Self‐Reported Health Problems of Birthing Persons During the First and Second Postpartum Years: Scope and Correlates

ABSTRACT

Background

Postpartum health‐related problems are diverse, and some may extend beyond the first postpartum year. The purpose of this study was to describe women's postpartum health problems in the first and second postpartum years.

Methods

We analyzed data from an online survey (N = 427) conducted in 2024. Respondents gave birth within the past 2 to 22 months. Open‐ended questions elicited women's health problems; physical and mental health ratings were also gathered. Data were analyzed by qualitative content analysis and non‐parametric statistics.

Results

The three most frequently reported problems were depression/anxiety, musculoskeletal issues, and genitourinary disorders. The number of physical health problems did not differ between women 2–12 months and 13–22 months postpartum, p = 0.958. Similarly, mental health problems showed no difference between the time frames, p = 0.087. The number of physical and mental health problems was correlated with each other (r = 0.156, p < 0.01). The number of physical health problems was correlated with body mass index (r = 0.136, p < 0.01) and negatively correlated with physical (r = −0.218, p < 0.01) and mental health ratings (r = −0.175, p < 0.01). The number of mental health problems was negatively correlated with physical (r = −0.202, p < 0.01) and mental health ratings (r = −0.310, p < 0.01).

Discussion

Women reported a broad range of postpartum health problems, with no significant differences between the first and second years. Findings underscore postpartum care should be extended into the second year.

1. Introduction

Increasingly, experts are recognizing the full extent of health problems experienced by women following pregnancy and birth [1, 2]. During the first 4 postpartum months, common postpartum health problems and their prevalences include: tiredness/fatigue, 39%–78%; back pain, 28%–80%; sexual issues, 29%–77%; urinary incontinence, 24%–58%; respiratory symptoms, 48%; and headache, 16%–38% [3, 4, 5, 6, 7, 8]. Breastfeeding‐related problems also occur among 38%–52% of lactating women [4, 6, 7]. Furthermore, postpartum health problems are not limited to the initial postpartum months [9]. At 12 months postpartum, the leading health problems and their prevalences are back pain, 34%–79%; tiredness/fatigue, 28%–61%; respiratory symptoms, 37%–51%; sexual issues, 11%–64%; urinary incontinence, 24%–48%; and headaches, 31%–39% [3, 4, 5, 8]. In addition, postpartum depression and anxiety with respective prevalences of 10%–19% and 14%–18% [10, 11, 12] are of special concern during the first postpartum year because of their adverse impact on maternal well‐being and quality of life and on infant development [13, 14, 15, 16].

The preceding postpartum health problems may stem from multiple factors including bodily changes resulting from pregnancy and childbirth, social and economic stresses, and caregiving demands [6, 7, 17, 18, 19, 20]. However, increasing age [21, 22] and weight [23] among childbearing women warrant attention also to evaluate their association with postpartum health problems. Research on maternal age and weight has focused on relationships to pregnancy and birth outcomes [22, 24, 25, 26, 27], not postpartum health problems.

An additional concern is that the checklists, questionnaires, and interviews utilized to measure postpartum health problems include differing health problems, quantified in differing ways, and measured at differing times [3, 4, 5, 6, 7, 8, 17, 28]. This results in uneven and inconsistent data on health problems. Only rarely do studies of health problems extend beyond the first postpartum year despite acknowledgement of longer‐term health problems [9]. Equally important, the structured measures used in studies may not fully capture problems experienced by postpartum women. By contrast, use of open‐ended items “allow for a richer and fuller perspective on a topic” [29], thereby offering a window into postpartum health problems from the viewpoint of women themselves. Thus, in this paper, we utilized an open‐ended survey item to capture postpartum health problems that arose during the first and second years.

The aims of this study were (1) to describe the scope and frequency of postpartum persons' responses to an open‐ended item about their postpartum health problems; (2) to examine if key health problems differed between the first and second postpartum years; (3) and to evaluate if the number of postpartum health problems were correlated with physical and mental health ratings, maternal age, and body mass index.

2. Methods

2.1. Data Source and Sample

This study is a secondary analysis of data drawn from a cross‐sectional health survey containing closed‐ and open‐ended questions. The survey of postpartum persons was conducted through Qualtrics^XM utilizing research panels of CloudResearch [30]. The survey, approved as exempt by the Institutional Review Board of the University of Texas at Austin, was conducted from July to September 2024 and focused on persons who had given birth 2 to 22 months earlier; were currently not pregnant, at least 18 years old, and English conversant; had Internet access; and lived in the United States. A data quality protocol [31] was used to exclude inattentive or fraudulent respondents. The sample has been described in detail previously [32]. In brief, of 614 respondents, 427 remained after screening for survey completion and eligibility criteria. The most frequent reasons for exclusion were currently being pregnant and at a postpartum timepoint outside of the inclusionary range.

2.2. Measures

Health problems referred to women‐reported new or continuing conditions experienced since childbirth. These were categorized as physical or mental health problems, identified through responses to an open‐ended survey question: “Describe any new or continuing health problems you have had since giving birth, for example, asthma, problems with bladder or urine, high blood pressure, pain, constipation, depression or something else.” We included examples to illustrate a range of possible problems that included, but were not limited to, formal medical diagnoses. Responses to the open‐ended health problem question were analyzed using qualitative content analysis (see Data Analysis section). During the coding process, reported health concerns were categorized into physical health problems (e.g., pain, high blood pressure, urine leakage, or fatigue) and mental health problems (e.g., depression, anxiety, or stress). Responses could be coded into more than one category if participants described both physical and mental health concerns.

Health ratings were physical and mental health scores that reflected women's self‐perceived overall physical and mental health status during the postpartum period, measured by the Patient Reported Outcomes Measurement Information System Global Health (PROMIS GH) scale, a measure of physical and mental health status that incorporates items from established health scales [33]. Based on principal components analysis of data from the postpartum women [19], the PROMIS GH postpartum physical health subscale contains three items with a Cronbach alpha of 0.85 [33], and a mental health subscale contains five items with a Cronbach alpha of 0.82 [33]. Each item has response options tailored to the question content, and these range from 1 to 5. For example, the physical health subscale is: “In general, how would you rate your physical health?” with response options of 5 (excellent) to 1 (poor). An item on the mental health subscale is: “In the past 7 days, how often have you been bothered by emotional problems such as feeling anxious, depressed or irritable?” with response options of 5 (never) to 1 (always). Subscale item scores are summated into total subscale scores with higher subscale scores signifying better health. Evaluating both health problems and health ratings is important because together they provide a more comprehensive understanding of postpartum health experiences. Health problems identify specific postpartum problems experienced by women, whereas health ratings reflect women's overall perceptions of their physical and mental health status.

2.3. Data Analysis

Content analysis was used as the data analytic strategy, as it has the advantage of enabling qualitative and quantitative analysis of text data [34]. To develop the coding categories, we followed the qualitative content analysis guidelines outlined by Neuendorf [35] to ensure rigor and reliability. The coding guide was developed by using an inductive process. First, two coders independently read through participant responses to familiarize themselves with the data and terms used by participants and identify potential patterns. Following this, preliminary codes were independently generated based on interpretations of the content. The coders then met to compare and develop a final coding scheme, which served as a codebook. This codebook included definitions and examples to ensure consistency in the application of codes across all data. Next, the two coders independently applied the coding scheme to the data, categorizing responses according to the codebook. The coded data were compared, merged into SPSS, and inter‐coder reliability was assessed. A Cohen's Kappa (K) value of 0.61–0.80—indicating substantial agreement between the coders—was regarded as acceptable [36, 37]. In this study, the K value was 0.95 (p < 0.001) for the first health problem category. When the final version coding scheme was solidified, each coder independently completed coding of the health problems.

Prior to analysis of quantitative data, distributions and statistical assumptions were assessed. Results indicated that several study variables deviated from normality; therefore, non‐parametric statistical methods were selected. Spearman's rho was used to examine the relationships between the number of health problems, physical and mental health ratings, maternal age, and maternal BMI. The Mann–Whitney U test was conducted to examine differences in the number of physical health problems, while the Chi‐square test was used to assess differences in the number of mental health issues between the first and second years postpartum.

3. Results

3.1. Sample Characteristics

Respondents who were in their first or second years postpartum did not differ significantly in race, partner relationship, number of children, education, employment status, income type, or disability status between participants in the first and second postpartum years (p > 0.05). The majority of participants in both years were White, married and living with their partner, had two or more children, attained a college degree or higher, and were employed full‐time. The only significant difference was in maternal age, with mothers in the second year postpartum being slightly older than those in the first year (U = 25,562, p = 0.027), as shown in Table 1.

TABLE 1.

Characteristics of the study sample.

Variables	First year (n = 204)		Second year (n = 223)		Statistics	p
	n	%	n	%
Race/Ethnicity					χ2 = 0.808	0.848
White/non‐Hispanic	138	67.6	154	69.1
Hispanic	24	11.8	23	10.3
Black	26	12.7	32	14.3
Asian, American‐Indian, Multiple	16	7.8	14	6.3
Partner relationship					χ2 = 0.302	0.860
Single or married, living apart	20	9.8	23	10.3
Single, living together	36	17.6	35	15.7
Married, living together	148	72.5	165	74.0
Number of children					χ2 = 2.865	0.091
1 child	61	29.9	84	37.7
2 or more children	143	70.1	139	62.3
Education					χ2 = 5.360	0.069
High school or less	37	18.1	41	18.4
Some college	49	24.0	75	33.6
College or more	118	57.8	107	48.0
Employment					χ2 = 0.355	0.837
Not employed	78	38.2	90	40.4
Part‐time	32	15.7	31	13.9
Full‐time	94	46.1	102	45.7
Income					χ2 = 0.034	0.854
Medicaid, out‐of‐pocket	76	37.3	85	38.1
Private or other insurance	128	62.7	138	61.9
Disable					χ2 = 0.829	0.362
Not disabled	196	96.1	210	94.2
1 or more disabilities	8	3.9	13	5.8
Maternal age					U = 25,562	0.027*
Mean (years)	31.81		32.97
SD	5.856		5.373
Min	19		21
Max	48		49
Maternal body mass index					U = 24,696	0.106
Mean	28.95		30.08
SD	7.67		7.74
Min	14.76		16.30
Max	60.56		55.35

Abbreviations: χ², Chi‐square test; U, Mann–Whitney U test.

^* p < 0.05.

3.2. Coding Categories of Postpartum Health Problems

All reported symptoms were included in the analysis and coded into their respective categories. Complex responses were segmented, allowing a single participant to contribute to multiple codes. This approach enabled a more comprehensive representation of the range and co‐occurrence of postpartum health problems. Thus, each reported symptom within a participant's response was treated as a separate unit and coded into its respective category. Table 2 presents 21 coding categories of postpartum health problems identified among 427 women, along with their definitions and representative examples reported within each category. The mental health problems consist of the “Depression and anxiety” and “Other mental health issues” categories; other categories fall under physical health problems.

TABLE 2.

Coding categories.

No.	Categories	Definitions	Examples reported by women
0	No health problems	Reported having no issues	None, no problems
1	Genitourinary	Includes urinary incontinence, pelvic floor issues, pelvic pain, prolapse, urinary tract infection (UTI), kidney stones, miscellaneous genitourinary	Urine leakage, weak bladder, frequent urination, pelvic floor problems, pelvic pain, UTI, kidney stones
2	Sexual problems	Includes low libido, dyspareunia	Lowered sex drive, pain during sex
3	Musculoskeletal	Includes arthritis, tendonitis, various joint pains, muscle pain, miscellaneous pain and soreness, muscle injury	Arthritis symptoms, tendonitis in my arms, wrist pain, back pain, hip pain, leg pain, knee pain, feet pain, diastasis recti, incision pain, cesarean section scar pain
4	Breast issue	Includes mastitis, breast pain	Mastitis when weaning, breast pain
5	Metabolic	Includes weight issues, diabetes mellitus, insulin resistance	Weight gain, weight loss, slow metabolism, high blood sugar, insulin resistance, type 2 diabetes mellitus, fierce appetite
6	Cardiovascular	Includes hypertension, (postpartum) pre‐eclampsia, eclampsia, arrhythmia	High blood pressure, (postpartum) pre‐eclampsia, eclampsia, hot flashes, irregular heartbeat
7	Dermatological	Includes eczema, psoriasis, skin issues, hair and scalp issues	Eczema, severe acne, psoriasis flare‐up, hair loss, dandruff
8	Immunological	Includes allergies, systemic lupus erythematosus (SLE)	Allergies, lupus
9	Depression and anxiety	Includes postpartum depression, postpartum anxiety	Depression, anxiety, worsened anxiety
10	Other mental health issues	Includes stress, panic disorder, attention deficit hyperactivity disorder (ADHD), autism, bipolar disorder, post‐traumatic stress disorder (PTSD), obsessive‐compulsive disorder (OCD)	Stress, panic, ADHD, autism, bipolar, PTSD, OCD
11	Endocrinological	Thyroid Issues	Hyperthyroidism, hypothyroidism
12	Gastrointestinal	Includes constipation, diarrhea, Crohn's disease, hemorrhoids, gallbladder issues, heartburn, gastroesophageal reflux disease (GERD), irritable bowel syndrome (IBS), nausea, bloated stomach, miscellaneous gastrointestinal	Constipation, diarrhea, Crohn's disease, hemorrhoids, gallstones, gallbladder removed, acid reflux, heartburn, IBS sensitivities, bloating, nausea
13	Neurological	Includes fibromyalgia, multiple sclerosis, numbness, headaches, migraines, miscellaneous neurological, postural orthostatic tachycardia syndrome (POTS)	Fibromyalgia, multiple sclerosis, numbness, tingling in hands, carpal tunnel syndrome, sensory processing disorder, sciatica pain, migraines, headaches, Chiari headaches, POTS
14	Reproductive	Includes cysts, fibroids, menstruation issues	Ovarian cysts, fibroids, irregular menstruation
15	Oral health	Dental issues	Teeth problems
16	Respiratory	Includes asthma, bronchitis	Asthma, bronchitis
17	Sleep issues	Includes insomnia, sleep interruptions	Difficult sleep, no sleep due to boob‐obsessed baby
18	Hematological	Includes anemia, postpartum hemorrhage, bruising, bleeding	Anemia, postpartum hemorrhage, easy bruising
19	Infection	Infection	Recurring strep throat
20	Other	Includes fatigue, dehydration, discomfort, dizziness, rare genetic disorder	fatigue, apathy, dehydration, discomfort, dizziness, HEADS [sic‐, hEDS]
21	Blank	No answer	—

The authors divided health problems into two time periods: the first year (2–12 months) and the second year (13–22 months) postpartum. The sample consists of 204 women in the first year and 223 women in the second year. The frequency of postpartum health problems is presented in Table 3. During the first year postpartum, the three most frequently reported health issues were musculoskeletal problems and depression/anxiety, each accounting for 18.14% (n = 37), followed by genitourinary disorders reported by 9.80% (n = 20) of respondents. In the second year postpartum, depression and anxiety remained the most prevalent problems, reported by 19.28% (n = 43) of women, followed by musculoskeletal problems at 13.45% (n = 30), and genitourinary disorders at 11.21% (n = 25). The frequencies of other health problems are presented in Table 3.

TABLE 3.

Frequency of health problems in the first and second years postpartum.

Categories	First year (n = 204)			Second year (n = 223)
	n	%	Rank	n	%	Rank
Depression and anxiety	37	18.14	1	43	19.28	1
Musculoskeletal	37	18.14	1	30	13.45	2
Genitourinary	20	9.80	3	25	11.21	3
Gastrointestinal	14	6.86	4	15	6.73	6
Cardiovascular	12	5.88	5	20	8.97	4
Neurological	11	5.39	6	18	8.07	5
Other mental health issues	7	3.43	7	9	4.04	8
Metabolic	6	2.94	8	15	6.73	6
Other	5	2.45	9	6	2.69	9
Dermatological	5	2.45	9	5	2.24	10
Respiratory	4	1.96	11	2	0.90	14
Endocrinological	4	1.96	11	0	0.00	18
Immunological	2	0.98	13	3	1.35	11
Reproductive	2	0.98	13	3	1.35	11
Sexual problems	2	0.98	13	1	0.45	16
Sleep issues	2	0.98	13	0	0.00	18
Hematological	1	0.49	17	3	1.35	11
Oral health	1	0.49	17	2	0.90	14
Breast issues	1	0.49	17	1	0.45	16
Infection	1	0.49	17	0	0.00	18
No health problems	35	17.16	—	30	13.45	—
Blank	66	32.35	—	73	32.74	—

Note: Rankings were assigned using a competition ranking method; categories with equal frequencies received the same rank, and subsequent ranks were skipped.

3.3. Differences in Overall Physical and Mental Health Problems Between the First and Second Postpartum Years

To examine whether the overall frequency of physical or mental health problems differed between the first and second postpartum years, two separate analyses were conducted (Table 4). The results indicated that there was no significant difference in the number of physical health problems that occurred in the first (mean rank = 213.71) and second postpartum years (mean rank = 214.27; U = 22,805.5; p = 0.958).

TABLE 4.

Comparison of physical and mental health problems between the first and second postpartum years.

Variables	Postpartum period		Statistics	p
	First year (2–12 months)	Second year (13–22 months)
Physical health problems (N = 427)			U = 22,805.5	0.958
Total (n)	204	223
Mean rank	213.71	214.27
Mental health problems (N = 427)			χ2 = 2.931	0.087
No (n = 341)
Total (n)	170	171
% within postpartum year	83.30%	76.70%
Expected count	162.9	178.1
Yes (n = 86)
Total (n)	34	52
% within postpartum year	16.70%	23.30%
Expected count	41.1	44.9

Abbreviations: U, Mann–Whitney U test; χ², Chi‐square test.

For postpartum mental health problems, there was no statistically significant difference in the number of health problems between the first and second years postpartum (χ² (1, N = 427) = 2.931, p = 0.087). While not statistically significant, the findings indicated a marginal trend toward higher reports of mental health problems in the second postpartum year.

3.4. Relationships Among the Number of Postpartum Health Problems, Physical and Mental Health Ratings, Age, and Body Mass Index

As shown in Table 5, the number of physical health problems was significantly positively correlated with the number of mental health problems (r = 0.156, p < 0.01) and maternal body mass index (BMI) (r = 0.136, p < 0.01), but significantly negatively correlated with both physical health rating score (r = −0.218, p < 0.01) and mental health rating score (r = −0.175, p < 0.01). Similarly, the number of mental health problems showed significant negative correlation with physical health rating score (r = −0.202, p < 0.01) and mental health rating score (r = −0.310, p < 0.01). Ratings of physical and mental health were strongly positively correlated (r = 0.576, p < 0.01), but physical health ratings were negatively correlated with maternal BMI (r = −0.355, p < 0.01). Maternal age was not significantly correlated with any variables.

TABLE 5.

The relationships between the number of postpartum health problems, physical and mental health rating score, maternal age, and maternal BMI.

Variables	1	2	3	4	5	6
1. The number of physical problems	1
2. The number of mental problems	0.156*	1
3. Physical health rating score	−0.218*	−0.202*	1
4. Mental health rating score	−0.175*	−0.310*	0.576*	1
5. Maternal age	0.037	−0.024	−0.008	0.038	1
6. Maternal body mass index	0.136*	0.069	−0.355*	−0.081	0.080	1

Note: The correlation is based on Spearman's rho.

^* p < 0.01.

4. Discussion

The findings of this study highlight the nature of postpartum health problems across the postpartum period. The three most frequently reported problems were depression/anxiety, musculoskeletal issues, and genitourinary disorders. The results showed no significant differences in the number of physical or mental health problems between the first and second postpartum years. Greater numbers of postpartum health problems were associated with poorer self‐rated physical and mental health, while higher maternal BMI was associated with lower physical health ratings. Maternal age was not significantly associated with postpartum health outcomes.

Health problems in the early postpartum weeks have been examined in multiple studies [7, 38, 39] where they fall within a period when persons may still be receiving follow‐up care after giving birth. Our study methodology, however, allowed us to focus on the longer‐term health problems occurring during the extended postpartum period, which may contribute to differences in findings compared to prior work. Our findings reflect fewer early postpartum problems, such as sleep loss and breastfeeding problems reported by Declercq et al. [40] This difference may be due to the timing of assessment, as those concerns may be more prevalent in the immediate postpartum weeks. Additionally, our use of participant‐reported, open‐ended responses may have shifted reporting toward more burdensome conditions that individuals perceive as ongoing concerns.

The top health problems of musculoskeletal problems, depression/anxiety, and genitourinary disorders found in this study have been reported in other studies as well [3, 4, 5, 10, 11, 17, 28]. Although fatigue was a frequently reported problem in previous studies [4, 5], it was less prominent in our findings. This may reflect differences in how fatigue is captured across studies, or the possibility that respondents normalize fatigue over time and may be less likely to identify it as a primary health concern later on. In contrast to studies using checklists or pre‐determined health problems, our open‐ended approach revealed a broader range of postpartum health problems. For example, three health problem domains that we found have been rarely, if ever reported in a survey of postpartum health problems: gastrointestinal, cardiovascular, and metabolic health problems. These are of significance because of their implications for chronic disease development in women, such as cardiovascular disease and diabetes.

The occurrence of health problems across both the first and second postpartum years expands on what is known about their duration and variation in the postpartum period. For example, depression and anxiety symptoms remained the most frequently reported issue in both postpartum years with our respondents, reinforcing the findings of mental health vulnerabilities [17, 40], and also showing through 22 months postpartum. Because this study used a cross‐sectional rather than longitudinal design, the similar health problems reported across the first and second postpartum years reflect group‐level patterns and cannot determine persistent problems within the same individuals over time. However, longitudinal studies of postpartum depression and depressive symptoms support consistent trajectories across the first 2 to 3 years postpartum [41, 42].

Musculoskeletal problems, including back and hip pain, diastasis recti, knee pain, pelvic dysfunction, and incision pain, were commonly reported across both postpartum periods. These findings are consistent with prior literature. Yalcinkaya et al. [20] reported that pregnancy‐related hormonal changes, joint laxity, and altered posture may contribute to persistent postpartum musculoskeletal pain. Chen et al. [43] found that reduced rectus abdominis thickness was associated with increased postpartum low back pain, while Aggeryd et al. [44] reported that chronic postpartum pain, including pelvic, low back, and incision pain, may persist for years after childbirth.

Consistent with prior literature demonstrating the overlap between physical symptom burden and psychological distress in the postpartum period [45, 46], the positive correlation between physical and mental health problems suggests that these problems co‐occur. The negative correlations between the number of health problems and both physical and mental health ratings indicate that greater symptom burden is associated with poorer perceived overall health. This stronger relationship suggests that psychological distress may be especially influential in shaping perceptions of overall well‐being during the postpartum period. Together, these findings underscore the importance of integrated postpartum care approaches that address both physical and mental health needs, as they are closely linked and jointly influence overall health perceptions.

Notably, there were no statistically significant differences between the first and second postpartum years in the total number of physical or mental health problems. These findings highlight the need to consider the postpartum period as more than a finite recovery window limited to six or even 12 months. This aligns with calls to expand postpartum care frameworks beyond the traditional six‐week postpartum visit, and even beyond the first year [2]. It also supports the American College of Obstetrics and Gynecologist recommendation for on‐going care based on needs [1] and the Academy of Pediatrics' recommendations [47] that extend breastfeeding and, by extension, monitoring of the birthing person into the second postpartum year. However, the study sample was predominantly White, married, college‐educated, and privately insured, which may reflect a relatively lower‐risk population. Therefore, the findings may not be generalizable to populations experiencing greater social, economic, or structural vulnerabilities. While early postpartum symptoms may resolve, future research should further examine whether additional or persistent health issues occur among higher‐risk postpartum populations.

4.1. Influence of Weight and Age

Two variables in our study—weight and age—require special consideration in interpretating our findings. Higher BMI was associated with a greater number of self‐reported physical health problems and with lower ratings of physical health in respondents. These results are consistent with other research showing that individuals with higher BMI are more likely to experience musculoskeletal pain, fatigue, and cardiovascular and metabolic conditions [48]. The rise in overweight and obesity rates—both globally and in the U.S.‐in birthing persons [23] may contribute to the broader range and persistence of postpartum problems reported by people like our study population.

Further, while not significantly correlated with health outcomes, there was a significant difference in age between the two groups, with respondents in the second postpartum year being older than those in the first year. Nationally, there is a trend of increasing maternal age [49] and increased maternal age has been associated with higher risk for postpartum complications, including pelvic floor disorders, sleep disturbances, and cardiovascular health concerns [50, 51, 52]. This can indicate that postpartum care should increasingly account for age‐related considerations.

4.2. Additional Clinical Implications

Our findings indicate that postpartum health concerns are varied and remain common beyond the early postpartum period. Many of the health problems reported (e.g., anxiety, joint pain, urinary issues, and fatigue) are not solely associated with giving birth, but may be part of broader physical and psychological adjustments to having a child that are not fully recognized under current postpartum care practices. Screening for both mental and physical health problems should extend into the second year postpartum and be tailored to risk factors, as well as other identified needs. As postpartum visits typically do not extend past the 12 weeks post‐birth period, continuity of care through providers such as primary care providers and gynecologists is essential for managing emerging or chronic health issues that arise after birth. Screening for depression also has been recommended at well child pediatric visits [53]. Additionally, neuromusculoskeletal issues may benefit from preventive strategies, including routine musculoskeletal screening during both prenatal and postnatal visits. Tailored interdisciplinary collaboration is also important, such as obstetricians and midwives working together with physical therapists to early screen for musculoskeletal problems. For women experiencing severe musculoskeletal problems, early referral to orthopedic specialists may help facilitate timely treatment and improve postpartum recovery.

For genitourinary problems, this paper found that women most frequently reported these issues during both the first and second postpartum years. This finding underscores the need to extend postpartum care beyond the traditional 12‐week period. At the same time, it is difficult to address all of a mother's health concerns in just one visit. Recognizing this, the American College of Obstetricians and Gynecologists (ACOG) recommends an ongoing postpartum care model, often referred to as the “fourth trimester,” [1] which includes multiple contacts with healthcare providers during the first 12 weeks after birth. This model reflects the understanding that postpartum recovery is a continuous process requiring sustained support from midwives, obstetricians, and gynecologists through routine follow‐up care. Supporting this need for continued care, a qualitative study by Lindqvist et al. [54], found that women with pelvic floor injuries 1 year postpartum expressed a continued need for guidance and support from healthcare providers during recovery. Additionally, in some cultural contexts, genitourinary symptoms may be viewed as socially stigmatizing, contributing to embarrassment, shame, and avoidance of healthcare seeking [55, 56].

To address these challenges, healthcare providers, including midwives and gynecologists, should incorporate routine screening for genitourinary dysfunction into postpartum care and provide ongoing, individualized education on pelvic floor muscle training. Creating a supportive, nonjudgmental environment is essential to encourage open discussion of sensitive symptoms, particularly in contexts where stigma may discourage care seeking. Interdisciplinary collaboration among midwives, gynecologists, and physiotherapists may further strengthen postpartum care by ensuring comprehensive support, facilitating recovery, and reducing the risk of long‐term complications.

4.3. Strengths and Limitations

A strength of this study includes its use of open‐ended responses, which allowed respondents to voice their health concerns without being limited to pre‐populated options. This methodology yielded a wide range of reported health problems, reflecting lived experiences more fully than structured surveys and allowing the participants to highlight health issues important or impactful to them. The study also included a broader time frame—2 to 22 months postpartum—offering insight into health symptoms long‐term.

A limitation of the study includes the inability to determine whether reported health problems were acute, chronic, or resolved by the time of the survey. Some participants provided this information as part of their response, but it was largely unavailable. As the information was self‐reported, the data may be subject to recall bias or variability in individual interpretation of symptoms. Additionally, the survey question included examples of postpartum health problems (e.g., asthma, pain, constipation, or depression), which may have influenced participant responses by increasing the salience of certain health problems and potentially contributing to response bias. Another limitation is the lack of data on delivery type, which may be a factor in postpartum musculoskeletal and genitourinary problems. Future research should consider examining the influence of delivery type on postpartum health outcomes.

Further, it is important to view differences between the first and second year groups with caution, as the study was cross‐sectional and participants were not followed up. Furthermore, this study did not include data on participants' history of depression or anxiety prior to or during pregnancy, which are important risk factors for postpartum mental health problems. Therefore, the absence of these data may limit interpretation of the findings, particularly regarding differences between women with and without a history of mental health problems. Lastly, while the sample was geographically and socioeconomically diverse, it excluded non‐English speakers and those without internet access, as it was an online survey. Future studies can expand to non‐English speakers and allow respondents to expand on whether symptoms are new or ongoing, resolved, or increasing in severity, etc.

5. Conclusion

This study contributes to a growing body of evidence that postpartum health problems are multifaceted and persistent. Using open‐ended responses, we captured a wide range of self‐reported physical and mental health concerns—many of which extend beyond the traditional scope of postpartum care. Our findings support other evidence that common health problems like depression, anxiety, musculoskeletal pain, and genitourinary issues remain prevalent well into the second postpartum year. Further, the associations between higher maternal BMI, lower self‐rated health, and more frequent health problems highlight the importance of accounting for characteristics such as weight and metabolic changes in postpartum care planning.

Recognizing the extended nature of postpartum recovery is necessary for improving outcomes and addressing long‐standing gaps in care [2, 57, 58]. Our results call for an expanded and more individualized model of postpartum care that extends beyond the early weeks and months after birth and includes ongoing assessment and support for birthing persons. Health systems and policies should support continued follow‐up into the second year postpartum, integrate care across specialties, and provide targeted interventions for those at higher risk. Future research should explore longitudinal patterns of postpartum health, particularly in relation to social and structural determinants, to better support diverse birthing populations.

Author Contributions

Sudhathai Sirithepmontree: conceptualization, data curation, formal analysis, investigation, methodology, visualization, writing – original draft, writing – review and editing. Lina Palomares: conceptualization, data curation, investigation, methodology, writing – original draft, writing – review and editing. Lorraine O. Walker: conceptualization, supervision, validation, writing – original draft, writing – review and editing.

Funding

The authors have nothing to report.

Conflicts of Interest

The authors declared no conflicts of interest.

Data Availability Statement

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.