Postpartum Health
Frederick R. Jelovsek MD
Any woman who has had a baby understands the significant
differences in how you feel for months after a delivery. A woman
who is pregnant but who has not delivered before, has no idea of
how she is supposed to feel after a delivery. In the absence of
advice to the contrary, a woman would assume that she will feel
the same after pregnancy as she did before. Wrong!
Most scientific studies have focused on major obstetric or
neonatal outcomes -- outcomes the doctor thinks are important,
not necessarily the patient-centered concerns. In a recent study,
Kline CR, Martin DP, Deyo RA: Health consequences of
pregnancy and childbirth as perceived by women and
clinicians. Obstet Gynecol 1998;92:842-8, focus groups
of women and clinicians were convened to see what issues they
each thought were the most important to be addressed about health
after a delivery.
Five focus groups of mothers and three groups of clinicians
(obstetricians, family practioners and midwives) were interviewed
as to what they thought were the major health outcomes, good or
bad, after a pregnancy. The authors analyzed the videotaped
sessions and categorized health concerns into one of 4 areas:
physicial problems, psychological concerns, social/role
functioning and sexual functioning.
Within these groups, women identified the following dominant
themes:
Health Concern Areas
Following Pregnancy
| Feelings/mood |
Theme |
Clinician
identified |
| depression |
yes |
| emotional lability |
no |
| self-esteem |
no |
| body image |
no |
| inspiration to improve situation |
no |
| inspiration for self-care |
no |
| Physical |
| fatigue |
yes |
| pain and discomfort |
yes |
| nausea |
no |
| pelvic floor relaxation |
yes |
| weight gain |
no |
| Social role |
| balancing roles |
no |
| confidence in parenting roles |
yes |
| breast feeding |
yes |
| partner-related issues |
no |
| Sexual function |
| satisfaction |
no |
| dyspareunia |
yes |
| change in libido |
no |
| physical consequences of delivery |
yes |
The clinicians identified many of the health concerns
but not all. They barely addressed emotional lability, the
desire of many women to improve their educational or living
situation, weight gain problems and partner-related issues. Not
all of the health concerns were negative. Some women felt the
body changes enabled them to fulfill a nurturing role. The was,
however, a predominant "I wish someone had told me that..."
expression on the part of the women. They felt unprepared for
postpartum health changes.
Clinicians felt that women were preoccupied antenatally with
pregnancy concerns and less motivated to learn about postpartum
issues, They also acknowledged, however, that there was little
information in the scientific literature about postpartum health that they had to give.
What can we learn from this study? There is a gap in health
education after delivery. Women need to be receptive to
learning about postpartum changes before they deliver. Clinicians
need to organize and present these postpartum changes in more
detail to women so that expectations are in line with likely
outcomes. All of the focus groups spontaneously came to the group question,
"What is normal postpartum recovery?" -- and no one knew.
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