More than a third of women have lasting health problems after childbirth, says Lancet study

Through their findings, authors of the paper emphasise the need to focus on these conditions within a public healthcare system as many of them develop even after the women have availed postnatal services. Effective care throughout pregnancy and childbirth is also a critical preventive factor, they argue, to detect risks and avert complications post-birth. “More and better measurement of these conditions is urgently required. Although data suggest that some conditions might be more prevalent in LMICs (lower middle income countries), the scale of the burden in these countries is not fully known,” the report says. In India, says Dr Nina Mansukhani, consultant obstetrician and gynaecologist with Jehangir Hospital, Pune (not attached with the study), “poor nutrition, protein-energy malnutrition and anaemia are major risk factors.” Repeated childbirths without rest and proper restoration of the body as well as inadequate nutrition between pregnancies may lead to prolapse and pelvic floor laxity even if the birth per se has been an uncomplicated one.

“Many postpartum conditions cause considerable suffering in women’s daily life long after birth, both emotionally and physically, and yet they are largely under-appreciated, under-recognised, and under-reported,” says Dr Pascale Allotey, Director of Sexual and Reproductive Health and Research at WHO. “Throughout their lives, and beyond motherhood, women need access to a range of services from healthcare providers who listen to their concerns and meet their needs. So that they not only survive childbirth but can enjoy good health and quality of life,” the authors wrote.

Several obstetricians in the country agree that even a normal vaginal childbirth can sometimes impact the quality of life many years after birth. Dr Mansukhani attributes postpartum complications to pelvic floor muscles becoming lax after childbirth, especially without proper care. “The laxity of pelvic floor muscles leads to incontinence, causing urine leaks whenever the patient coughs, sneezes or performs strenuous activity. Pelvic floor laxity can also result in prolapse of the uterus and vaginal area,” she says.

What about many women who have had an uncomplicated delivery without intervention? “It depends on the health of the woman before the pregnancy, how well she maintains her physical strength and activity during the pregnancy. The woman may not encounter these problems if she has opted for postpartum rehabilitation in terms of physiotherapy for pelvic floor muscles,” Dr Mansukhani adds.

The lack of a codified post-birth protocol across hospitals and the urban-rural divide make mothers more vulnerable to complications. Says Dr Supriya Puranik, infertility specialist at Ankura Hospital, Pune, “In the Indian context, socio-economic disparities, access to healthcare and cultural influences may contribute to varying degrees of impact on women’s postnatal health. We require a comprehensive approach that considers healthcare infrastructure, awareness programmes and policy initiatives.”

The Lancet authors lament that postpartum complications have largely been neglected in clinical research, practice and policy, too. During a literature review spanning the last 12 years, the authors identified no recent high-quality guidelines to support effective treatment for 40 per cent of the 32 priority conditions analysed in their study. Neither was there any guideline, nor was there any data, they said.