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
|inspiration to improve situation||no|
|inspiration for self-care||no|
|pain and discomfort||yes|
|pelvic floor relaxation||yes|
|confidence in parenting roles||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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