While childbearing women and programs and policies for them focus extensively on care during pregnancy and around the time of birth, considerably less attention is given to women’s postpartum health, including access to high-quality care and coordinated services after birth. However, postpartum maternal health influences women’s lifetime risk of chronic disease, health in subsequent pregnancies, family functioning, and the well-being of children and other family members. Listening to MothersSM surveys provide the most comprehensive national data about U.S. women’s well-being after giving birth. These nationally representative data are from an initial survey of 2400 women, 18-45, who had given birth to a single baby in U.S. hospitals from July 2011 through June 2012 and could participate in English, as well as a follow-up survey of 1072 of the initial participants carried out several months later. Childbirth Connection’s Listening to MothersSM III surveys were conducted by Harris Interactive and funded by the W.K. Kellogg Foundation.
SUMMARY OF KEY FINDINGS
Most women experience pain after childbirth, including many for whom pain is persistent.
- 58% of women who had cesareans considered pain at the site of the incision to have been a problem in the first two months after birth, with 19% citing it as a major problem, and 16% saying the problem persisted at least 6 months
- 41% of women who had vaginal births considered perineal pain to be a problem in the first two months after birth, with 11% citing painful perineum as a major problem and 7% saying the problem persisted at least 6 months; perineal pain was related to having an episiotomy
- Other types of pain experienced by many women in the first two months included nipple soreness/breast tenderness (48%), backache (46%), frequent headaches (29%), and pain with intercourse (27%)
- 13% of women had been hospitalized since giving birth. Pain related to childbirth was the most common reason, with 3% of all women rehospitalized for a pain-related problem
- More than half (55%) of mothers said that pain interfered at least “a little bit” in their routine activities in the two weeks before the follow-up survey, with 7% indicating that pain interfered either “quite a bit” (5%) or “extremely” (2%).
Infections are common after childbirth, especially among women having cesareans. Perineal and breast infections also affected many women.
- 24% of women who had cesareans reported infections in the first 2 months, with 8% citing it as a major problem
- 18% of women who had vaginal births cited a problem with perineal infection, with 5% saying it was a major problem
- 15% of women reported a breast infection in the first two months, with 6% citing it as a major problem
- 2% of women were rehospitalized due to fever or infection
Most women report stress, exhaustion, and sleep disturbances after giving birth, including many for whom these are major or persistent problems.
- 54% of women reported feeling stressed in the first two months, including 17% who viewed stress as a major problem, and 34% for whom the problem persisted at least six months
- 51% of women cited physical exhaustion in the first two months, including 16% who viewed it a major problem, and 27% for whom the problem persisted at least six months
- 58% of mothers reported sleep loss in the first two months, including 21% who considered it a major problem, and 30% for whom the problem persisted at least six months
Many women met screening criteria for depression, and fewer than half of these women had accessed counseling, treatment, or other mental health services for depression. Women were asked both in the initial and follow-up survey to respond to two questions that comprise a clinical screening tool for postpartum depression.
- In the initial survey, 14% of mothers screened as likely to be depressed, using the established Patient Health Questionnaire-2 (PHQ-2) depression screener
- In the follow-up survey, 17% of mothers screened as likely to be depressed, using PHQ-2
- Signs of depression were more common in mothers who paid for the birth out-of-pocket (38% screening as likely depressed), had five or more children (36%), had neither a spouse nor a partner (33%), had had an unintended pregnancy (29%), and were uninsured (25%).
- Fewer than half of mothers (45%) who met screening criteria for depression in both the initial and follow-up surveys reported that they had consulted a provider about their mental or emotional health
- Fewer than two-thirds (63%) of women reported being asked about symptoms of depression at their postpartum office visits, and only 44% reported that their care providers had provided enough information about postpartum depression during their office visits.
Some women struggle with nutrition, exercise, and other wellness activities after having a baby. We asked mothers who completed the follow-up survey to rate how they were doing in the two weeks prior to the survey on several basic health promotion behaviors. Mothers reported the greatest concern with getting enough exercise and rated themselves most positively in terms of managing stress (see table).
Women’s physical and emotional well-being after birth affects their ability to care for their babies. Mothers were asked to rate if physical or emotional problems interfered with their ability to take care of their baby in the first two months after birth, and 37% reported their postpartum physical health interfered at least “some” with their ability to care for their baby, while 29% reported that their postpartum emotional health interfered at least “some.”