Congratulations, it's weeks of pain

Post-natal health problems can be a nasty surprise for many new mothers. 'For many Western women, pregnancy and childbirth are totally alien. In traditional societies women grew up knowing about what happened to their bodies, because they were surrounde...

"Everyone thinks that when you've had the baby, it's all wonderful," says Caroline. "You read that once you've given birth and everyone's come to visit, well, that's the end of it. It's all marvellous from then on. You're not prepared for the enormous pain."

Aches and pains after labour are as common as aches and pains during it. In a recent survey of post-natal health, up to 87 per cent of women experienced at least one health problem after delivery. Sore stitches, backache, anaemia, exhaustion, headaches, constipation, cracked nipples, engorged breasts, piles, thrush: nothing compared with the prospect of death which mothers-to-be of just a couple of generations ago had to face, but they are nevertheless painful and debilitating, particularly when they all come together and drag on for weeks and months.

While common and painful, post-natal ailments are under-publicised, particularly as far as new mothers are concerned. "Why didn't somebody tell me I would feel the way I did?" asks Hannah. "I was really happy to have Katie, but I was wobbling around the ward like a sumo wrestler, feeling like my fanny was hanging by my knees, thinking, 'Is this normal? Is this what every new mother feels like?' "

"We do try to tell mothers-to-be about some of the more painful aspects of new motherhood," says Angela Cornwell, a teacher with the National Childbirth Trust, which has recently issued a directive to its groups to focus more on the post-natal period, "but they don't listen. I was talking to my group the other day about stitches and engorged breasts and one woman said 'Yes, yes, but exactly how many flannels should I take into the birthing room?" An attitude that would seem to reflect the view held by some psychologists that pregnant women find it difficult to focus on anything beyond the birth. Joan Raphael-Leff, a psychologist and author of Psychological Processes of Childbearing, says: "It's very hard for pregnant women to foresee what happens after childbirth when most haven't even held a baby before, let along know what's going to happen to them once they've had it. For many Western women, pregnancy and childbirth are totally alien. In traditional societies women grew up knowing about what happened to their bodies when they were pregnant, and after childbirth, because they were surrounded by it."

Although, as Raphael-Leff is the first to admit, this "inability" is not only tied up with sociology and psychology. The way ante-natal care is structured is also to blame. We are very good these days at preparing women for birth. Books, magazines, midwives, doctors, ante-natal check- ups and parentcraft classes deal with every possible flutter and bump of pregnancy and childbirth: how to arrange your pillows to avoid heartburn, how to sit to avoid backache, what sort of music to give birth to. And although it's getting better, what comes after stills tends to get squeezed into the closing pages. Hannah says, "I thought, 'Surely, there would be the same attention after, if it was needed?' " But no. There is the midwife who visits for the first 10 days, the health visitor who visits once and then there is the GP's six-week mother and baby check, but all too often the baby takes priority. As Caroline says: " 'How are you?' becomes 'How's the baby?' " The baby's sleeping, the baby's feeding, the baby's health becomes all-important. "Maternal health," on the other hand, according to Dr Cathryn Glazener, a Wellcome research fellow at Aberdeen University and one of the author's of the recent report, "is one of the most neglected areas of modern medicine."

Another reason women are not told more about post-natal piles and stitches, believes Dr Glazener, is that nobody, until recently, knew they were a problem. Dr Glazener's report and a survey by researchers at Birmingham University, Health After Childbirth, published in 1992, are the first studies to be done on post-natal health. "Pockets of research have been done in stress incontinence and post-natal depression, but otherwise it's a very under-researched area," says Dr Glazener. The reason? "It's not exciting for doctors that women have sore breasts, are tired and have constipation. In ante-natal work you can see dramatic results; at delivery, you can rescue the most appalling cases. Fewer women die in childbirth today than ever before - that's exciting. Fifty per cent fewer women have piles than 10 years ago - that's not exciting."

Ante-natal care is one of the great success stories of modern medicine, but at the expense of health after childbirth. All of which, according to Dr Glazener, has contributed to the popular misconception that "you go into hospital, have the baby and bounce back to normal, if not straight away, then certainly by the six-week check." That time, it turns out, is not related to overall health, but principally to how long it takes for the uterus to return to its non-pregnant state. The assumption is that once a woman's reproductive system is back to normal, she herself is, too.

All of which can lead new mothers to think that their health problems lie not in their bodies, but their minds. They blame themselves, think they are unusual or weak and don't want to bring up problems because of embarrassment or fear of being seen as complainers. This in turn, Dr Glazener thinks, can affect their ability to mother. "Post-natal health can have a profound effect on mothers and babies. If you have a bad experience, you may react badly to your children and that can have long-lasting effects in later life."

According to Raphael-Leff, the media have a lot to answer for. "They have constantly plugged the idealised versions of cherubs and madonnas and the idea that once you have a baby all will be hunky dory, which clearly isn't true." Caroline says: "When I thought of having a baby, I imagined sunshine and parks, decorating the nursery with Winnie the Pooh curtains. I didn't think for one moment about what having a baby would do to my body."

And for mothers-to-be like Helen who wanted to find out, there was little information available. "The only interesting thing I found out at my hospital parentcraft classes was which door I needed to go through if I arrived in the middle of the night. Nobody would tell me about what really happened after. I think they thought I'd be put off or something, but if you're going to have a baby, you're going to have a baby and you want to know."

"The best people to prepare mothers-to-be," claims Raphael-Leff, "are not experts, but mothers. More recent mothers need to talk at ante-natal classes, and not just about piles and stitches. Piles are important, but so are the profound psychological changes involved in becoming a mother." Ideally, she thinks, preparation for parenthood should start at nursery and primary schools, "not just in terms of sex education, but on relationships, on what parenting is all about and what babies are like."

Dr Glazener wants the six-week check revamped. "Things have changed so fast, and everything is so different and focused on the baby, that it is often hard even to know what has really happened to your body at that stage. Three months would be better. And the focus should be much more on the mother. Above all, knowing that post-natal problems are normal and acknowledging that many aspects of motherhood, piles included, can't be controlled, can help. Having a baby may be natural, but the process of recovery from it is actually very complex." Hannah says, "The simple fact of telling myself that I had a year to recover relieved much of the pressure to be 'normal' right away."

Sally Williams is the author of 'Birth and Beyond: What Every New Mother Should Know' (Boxtree, pounds 9.99).