Amanda Cupples has a vivid memory of pushing her newborn son around the park and being astonished that, having just given birth, she was expected to get on with things as though she felt totally normal. “I was looking around at all the other women thinking, ‘Is it just me? Or does everyone do this?’” she recalls.
The 44-year-old, who lives in London with her husband and two children, aged nine and seven, had, she says — with a raised eyebrow — the sort of “unremarkable journey” that so many women experience. By which she means two emergency caesarean sections, one during which she lost a lot of blood; postnatal anxiety; and a baby who refused to take a bottle, meaning she was chronically sleep-deprived. Oh and an “angry pelvic floor”, meaning her muscles weren’t able to relax postpartum, something that can cause chronic pain and bowel dysfunction. “I had to get help for that privately, through a WhatsApp number someone passed me. It was like being in a secret society,” she says. “Why is that sort of postpartum care not transparent and accessible to everyone?”
To that end, Cupples, who formerly ran the UK and northern Europe division of Airbnb, has teamed up with Dr Sujitha Selvarajah, 32, a practising NHS obstetrics and gynaecology doctor, to launch Hesta Health, a new postpartum app for women.
The pair were introduced by a mutual friend and realised they were passionate about the same problem: postpartum women are falling through a gap in the NHS, despite many needing support and opportunities to improve their long-term health.
A damning report, published last month by the National Childbirth Trust, goes further, concluding that postnatal care in the UK is failing women. Thousands of new mothers feel unsafe, unsupported and overwhelmed in the weeks and months after giving birth, it said, thanks to a system that is “dangerously underfunded and understaffed”.
I find myself nodding along as I speak to the pair over Zoom. I’m 15 months postpartum and almost everything they say could apply to me: the strange feeling of being closely monitored during pregnancy and then… nothing. There was a rushed GP check-up six weeks after my son was born, during which the doctor mostly examined the baby, only briefly pausing to ask me if everything was OK at home and did I want contraception.
• Louise Thompson: I nearly died during childbirth. This is for women who didn’t survive
“We hear that from so many women,” Cupples says. As one told them during their research: “I had a more helpful conversation with the postman.” And that’s if they get to their GP. Up to 40 per cent of women don’t even have the six-week check; some aren’t invited by their surgery and others feel unable to make it so soon after giving birth.
“The fact is that we don’t really have postnatal healthcare beyond about six weeks in this country. But we know that one in three women who have a baby go on to have a longer term health issue,” Selvarajah says. “Postnatal is a great time to intervene. You can help a woman right now, but also change the trajectory of her life for the future.”
Those long-term issues might be related to pelvic floor complications, mental health conditions (experienced by an estimated one in five expectant and new mothers in the UK), metabolic disorders, hormone fluctuation and sleep disruption. Not to mention the one in three women who have had traumatic childbirth experiences; or that suffering with gestational diabetes increases your chance of getting type 2 diabetes tenfold.
“It’s not good enough,” Selvarajah says. “I was seeing day in, day out the outcome that we wanted for the baby, but then we’d tell the women, ‘OK, you can go home now — make sure you do your pelvic floor exercises.’ I realised that it didn’t matter how much of a fantastic clinician you are, hospital care is not good enough for the needs of women that are going to extend months, years beyond that.”
• Read more parenting advice, interviews, real-life stories and opinions
What’s more, as a new mother, it can be hard to know yourself when something isn’t right. What does “normal” look like? Take it from me, it’s all too easy to go into a Google spiral (“c-section scar numb OK?”) when you don’t know what you’re actually looking for.
The pair called it “normalised suffering”: the idea that we should just suck it up. “The baseline is that you should be feeling awful at this point, so just get on with it,” Cupples says. “We think women deserve more.”
The pair talk convincingly about new mothers having “milestones” in the same way as their babies — stopping breastfeeding, exercising again, returning to work — around which their care could be plotted. Frankly, any sort of plan would be a relief. To me, it felt as though everything was geared towards getting my baby out safely (and thank goodness for that) but that my health was barely a consideration beyond that. Postpartum care wasn’t part of the conversation. It was almost as if I didn’t matter.
“Mothers get the message from society that they have to subjugate their own needs,” Cupples says. “Healthcare is not immune to that cultural conditioning.”
They have been overwhelmed by the number of women who have come forward to share their own “shocking and heartbreaking” stories, often for the first time. “Some of them are friends, women I thought I knew — so why did I not know this?” Cupples says. “If I go to a dinner party, at least two women, or sometimes their husbands, will tell me something really quite personal and dreadful. If I go out with the mums, after a couple of glasses of white wine someone will say, ‘I’m still leaking when I sneeze.’ It’s not normal for that to be happening.”
One mum, on hearing about the pair’s plans to support women through birth trauma, burst into tears at the schoolgates in front of Cupples because she was still struggling herself. Her son is seven. “We hear the same things over and over,” Cupples says. “There’s an endless supply of women who want to tell us what happened to them. That’s why we feel confident we’re on the right track.”
• Jennifer Lawrence backs this postnatal depression pill. Does it work?
There are other apps offering postpartum help — Carea and Baby Buddy to name a couple — but what sets Hesta Health apart, according to its founders, is that “we’re delivering real healthcare, not just advice and content”. It is, they emphasise, CQC (Care Quality Commission) registered and input comes from top-tier clinicians, such as the head of the Royal College of Obstetricians and Gynaecologists. It’s aimed at everyone: women who don’t know if there’s anything wrong, women who feel “a bit rubbish”, and those seeking specific support.
It costs £200 to sign up to the app, which launches on February 24. For this subscribers receive postpartum blood tests which aim to provide a comprehensive view of recovery and overall wellbeing, from heart and metabolic health to thyroid function and nutrient deficiencies. The tests are done at home by a registered phlebotomist. There’s also access to an online health check covering everything from physical recovery from the birth to mental health and breastfeeding issues. The upshot is a personalised report, with the results interpreted by specialist clinicians and advice on next steps.
That might be a prescription for iron or vitamin D supplements from one of the GPs working with the app. It could be personalised pelvic floor exercises. It might be asking Hesta to arrange a postnatal clinician appointment (from an additional £40) or specialist care with a physio or mental health expert, also at an extra cost. But when new parents are encouraged to splash the cash on pricey antenatal groups and expensive baby nonsense (that device which claims to rock your newborn to sleep in their pram, I’m looking at you), £200 to help get your health back on track doesn’t seem far-fetched to me. It would make a great gift.
• Read more expert advice on healthy living, fitness and wellbeing
Initially, Hesta is focusing on women up to six months postpartum, with plans to quickly expand to include those up to two years postbirth (glad to hear it). “I was listening to a podcast the other day between two women, and one asked, ‘How long can you call yourself postnatal for?’” Cupples says. “The other replied, ‘I think you’re postnatal for ever. Once you’ve had a baby, that’s it.’
“I think there’s truth in that. I’ve had two emergency caesareans, my scar still bothers me sometimes, my brain has changed. I would have really benefited from Hesta. I wasn’t at risk of harming myself, I didn’t have organs dropping out, but I needed health care and support.”
They are already working on pilot schemes with NHS organisations and hope the app will be taken up by employers and insurers to get it into the hands of as many women as possible. They’ve set aside funding to offer free access to women from lower incomes.
“I don’t want to do concierge medicine,” Cupples says. “Hopefully from day one, we will start to make individual women’s lives happier and healthier. If we intervene now, we know that we can change lives.”
Hair and make-up by Alice Theobald @ArlingtonArtists using SUQQU & Revitalash
link