June 9, 2026
When mothers need more: Postnatal care and complex social needs
<p>Today, we’re speaking to Dr Clare Macdonald, an Academic Clinical Lecturer in General Practice based at the University of Birmingham.</p><p>Title of paper: Complex social needs and maternal postnatal care: what can primary care do?</p><p><strong>Available at: <a href="https://doi.org/10.3399/BJGP.2026.0069" rel="noopener noreferrer" target="_blank">https://doi.org/10.3399/BJGP.2026.0069</a></strong></p><p>Throughout the discussion we use the terms ‘woman’ and ‘women’, but we know that not all those who give birth will identify as women and intend this to mean all those who give birth.</p><p><strong>Transcript</strong></p><p>This transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.</p><p></p><p>Speaker A</p><p>00:00:00.480 - 00:00:51.740</p><p>Hello and welcome to BJ GP Interviews. I'm Nada Khan and I'm one of the Associate Editors of the Journal. Thanks for listening to this podcast today.</p><p></p><p>In today's episode, we're speaking to Dr. Claire MacDonald. Claire is an academic clinical lecturer in general practice, and she's based at the University of Birmingham.</p><p></p><p>We're here today to talk about the editorial she's just published in the May issue of the bjgp, and it's titled Complex Social Needs and Maternal Postnatal Care. What Can Primary Care Do?</p><p></p><p>So, hi, Clare, it's lovely to meet you and to talk about this brilliant editorial, but before we get into the editorial itself, I wonder if you can just talk us through what you actually mean by complex social needs in the context of postnatal care.</p><p></p><p>Speaker B</p><p>00:00:51.980 - 00:02:21.290</p><p>Yeah.</p><p></p><p>So I think when we talk about social complexity in the postnatal population, we're talking about women who have multiple factors that might be influencing how they can access care or influencing the clinical and social risks that they have. So for most people, the time after they've had a baby results in some social change.</p><p></p><p>Even in the most straightforward, most brilliantly supported, most physically well person, there are big social changes. And that is a period of a complex time to navigate and finding your way and your identity as a family with a new baby and so on.</p><p></p><p>When we talk about complex social needs, we're talking about women who face other aspects of adversity.</p><p></p><p>So it might be that they have housing instability, it might be that they have experienced domestic abuse or they continue to experience domestic abuse, that they have a history of safeguarding issues, safeguarding for themselves or safeguarding concern, concerns about other children or other family members.</p><p></p><p>And when we see women who have overlapping social risk factors that produces this kind of network of complexity that puts them at compounded additional risk and they need additional help in navigating their health needs in that time.</p><p></p><p>Speaker A</p><p>00:02:21.450 - 00:02:47.310</p><p>And I wonder why you felt that this was an important issue to highlight right now. So is there anything in particular that makes you think that this is the right time to sort of look into this?</p><p></p><p>I know that there's a complex picture in terms of sort of maternal care, and if we look at things like the cost of living crisis, which is compounding a lot of the pressures that people are facing. But talk me through what your impetus was in thinking about this as a now issue.</p><p></p><p>Speaker B</p><p>00:02:48.110 - 00:05:26.470</p><p>Yeah, that's right.</p><p></p><p>So maternity services are really high profile in the news a lot at the moment, but from a secondary care perspective, and quite rightly, there's a spotlight on the poor care that some women and their families and their babies receive from secondary care. And there are, you know, huge pieces of work being done to improve that, to improve outcomes and to improve people's experiences.</p><p></p><p>But that focus tends to be on intrapartum care.</p><p></p><p>So the care that people receive in hospital around the time of birth, sometimes there's a little bit of focus on antenatal care as well and reducing risk during pregnancy, there's a lot less focus on what looks like the less exciting time of preconception care and then postnatal care. So after women get discharged from maternity services, we know that they're often left feeling a little bit isolated in the healthcare context.</p><p></p><p>Some qualitative research that we've done in the past, looking at women's experiences of postnatal care, women told us that they were surprised about they'd had so many appointments during pregnancy and then so much healthcare retention in the first few days after birth, and then they were just surprised. No, you know, they had a baby and no one was really interested in their health anymore. And that genuinely came as a surprise to them.</p><p></p><p>We know that maternal mortality in the uk, which, thankfully, in absolute numbers, is. Is quite small, but it's certainly higher than it could be and maybe should be, particularly compared to other kind of similar European countries.</p><p></p><p>And there are actually more maternal deaths postnatally, so in the sort of later postnatal period, six weeks to a year after birth, than there are in that sort of antenatal, intrapartum and early postnatal period. And all of the political drive tends to be about reducing maternal mortality in its traditional definition of being up to six weeks after birth.</p><p></p><p>But as GPs, where we can really have an impact is in those late maternal deaths.</p><p></p><p>And of course, very few of us, thankfully, will be involved in the care of a woman who dies in that period, because they are small in absolute numbers. But there are all the women who do not die, but have those risk factors and have that complexity.</p><p></p><p>And the longer they live with those sort of adverse health conditions and adverse social conditions, that is dramatically reducing their quality life course health. And we can really step in, in that postnatal period to look at how we can influence that.</p><p></p><p>Speaker A</p><p>00:05:26.870 - 00:05:49.080</p><p>Yeah, and you've mentioned about the kind of care that women get in during their pregnancy. And sometimes, I'm sure for some women, the postnatal period can feel already pretty fragmented for those reasons.</p><p></p><p>But how do you think that that fragmentation can become amplified for women with complex social needs? Do you have any thoughts about that?</p><p></p><p>Speaker B</p><p>00:05:50.280 - 00:08:25.320</p><p>Absolutely. So a Lot of people will know how to contact their gp, right?</p><p></p><p>I think if you ask people, most people have probably got that number saved in their phone or they know where their GP practice is.</p><p></p><p>But after you have a baby, women are then given all these kind of new healthcare professionals who are interested and involved and it's impossible to know how that all fits together.</p><p></p><p>So the midwife will typically follow women up for that kind of, you know, 10 to 14 days postnatally, usually just at the time the midwife is giving you the final sign off appointment. Within a day or two, you have an appointment with the health visitor, which again is somebody new, and then you might have a follow up.</p><p></p><p>For example, if a woman's had a third degree tear or is having some additional hospital follow up because of hypertension or gestational diabetes, then the hospital are involved and then they come back to the GP.</p><p></p><p>And I often feel like, for us as GPs, women, as soon as they're pregnant, they can generally self refer to the midwife and they get kind of lifted out of the primary care system to an extent.</p><p></p><p>We might not see them through their whole pregnancy, then they have a baby, we might or might not get a discharge summary that gives us some details about the birth and then we invite them for their postnatal consultation and in that time, you know, they've had an entire pregnancy, a huge life changing event, and then we get to see them for this one appointment. And it's so complicated.</p><p></p><p>Often for women who are not sure where they're going to get their next meal from, how can they be giving any kind of cognitive time to figuring out if the midwife told the health visitor and if the health visitor told the GP and if they're worried that their bleeding's gone on for a bit too long, do they try and phone the woman who came on Thursday or the woman who came on Monday, or do they come back to their gp?</p><p></p><p>We're asking a lot and we also place a lot of burden on women to retell their story because information transfer is not always timely, it's not always sufficiently detailed.</p><p></p><p>And again, for women who are living in more precarious social situations, that burden then of having to, you know, they're juggling and the, you know, the mental load of everything they're trying to figure out. And then we're asking them, can you remember if your blood pressure was high during your pregnancy?</p><p></p><p>Whereas we should know that we should have that information from those other services. So that fragmentation in services really means that the burden is unduly placed on women to kind of patch that up.</p><p></p><p>And we need to find a better way of dealing with that.</p><p></p><p>Speaker A</p><p>00:08:25.640 - 00:08:38.260</p><p>One of the things I think that comes through really strongly is that some of the women with the greatest needs often face the biggest barriers, care. And what kind of barriers are we talking about here that these women are facing?</p><p></p><p>Speaker B</p><p>00:08:38.980 - 00:10:06.270</p><p>The Embrace report, which is well, well worth a look at at least their infographics, I think for every gp, it's just a...
