Why Women's Bodies Need After-Birth Care As Much As Their Babies

Mums-to-be are encouraged to write a birth plan, but what about a recovery plan?

The majority of pregnant women (91%) do not feel they are given enough advice during pregnancy about postpartum recovery. Tens of thousands of women are also giving birth each year without a recovery plan in place. Those are the damning findings of a study conducted by the pre and postnatal care app MUTU System, shared exclusively with HuffPost UK.

A shocking 84% of respondents experienced some form of postpartum health issue – such as abdominal muscle separation or incontinence – but almost all respondents (89.1%) said they did not feel prepared in recovery methods.

The study included participants from both the UK and US, where healthcare systems vary greatly, but it highlights that mothers in the UK are facing real challenges. Of the 3,349 respondents, 1,874 study participants were from the UK, around 56%. The study follows reports by HuffPost UK highlighting the gaps in NHS postpartum care, exacerbated by the pandemic, with new mums repeatedly saying care is often baby-focused, with very little help for mothers.

Kay Barnes, 33, from Cornwall, gave birth to her son in 2017. Her baby was “really big” and experienced a shoulder dystocia during birth, meaning his shoulder got stuck inside her pelvis. The three-year-old is healthy now, but Barnes says the experience of birth and the aftermath left her with PTSD.

“The whole thing was very worrying and traumatic. I did have postpartum depression and anxiety after that and actually, I’m still to this day having the odd counselling session to work through that,” she says. “I’m okay, but I know I probably won’t have another child because of it.”

Barnes was given the thumbs up to get back to exercise and sex at her six-week postnatal check, but says she knew something was wrong. She still had an uncomfortable sensation of heaviness and sex was excruciatingly painful.

Kay Barnes and her son. 
Kay Barnes and her son. 

She says it took multiple doctor’s appointments until she was referred to a women’s physiotherapist and diagnosed with a hypertonic pelvic floor – when the muscles in the pelvic floor become too tense and are unable to relax.

She knew nothing about the condition, or the exercises needed to combat it, and believes women should be taught about potential postnatal complications during pregnancy, so they’re empowered to spot signs and access help.

“I went in blind thinking, ‘I’ve totally got this because I’m really fit and healthy and it will be fine,’ but it’s just ended up being an utter car crash,” she says.

“I went in blind thinking, 'I’ve totally got this because I’m really fit and healthy,’ but it’s just ended up being an utter car crash.”

- Kay Barnes, 33

“I don’t want to bash our NHS, because I know that they are really thinly spread, but I think there’s a lot of emphasis on the birth plan and asking if you’ve got your hospital bag packed and it feels like there’s an element missing. I’d like to have been asked: ‘Have you got your recovery plan in place?’”

It took Barnes a year to recover physically from birth, and another year until she started to feel mentally back on track. One of the worst parts, she says, was not knowing what was happening to her body for so long.

There are a number of conditions women want to know more about before pregnancy and birth. The most common postpartum symptom experienced by women in the study was diastasis recti (73.2%), which is the partial or complete separation of the abdominal muscles during or after pregnancy.

The second most common symptom was incontinence (41.9%), followed by postnatal depression (35.8%), prolapse (17.6%) and hernia (15.2%). Significantly, over 76% of respondents claimed their symptoms had a direct impact on their mental health.

Niki Odogwu, whose two daughters were born in 2011 and 2015, struggled with multiple symptoms. The 40-year-old, who lives in London, experienced diastasis recti – separation of the abdominal muscles – after her first birth. The gap only widened after her second birth and she went on to develop an umbilical hernia.

“I had a stomach bulge and poor posture and was often mistaken for being pregnant, despite having had my second baby two years ago,” she tells HuffPost UK. “I noticed that I would wet myself when I sneezed and when I jumped on the trampoline, which was quite mortifying.”

Niki Odogwu
Niki Odogwu

All this affected her confidence and Odogwu says she didn’t feel like herself for a long time. “I was very conscious with how my clothes fit and it was embarrassing when people mistook me for being pregnant. My back pain was very debilitating and I was often off sick from work and was unable to care for my two children at times,” she says.

“I had no idea what was happening to me, and although it was explained to me that my stomach muscles had separated during pregnancy, the subsequent symptoms were not explained so I didn’t make the connection.”

Jessica Girards, 34, from Guernsey, also says she severely lacked information about postpartum health. She has three children, born in 2013, 2014 and 2020.

Recovery after her firstborn was straightforward, but when she got pregnant with her second child a year later, she started to experience back pain. “No one had ever said to me: ‘It takes this long for your body to fully heal after having a baby,’” she says of having two babies close together.

The back pain continued for four years after she gave birth, as a constant daily ache with extremely painful flare-ups.

“If I went to a picnic or a wedding where I’d sit in a hard chair all day, the next week I wouldn’t be able to walk around,” she says.

Jessica Girards with her youngest child. 
Jessica Girards with her youngest child. 

The mum-of-three paid hundreds of pounds for physiotherapy and osteopathy appointments, but they didn’t do much to ease her chronic pain. It was only when she began searching back ache after pregnancy online, that she learned it can be linked to a weakened pelvic floor.

“I’d gone to see physios, I gone to the osteopath and nobody had ever told me about that,” she says. “I don’t know why it’s not part of antenatal classes. Everybody talks to you about ‘this is what you need to do to get your baby out,’ but not ‘this is what you need to do to rehab your body afterwards.’”

Girards says the backache she’d experienced for four years started to ease after just two weeks of doing pelvic floor core exercises on the MUTU app. Access to the programme costs £99 per year, which Girards says has been “worth the money”, as she felt able to have a third child with techniques to manage her chronic pain. But what about women who can’t afford to access help via a private company? Shouldn’t support be available to all women after birth?

Registered midwife Zeenath Uddin, head of quality and safety at the Royal College of Midwives, told HuffPost UK that midwives “know that the period after the birth can be challenging and exhausting for many women, and that the right support and advice is essential”.

“A lot of work is being done to improve it,” she said. “New guidance was published last week to make the transition around 10 days after the birth and beyond from midwifery to health visitors better, providing more support for women and babies. Midwives will also discuss postnatal care with the woman leading up to the birth, so they know what to expect and how often they will see their midwife.”

“Everybody talks to you about ‘this is what you need to do to get your baby out,’ but not ‘this is what you need to do to rehab your body’.”

- Jessica Girards, 34

Maternity services have been through challenging times during the pandemic, Uddin added, and existing and serious midwife shortages worsened as staff were off sick with Covid or self-isolating. “This meant fewer face-to-face appointments than midwives would like to have provided. To deliver the world-class maternity care that women deserve we must tackle this midwife shortage,” she said. “More funding is coming through for extra midwives in England, and the RCM is urging the government to get the money and staff to the front line and making a difference as quickly as possible.”

Wendy Powell, the founder of MUTU System, has launched a campaign #IWishIKnew in light of the study. The campaign calls for pregnant women to get the information and support they need at the right time, to ensure they are fully equipped to have an improved chance of better recovery.

The purpose of the study is not to “scrutinise the work of midwives... as it is not necessarily their remit to cover the long-term postpartum experiences of women,” she tells HuffPost UK. Instead, she wants to highlight that this is a vital piece of women’s healthcare that’s falling through the cracks.

“Health checks often revolve around acute healing, rather than the sustained impact,” she explains. “At present, nobody is fulfilling the role of longer-term advisory and support within the care system pathway, meaning women are often left alone to recover without knowledge of what has happened to their body or how long it will be this way, which is scary.”

Postpartum recovery takes much longer than is often expected and there’s a misconception that after “a quick check we’re good to go,” adds Powell. In reality, the six-week check is just the start. “We want to raise awareness that postpartum care is as much about being emotionally prepared for what’s coming, and about knowing simple strategies to help with and recover from symptoms,” she says.

HuffPost UK contacted NHS England and the Department of Health and Social Care (DHSC) in relation to the study findings and the interviews we conducted.

The DHSC said: “We recognise the challenges new mothers and their loved ones face particularly during these difficult times. Evidence shows better outcomes and experiences are possible when women have the opportunity to shape their care.

“The commitment in the NHS Long Term Plan to rolling out Continuity of Carer models, which provides consistency in the midwife or clinical team throughout the three phases of maternity, will ensure thousands of women receive safe and personal maternity care.

“We urge new mothers who are struggling to reach out to their GP. Support is out there and nobody should have to suffer in silence.”

An NHS spokesperson added: “Providing high quality postnatal care is a key part of any woman’s maternity journey and the NHS has set how every new mum should receive a six-week health check to look after their physical and mental health after birth.

“In addition to this, as part of the NHS Long Term Plan, tens of thousands more women will be able to access specialist perinatal mental health services as well as having access to pelvic health clinics.”

Until then one thing is clear: urgent reform is needed to make sure women like Odogwu, Barnes and Girards feel supported.

“As mums, we are expected to just get on with it and not complain, just like how it was for our parent’s generation. It’s as if we don’t matter and as a result a lot of women feel they lose their identity after having a baby. It can be very isolating,” says Odogwu.

“You are left to figure a lot of things out for yourself when this information should be readily available from the beginning so that women are prepared.”