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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