Abigail Smith didn’t imagine that the weeks following the birth of her first child, Daniel, in August would be easy. Neither did she imagine she’d spend a third of the year in agonising pain, unable to use the toilet, sit down or use the stairs. However, the 31-year old expected that there would always be help available if anything went wrong. ‘It’s been four months since I gave birth, and I’ve barely heard from a health professional to check I’m OK,’ says the communications manager from Kent.
Abigail said that Abigail’s obstetrician offered frequent monitoring after the complex forceps delivery. However, Abigail suffered a serious tear to her pelvic tissues which extended all the length of her pelvis.
Although she had an emergency procedure to fix the injury immediately after giving birth, the wound did not heal.
‘I was in tears almost daily for the first two months, and I’m usually quite a resilient person,’ she says. ‘It’s not just the physical pain, but I was shaken up by the emotional trauma of a complicated birth.
‘My GP just directed me to a local NHS counselling service. And I didn’t even qualify for that – I was told I wasn’t having flashbacks so I wasn’t traumatised enough to get access to therapy.
‘I’ve always dreamt of a bigger family, but right now I can’t even contemplate it.’
The health and well-being of babies is monitored by midwives. After two weeks, when the baby’s health is good, it is time for the midwife to transfer them to the care and supervision of their GP.
Carla Marsh, 37, a sales manager from Stoke-on-Trent, says: ‘For the first two months I could barely hold my baby – I was struck by this unbearable fear that I would hurt her. In case she smashed her head, I was afraid to push her through doors.
According to the Government’s Healthy Child Programme, before a baby is a year old there should be at least four appointments with a health visitor – a specialist child health nurse, working within local district nursing teams
According to the Government’s Healthy Child Programme, before a baby is a year old there should be at least four appointments with a health visitor – a specialist child health nurse, working within local district nursing teams.
The mother must be seen by a GP six- to eight weeks after giving birth to check for any signs of mental illness. They also need to have essential physical exams done on her baby. But because of Covid-related pressures on Abigail’s local health service, none of it happened.
‘I was told there was a big backlog due to the pandemic and was given a phone appointment instead, so they couldn’t carry out any of the checks or see if my wound was infected or not,’ says Abigail. ‘I’d understand if this was in the middle of lockdown, but I gave birth in August – everything was pretty much back to normal.’
Although baby Daniel had his scheduled vaccinations, these were with a practice nurse ‘and it wasn’t really a situation where you could discuss anything else’, Abigail continues. ‘I was due to have a follow-up appointment three months after the surgery to check on my injury.
‘I’m supposed to have physiotherapy to help me recover, too. But it’s been more than four months and I’ve heard nothing.’
These terrible birth stories became more common during the first fifteen months of the epidemic. Infection-control rules prevented regular face-to–face meetings with midwives, gynaecological and physiotherapy teams.
The few instances of in-person consultations were not attended by partners, which meant that women felt very alone.
Women have told of facing delays of up to 18 months for support for post-natal depression, while others have been left housebound with birth-related injuries – some were even told by their GP surgery to send in photographs of gruesome wounds to intimate body areas
After most of these Covid restrictions had been lifted, problems persist across the country months later. New mothers and maternity health professionals both share shocking stories about the state of maternal care. Many women are left without any professional assistance and abandoned by local teams.
Women have told of facing delays of up to 18 months for support for post-natal depression, while others have been left housebound with birth-related injuries – some were even told by their GP surgery to send in photographs of gruesome wounds to intimate body areas.
One woman suffering suspected pelvic organ prolapse – where organs in the pelvis slip down from their normal position and bulge into the vagina – was told she would have to go private if she wanted to be seen. One woman with post-natal anxiety was also distressed and called the local health centre 20 times in a single day. She needed help desperately but couldn’t get through to someone.
Carla Marsh, 37, a sales manager from Stoke-on-Trent, says: ‘For the first two months I could barely hold my baby – I was struck by this unbearable fear that I would hurt her. She was scared of me crashing her head and I was scared to take her out through the doorframes.
‘When I finally got through to a health visitor on the phone I immediately burst into tears – I was at rock bottom. And even then, they didn’t help. I was told by the nurse to hold my head high. She said, because this was my second birth, I should be able to cope with it because it’s a familiar situation.
‘When the health visitor did eventually turn up, about eight weeks after the birth, she was just concerned about the health of the baby and didn’t really ask about me. After a quick check of my daughter Charlotte, she said everything was fine and discharged us from the service.’
Carla says it was ‘worlds apart’ from the care she received after the birth of her first child, son Ethan, seven years ago, adding: ‘The health visitor was on my Christmas list! I saw her all the time – we became very good friends.’
The health visitors have the ability to identify early warning signs and help with issues with breastfeeding. They are also trained to treat mental disorders in children. These health visitors can examine and check for infection, as well as connect women to local services like gynaecological centers or physiotherapy that can offer more skilled support. This service is now very limited, at least according to anecdotally.
Only six percent of mothers in some areas received a six-week face-to-face checkup during the period April 2013 to this year.
Official figures seen by The Mail on Sunday show that nationally between April 2020 to the beginning of April 2021, there were roughly 20 per cent fewer checks at six weeks after birth – deemed the most crucial point, where problems are most likely to arise – compared with the same period in 2019 to 2020.
Only six percent of mothers in some areas received a six-week face-to-face checkup during April and May last year.
Another charity report suggests that about one-third of all appointments with health visitors in England were swapped for Zoom calls or phone calls.
According to data from the NHS, over a third have to wait 18 weeks to see a doctor.
About 40,000 women experience debilitating, severe tissue tears in childbirth every year.
‘The most common stories we hear now are health visitors just not turning up, or doing one visit over the year, or just offering the occasional phone call,’ says Kim Thomas, chief executive of The Birth Trauma Association charity.
‘This means mental health referrals aren’t being made until women reach crisis point.
‘There are lots of physical problems that aren’t getting picked up. A woman who suffered from severe anemia after childbirth due to blood loss was brought her to our attention. Another found breastfeeding excruciating because of her baby’s tongue tie – which no one spotted until months later, at which point the child was very underweight.
‘The nature of all these problems is that they can become very serious if not spotted early enough. And the longer women go without seeing a professional, the more they become acutely anxious and paranoid about their baby’s health, which can easily tip into a serious mental health issue.’
Mental health professionals say they’re now dealing with the consequences of severe mood disorders flying under the radar for so long.
‘I’m the busiest I’ve ever been, and seeing an increase in women reaching crisis point,’ says Dr Rebecca Moore, a consultant psychiatrist working in East London who specialises in perinatal mental health – the time period from pregnancy to up to a year after giving birth. ‘The idea of frequent checks is to spot signs of mental health problems early and prevent mothers from spiralling into a pit of anxiety or depression.
‘Without these, the onus is on new mothers to seek support, but it’s very hard to convince them to prioritise their own health over their baby’s.’ According to guidance by the Royal College of Obstetricians and Gynaecologists, women who display signs of mental illness should be subject to an urgent referral to mental health services and given an initial assessment within two weeks. But experts say this simply isn’t happening.
‘The demand for mental health services is so high, most women find they get stuck on a big waiting list for specialist help or they struggle to get someone to call them back,’ says Becky Saunders, from family support organisation Home Start. ‘There are some dedicated perinatal mental health teams across the UK, but it’s patchy. Accessing one will depend on where you are located.
‘We know that catching a perinatal mood disorder early can make an enormous difference to the development of babies.’
A recent British study of 600 women who gave birth since the start of the pandemic found that roughly a third who met the criteria for a clinical mental health problem – either anxiety or depression – were undiagnosed
A recent British study of 600 women who gave birth since the start of the pandemic found that roughly a third who met the criteria for a clinical mental health problem – either anxiety or depression – were undiagnosed.
Campaigners claim that the greatest problem is the lack of a highly trained health professional to help.
NHS England suspended face-to–face contact with community doctors in March 2012. This is excepted from those cases when parents or children are considered vulnerable. In these instances, thousands of NHS England staff were redeployed and sent to other parts of the NHS.
According to the National Institute for Health Research’s research, health workers were more often redeployed last year than any other professionals working with children young, such as midwives and community paediatricians.
Then, early last summer the guidance changed back, with health visitors encouraged to return to patients’ homes. But speaking to The Mail on Sunday, one senior health visitor working in the South of England who wishes to remain anonymous, claims it wasn’t as simple as going back to normal.
She said: ‘Suddenly the work became a lot more complex and demanding, because the other services we refer to – such as social work and mental health services – weren’t back up and running yet, so we had to mop up all that.’
According to her, the pandemic is a recurrence of a severe staffing shortage that was already present. ‘NHS trusts have been fishing from an empty pool of staff for years now.
‘It used to be the case that health visitors would see families every couple of weeks and get to know them extremely well, and be able to spend a great deal of time with them. We’d help with seemingly silly things, like taking the baby out in the pram for the first time, as this is often a nerve-racking experience, with many first-time mums struggling with confidence.
‘If you could see a mother looked like a rabbit in the headlights, you had the time and autonomy to say, “I’ll come back and check on you next week.” It’s almost impossible to do that now.’
According to data from National Institute for Health Research (NIHR), the English number of health workers has fallen by one-third since 2015. This results in an estimated deficit of 5,000 professionals.
Experts believe that many have taken early retirement due to increasing staff pressures over recent years. And in a report published last month, compiled using testimony from more than 1,200 health visitors across the country, one in four currently has 750 children on their books – three times the number recommended by NHS England.
Concern has been expressed about health visitors being swapped out for junior nursing staff who haven’t undergone the same specialist training.
The health visitor said: ‘In many areas, health visitors are being saved for referrals from social care, where you find the most complex, challenging families – like cases of domestic abuse, post-natal psychosis or severe developmental problems. But this means the average family doesn’t get the specialist support.
‘Having to deal with extreme cases all the time also means health visitors become desensitised and struggle to decipher what is normal or abnormal. If you spend all day dealing with cases of domestic abuse, it doesn’t take long before you think: I’d like to do something else for a while. It’s burnout city.’
For this reason, the health professional has just left.
She says: ‘I needed to take some time out – I was dealing with four of these types of visits every day, and having to write safeguarding reports about child safety in between, as well as speaking to other support services which don’t have the capacity to help.
‘Like many health visitors, I’ve decided to take some work in other fields of nursing for a little bit.’
Abigail has had to turn to a private physiotherapist for help to get back on her feet. ‘I am lucky because I don’t now have any of the problems going to the toilet that I know a lot of women have,’ she says.
‘But I am still in tremendous amounts of pain, even four months on, and I haven’t really seen an improvement yet.
‘I can walk again, thankfully, and the physiotherapist is helping me find certain positions that are less painful. But I’m still desperately worried that I’m not healing normally, and that’s the worst part.
‘As a first-time mother thrown into the deep end with a newborn baby, all you want is reassurance that everything is fine. I think it will be a long time before I get that.’