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New mums at risk of postnatal depression and physical complications have been “left to get on with it” during the coronavirus lockdown – because a vital postnatal appointment is being cancelled.
All women in England are supposed to be offered a check at their GP surgery six weeks after giving birth. But some say that, with the country in lockdown amid the coronavirus pandemic, these appointments are being conducted over the phone – or abandoned altogether.
During the six-week check-up, GPs usually ask women about their mental health after giving birth, and offer a physical examination for those who have stitches from an episiotomy or caesarean section. Mums are advised against doing any high-impact exercise such as running until after this check.
One senior midwife described the appointment as “vital” to a mother’s health and safety, especially given the challenges and isolation of lockdown – and the increased threat of domestic abuse among households with a new baby.
New mums who have failed to be offered this check-up face-to-face told HuffPost UK it feels as if they’re being left in limbo, with many other postnatal services also conducted remotely in line with social distancing rules.
After Emily Smith gave birth to her son Henry on April 17 – at the peak of the UK’s coronavirus outbreak – she was eagerly awaiting her six-week GP appointment.
For the first few days of her baby’s life, Smith and her husband were unable to see him in the Special Care Baby Unit over fears the newborn had Covid-19 – a period that was “tough” on her mental health.
But since Henry was given the all-clear and discharged, Smith has largely been left to care for him alone – with all but one of her midwife and health visitor appointments conducted over the phone.
“There have been long nights where I have struggled with feeding and tiredness and felt very abandoned,” the 35-year-old from West Sussex told HuffPost UK.
“As a new mum, it is hard not to be anxious about whether things are going as they should.”
Smith, who has resorted to weighing her baby with her dad’s fishing scales, had seen the appointment as a chance to get some help face-to-face after being repeatedly directed online by other services. But she’s since learned that face-to-face appointments have been cancelled at her GP surgery.
Instead, she’ll receive another telephone consultation. “I’m really missing the mental health benefits I get from getting outside for a run and I have been waiting for my six-week check to get the OK to get back into it,” she said.
“I’m really not sure what we could go through on the phone that would be that helpful and it really feels like the phone call is probably just a box-checking exercise in terms of NHS paperwork and discharging me from obstetrics care.”
“Virtual appointments can’t really replace an appointment like that, face-to-face.”
Claire Livingstone, professional policy adviser at the Royal College of Midwives, says it is “really disappointing” that women are unable to access face-to-face appointments. “These checks are really vital for mothers and babies,” she says.
“But physically mothers need to be seen for a mental health assessment and check they’re doing OK. Virtual appointments can’t really replace an appointment like that, face-to-face.”
Having a baby is “extremely challenging” at the best of times, says Livingstone. “At the moment, new parents are being presented with some additional challenges like isolation from support networks, family and friends. The kind of encouragement that brings is sadly lacking,” she says. “I think there’s a much greater risk of mothers and fathers struggling to cope in these times.”
Having a baby can be a “trigger” for domestic abuse, the midwife adds. “something that could be missed with a virtual appointment.”
“We don’t know when we undertake a virtual appointment whether there might be somebody who is in the room who is controlling what is being said. We don’t even know if the woman has access to a device of her own. So those are issues which really do need looking into.”
Women may have physical concerns that also need to have addressed by their GP that can’t be dealt with virtually. “After a C-section, which is after all major surgery, that should be followed up and checked that the wound has healed properly,” says Livingstone. “But even with a vaginal delivery, there may well be some concerns that require a physical examination.”
Jenni Stuart, 32, from Carlisle, gave birth nine days before lockdown began. After a forceps delivery and an episiotomy, which caused anaemia, she was prescribed iron tablets and instructed to take them until her six-week check.
She was shocked – and confused – when she rang her surgery and the receptionist informed her that all six-week checks had been cancelled.
“I was also in a lot of pain from my wound and was worried that it may not be healing properly,” she says.
Stuart called her health visitor with her concerns, who arranged for the GP to give her a call. The GP asked if she’d checked her own wound, which she found “insulting”.
“He looked at my blood test results – from the hospital five weeks previously – and told me I was very anaemic and prescribed not only iron but two other medications on top,” says Stuart, who worried the GP could be prescribing medication she no longer needed, as she hadn’t had a blood test in over a month – “which is not what I would wish for as a breastfeeding mother”.
Her baby has now had his eight-week check and immunisations, while Stuart has booked herself in for a blood test so her GP has up-to-date levels for any further prescriptions. She feels reassured, but says she’s had to be proactive in order to access basic healthcare.
Her concern is that “mums have been left to get on with it”.
Nana-Adwoa Mbeutcha, a 33-year-old mum from Bedfordshire, gave birth on March 3 and says some of the midwife and health visitor appointments deemed “non-essential” were cancelled, or conducted over the phone.
On the day of one of her scheduled health visitor calls she was “feeling a bit low” and felt she would have benefited from talking to a professional – but the call didn’t come.
“I did text her to find out if she would be calling me as I had a time and everything booked for it, but I never heard anything back until perhaps a week later – then she did the assessment over the phone,” explains Mbeutcha, who is co-host of the Dope Black Mums podcast and parenting community.
Mbeutcha isn’t a first-time-mum, so says she was able to use her previous experience and speak to her husband to get through the “dip” – but she worries about women facing motherhood for the first time.
Her baby’s six-week check was rolled into his eight-week immunisations at the doctor’s surgery. Mbeutcha says she was not offered an in-person appointment or phone call for herself.
“I was not seen at all or spoken to at all about how I am – it was all to do with the baby,” she says. “He had his checks and his vaccinations, but it was all done quickly – not in a rushed way that wasn’t taking care, but there was no dilly-dallying. It was a case of ‘let’s get you in and get you out as soon as possible.’”
Again, Mbeutcha had to rely on her memories of her previous postnatal appointments to judge if she was healed and safe to exercise.
“I was not seen at all or spoken to at all about how I am – it was all to do with the baby.”
“Because this isn’t my first child, I had an awareness of my body and what I can or can’t do and remembered previous advice,” she says. “But no one had gone through it for me. I had to just use my past experience or Google.”
Many of the women HuffPost UK spoke to said midwives and health visitors have done everything they can to provide postnatal care, but their “hands are tied” by the restrictions. One midwife offered to weigh a mother’s baby on the front lawn to ease her concerns about his weight. Another organised a socially-distanced garden visit outside her long working hours, to provide the mother with the face-to-face reassurance she needed.
Several mums expressed concern that other women won’t receive care unless they ask for it. “For mums with postpartum depression, if no one is around to check on them, how will they get the support they need, especially if in denial or they don’t know that they have it?” said Stuart.
Sherica, 30, who’s based in Harlow, Essex, had her second child on March 3, and had to push to get access to a six-week appointment during lockdown.
She’d been told the GP surgery would call her to arrange a date and time, but as her son reached eight-weeks-old, she’d still heard nothing. She decided to call herself and says it took several calls before he was booked in for the check and his immunisations.
He was 10 weeks by the time he was seen. “If I hadn’t have chased it, I don’t know when someone would have gotten back to me,” says Sherica, who chose not to share her surname. “I hope they would have done it eventually, but I just don’t know when.”
Sherica wasn’t examined during that appointment, receiving a brief, follow-up call instead. The doctor asked two questions: whether her periods had started again and if she needed contraception.
“I know they normally check in on people’s mental health and how they are doing, but it was nothing like that,” she says. “In terms of how my body is physically, I was not seen, I was not given an examination, I was not asked any questions.”
“I understand doctors are stressed out, but we don’t need new mothers who are stressed out with a little one as well.”
Initially, Sherica “brushed off” the experience and wondered if it was the norm to skip over details for second-time mums, but speaking to other new mums made her realise something wasn’t right. “I understand that doctors are stressed out, but at the same time, we don’t need new mothers who are stressed out with a little one as well.”
The National Childbirth Trust (NCT) was one of the groups which campaigned for a mandatory six-week check. Sarah McMullen, interim head of insight and engagement said: “We know and understand that health services are under tremendous strain due to the Covid-19 pandemic, but this check for new mums is vital so that any problems, including mental health issues are picked up.
“At NCT we’ve seen a surge in queries and concerns from expectant and new parents who are anxious about the impact of the pandemic, which is why it’s even more essential that the check is carried out to ensure that new mums are getting the help they need.”
Acutely aware of the pressures on doctors and midwives at the moment, Rachel Murphy, a first-time mum who gave birth on April 23, says she found it hard to be honest about her body and mental state over the phone.
“It’s very difficult when a doctor or midwife says over the phone: ‘Is everything feeling normal?’ because my honest answer is: ‘I don’t know.’ It’s also all too easy to say: ‘Sure, I’m feeling fine,’ when you’re not,” she says. “I’ve been finding it really hard, emotionally and mentally. It’s not been easy for me.”
“I’d had the six-week check as a goal I was heading towards... where I could start having some normality back in my life.”
When she called to make an appointment with her GP, she was told her baby would be checked over when he received his eight-week jabs – but that checks for mums had been postponed for the foreseeable future.
“In my mind I’d had the six-week check as a goal I was heading towards. I was thinking about it as this milestone I could get to where I could start having some normality back in my life,” says the 31-year-old, from Nunhead, London.
Even for women who have been able to access face-to-face six-week checks, lockdown has led to severe delays. Steph Almond, 35, from Manchester, is awaiting an in-person appointment for herself and her son, George, who was born on May 9. However, due to strains on services, the six-week check is delayed and will be “more like 12 weeks”.
“I want to know if my stitches have healed and if I can go out for a run,” says Almond, who had the added stress of being diagnosed with Covid-19 during labour. For them it’s only an extra five or six weeks, but for me it’s such a big difference.”
Hana Morvay, 31, from West Lothian, in Scotland, was due to have her check on March 31, a few days into lockdown, but her GP called to postpone it until early May. When the check eventually arrived, Morvay says it was quick and entirely centred on the baby. She wasn’t offered a physical examination or asked about her wellbeing.
“I understand that they have to prioritise the baby’s wellbeing, but lockdown isn’t easy for anyone and it’s even more difficult for new mums,” she says. “Especially not being able to see family and friends who would be able to offer support and help.”
A spokesperson for the NHS told HuffPost UK that staff are working “around the clock” to respond to the Covid-19 pandemic, “while also ensuring vital services like six to eight week checks can still take place in a safe way”.
“If you’re a new mum, the NHS is still here for you and your baby. If you’re worried about your health or that of your baby, contact your GP just as you always would, and if you’re asked to come in for a planned or urgent check, it’s vital that you do so.”
Victoria Tzortiou Brown, honorary secretary at the Royal College of General Practitioners, says GPs have changed the way they work during the coronavirus lockdown, conducting the majority of appointments via phone or video. “We do provide face-to-face assessments as well wherever appropriate. So if we speak to the patients and feel that, actually a physical examination is required, we don’t avoid that. We invite the patient to come to the practice, with safety measures in place.”
This offers little reassurance for mums like Rachel Murphy, who still hasn’t had any confirmation about when her physical examination might be.
“Something I feel is that all throughout the pregnancy, the mother is the priority to make sure the baby is well,” she says. “[But] once the baby has been born, the baby becomes the priority. Where that helps the baby, fantastic. But I think the health and wellbeing of the mother does get sidelined.”