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In the past three decades, significant progress has been made in reducing maternal mortality. However, in some regions, it remains unacceptably high. According to the World Health Organization, more than 800 women worldwide die every day from complications related to pregnancy or childbirth.

An article published in early December in The Lancet highlights that despite various achievements in maternal health, the historical focus on reducing maternal mortality has been accompanied by a relative neglect of complications arising or persisting months or years after giving birth.

The study, a comprehensive review of epidemiological data, collected from 2000 to 2022, on physical and psychological complications occurring in the mid to long term after childbirth concluded that many conditions caused or exacerbated by pregnancy and childbirth can manifest in women months or even years after giving birth. These conditions have been overlooked in the global health agenda and national action plans, leading to the misconception that they are uncommon or insignificant. The historical limitation of postnatal care services to the first 6 weeks after birth also contributes to the alarmingly high prevalence of problems faced by some mothers.

Common Health Issues

The most common health problems at 6 weeks after birth include painful sexual relations (dyspareunia), anal or urinary incontinence or both, postpartum depression, tocolophobia (severe fear of childbirth), and chronic postpartum pain such as lower back and perineal pain. According to the review, among the most prevalent conditions in women's morbidity related to labor and childbirth in the mid to long term, more than a third of women recorded dyspareunia in 35% of cases, lower back pain (32%), urinary incontinence (8%-31%), anxiety (9%-24%), anal incontinence (19%), depression (11%-17%), tocolophobia (6%-15%), perineal pain (11%), and secondary infertility (11%).

The authors noted that less common conditions resulting from labor and childbirth also have serious effects on women's health and well-being. These conditions include pelvic organ prolapse, posttraumatic stress disorder, thyroid dysfunction, mastitis, HIV seroconversion, episodes of psychosis, venous thromboembolism, and peripartum cardiomyopathy.

The study, which gathered information from sources such as the United Nations and national and international maternity registries like MedlinePlus, also warned that while many interventions during labor and childbirth are offered to minimize harm to the mother or baby, their misuse or overuse can lead to iatrogenic complications. An example is episiotomy: A common routine involving an incision in the perineum to widen the vaginal opening during the last part of the pushing stage of labor or during childbirth itself. Various studies have long reported that restrictive use of episiotomy is associated with less posterior perineal trauma and fewer future complications. As forceps delivery is a protective measure for the fetus but is associated with more maternal tissue damage, imprudent use of uterotonics to increase weak contractions during labor is a well-known risk factor for potentially deadly complications, such as uterine rupture, leading to devastating consequences like secondary infertility due to uterine wall repair and tubal ligation, partial or total hysterectomy, or pelvic sepsis. According to data collected in The Lancet, even justified pharmacological interventions, such as the use of oxytocin or misoprostol for labor induction, or surgical interventions, like episiotomy and cesarean section, can still interfere with women's recovery. These complications can trigger adverse physical, social, or psychological outcomes that may persist or emerge long after childbirth.

As the authors of the study warned, most data on the prevalence of these postpartum ailments come from high-income countries with resource-rich health systems. Except for the mental health field, there is barely any population-level data from low- and middle-income countries. Therefore, the authors suggested that the situation for those who have become mothers could yield more severe results in these regions. According to studies reviewed in The Lancet, there is a higher prevalence of postpartum depression among women in low- and middle-income countries than among those in high-income countries. Rates reach 17% in the former and 11% in the latter.

Based on nearly a 100 clinical guidelines consulted for the prevention, recognition, and treatment of mid- to long-term morbidities resulting from labor and childbirth, the authors concluded that while there are high-quality guidelines for some of these conditions, they are mostly developed and adapted for high-income country settings. These measures consistently emphasize the importance of high-quality care during childbirth, systematic clinical assessments, postpartum screening for identifying those at risk, and prompt treatment.

Comprehensive Healthcare Services

To address these conditions holistically, researchers emphasize the need for broader and more comprehensive healthcare services extending beyond the first 6 weeks postpartum, encompassing multidisciplinary care models. In addition, they call for increased recognition, better measurements, collective action, and funding to prevent and manage the mid- to long-term consequences of labor and childbirth that affect millions of women worldwide and are not included in the global agenda or national health action plans of many countries. Finally, the authors advocated for increased investment in epidemiological, interventionist, and implementation research. As they concluded, timely, woman-centered, evidence-based care is the most effective preventive and reparative strategy for all the complications mentioned.

This article was translated from Univadis Spain, which is part of the Medscape Professional Network.