McDonald et al.
Longitudinal perspective is needed to improve postpartum health C Sakala Childbirth Connection Programs, National Partnership for Women & Families, Washington, DC, USA Linked article: This is a mini commentary on EA McDonald et al., pp. 672–9 in this issue. To view this article visit http://dx.doi.org/10.1111/1471-0528.13263. Published Online 21 January 2015. Our attention in maternity care research and practice is focused primarily on short-term outcomes. A systematic review of randomised controlled trials evaluating perinatal interventions concluded that only a minority of trials reported offspring outcomes following hospital discharge (Teune et al. BJOG 2013;120:15–22). A parallel analysis would perhaps yield an even lower proportion of studies measuring medium to longer term maternal outcomes. This is troubling, as frameworks such as epigenetics, developmental origins of health and disease, life-course health development, and the human microbiome highlight the importance of long-term impacts of exposures during early sensitive windows of most rapid human development, with long-term impacts on childbearing women increasingly identified as well. When we shine the light on just a small area, what are we missing out there in the dark? McDonald and colleagues’ Maternal Health Study investigated first-time mothers’ experience of postpartum dyspareunia and the results are illuminating. Experiences of dyspareunia soared above baseline prepregnancy levels, with more than one in four participants reporting persistent dyspareunia. In the adjusted analysis emergency
680
caesarean section was associated with persistent dyspareunia. Professional recognition of the overuse of caesarean section, calls for safely preventing such procedures, and identification of wellsupported ways to do so point to opportunities to prevent persistent dyspareunia (American College of Obstetricians and Gynecologists and Society for Maternal-Fetal Medicine Obstet Gynecol 2014;123:693–711). Mothers and babies have the rest of their lives ahead of them, and high performing healthcare systems cannot rely primarily on myopic knowledge. With a longer view, notable proportions of women experience a range of new-onset morbidities in the weeks after giving birth, persisting in many to 6 months and beyond (Declercq et al. Listening to Mothers III: New Mothers Speak Out. New York: Childbirth Connection; 2013). We need long-term follow up in randomised controlled trials and complementary well-conducted observational studies. It is important to monitor and treat postpartum morbidity in clinical practice. In a national survey in the USA, excluding infection, more than seven out of ten participants did not seek help from a health professional for various new-onset postpartum problems (Declercq et al.
Listening to Mothers; Report of the First National U.S. Survey of Women’s Childbearing Experiences. New York: Maternity Center Association, 2002). A high-quality patient-reported outcome measure of composite maternal morbidity captured 4–8 weeks postpartum could improve maternal health in several ways. It could engender discussion, counselling and treatment during postpartum care. Relevant information would be captured in the health record for continued attention within primary care in settings with the capacity to share health records from other providers. More generally, such a measure could inform professionals and the public regarding maternity-care outcomes, fostering quality improvement and patient choice. Better research, measurement, prevention and treatment are needed to address issues of great interest and consequence to women during a phase of maternity care and the life cycle that have received incommensurate attention.
Disclosure of interest I am a co-investigator of the Listening to Mothers surveys. I have no financial interests in matters discussed in this commentary. &
ª 2015 Royal College of Obstetricians and Gynaecologists
Copyright of BJOG: An International Journal of Obstetrics & Gynaecology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
Longitudinal perspective is needed to improve postpartum health C Sakala Childbirth Connection Programs, National Partnership for Women & Families, Washington, DC, USA Linked article: This is a mini commentary on EA McDonald et al., pp. 672–9 in this issue. To view this article visit http://dx.doi.org/10.1111/1471-0528.13263. Published Online 21 January 2015. Our attention in maternity care research and practice is focused primarily on short-term outcomes. A systematic review of randomised controlled trials evaluating perinatal interventions concluded that only a minority of trials reported offspring outcomes following hospital discharge (Teune et al. BJOG 2013;120:15–22). A parallel analysis would perhaps yield an even lower proportion of studies measuring medium to longer term maternal outcomes. This is troubling, as frameworks such as epigenetics, developmental origins of health and disease, life-course health development, and the human microbiome highlight the importance of long-term impacts of exposures during early sensitive windows of most rapid human development, with long-term impacts on childbearing women increasingly identified as well. When we shine the light on just a small area, what are we missing out there in the dark? McDonald and colleagues’ Maternal Health Study investigated first-time mothers’ experience of postpartum dyspareunia and the results are illuminating. Experiences of dyspareunia soared above baseline prepregnancy levels, with more than one in four participants reporting persistent dyspareunia. In the adjusted analysis emergency
680
caesarean section was associated with persistent dyspareunia. Professional recognition of the overuse of caesarean section, calls for safely preventing such procedures, and identification of wellsupported ways to do so point to opportunities to prevent persistent dyspareunia (American College of Obstetricians and Gynecologists and Society for Maternal-Fetal Medicine Obstet Gynecol 2014;123:693–711). Mothers and babies have the rest of their lives ahead of them, and high performing healthcare systems cannot rely primarily on myopic knowledge. With a longer view, notable proportions of women experience a range of new-onset morbidities in the weeks after giving birth, persisting in many to 6 months and beyond (Declercq et al. Listening to Mothers III: New Mothers Speak Out. New York: Childbirth Connection; 2013). We need long-term follow up in randomised controlled trials and complementary well-conducted observational studies. It is important to monitor and treat postpartum morbidity in clinical practice. In a national survey in the USA, excluding infection, more than seven out of ten participants did not seek help from a health professional for various new-onset postpartum problems (Declercq et al.
Listening to Mothers; Report of the First National U.S. Survey of Women’s Childbearing Experiences. New York: Maternity Center Association, 2002). A high-quality patient-reported outcome measure of composite maternal morbidity captured 4–8 weeks postpartum could improve maternal health in several ways. It could engender discussion, counselling and treatment during postpartum care. Relevant information would be captured in the health record for continued attention within primary care in settings with the capacity to share health records from other providers. More generally, such a measure could inform professionals and the public regarding maternity-care outcomes, fostering quality improvement and patient choice. Better research, measurement, prevention and treatment are needed to address issues of great interest and consequence to women during a phase of maternity care and the life cycle that have received incommensurate attention.
Disclosure of interest I am a co-investigator of the Listening to Mothers surveys. I have no financial interests in matters discussed in this commentary. &
ª 2015 Royal College of Obstetricians and Gynaecologists
Copyright of BJOG: An International Journal of Obstetrics & Gynaecology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
