Women’s health after having a baby

: exploring the impact of severe maternal morbidity on psychological and physical health at 6-8 weeks postpartum

Abstract

Background
The incidence of severe maternal morbidity (SMM) is increasing in high-income countries as a consequence of increased obstetric intervention and increasingly complex medical needs of women who become pregnant. The most commonly reported SMM in the UK includes postpartum haemorrhage and hypertensive disorders. Access to emergency obstetric care means that for the majority of UK women, SMM is unlikely to result in loss of life. However, little was known about the impact on postnatal morbidity

Aim
To assess the impact of SMM (defined as major obstetric haemorrhage, severe hypertensive disorders, critical care unit admission) on maternal health, focusing particularly on post-traumatic stress disorder (PTSD) symptoms at 6-8 weeks postpartum.

Method
A prospective cohort study was undertaken of women who gave birth over six months in 2010 in one inner city maternity unit in England. Data on health outcomes were collected on 1824 women using self-administered questionnaires at 6 – 8 weeks postpartum (response rate=53%). The questionnaire included several validated measures to assess aspects of postnatal health and well-being. Multivariable logistic regression analysis examined the relationship between SMM and PTSD adjusting for potential confounders and differences in other postnatal outcomes between women with and without SMM.

Results
There was a higher risk of PTSD symptoms following SMM (intrusion: OR=2.22, 95%CI=1.26-3.93, p=0.006; avoidance: OR=3.33, 95%CI=2.06-5.40, p<0.001; both intrusion and avoidance: OR=3.22, 95%CI=1.62-6.43, p=0.001). Women’s sense of control during labour and birth and neonatal outcomes contributed to the risk of PTSD symptoms. There were no statistically significant differences in other mental outcomes, however women with SMM had poorer physical health than women without SMM. Associations between SMM, breastfeeding practice and health service use were inconsistent across indicators of SMM.

Conclusions
Findings have important implications for women's health, and the content and organisation of maternity services. Women and clinicians should be aware that SMM can trigger symptoms of PTSD, with further work required to promote care to prevent these symptoms.

Date of Award	1 Sept 2012
Original language	English
Awarding Institution	King's College London
Supervisor	Jane Sandall (Supervisor) & Debra Bick (Supervisor)