The global maternal health agenda acknowledges that women’s quality of life, health and wellbeing in later life are a culmination of the earlier phases of life,^1,2,3 and focuses on the need to view women’s health in life-course terms and enabling them to thrive, not merely survive.^4,5 It also calls for a recognition of the spectrum of maternal morbidity, identifying and measuring non-severe, ie. non-life-threatening, morbidity.⁶

Background

The Maternal health And Maternal Morbidity in Ireland (MAMMI) study (www.tcd.ie/mammi/) was set up in 2011 to identify the existence and extent of morbidities in first-time mothers before and during pregnancy, and up to one year postpartum. It was established because no data are routinely collected or reported on women’s health after they leave maternity hospitals in Ireland. This means that there is a national silence around postpartum health issues, and this can lead women to believe that these issues are simply a consequence of pregnancy and birth, to be endured. 

A total of 3,047 women were recruited to the MAMMI study, and findings show that the overall scale of the problem is far greater than is generally recognised, with many women experiencing at least one health problem before pregnancy. One in three women experienced urinary incontinence,⁷ two in three experienced sexual health problems⁸ and one in two experienced lumbopelvic pain.⁹

One in four women experienced three or more health problems.⁹ Postpartum, more than one in two experienced urinary incontinence, almost two in five experienced dyspareunia,⁸ and one in six experienced pelvic girdle pain. However, many women do not know that these problems, while common, are not normal and can be prevented and treated, so some do not seek help.^10,11 Many women also told us that they gained new information and insights into their own health and wellbeing, and benefited personally, simply from taking part.¹²

The national silence has also contributed to a lack of awareness and understanding about the clinical and economic impact, and the burden on women and their families, of postpartum health issues. 

This was the inspiration behind the development of a Massive Open Online Course (MOOC) and a suite of resources on Women’s Health after Motherhood. We developed the course and resources with mothers, women in the MAMMI study, and with women’s health physiotherapists, midwives, mental health and sexual health experts. The content was built around what women told us they wish they had known about their postpartum physical and mental health. 

These resources are for women, their partners, and for healthcare professionals to use to complement their practice. They are available in English and Spanish, and will be available in Dutch in 2020. 

Course content

Women’s Health after Motherhood is a four-week online course, structured in one-hour modules, that aims to address the knowledge gaps that surround women’s postnatal health, and improve women’s health by providing them, their partners and healthcare professionals with easy-to-access, free, evidence-based educational content. It shares strategies to enable women to look after their bodies and minds during the postpartum period and know when to seek professional help, if needed. Each week contains the voices and experiences of women, videos, articles, downloadable infographics and leaflets, and links to additional materials. 

Week 1: Maternal health and returning to exercise 

In Week 1 myths and misconceptions about maternal health are challenged in a ‘bias-buster’ quiz, an interactive infographic that addresses health problems that are common but not normal, and offers tips on how to prioritise health postpartum. This week also looks at returning to activities and exercise, highlighting the importance of pelvic floor health and recovery, and providing an ‘Exercise Timeline’ as a guide for returning to exercise postpartum.

Week 2: Staying continent

Week 2 focuses on maintaining pelvic floor health. Women’s health physiotherapists Cinny Cusack and Niamh Kenny discuss the science behind urinary incontinence, the different types of incontinence and the causes, how the bladder works and the impact of urinary incontinence on women’s quality of life. It includes a coached pelvic floor muscle exercise task, which has visual and auditory feedback, to help women do pelvic floor muscle exercises and complete a full routine correctly. There are downloadable editable pelvic floor muscle exercise trackers, providing beginner to advanced levels that are tailored to the woman’s ability, and a habit-building infographic to help women view pelvic exercises as integral to their overall health. 

Week 3: Mental health and wellbeing and advocating for yourself

Week 3 encourages women to speak up for themselves and their health, and focuses on breaking the stigma and silence around mental health or other sensitive issues. Perinatal psychiatrist Dr John Sheehan and mental health expert Prof Agnes Higgins discuss postpartum anxiety and depression, and life strategies and techniques that help achieve and maintain mental wellness. 

Week 4: Sexual health and relationships 

Our final week looks at relationships, both intimate and social, and building social support networks. Dr Deirdre O’Malley discusses what women said about returning to sexual intimacy, sexual health problems and how to ask for professional help, and Emily Power Smith, clinical sexologist, offers advice on choosing lubricants. Sarah Benson, director of Women’s Aid Ireland, explores domestic violence, intimate partner violence and coercive control, and how to support yourself or a friend. 

Conclusion

Our hope and wish for women as mothers is that they use these resources and this course to become informed, and help themselves maintain, or take back, control of their health and wellbeing. We hope that by working together as genuine partners, women and maternity care professionals begin to break the silence on health problems that are common but not normal during motherhood. Our ultimate goal is that these trustworthy resources help women thrive, and not just survive. 

Women’s Health after Motherhood  is open until December 26, 2019, and will run again from January 20, 2020, see: www.futurelearn.com/courses/womens-health-after-motherhood

The online course creates a community of learners, where women and others can offer support to one another. The resources are also available to access, download and share with women on the MAMMI study website, see: www.tcd.ie/mammi

Acknowledgements:  Thanks to EIT Health for funding WHAM (Women’s Health After Motherhood), Science Foundation Ireland (SFI) for funding MESSAGES (Motherhood, Empowerment, Sustainable Self-Help: Addressing Gaps in Knowledge through Science), the resources on urinary incontinence and PFMEs, and to the Health Research Board (HRB) for funding ON-TRACK (Towards Recovery After Childbirth through Knowledge), the resources on pelvic girdle pain, mental health (anxiety) and sexual health. Sincere thanks to the women in the MAMMI study, to other women and all the experts who contributed content. 

1. WHO Regional Office for Europe. (2015) Beyond the mortality advantage. Investigating women’s health in Europe. Retrieved from: http://www.euro.who.int/en/health-topics/health-determinants/gender/publications/2015/beyond-the-mortality-advantage.-investigating-womens-health-in-europe 
2. WHO Regional Office for Europe. (2016b) Women’s health and well-being in Europe: beyond the mortality advantage. Retrieved from: http://www.euro.who.int/en/health-topics/health-determinants/gender/publications/2016/womens-health-and-well-being-in-europe-beyond-the-mortality-advantage-2016 
3. WHO Regional Office for Europe. (2016a) Strategy on women’s health and well-being in the WHO European Region. Retrieved from http://www.euro.who.int/__data/assets/pdf_file/0003/333912/strategy-womens-health-en.pdf?ua=1
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9. Wuytack F, Curtis E, Begley C. (2015) The health-seeking behaviours of first-time mothers with persistent pelvic girdle pain after childbirth in Ireland: A descriptive qualitative study. Midwifery, 31(11): 1104-9. DOI: 10.1016/j.midw.2015.07.009
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11. O’Malley D, Higgins A, Begley C, Daly D, Smith V. (2018) Prevalence of and risk factors associated with sexual health issues in primiparous women at 6 and 12 months postpartum; a longitudinal prospective cohort study (the MAMMI study). BMC pregnancy and childbirth, 18(1): 196. DOI: 10.1186/s12884-018-1838-6
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