Health consequences of pregnancy and childbirth as perceived by women and clinicians

OBJECTIVE: To develop patient-centered outcome measures for clinical research by characterizing the effects of pregnancy and childbirth on functioning. METHODS: Five focus groups of mothers (n = 33) and three focus groups of clinicians (midwives n = 8, obstetricians n = 4, and family practitioners n = 7) were convened. Discussions were audiotaped and transcribed. Major narrative themes were identified by using two independent readers and were confirmed by participants and additional clinicians. RESULTS: Themes were grouped into four outcome domains: physical, psychologic, sexual, and social. Themes identified included lack of knowledge about postpartum health, emotional lability, sexual satisfaction, depression, parenting skills, body image, fatigue, and incontinence. Lack of knowledge about typical postpartum health was the dominant theme for mothers and clinicians. Mothers felt unprepared for the health consequences of pregnancy and delivery. Clinicians lamented that paucity of data made counseling and treating patients difficult. Decreased functioning months after delivery was reported. Differences between mother and clinician concerns surfaced, particularly in emphasis. Mothers wanted more information about their health; providers emphasized newborn care. Mothers reported inspiration to improve their economic circumstances; clinicians emphasized improving maternal health. Mothers wanted control during labor, whereas clinicians believed control was not always possible. CONCLUSION: Women often felt poorly prepared for the postpartum period in part because functional health consequences are not well understood. This study suggests maternal functional health may be decreased for months after delivery, even among uncomplicated patients. This study identified new maternal outcome measures, which are being incorporated into an outcomes questionnaire.