Motherhood
Why we need to start prioritising postpartum care
With some studies suggesting as many as six out of seven women miss vital postnatal visits, FemTech World investigates why we need to change the narrative around postpartum recovery.
Sandra Wirström was working in the digital health sector in Sweden when she had her two daughters. She experienced birth injuries both times and she was surprised by the lack of data and support around post-natal care.
“I had to fight for every single piece of information and every single doctor appointment. I was extremely frustrated that nothing has been digitalised when it comes to the postpartum care,” says Sandra.
Sandra’s experience applies to hundreds of women across the UK. Recent figures show that six out of seven new mothers in England are not getting a check-up of their health six weeks after giving birth, despite such appointments becoming a new duty on the NHS. Of those who attend one, only 15 per cent have a dedicated consultation with a GP to discuss their physical and mental health, according to the National Childbirth Trust (NCT).
Another US study from the American College of Obstreticians and Gynecologists revealed that as many as 40 per cent of women do not attend a postpartum medical visit after giving birth.
“Nothing has been done when it comes to postpartum digitalisation,” says Sandra. “So, about a year ago when I was on one of my walks with my second daughter, I thought ‘okay, we need to do something about this and change the narrative around postpartum care’.”
Soon after that Sandra met Astrid Gyllenkrok Kristensen, who was as passionate about women’s health as Sandra and like so many other mothers out there, struggled with the physical and emotional recovery process after giving birth.
They decided to set up LEIA, an app co-developed with midwives and medical experts that offers women personalised physical and mental health support during the postpartum months, also known as the fourth trimester.
“There are hundreds of apps to help you during pregnancy and everyone asks you how you feel,” says Astrid. “Post-delivery, you are left on your own in what seems to be the most overwhelming and sometimes traumatising time of your life. Out of 140 million women giving birth each year 90 per cent will experience emotional or physical difficulties, from breastfeeding complications to postnatal depression and pelvic dysfunction.
“When we started looking into this, we found that there were a couple of key issues leading to women struggling in silence,” Astrid continues. “The lack of digitalisation that Sandra mentioned is one of them, along with the lack of medical experts. Women do not get the information they need. They end up self-diagnosing and they have no idea who to turn to. There’s no structure and globally, the healthcare chain is very fragmented.
“There’s also a massive stigmatisation in society surrounding postpartum. The narrative, especially in Sweden, is that you’re supposed to give birth, and then within a week, go for power walk and have friends over.”
A study from the polling company Survation, revealed that 85 per cent of the 893 mothers in England interviewed over a month said their appointments were mainly or equally about the baby’s health and they did not get the chance to talk to the GP about their mental wellbeing.
Astrid says: “One of the problems of women are not getting the health care they need is because the healthcare system is not focused on the women’s perspective and is not based on their needs.
“Studies show us that suicide is now one of the leading causes of death in new mothers, up to one year after giving birth and this is something that shows the acceleration of the problem. The system is broken.”
The pandemic has only amplified this. Research by the Maternal Mental Health Alliance shows that more mothers than usual have been struggling during the pandemic because restrictions on social contact means they have been denied support from family and friends, which has led to more anxiety and loneliness.
LEIA is an app based on science and self-lived experiences of motherhood. Astrid explains that: “Together with both private and public health care, we created a medical advisory board to make sure that we achieve our primary focuses to create a solution and meet the needs of new mothers.”
“Before going into the product, what we wanted to do was to create an app that would help by giving women AI or data driven insights about their emotional and physical health, to help understand what’s going on in their head, what’s going on in their body and what the recovery process in the fourth trimester is.
“But we also wanted to include the partner within that experience, because men are also getting diagnosed with depression. Seeing it as a unit and not just pinpointing the woman, is something that we feel is integral for a healthy recovery.”
Astrid highlights how crucial postpartum check-ups really are when it comes to mental health.
“One of the key things during these visits is to screen women for postnatal depression, which is normally done face-to-face with a questionnaire called EPDS – Edinburgh Postnatal Depression Scale. With LEIA, we’ve digitalised screening models for both postnatal depression, but also pelvic dysfunction, identifying women in risk at a much earlier stage. This means even before giving birth, we’ll be able to identify women at risk of postnatal depression.”
However, changing the narrative around postpartum care is as important as offering women the support they need.
Astrid says that: “Most people understand the first three trimesters and the changes in the women’s bodies because that narrative has been established.
“So, we want to establish a narrative around postpartum as well. People need to know that there’s a physical recovery and it takes a year for the body to recover after childbirth. We think that by educating people about the recovery process we can normalise it and start breaking down the stigma.”
Sandra adds: “There’s been a boom in the femtech market focusing on fertility and pregnancy.
“In the past years, there has been a digital transformation in areas such as fertility, period tracking and menopause. However, there are still a lot of things to do, especially when it comes to postpartum care. We’re still not getting educated enough about what is happening in our body after giving birth.”
LEIA’s data-driven approach aims to influence improvements in public health.
Globally, research data on postpartum care is limited. Amid a lack of awareness of postpartum conditions, however, investment in further studies and in developing options which address postpartum symptoms is also limited, says Astrid.
“We all know that politics is driven by economics,” she says.
“By collecting this data, we will be able to show how the lack of investment and support is actually affecting women. We have to put a number on the problem before they actually start looking into it.”
Sandra agrees: “It’s not only our perspective and our motivation, we are in fact putting the mothers in focus in everything we do by building an app for the mothers out there.”
Clearly, fundamental changes will be required to adequately address postpartum challenges in future. The success of LEIA in starting a conversation around postpartum care is, however, an important first step in driving this change.
Find out more about LEIA here.
Pressure to have a natural birth can cause lasting psychological harm when labour does not go to plan, new research shows.
The study found that the messages women receive during pregnancy are directly linked to the shame and self-blame many feel when those expectations are not met.
For the first time, the research provides an explanation for why unmet birth expectations contribute to psychological harm.
Several women involved in the research said they felt they had not given birth “properly”, even when medical intervention had saved their lives.
Rebecca Matthews, lead author and PhD researcher at the University of Reading, said: “These women were not failed by their bodies, they were failed by the messages they were given.
“Birth trauma does not begin with birth. It begins in the ideology sold to women throughout pregnancy.
“For the first time we can explain precisely how, by showing how birth culture creates a moral standard for women that defines what a good mother does and then leaves them to blame themselves when birth does not match that.
“Until we reform the way we prepare women for birth, we will keep seeing the same devastating consequences for mothers and their babies.”
The researchers interviewed 21 first-time mothers in the UK whose births did not go as planned.
From NCT and hypnobirthing classes, to social media to midwives, the researchers heard how women are surrounded by messaging that frames natural, unmedicated vaginal birth as the “gold standard”, not just medically preferable, but as a mark of being a good mother and the first test of maternal worth.
Research shows around half of women report their birth differed significantly from their expectations, and for the women in this study, all of whom experienced exactly that, the psychological consequences were profound.
Women judged themselves against the internalised moral standard that this ideology had created.
The researchers are calling for antenatal education to stop treating one kind of birth as the goal and to present all birth outcomes as equally valid routes to motherhood.
They also call for better postnatal screening for women whose births did not go as expected, specifically targeting the shame, self-blame and identity disruption that this research identifies as mechanisms underlying birth trauma.
The findings align with and extend the conclusions of the Kirkup, Ockenden and Birth Trauma Inquiry reports, all of which documented how the institutional pursuit of “normal birth” contributed to preventable harm.
This research provides the first theoretical explanation of how that ideology generates individual psychological harm and points to antenatal messaging as the primary site of such preventable harm.
System C has completed the national rollout of BadgerNet Maternity across all seven NHS Health Boards in Wales. This is the first time any UK nation has unified its maternity care under a single digital record and patient-facing app.
With approximately 26,000 babies born annually in Wales, BadgerNet connects maternity information across organisational boundaries in the country.
Expectant parents can access their records, maternity appointments and key updates digitally through a single app, wherever they receive care while clinicians have secure access to the right information at the point of care.
The national three-year agreement across all Heath Boards replaces a patchwork of separate local systems and eliminates the need for paper hand-held notes.
Anthony Tracey is director of digital at Hywel Dda University Health Board, the final of the Welsh Health Boards to go live with BadgerNet.
He said: “The rollout of BadgerNet across Wales is a vitally important step forward in modernising our maternity services and providing a consistent service across the country.
“By giving expectant parents direct access to their information and enabling clinicians to share data more effectively, we are strengthening safety, transparency and consistency in maternity care nationwide.”
For expectant parents, the single digital maternity record transforms how they engage with their care.
Instead of carrying paper notes and repeating information at every appointment, parents can access key details, appointments and updates digitally, supporting more informed conversations and shared decision-making.
The result is greater transparency, fewer administrative frustrations and a more joined-up experience throughout pregnancy and into the postnatal period, regardless of which health board they fall under.
For clinicians and Health Boards, the joined-up approach reduces duplication and streamlines handovers across teams and sites. Information is digitally captured once and made available securely wherever it is needed, helping to minimise errors, reduce time spent tracking down notes and support more efficient multidisciplinary working.
At a national level, linking maternity data across Wales creates a foundation for safer, more consistent care.
Aggregated, standardised information enables earlier identification of trends and variation, supports evidence-based policy decisions and enhances long-term service planning.
With a comprehensive view of maternity activity and outcomes across the country, Wales is now better positioned to raise standards for parents, babies and families.
Guy Lucchi, managing director of healthcare at System C, added: “Delivering a truly national approach across all seven Health Boards is a significant achievement for Wales.
“One shared system means information flows with the patient, not the organisation.
“That reduces duplication, supports earlier identification of risk and frees up valuable clinical time.
“Crucially, linking maternity data at a national level provides powerful insight to drive improvement. Health Boards can benchmark, plan services with greater confidence and ensure resources are targeted where they are needed most, while expectant parents benefit from clearer communication and a more connected experience of care.”
Early birth may cut serious complications and stillbirth risk in high blood pressure pregnancies without increasing caesarean rates, a Cochrane review suggests.
Planned early birth after 34 weeks cut serious maternal complications by nearly half compared with watchful waiting, the findings suggest.
It also likely reduced the risk of stillbirth by about 75 per cent, although the authors said this should be interpreted with caution.
Catherine Cluver, senior author of the review and researcher at Stellenbosch University and Tygerberg Hospital, said: “These findings give clinicians and women clearer guidance about the timing of birth when high blood pressure develops in pregnancy.
“For women with pre-eclampsia in particular, the evidence supports offering planned early birth from 34 weeks, and no later than 37 weeks.”
This Cochrane review, led by King’s College London, pooled data from six randomised controlled trials involving 3,491 women.
The trials compared planned early birth after 34 weeks with watchful waiting in women with one or more hypertensive disorders of pregnancy.
Hypertensive disorders of pregnancy, including pre-eclampsia, gestational hypertension and chronic hypertension, are the second leading cause of maternal death globally.
For women with pre-eclampsia, early birth remains the only definitive treatment, as the condition is driven by the placenta and will only resolve once it is delivered.
The trials took place in the Netherlands, UK, US, India and Zambia.
The review found high-certainty evidence that serious maternal complications were nearly halved in women who had planned early birth compared with those managed with watchful waiting.
The finding on stillbirth was based on moderate-certainty evidence and was driven by a single trial in India and Zambia, where stillbirth rates are higher. No stillbirths were recorded in the high-income country trials.
The review also found that planned early birth likely does not increase neonatal unit admission, although this finding was also based on moderate-certainty evidence.
The authors said the maternal benefit held across both high- and low-income settings, suggesting early birth reduces complications even when women are already receiving appropriate monitoring and care.
Alice Beardmore-Gray, lead author of the review and obstetrician at King’s College London, said: “Judging when to offer birth is the question that we battle with clinically every day.”
The authors added that in two of the trials, more than half the women allocated to watchful waiting ended up needing emergency birth before 37 weeks.
They typically gave birth just three to five days later than women allocated to planned early birth and often experienced more complications.
Beardmore-Gray said: “A common misconception is that by waiting longer, mum and baby are gaining more time, but often what you are doing is just delaying an inevitable emergency birth, when both may be in a worse condition.”
The review found high-certainty evidence of no increased risk of caesarean section associated with planned early birth.
Beardmore-Gray said: “That is the first question anyone asks when you offer them an early induction: won’t it increase my risk of a C-section?
“Being able to clearly answer no is a really important piece of information to give women when counselling them about the timing of their birth.”
The authors said the timing of birth should take into account the woman’s preferences and the severity of her condition.
They said these findings are consistent with and reinforce current international guidelines, which recommend that all women with pre-eclampsia should be offered planned early birth no later than 37 weeks.
Women with gestational hypertension or chronic hypertension without severe features may choose to continue with careful monitoring, with planned early birth considered from 39 weeks onwards.
Further research is needed on longer-term outcomes for infants born late preterm and on the long-term cardiovascular health of mothers affected by hypertensive disorders of pregnancy.
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