After 40 weeks (or more) of regular check-ups and monitoring, the abrupt end to medical care at six weeks postpartum can feel very much like ‘wam, bam, thank you mam’ with the door hitting your backside on the way out.
During pregnancy you get around 10 check-ups (or more, if there are complications) over nine months.
*Theoretically* you should receive the same amount postpartum, but all of these checks happen within a much shorter time frame, with a myriad of different health professionals – and they also mostly focus on the baby.
Even the so-called maternal check with your GP between six and eight weeks postpartum (also known as the six-week check, which was added into GP contracts in 2020) is often tagged onto the baby check, meaning women can feel rushed and unable to concentrate on their own health.
The six-week check is vital – indeed, I was part of a group who helped put together a new GP template, but I am unconvinced that the check-up is both thorough and enough.
By six weeks, hormones should be stabilising, bleeding should be slowing (or have stopped), and your uterus should have shrunk back – but what about everything else? What about our scars, and our brains, and our leaking everything?
Whilst undertaking the research for my book Your Postnatal Body, I was astounded about how little of our body isn’t affected by pregnancy and birth.
From the hairs on your head (shedding temporarily at about three months postpartum) to the tips of your toes (now scrunched up at the ends of your shoes as your feet flatten and widen) – not to mention all the bits in between, there is a lot going on.
And yet, we are jettisoned at precisely the moment we are starting to figure out what has gone back to normal and what hasn’t.
Journalist and presenter of the Mother Bodies podcast, Rosie Taylor, had a difficult birth and postpartum experience. The delay in both her physical and mental trauma being picked up has made her a strong proponent of an additional maternal check within the first year postpartum – and this is where we joined forces.
As a campaigner, I have been calling for changes to our postnatal care model for some years, and Taylor and I will be revisiting Parliament with health professionals again later this year.
Whilst there has been talk of change, the pace can be frustratingly slow. Meanwhile, thousands of women suffer.
Natalie Dale, a yoga teacher from London, was left feeling suicidal after a difficult birth resulting in a bad tear, pelvic organ prolapse and her baby needing to go to NICU.
This was exacerbated by an inability to access the mental health support that she needed.
Dale, who is 37, is convinced that a second maternal check-up would have been beneficial to her. “I felt completely abandoned by the system. My mental health took a dive after the six-week check and it took a year to get help,” she says.
“As a sporty person, the prolapse felt like a life sentence and then the birth trauma – I thought we were both going to die – added an extra layer to that.
“You feel so important during pregnancy, the feeling of being left alone afterwards just added to my postnatal depression.”
Dr Eloise Elphinstone – who works as a GP – told me that since becoming a mother herself, she has dramatically changed how she conducts maternal checks, asking more questions, such as about incontinence, which women can be reluctant to bring up themselves.
Dr Elphinstone believes there should be more flexibility around maternal checks, giving GPs the chance to focus on the woman in front of them, rather than it being a tick box exercise.
She is an advocate for an additional maternal check. “Another check-up would allow us to pick up problems before they get bigger,” she says.
This could be pelvic issues such as incontinence, prolapse and painful sex or it could be monitoring ‘red flags’ from pregnancy such as gestational diabetes or pre-eclampsia, which increase your long-term risk of type 2 diabetes and hypertension respectively.
Postnatal mental health issues can also surface much later than six weeks, as birthing parents face more hormone changes (especially around weaning) and lifestyle changes such as going back to work.
With Black women and women from other ethnic minority backgrounds, who experience worse outcomes in maternity, we really need to see this as a chance to stop these women in particular from slipping through the gaps.
I remember how I felt postnatally; unimportant and abandoned. Now, running the online @postnatalhealthcommunity, this is something I hear time and again from other mothers, many of whom silently battle their mental and/or physical health issues or end up going private if they can afford it.
An additional check-up within the first year would reinforce the idea that new mothers’ health is important. It would be a chance for women, and birthing people, to leave their baby with a trusted family member so they can focus fully on themselves.
It may even give some women the time to pluck up the courage to talk about problems they’re having, particularly if they are from a community where asking for help in this way is stigmatised.
Anecdotally I also know that, for some NICU parents, this might be the first time they have been checked over at all as they can too easily fall out of the system.
It’s time we recognise that the postnatal period is much longer, and often more complex, than the current ‘sign off at six weeks’ would have us believe – and adapt the care model accordingly.
With the worrying MBRRACE statistics from last year showing a concerning rise in maternal suicide deaths, coupled with high rates of postnatal mental health issues and pelvic issues, we would do well to put our money where our mouth is when it comes to preventative care.
Women have been an afterthought in postnatal care for too long, we deserve more.
Lyanne Nicholl is the author of ‘Your Postnatal Body – a top to toe guide to caring for yourself after pregnancy and birth’ – available at online bookstores.
If you are struggling with perinatal mental health issues, PANDAS Foundation can be a great help: 0808 1961 776.