Earlier this year, the federal Department of Health sent nudge letters to more than 5000 GPs targeting the over-ordering of specific pathology requests. The doctors were encouraged to reduce the requests made for thyroid stimulating hormone (TSH), thyroid function tests (TFTs), iron studies, vitamin B12 and vitamin D.
These are all tests that are relatively common for women from pre-conception and through pregnancy.
This is a cost-cutting exercise that will significantly affect women in early motherhood, and I’m personally a prime example of the impact it could have.
Recent blood tests revealed that my iron levels are startlingly low and I need an iron infusion. Furthermore, results show that I need to adjust my medication for Hashimotos, an auto-immune disease that my GP discovered in a thorough preconception blood screening nine years ago. My situation is not unusual, especially for menstruating women of child-bearing age.
Iron deficiency is a common mineral deficiency in postpartum and it’s important to correct it because its associated symptoms – fatigue, poor exercise tolerance, shortness of breath, poor stress tolerance and increased anxiety and depression – can significantly affect day to day life.
Many of the nudge letters were sent to female GPs who, it’s fair to assume, have a patient demographic that is largely female.
It’s not far-fetched to say this is a gendered issue, nor am I being alarmist in presuming that this is going to significantly affect women in the vulnerable postpartum period, when blood tests aren’t routine despite mineral deficiency and thyroid issues commonly arising during this transformative time.
I’ve interviewed more than 300 mothers on my podcast, Australian Birth Stories, and there are a number of common themes in their accounts of postpartum: overwhelm, general anxiety and exhaustion are common experiences in the fourth trimester. While many women note they have been well looked after during pregnancy, once they’ve got a baby in their arms they feel as if their care is discarded. At best, they’ll receive a 30-minute check up six weeks post-birth which will include questions about their mental health and a succinct reminder to do their pelvic floor exercises and then they’re sent on their way.
Advocating for their own health moving forward requires education, information and confidence in their GP.
Preventative blood screening should be a matter of routine for postpartum women six weeks post-birth
During pregnancy it’s common for a woman to have up to three blood screening tests, more if they are considered high risk. However, in postpartum there is no routine screening, hence many women persist through fatigue and hormonal fluctuations, dismissing them as standard symptoms of new motherhood when there may be underlying causes. Postnatal depletion is real and investigative blood tests are imperative to ensure women are prioritising their health and wellbeing after birth.
The aftereffects of pregnancy, birth and breastfeeding can persist for years. Postpartum is forever is a common phrase in the birth world and if that’s true, then postnatal depletion and its symptoms can also be forever if not addressed. For women who have the financial privilege of a trusted GP, it will no doubt be easy for them to access postpartum blood screening. But for those who are economically or socially disadvantaged and can only access bulk-billed care, having the awareness and confidence to advocate for their own health in a cost-cutting climate is unlikely.
New mothers need support in postpartum, including the encouragement and guidance from a trusted family GP. Limited access to adequate healthcare in the form of routine blood tests will lead to poor physical and mental health outcomes, the effects of which are far-reaching.