All