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Why we need to start prioritising postpartum care

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With some studies suggesting as many as six out of seven women miss vital postnatal visits, FemTech World investigates why we need to change the narrative around postpartum recovery.

Sandra Wirström was working in the digital health sector in Sweden when she had her two daughters. She experienced birth injuries both times and she was surprised by the lack of data and support around post-natal care.

“I had to fight for every single piece of information and every single doctor appointment. I was extremely frustrated that nothing has been digitalised when it comes to the postpartum care,” says Sandra.

Sandra’s experience applies to hundreds of women across the UK. Recent figures show that six out of seven new mothers in England are not getting a check-up of their health six weeks after giving birth, despite such appointments becoming a new duty on the NHS. Of those who attend one, only 15 per cent have a dedicated consultation with a GP to discuss their physical and mental health, according to the National Childbirth Trust (NCT).

Another US study from the American College of  Obstreticians and Gynecologists revealed that as many as 40 per cent of women do not attend a postpartum medical visit after giving birth.

“Nothing has been done when it comes to postpartum digitalisation,” says Sandra. “So, about a year ago when I was on one of my walks with my second daughter, I thought ‘okay, we need to do something about this and change the narrative around postpartum care’.”

Soon after that Sandra met Astrid Gyllenkrok Kristensen, who was as passionate about women’s health as Sandra and like so many other mothers out there, struggled with the physical and emotional recovery process after giving birth.

They decided to set up LEIA, an app co-developed with midwives and medical experts that offers women personalised physical and mental health support during the postpartum months, also known as the fourth trimester.

“There are hundreds of apps to help you during pregnancy and everyone asks you how you feel,” says Astrid. “Post-delivery, you are left on your own in what seems to be the most overwhelming and sometimes traumatising time of your life. Out of 140 million women giving birth each year 90 per cent will experience emotional or physical difficulties, from breastfeeding complications to postnatal depression and pelvic dysfunction.

“When we started looking into this, we found that there were a couple of key issues leading to women struggling in silence,” Astrid continues. “The lack of digitalisation that Sandra mentioned is one of them, along with the lack of medical experts. Women do not get the information they need. They end up self-diagnosing and they have no idea who to turn to. There’s no structure and globally, the healthcare chain is very fragmented.

“There’s also a massive stigmatisation in society surrounding postpartum. The narrative, especially in Sweden, is that you’re supposed to give birth, and then within a week, go for power walk and have friends over.”

A study from the polling company Survation, revealed that 85 per cent of the 893 mothers in England interviewed over a month said their appointments were mainly or equally about the baby’s health and they did not get the chance to talk to the GP about their mental wellbeing.

Astrid says: “One of the problems of women are not getting the health care they need is because the healthcare system is not focused on the women’s perspective and is not based on their needs.

“Studies show us that suicide is now one of the leading causes of death in new mothers, up to one year after giving birth and this is something that shows the acceleration of the problem. The system is broken.”

The pandemic has only amplified this. Research by the Maternal Mental Health Alliance shows that more mothers than usual have been struggling during the pandemic because restrictions on social contact means they have been denied support from family and friends, which has led to more anxiety and loneliness.

LEIA is an app based on science and self-lived experiences of motherhood. Astrid explains that: “Together with both private and public health care, we created a medical advisory board to make sure that we achieve our primary focuses to create a solution and meet the needs of new mothers.”

“Before going into the product, what we wanted to do was to create an app that would help by giving women AI or data driven insights about their emotional and physical health, to help understand what’s going on in their head, what’s going on in their body and what the recovery process in the fourth trimester is.

“But we also wanted to include the partner within that experience, because men are also getting diagnosed with depression. Seeing it as a unit and not just pinpointing the woman, is something that we feel is integral for a healthy recovery.”

Astrid highlights how crucial postpartum check-ups really are when it comes to mental health.

“One of the key things during these visits is to screen women for postnatal depression, which is normally done face-to-face with a questionnaire called EPDS – Edinburgh Postnatal Depression Scale. With LEIA, we’ve digitalised screening models for both postnatal depression, but also pelvic dysfunction, identifying women in risk at a much earlier stage. This means even before giving birth, we’ll be able to identify women at risk of postnatal depression.”

However, changing the narrative around postpartum care is as important as offering women the support they need.

Astrid says that: “Most people understand the first three trimesters and the changes in the women’s bodies because that narrative has been established.

“So, we want to establish a narrative around postpartum as well. People need to know that there’s a physical recovery and it takes a year for the body to recover after childbirth. We think that by educating people about the recovery process we can normalise it and start breaking down the stigma.”

Sandra adds: “There’s been a boom in the femtech market focusing on fertility and pregnancy.

“In the past years, there has been a digital transformation in areas such as fertility,  period tracking and menopause. However, there are still a lot of things to do, especially when it comes to postpartum care. We’re still not getting educated enough about what is happening in our body after giving birth.”

LEIA’s data-driven approach aims to influence improvements in public health.

Globally, research data on postpartum care is limited. Amid a lack of awareness of postpartum conditions, however, investment in further studies and in developing options which address postpartum symptoms is also limited, says Astrid.

“We all know that politics is driven by economics,” she says.

“By collecting this data, we will be able to show how the lack of investment and support is actually affecting women. We have to put a number on the problem before they actually start looking into it.”

Sandra agrees: “It’s not only our perspective and our motivation, we are in fact putting the mothers in focus in everything we do by building an app for the mothers out there.”

Clearly, fundamental changes will be required to adequately address postpartum challenges in future. The success of LEIA in starting a conversation around postpartum care is, however, an important first step in driving this change.

Find out more about LEIA here.

 

 

 

 

Sorina Mihaila is the Femtech World editor, covering technology, research and innovation in women's health and wellbeing.

Motherhood

Operate your breast pump from your phone – how cool!

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Mums can now have control of their breast pump from their smartphone.

The Ardo Alyssa breast pump can be operated using the specially designed MyArdo app.

So simple to use, mums can just download the MyArdo app on both Apple and Android phones, and pair with the Alyssa by scanning the QR code with your camera, quick and easy. Once it is set up they don’t have to do this again, saving precious time.

The app allows mums to control all functions of the breast pump remotely, giving them more flexibility when they express.

The Automatic Power Pumping is a unique feature on the Alyssa which helps to increase breast milk supply. Using the app, women can view the phase of the power pumping programme and see a live countdown of each phase.

The Memory Plus function means that mums can easily save a whole expressing session. By tapping the save button on the app, they can find the settings that suit them best.

They can also view a detailed history of the settings used, overwrite the old session with a new one and easily delete a session via the app.

Not only can they control the Alyssa breast pump, but they are also able to access lots of helpful information like how to increase what they express, breastmilk storage and the correct breast shell size, and change the language.

For more information, check out this video on YouTube.

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Pregnancy

From OB/GYN to entrepreneur: the Kenyan doctor rethinking maternal health

Maternal and newborn deaths are still a major public health problem in Kenya

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Dr Lorraine Muluka, OB-GYN and founder of Malaica

Kenya has one of the highest maternal mortality rates in the world. In 2020, the maternal mortality ratio in the East African country was 530 deaths per 100,000 live births – much higher than the global average of 223 maternal deaths per 100,000 live births. The ratio of babies who die in the first month of life is also higher than the global average.

However, as Dr Lorraine Muluka, a Nairobi-based OB-GYN and founder of the health tech start-up Malaica, has found out, most of these deaths can be prevented if women have access to safe and affordable maternal health services.

Here, the consultant-turned-entrepreneur tells us why she thinks innovation will prove to be essential in bridging the health gaps in the Kenyan healthcare system.

Hi Lorraine, could you tell us a bit more about your background?

My name is Dr Lorraine Muluka and I am an OB-GYN. I am also the co-founder and CEO of Malaica, a health tech start-up that focuses on maternal health in Kenya. I hold a master’s degree in medicine in obstetrics and gynaecology from the University of Nairobi and have worked in various private and mission hospitals in Kenya’s maternal healthcare sector.

Over the past decade, I have been involved in several healthcare start-ups, driven by my passion for innovating and improving the Kenyan healthcare system. I have also been practising as a consultant obstetrician at my private practice in Nairobi. In 2021, I decided to fully commit to my vision of improving maternal health in Kenya by co-founding Malaica.

What inspired you to create Malaica?

The birth of Malaica was driven by a shared passion by the co-founders for safe motherhood and an aspiration to transform the narrative of maternal and neonatal mortality ratios in Sub-Saharan Africa.

Personally, as an OB-GYN several times it was very frustrating seeing mothers lose their lives to preventable causes. A need to fix the gaps and delays in maternal healthcare that lead to poor pregnancy outcomes is at the core of Malaica and the inspiration behind its creation.

The delays women experience begin with a woman’s decision to seek care, extend to her access to the appropriate healthcare facility and also the quality of care she receives once there. These gaps result from the various challenges women face which include limited access to quality care, lack of continuous support and high healthcare costs among others.

By recognising and addressing these gaps, Malaica aims to provide a holistic, affordable, and supportive environment for expectant mothers, ultimately improving maternal and neonatal health outcomes.

How would you describe Malaica in a few words?

Malaica provides a dedicated online support team for expectant mothers, making the journey of pregnancy happier, more affordable, and safer. With Malaica by their side, expectant mothers can rely on the invaluable companionship and guidance they need throughout their pregnancy.

What makes Malaica different?

Malaica offers a unique approach to pregnancy support that focuses on the holistic wellbeing of expectant mothers, including physical health, mental wellness, and delivery readiness. Our online platform offers personalised care for each woman at an affordable cost, with a personal nurse midwife assigned to provide support throughout pregnancy.

We provide access to obstetricians/gynaecologists, educational content, and a nurturing online community moderated by supamums for peer support. In Nairobi, we offer both virtual and in-person ANC clinics and birth preparation classes.

What sets us apart is our unwavering empathy, creating a warm and supportive environment for expectant mothers. Malaica adapts to evolving needs, making us the ideal choice for pregnancy support.

Women’s health comes with a lot of stigma. How has this impacted you as a founder?

In all my years of practising medicine, especially in obstetrics and gynaecology, I have noticed that there is a lot of stigma surrounding women’s health, especially during pregnancy. This stigma can take many forms, from societal taboos to misunderstandings about women’s health issues. Sometimes, it’s challenging to remove these barriers and create an open and supportive environment where soon-to-be mothers can access the care and assistance they need.

However, this awareness of the problem has become a powerful motivation for me. It has encouraged me to work even harder to break down these obstacles and create a safe space where women can receive the care and support, they require without being judged. It has reinforced Malaica’s commitment to empathy and understanding, ensuring that we remain a platform that is free from stigma, where mothers-to-be can access the care and guidance they need with dignity and respect.

What obstacles have you encountered on this journey?

As pioneers in the industry, we face a unique set of challenges as a remote company. One of our main challenges is proving to potential clients that our services are genuine and essential. We also strive to provide high-quality care while managing costs, which can be difficult for affordable programs like Malaica’s.

Providing physical services in remote or underserved areas poses a logistical challenge, especially considering the competitiveness of the healthcare and pregnancy support industry. Many other providers are offering similar services, so we must work hard to stand out.

As a tech company, we require ongoing technological investments and cybersecurity measures to maintain a reliable online platform for our subscription program and telehealth services.

Another challenge we face is health education. Educating expectant mothers about the importance of maternal health and the services available to them can be difficult, particularly in areas with limited health literacy.

Finally, ensuring the financial sustainability of the business, especially when offering affordable subscription programs, can be quite challenging. However, social enterprises like Malaica play a vital role in improving maternal health and supporting expectant mothers. Our dedication to our mission can lead to positive outcomes for both the business and the community it serves.

What lessons have you learned?

My journey as the founder of Malaica has taught me several vital lessons. I’ve come to understand that empathy is the cornerstone of effective support for mums-to-be. Recognising the diversity of experiences among our users and tailoring our services accordingly is crucial.

Building a strong community of support through supamums and support groups is powerful. The world of women’s health is ever-evolving, necessitating continuous adaptation and improvement.

Challenging the stigma surrounding women’s health is essential, and affordability should never be compromised. Collaboration with experts enhances the quality of care, and unwavering passion fuels dedication to our mission. These lessons guide our commitment to making pregnancy safe, convenient, and stigma-free for women worldwide.

Where are you with Malaica now?

Malaica has come a long way since its inception. We are now a reliable and easily accessible online platform for pregnancy support services, with a reach across the nation. Our commitment to providing comprehensive care, including access to nurse midwives, specialists like gynaecologists, paediatricians, psychologists, and support groups, has cemented our position as a go-to resource for expecting mothers. We strive to eliminate the stigma surrounding women’s health and continue to evolve and grow.

Malaica’s commitment to affordability and inclusivity ensures that we remain a beacon of support for women worldwide. Although our journey is ongoing, we are proud of the progress we have made.

Where do you see the company in the future?

We are committed to expanding Malaica’s reach and improving the pregnancy journey for expectant mothers in Kenya and beyond. Our ultimate goal is to ensure that even more mothers have access to better support and care throughout their pregnancy.

As a health tech company, we will continue to leverage advanced technology for telehealth services, making our services more accessible and convenient, especially for mothers in remote areas.

We also aim to foster connections among mothers and provide a strong network of emotional support through our expanding community of expectant mothers. Additionally, we are building partnerships with healthcare institutions, NGOs, and government bodies to strengthen our impact on maternal health and reach underserved populations.

Education and advocacy are major challenges in the pregnancy healthcare space, and we will continue to engage in initiatives that raise awareness about maternal health issues and promote healthy pregnancy practices.

Overall, we are optimistic about Malaica’s future as we adapt to the changing healthcare landscape and provide essential support to expectant mothers.

 

Dr Lorraine Muluka holds a master’s degree in medicine with a specialisation in obstetrics and gynaecology. Driven by a passion for improving the Kenyan healthcare system through innovation, Dr Muluka has played significant roles in several healthcare start-ups over the past decade, while also maintaining her role as a consultant obstetrician at her private practice in Nairobi. At the end of 2021, Muluka co-founded the health tech start-up Malaica. She is currently serving as the CEO of the company.

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Motherhood

NHS England to boost health support for new mums

New mums in England will benefit from personalised postnatal care to support their physical and mental health

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All new mums in England will receive better mental and physical check-ups from their GP in the weeks after giving birth, as part of a significant NHS guidance update. 


GPs will carry out the comprehensive postnatal check-up six to eight weeks after women give birth, covering a range of topics such as mental health, physical recovery and breastfeeding.

Around 600,000 women give birth in England every year and they are all entitled to a postnatal check-up after they give birth, in addition to the newborn check-up.

The new NHS guidance written in collaboration with the Royal College of GPs will ask family doctors to provide personalised postnatal care for their physical and mental health and support them with family planning.

One of the country’s most senior GPs said the guidance would boost postnatal care and encouraged women to attend the important check-up.

Dr Claire Fuller, NHS medical director for primary care and the NHS’ lead GP in England said:“More than 600,000 women give birth every year in England, and so it is vital that they can get the right NHS mental health and physical support at what can be a hugely pressured moment in their lives.

“GPs are perfectly placed to offer new mums a welfare checks six to eight weeks after giving birth – for not only their physical health but also their mental wellbeing and this new NHS guidance published today ensures that family doctors have the resources to provide this comprehensive support.

“If you are a new or expectant mum and struggling with your mental health, the NHS is here to help so please come forward through your GP practice or midwifery team”.

The routine check-up is hoped to be an opportunity for GPs to better assess and support women in their physical and mental recovery post-birth, making sure they can be referred, if necessary, to a specialist straight away.

Health and Social Care Secretary, Victoria Atkins, said: “Mothers should be supported after giving birth. This includes being able to get the mental and physical health support needed for a healthy recovery – while giving new-borns the best start in life. The postnatal check provides an important opportunity for GPs to listen to women in a discrete, supportive environment.

“This builds on part of a wider scheme of support – including making new maternal mental health services available across all areas of England by March 2024 and £25 million to expand women’s health hubs”.

Women’s Health Ambassador, Dame Lesley Regan, said: “Supporting GPs to advise on contraception after giving birth makes it more convenient and easier for women to make safe, effective choices about the many benefits of spacing their future pregnancies.

“This new advice for GPs around the long-term health implications of conditions that may first appear during pregnancy, such as gestational diabetes, hypertension, and depression, will mean women are offered guidance about conditions that may develop or become more severe later in life.

“This guidance will empower women to be able to make more informed decisions about their own health and their babies’ welfare.”

She added: “A major focus of our women’s health strategy is to make the healthcare system work better for women. Having access to a comprehensive post-natal check by a GP will mean women can get on with their day to day lives swiftly. I think this guidance is a great step in the right direction.”

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