The state of postpartum care in the UK..Where it fails and how to fix it

This week I bring you an episode on the state of postpartum care, as it relates to the mother, in the UK.

Basically I have a look at where it fails, and it does, why it fails. How it can be improved and I even give a quick breakdown of the cost of improving it. It's nowhere near as expensive as you might think it is, and it's outrageous that it's not been done yet.

Some show notes at the bottom so you have access to the figures that I used.

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Playing us out "Dresden the Flamingo" with "Tiki time"

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Link to Threads post

https://www.threads.com/@healthy_post_natal_body/post/DWrXBr0jMwJ?xmt=AQF02SJWxIikgIWVjpHbbFIC1_NBa-cgazv-k63x-OeYBQ

Key Inquiries and Investigations:

• National Maternity and Neonatal Investigation (2025–Present): Launched in August 2025, this major investigation is focusing on 14 NHS trusts and the wider maternity system, following a "rapid review" of care.
• Birth Trauma Inquiry (2024): The first Parliamentary Inquiry into birth trauma was published in May 2024, analyzing over 1,300 submissions of traumatic birth experiences.
• Ockenden Review (Shrewsbury and Telford, 2022): Found that over 200 babies and mothers could have survived with better care.
• East Kent Hospitals Inquiry (Kirkup Report, 2022): Reported that 45 babies might have survived if provided with proper care.
• Morecambe Bay Investigation (2015): Investigated maternal and baby deaths between 2004–2013.
• Nottingham University Hospitals Review (Ongoing): Known as one of the largest, examining around 2,500 cases. [1, 2, 3, 4, 5, 6, 7]

Key Findings on Postpartum Care:

• Postnatal Care Gaps: The 2024 Birth Trauma Inquiry described poor postnatal care as "tolerated as normal" and found a "postcode lottery" in care quality.
• Six-Week Check Failures: Research by Healthwatch England (2023) highlighted that 16% of new mothers did no

Transcript

Welcome And Why Postnatal Care Matters

Peter 0:00

Hey, welcome to the Healthy Postnatal Body Podcast of your postnatal expert Peter Lap. That, as always, will be me. This is the podcast for God knows what we are, the 12th of April 2026. And this is the episode I mentioned last week. I am doing one about basically the state of postpartum care in the UK. Um with regards to what is it actually, what does it look like? Where are things going wrong? Because you know, things aren't going particularly well. Um what we can improve and all that sort of stuff. It's going to be uh it's going to be one with quite a few numbers and all that sort of stuff. So, you know, get your pen and paper ready. I kid, I kid. It's all in the in the podcast notes and and and all that sort of stuff. Um, you're gonna like this episode, I promise you, it'll be really, really useful uh to find out. So I'm talking about postpartum physical care for money. Um and without further ado, here we go. Um I am joined by all the all the little fluffies, you know, cookie and kitty and and and everybody's here, which is nice. Um I hope you're well. I hope you had a good week. Uh let me adjust this microphone a little bit. The way the reason I said that is so I don't have to edit and start again and all that sort of stuff, because I've been going at it for a while today. Like I mentioned last week, uh last week we did uh from the vault episode about whether you need supplementation, protein, creatine, and all that type of stuff. Uh, the answer is no. For for those things. Um uh, but like I mentioned in that episode, I put a thing on Threads, which is the social media platform where I'm actually active, you know. And I said, after a discussion with somebody, um, some guy who said postpartum care is readily available on the NHS. And I said, What is it really? You know, do you know how long the the waiting list for pelvic floor physio is, how the NHS deals with diastasis, uh postpartum mental health services are do you think they're adequately funded? And have you been to see a GP about postpartum back pain, how did that go and all that sort of stuff? Uh and I can explain there are many areas where the NHS is underfunded, and postpartum care is right at the top of that list. And I mean that. I mean we're talking postpartum care and palliative care. Those two are chronically and criminally underfunded. Anyways, I put that out, and I had about 50-60 comments from people with stories about their experience. Uh, from someone saying, I still have diastasis four and a half years on, to um my second was premature. We were both in hospital for nine days after birth. Some midwives doctors on the mental health team every day. Um, my first was 37 week, horrible BPD, postpartum depression and postpartum anxiety, multiple doctors. And my health visitor was putting a referral after referring for someone to come back and say my depression wasn't serious enough, airquads. Or that it was too serious for them to handle, so you know, in between. Took six months before she got an appointment. So and she said the person was amazing that she saw for, but the six months wait is horrible. Someone else pointing out that charities are paid by the NHS, thanks to Jeremy Hunt, which is true, uh, to provide a service that used to be within the NHS. And you know, someone else saying that they had a really good experience with uh physio for pelvic floor, and the and the the GP and mid-wives were great. And then someone else pointed out that uh in France you automatically get pelvic floor therapy and all that sort of stuff. 10 to 20 sessions. It used to be six, and they've updated 10 to 20. And hence for why we're doing this episode. I will I will link to the thread. There's some amazing, not in a good way, stories um in that uh in that thread. And you know, I will only in this episode I'll only be discussing the postpartum care as it relates to the mother. There are huge there are huge issues, and and many of them regarding babies and prenatal procedures. But that I I could do a 15-part series on that, and I'd have to bring in other other people because that's outside my area of expertise, right? I've that that is not the world I I I live in. It it's the world that I see and hear stories about, but it's not the one I live in. So I um I'm just focusing on on the mother rather than baby postpartum care. Um and also to be honest, you know, and you'll find this when you listen to episodes and shows about postpartum care. A lot of it centers around the baby, anyways. A lot of talking points centers around postpartal, uh postpartum, postpartal, postpartum care uh for the baby. Um and therefore that's that's covered, right? There are currently, and just to talk you through the state of postpartum care a little bit, there are currently um one, two, three, four, five, six, seven, about twelve investigations into maternity, neonatal, postpartum care. We know that Okindon, um the Okindon Um review um has been going for a while. So we've heard stories about, you know, in the Ockenden review for for Shrewsbury and Telford, for instance, in 2022. You find that over 200 babies and mothers would have survived with better care. The East Kent Hospitals inquiry, which was uh Dr. Kirkkup did that. 45 babies would have survived with proper care. Morgan Bay, there was a nightmare of a of a situation there, and and and there's a there's the um currently there's a national maternity and neonatal investigation that was launched in 2025 in August, uh, and that focuses on 14 NHS trusts and the wider maternity system. So, you know, following a air quote rapid review of care, make of that what you will. Those inquiries had between them, between them already, the ones that I've concluded had 748 recommendations for improvement over the past decade, and most of them have not been implemented yet. And this is of course, this is usually a funding issue, right? These things cost money, but also, as I will explain in this episode, um it is not just money that that's that's failing here. Some NHS trusts, as the the the Freds will will uh post will show you as well. Some NHS trusts are are absolutely crushing this. They're doing a wonderful job, they have the procedures right, and that's operating smoothly. Um you cannot have 700 plus recommendations for improvement over the past over a decade. Hardly anyone implement it, like I said, and and blame it all on funds. There's a cultural problem here somewhere, right? And and and I know that for many of you it will be clear that the cultural problem is we don't care about the woman when it comes to postpartum health. We care about the baby significantly more about the woman than about the woman, and babies are below men, right? If if you can imagine, you know, like I said, the Oknen Review found that 200 babies and mothers would have survived for better care uh in Shrubers Brean Telford alone. That never would have happened if that had been 200 guys that died. It just wouldn't. It just that is just not, you know, that would have been picked up on much sooner. That would there never would have been 200. Uh it's it's it's outrageous, right? We're talking a lot in in in when we're talking um medical uh um medical situations and all the sort of stuff, medicine, medic uh treatment of illnesses and all that sort of stuff. We're talking a lot about funding of studies, and most studies are done on men and all that type of stuff. And admittedly, there's some good reasons for some of that, right? So I'm not going to get into that particularly. Um very few studies are done on um pregnant women for obvious reasons, right? It's really difficult to test brand new medication on pregnant women because you know you're asking for trouble if things go wrong, and there's a lot of stuff happening there. So I'm not going to go into that, but it's clear that even in actual care where we know what to do, the the system just doesn't work. Right now, the fun thing I had to look up a little bit because I'm in Scotland and and I wanted to make this as wide as possible, as UK-wide as possible, and therefore the NSS in England is actually because of the size of it, is the best one to take the numbers from. And even in in England, um, where how many how many kids is it? So in England, we have around about 600,000. In the UK, there's 600,000 babies born every year. In England, I believe the number is somewhere around 500,000, 530,000. Um, so then we add Wales, Northern Ireland, and Scotland, and we get to 600,000. NHS in England spends 3 billion pounds annually on total maternity and neonatal services. So that covers care from pregnancy through to the postnatal period. Right? Now, that sounds like a lot of money, but it really, really isn't if you consider the budget. That's less than 3% of the budget, right? So that that is not for 500,000 major um major events, because giving birth is a major event, and this covers everything. Apologies, this is a clear my throat. Um, this covers everything from the moment you find out that you're pregnant up until your postpartum and including your postpartum period. Now, 3% isn't isn't actually 3 billion isn't that much, right? Average cost is roundabout cost per case, as as we call it. The minimum cost for full maternity care, including postnatal, is about 7,000 pounds per person. Because some of those 500,000 kids are twins and all that sort of thing, right? Now, average cost 7,000 pounds. That's not a lot, and I can prove that that's not a lot by giving you the next number. It is estimated that the cost of maternity negligence claims in England from 2019 to 2025, so six-year period, reached 27.4 billion pounds. Now, oh that's over six years. Six times three billion is 18 billion. That's the total budget for direct maternity services. So, like I said, from the moment you find out that you're pregnant and go see the doctor until your postpartum period included, we spend one and a half times, we spend 50% more, 9 billion pounds more on maternity negligence claims than we do on actual actual um actual event, the actual care. That's insane, right? This this equates to the cost for full maternity care, and because I need to hammer this home a little bit because it drives me nuts. The cost for full maternity care is 7,000 pounds per person. If you pay that out per person, of course we don't, is ten and a half thousand pounds per person. This means that we're wasting more money on uh on on stuff that can be prevented. We can't afford not to spend the money. That that's kind of what that means. Obviously, everybody who's been involved in a maternity negligence claim deserves that money, right? And I'm I'm not saying anything on that. I'm just saying that when people say we can't afford to spend more on the NHS, uh, on maternity care in the NHS, they are mistaken. We have to spend more because we have to bring that 27 billion figure down. And of course, we do that by taking better care of people, taking better care of babies, and and and having more people be well and alive at the back end of that, right? So so what should happen, right? Let's because you know, at the end of the day, I tried I try to be a solutions guy, and we're 15 minutes in, and and I've only I've only complained. Sorry. Um, so what happened? What's what should happen? First of all, the postcode lottery system. The element has to has to end, right? We we have seen that uh from from the threads comments, some people saying it's wonderful, but then we also know 14 trusts are currently under investigation, and a lot of them aren't even under investigation yet for missing um for missing like checkups and all that sort of stuff. One of the studies came across found that 350,000 women in the UK may miss the formal postnatal checks within six weeks, it's within 10 weeks of giving birth each year. Now think only 500 births, right? 500,000 births, 350,000 don't get the postnatal checkup in time. That's the vast majority of it. Right? 16% don't receive a checkup at all. And 44% of those that don't get any um don't feel that their mental health is adequately discussed. As in you get, you know, we all know how these appointments go. You show up, they look at your baby for eight minutes, and you get two minutes, get told to bugger off. Right? It is it is shocking, it is absolutely atrocious. Um, and of course, we know that there's a the there's a huge socioeconomic link to this, right? So the uh younger women and in the private areas, your your social care, your your maternity care is significantly worse, and this leads directly into the black, Asian, mixed, ethnic uh race bias that we see in in the UK, where I saw something the other day, 80%. What was what was that stat 80% of postpartum diagnosis uh postpartum depression diagnosis get missed in in black women? 88%, four in five, four out of five, it's on on Fed somewhere as well. I I know I reposted that, but that that is that was the number from from that study. Right? So this stuff is all is all linked. So what it should look like, right? We need to we need to end the postcode lottery element. There have to be completely standardized procedures across the UK, and and you know, it's not difficult to do that because this stuff we know how to do this, we know what the procedure should look like, it's just a case of implementing it. The big thing is there should be legal consequences, not just for an NHS trust that fails to meet them, but also for the people involved. Because we don't see that directors of the NHS trust get moved from place to place. Uh, when their one trust fails, they'll move on to another one. No, you're going to go to jail. If your organization is so poorly run that it kills people, you're going to go to jail. It is that simple. I'm very, very strong about this. So, what it should look like for the first six weeks postpartum, there should be regular for the first six weeks. So, I'm not saying at six weeks. For the first six weeks postpartum, there should be regular mental health checkups with new parents. I would personally say at least twice a week for that six-week period. At that six-week period, you can move that GP checkup to eight weeks. I personally don't even think it should be a GP checkup. And I'll get to that in a little bit. That eight-week checkup doesn't need to be a GP. Because God love them. I've trained many GPs, and they will tell you they don't know what they're checking, they have no idea what they're doing with regards to that. Because it's not in, they don't see it often enough.

unknown 18:26

Right?

Pelvic Floor Physio For Everyone

Staffing The Plan And Learning From France

Peter 18:26

I've done an episode on on this before. Like I say, I've trained a lot of GPs, I work with a lot of GPs, and they will tell you that, for instance, in Edinburgh, which is where I am, there are 5,000 babies born every every year. The average GP sees, I don't know, two, three thousand people a year. Maybe 20 of them are pregnancy-related stuff. So they don't they don't know. That is not what their expertise is. They do coughs and goals and other horrible illnesses, and and it's really important, I'm also saying, it's not, but this is not what their wheelhouse is. So these things should be done. The eight-week checkup, if you've been in touch with a mental health professional, we can take the mental health element out of that. That's done, right? That's taken care of. The it it's that conversation can then that that eight-week checkup, which like I said, the six weeks becomes an eight-week checkup. You can then move that to a women's health slash pelvic floor specialist. Those are the people now. Postpartum depression isn't isn't difficult to spot if someone has been in touch with a mental health professional. So then we're just looking at as physical things. That should be a physio. End of you don't go to your doctor to get diastasis rectile checked out. That's ridiculous. Right? They'll do 20 cases and they don't know how to measure it. Um, 20 cases a year, so they don't know how to measure it. They don't, this is not their wheelhouse, this is not their expertise, and it just adds a layer. And I will come to costing for this in a bit, by the way, for people who say this is too expensive. Um but diastasis recti, aches and pains, including including leakage, uh, you know, prolapse leakage, all that type of stuff, that should all be checked out. Right? So that that is a a uh a women's health appointment. That should be a women's health appointment for anyone, and that should happen for anyone who's given birth, by the way. Um, they should all be booked in. And then this comes a little bit with a with a required cultural change, because um, you know, that it's it's going to be a little bit difficult. Um, not because we a lot of people would pull back if they had to go to see, for instance, uh uh a women's health physio for 10 sessions or something like that. Right? Women's health pelvic for physio should, of course, be free from that point onwards, right? You've been checked by the physio. Um, they can be employed by the NHS. Like I said, I've got the costing for this, it's not as expensive as you think. Um Women's Health Physio has already seen you as either signs you off or say you need to do X amount of appointments. Everyone should get at least six to ten, twelve uh appointments for a standard, but in a standard postpartum situation, six to ten is usually enough. Um twenty, uh, like they do in France, if if it required that that is at the high end, that won't be necessary in most cases. And in a lot of cases, you won't need 10 at all. It it'll be done, it'll be resolved quicker, but at least that way all your issues have been dealt with. Like I said, we have to change the culture around this a little bit because a lot of people would say, you know, I have to visit a physio every day for uh every week for 12 weeks you know got a new baby have a busy life and slapping yourself to a physio is a pain in the butt and i know that from when i have my own uh my own facility with my own my my my own gym environment so to speak that it's a best for new mums or people who've relatively recently postpartum to have to travel to a facility then have an hour long session or 45 minutes and then go back again everything is at least half an hour travel um a lot of these things are not child friendly even though they should be um right so then you're away from your child for an hour and a half two hours of every week and that's we have to find and and and that's a difficult thing to do practically already but especially if we add the layer of everything is about the baby postpartum right so we have to change that a little bit your health as the mother as the birthing person whatever you want to call it right because this goes for surrogates as well I suppose um you should you should realize how important it is that you get your health back um right so it's it's we have to part make this part of the what I call the you know un unless we can find the money to do home visits which let's be honest we will never do that uh though we should we have to make this part of it is what you do is a new parent culture um and like I said we're 27 billion pounds spent on maternity negligence claim so we're wasting a ton of money so don't come to me with this is too expensive the broad stroke costs like I said around 600 000 babies born across the UK total NHS spent to remind you 7,000 pounds per person right if we add 10 physio appointments to this this would go up by approximately enough price to physio at the high high end of 70 pounds an hour would go up by 700 pounds or so 10% right 7,000 plus 700 pounds is 10% 300 million which is pennies considering we spent we spent uh 27 billion over six years so it's four and a half billion in negligence uh claims and and and all that type of stuff it would also create a ton of jobs by the way so I'm going to uh now my background is in economics and um originally long long time ago and I could go into a half hour rant about how this actually makes us money and saves us money but I'm not going to you're gonna have to trust me on this a little bit and look up multipliers and how this works. Right? But we'd we'd save at least uh money and hassle regarding you know dissect our public floor issues sick days due to back pain and all that sort of stuff it should be very easy for the NHS to find an extra what did I say 300 million 300 million is pennies for the NHS but one of the main show points and I used to get this a lot from people would be the number of physios they're currently and I've looked this up around about 6700 physios in the UK um half work in the NHS and and don't specialize in women's health but the the the other half are just private physios so I'm thinking that if people find we need an additional right we need five hundred thousand uh we have five hundred thousand uh women to give birth every year so we need about three million appointments for women's health physios some some people like I said won't show up on to the six some will do 10 some will need a bit more I estimate three million appointments like the average physio does 10 visits a day according to Google I look that up so that's 50 a week they see around 15 a week 2000 a year but basically even if we drop that number down quite a lot we only need around 1500 to 2000 to specialize women health physios in the UK in addition to to what we're currently in addition to what we're currently doing now 2000 recruiting 2000 new people right going for years for four four five six years of of of physio school of of uni and all that sort of stuff isn't that difficult it just isn't it sounds like a lot but if people find out that hey we're changing the system in this way there's going to be guaranteed work out there because women's health physios are not going to get replaced by AI anytime soon it's a fulfilling job it's a well paying job right a quota 70 pounds an hour that's chunky right over 2000 visits even 1500 visits a year is 100 grand a year obviously you won't make that much but that just makes my argument better because it means that that 700 pounds is less than right that that 300 million is actually a significantly smaller pot um so if you say 45 pounds per physio which is much more for someone permanently employed all of a sudden you're only talking about 200 million pounds extra for the NHS but that's not that bad right so and we have to remember that the UK and I've always thought this we are way behind other civilized nations with regards to physio numbers and looking at France and all that sort of stuff I think in the UK there's one physio for every 1300 people in France and other nations it's like 400 as in one per 400. Same in Germany same in the Netherlands same in Denmark and all that sort of stuff right this is an issue that we can fix within five to eight years and there's no reason not to do it considering a hundred percent of people who give birth will need improved postpartum care. This is an absolute no-brainer for me this can be resolved fairly easily and we don't the inquiries alone into uh what was it the uh the six weeks chaler check failures which was researched by HealthWatch England um that said that 16% of new mothers never get a checkup and Miss Checkup suggested the most the majority of of women gives don't get the checkup within the first 10 weeks of giving birth anyways 500 000 women give birth 35000 so 66% almost miss don't get the checkup in time those numbers we can we can fix that we just have to streamline the process and put some money into this and we're putting pennies into this the total NHS budget is something like 150 billion pounds maternity negligence is four and a half billion pounds a year four and a half billion pounds that we're paying out anyway why not spend two hundred million and make life significantly better for for women postpartum this is such a no brainer it really is it is it is shocking that it's not already done and this works this works we all have the same procedures we take the GP out of the loop postpartum there there's no requirement we have mental health professionals which you have enough of um to to do checkups right um I'm not saying we have enough to to treat all this but you know that's a different but there's more funding in postpartum depression stuff now than there used to be and the funding will increase because that's the one that everybody focuses on but nobody focuses on women's physical health and we really really have to go and do that. This is not acceptable like I said for the average cost of 700 pounds per person per month we can resolve almost all the postpartum healthcare issues that we new mothers have think about it 700 quid come on now and it should be available on NHS that's why we have the NHS you should not need to come to people like me postpartum and pay whatever I charge depending on where you are but I'm like 50 quid an hour right and I only work in every and I don't like to work that much so I do a few sessions a day and that's pretty much it um because I have other things to do. Right and and you know you just shouldn't have to come to people like me. Women's health physios we need 2000 of them every and we and we say we don't need 2000 new ones every year by the by the right we need an increase in two of two thousand as a one off and then we're covered that we just need to replace some of them as they naturally drift off and some retire some go work somewhere else and all that sort of stuff this is such a no-brainer such a no brainer I I I genuinely uh it's baffling anyways that's my waffling done fixed it half an hour fixed the postpartum care problem of women in the UK Peter at healthypostnasalbody.com if you have any questions any comments get in touch let me know I like hearing from you people um next week we're doing part two of the of the supplement thing which is NMN sort of thing I know I always get when I talk protein I get more listeners than NMN but NMN and all that sort of stuff not plus and all that sort of thing um but there's a lot it's it's it's in the news a lot now and and you know you might find it useful to listen next week as well anyways here's a new bit of music you take care of yourself by now