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Researchers Address the Long-Term Health Risks of Childbirth

written by brooke peckenpaugh Jun 06, 2024

Childbirth is a miraculous event that can mark the beginning of a new chapter for families. However, behind the excitement lies an often overlooked reality: the long-term health risks that some people face after giving birth. Reducing maternal mortality has been the primary focus of maternal health researchers for decades. As a result, non-fatal labor and birth complications that persist for months or even years after childbirth have been comparatively neglected, according to a new study.

What are the long-term effects of childbirth?

In a comprehensive review in The Lancet Global Health, researchers examined data collected between January 2000 and April 2022 on the frequency of health complications that persisted in the medium- to long-term (beyond 6 weeks after childbirth). The most common complications (and their frequency in postpartum patients) included:

  • Pain during sex (35%)
  • Back pain (32%)
  • Urinary incontinence (8-31%)
  • Anxiety (9-24%)
  • Anal incontinence (19%)
  • Depression (11-17%)
  • Fear of childbirth (6-15%)
  • Perineal pain (11%)
  • Infertility (11%)

Additional, though less frequent, complications included:

  • Pelvic organ prolapse
  • Post-traumatic stress disorder (PTSD)
  • Thyroid dysfunction
  • Breast inflammation (mastitis)
  • HIV seroconversion
  • Nerve injury
  • Psychosis
  • Venous thromboembolism
  • Peripartum cardiomyopathy

Why do these complications occur?

Pregnancy leads to a suite of physiological changes, including changes in the cardiovascular system, the immune system, hormone levels, and the musculoskeletal system (i.e., the mobility of ligaments). All of these bodily changes can have consequences in the long-term.

In addition, labor and childbirth is particularly complex in humans compared to many other animal species. The size of our brains is the primary cause of such difficulty; for instance, humans experience labor complications more frequently than non-human primates due to the relatively large size of fetal heads and relatively small female pelvises. The human brain also requires greater blood flow during development than non-human brains, which puts an additional strain on mothers.

What can be done to address these complications?

The researchers identified several avenues for addressing medium- and long-term postpartum complications.

First, effective care during labor can prevent complications from arising later on. For instance, episiotomy, or an incision of the vaginal wall used to make space for the baby during childbirth, is still used routinely by many doctors. However, previous work has shown that using an episiotomy selectively, rather than liberally, is associated with fewer overall complications.

The researchers point out that in addition to evidence-based medical practices, socioeconomic factors also play an important role in providing women with positive birth experiences. Climate, food security, housing, clean water, sanitation, and employment can all help to prevent negative postpartum outcomes.

Second, while postpartum care has historically focused on the 6 weeks after birth, this study suggests that this timeframe is not sufficient. Many postpartum conditions, and even childbirth-related deaths, continue to occur after 6 weeks. The authors therefore proposed that medical professionals should strive for better integration of postnatal care services with other disciplines to ensure that postpartum patients receive the care they need in the long term.

Finally, the researchers call for more and better data regarding postpartum complications. In particular, the lack of data from low- and middle-income countries makes it impossible to assess how circumstances may differ from high-income countries. With a more complete dataset, the medical community will be able to update clinical guidelines regarding postpartum services accordingly, and therefore provide the most effective care possible.

To avoid or mitigate the long-term health risks associated with childbirth, several measures can be taken:

  1. Preventive Care: Regular prenatal care can help identify and manage conditions that may lead to complications during childbirth, such as pre-eclampsia and gestational diabetes.
  2. Healthy Lifestyle: Maintaining a healthy diet, regular exercise, and avoiding smoking and excessive alcohol consumption can reduce the risk of developing cardiovascular disease and other health issues.
  3. Pelvic Floor Exercises: Doing pelvic floor exercises, such as Kegels, can help strengthen the pelvic floor muscles and reduce the risk of pelvic floor dysfunction.
  4. Mental Health Support: Providing support for mental health issues, such as postpartum depression, through counseling, support groups, or medication, can help reduce the long-term impact on both the mother and child.
  5. Posture and Lifting Techniques: Proper posture and lifting techniques can help prevent musculoskeletal problems after childbirth.
  6. Education and Awareness: Increasing awareness among healthcare providers and the public about the long-term health risks of childbirth can lead to earlier diagnosis and treatment of complications.
  7. Access to Healthcare Services: Ensuring access to affordable healthcare services, including postnatal check-ups and screenings, can help monitor and manage potential health issues.
  8. Supportive Policies: Implementing supportive policies, such as paid maternity leave and flexible work arrangements, can help reduce stress and support overall health and well-being after childbirth.

By taking these measures, pregnant people and healthcare providers can reduce the risk of long-term health complications after childbirth. To improve overall quality of life for postpartum patients, it is essential to recognize and address the potential long-term health risks that they may face.

 

Written by Brooke Peckenpaugh. 

Edited by Devangi Pethani.

 

References

  1. Vogel JP, Jung J, Lavin T, et al. Neglected medium-term and long-term consequences of labour and childbirth: a systematic analysis of the burden, recommended practices, and a way forward. The Lancet Global Health 2023.
  2. Haeusler M, Grunstra NDS, Martin RD, Krenn VA, Fornai C, Webb NM. The obstetrical dilemma hypothesis: there’s life in the old dog yet. Biol Rev Camb Philos Soc 2021; 96: 2031–57.
  3. Ashwell KW, Shulruf B. Quantitative comparison of cerebral artery development in human embryos with other eutherians. J Anat 2015; 227: 286–96.
  4. Jiang H, Qian X, Carroli G, Garner P. Selective versus routine use of episiotomy for vaginal birth. Cochrane Database Syst Rev 2017; 2: CD000081.
  5. Gazeley U, Reniers G, Eilerts-Spinelli H, et al. Women’s risk of death beyond 42 days post partum: a pooled analysis of longitudinal Health and Demographic Surveillance System data in sub-Saharan Africa. Lancet Glob Health 2022; 10: e1582–89.
  6. Kassebaum NJ, Bertozzi-Villa A, Coggeshall MS, et al. Global, regional, and national levels and causes of maternal mortality during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2014; 384: 980–1004.