Listening to Mothers in the Postpartum Window: Dr Kenga Sivarajah on Birth, Recovery & Relationship-Based Care
- Dr Kenga Sivarajah
- May 26
- 5 min read
Updated: Jun 2
Postnatal care is often spoken about as though it begins once a baby is born. In reality, recovery after birth is shaped long before labour starts. The quality of antenatal care, continuity with an obstetrician, emotional preparation, support systems, birth planning and postpartum expectations all influence how a woman experiences the weeks and months after delivery.
In a recent episode of the Sacred Window podcast, consultant obstetrician Dr Kenga Sivarajah spoke candidly to Christine Devlin Eck about what modern maternity care often overlooks, particularly in the postpartum period, and why continuity, emotional support and realistic preparation matter so deeply for mothers and families.
As Lead for Obstetrics Care at Central Health London’s private obstetrics service and Consultant Obstetrician at King’s College Hospital, Dr Sivarajah works across both NHS and private maternity care, with specialist expertise in high-risk obstetrics, maternal medicine, birth after trauma and perinatal mental health.
Why the postpartum period is often overlooked
One of the strongest themes throughout the conversation was the gap between clinical safety and genuine postpartum recovery.
Dr Sivarajah described how many women leave hospital physically exhausted, emotionally overwhelmed and underprepared for the intensity of early motherhood. She spoke openly about overstretched postnatal wards, fragmented care and the unrealistic expectations many women place on themselves after birth.
In particular, she highlighted several challenges commonly seen in the first days after delivery:
Severe sleep deprivation
Difficulties establishing breastfeeding
Physical recovery after labour or caesarean section
Lack of practical support at home
Isolation and emotional overwhelm
Pressure to appear as though they are coping
As Dr Sivarajah explained during the interview, women are often encouraged to breastfeed while simultaneously receiving very little rest, continuity or practical support.
This is one reason why preparation before birth matters so much.
Women considering obstetrics care are increasingly looking not only for clinical expertise, but also for continuity, accessibility and more personalised support throughout pregnancy and recovery.
“It takes a village”: why support systems matter after birth
Throughout the discussion, Dr Sivarajah repeatedly returned to one idea: mothers are not supposed to navigate the postpartum period alone.
She described how many couples underestimate how physically and emotionally demanding the first six weeks with a newborn can be, especially without family help, community support or additional care.
According to Dr Sivarajah, one of the most important questions to ask during pregnancy is:
“Who is going to support you?”
This support may include:
Family and friends
Doulas or maternity nurses
Lactation consultants
Postnatal support groups
Community mother-and-baby groups
Mental health support
Practical household help
The conversation also explored how many traditional cultures prioritise postpartum rest and recovery far more explicitly than modern Western healthcare systems.
Dr Sivarajah discussed examples from Chinese postpartum traditions, where mothers are supported intensively at home for several weeks after birth with food preparation, rest and practical care.
While not every family can recreate those models exactly, the broader principle remains highly relevant: women recover better when they are supported properly.
Continuity of care changes the maternity experience
A major focus of the interview was continuity of care and the importance of relationship-based maternity support.
Dr Sivarajah explained that fragmented systems, where women see multiple clinicians throughout pregnancy, often make it difficult for doctors and midwives to fully understand a patient’s fears, wishes, birth preferences and previous experiences.
By contrast, continuity allows a much deeper understanding of the individual patient.
This is especially important for women who:
Have experienced previous traumatic birth
Are planning birth after caesarean
Have anxiety around labour
Have medical complications
Want highly personalised birth planning
Need emotional reassurance throughout pregnancy
At Central Health London’s private maternity care service, many women specifically seek continuity with an obstetrician they feel comfortable with personally, as well as clinically, which may include a preference for a female obstetrician.
During the interview, Dr Sivarajah emphasised that her role is not to impose one “correct” type of birth, but to help women understand risks and benefits clearly so they can make informed decisions that feel right for them.
That includes supporting:
Vaginal birth after caesarean (VBAC)
Planned caesarean section
Birth after trauma
Physiological birth preferences
Higher-risk pregnancies requiring closer monitoring
Birth planning should not happen during labour
One particularly important theme was the need for honest antenatal conversations before labour begins.
Dr Sivarajah spoke about how women are often not fully informed about the range of possible birth outcomes, particularly around instrumental delivery, induction or emergency intervention.
Rather than frightening patients, these conversations can actually reduce anxiety because they help women feel more prepared and involved in decision-making.
She explained that many obstetric scenarios are not strictly “right or wrong”, but involve balancing risks, preferences and individual priorities.
This is especially important in high-risk pregnancy care, where personalised planning and continuity can significantly shape both safety and emotional experience.
Perinatal mental health deserves more attention
Another major topic throughout the podcast was maternal mental health.
Dr Sivarajah discussed both severe postnatal psychiatric illness, including postpartum psychosis, and the far more common experiences of anxiety, overwhelm, sleep deprivation and postnatal depression.
She highlighted several factors that commonly contribute to deterioration in maternal wellbeing:
Contributing factor | Impact on postpartum wellbeing |
Sleep deprivation | Increased anxiety, low mood and emotional instability |
Isolation | Reduced emotional resilience |
Lack of support | Higher stress and exhaustion |
Unrealistic expectations | Feelings of failure or guilt |
Difficult feeding experiences | Increased distress and self-criticism |
Birth trauma | Ongoing fear and emotional dysregulation |
One of the most striking points in the interview was Dr Sivarajah’s observation that many women reaching crisis point have simply not slept properly for weeks.
Her advice was refreshingly practical:
Prioritise sleep wherever possible
Accept help
Lower expectations around housework and productivity
Focus on nourishment and recovery
Stay socially connected
Reach out early if struggling emotionally
These themes align closely with many of the ideas explored in Central Health London’s wider obstetrics resources, particularly around continuity, personalised maternity care and emotional wellbeing in pregnancy.
Breastfeeding support needs to improve
The podcast also explored the reality that breastfeeding often does not come naturally or easily in the first days after birth.
Dr Sivarajah stressed that women frequently need ongoing lactation support rather than a single conversation in hospital.
She described the importance of:
Community breastfeeding clinics
Home visits where possible
Access to lactation consultants
Emotional reassurance
Realistic expectations around feeding
Reducing shame or guilt if feeding is difficult
Importantly, she also acknowledged that breastfeeding should not come at the cost of severe maternal distress or exhaustion.
Why postpartum care should feel more human
Towards the end of the conversation, Dr Sivarajah described what a more integrated postpartum system could look like.
Rather than isolated hospital appointments, she imagined community-based spaces where women could access:
Obstetric reviews
Midwifery care
Lactation support
Mental health support
Mother-and-baby groups
Yoga or recovery classes
Peer connection
Practical postpartum education
The central idea was simple: women recover better when they feel supported, listened to and connected.
The importance of listening in maternity care
Perhaps the most powerful part of the discussion was Dr Sivarajah’s emphasis on listening.
Throughout the interview, she repeatedly returned to the importance of understanding:
A woman’s previous experiences
Her fears around birth
Her hopes for labour and recovery
Her support structures
Her emotional wellbeing
What matters most to her personally
That level of understanding rarely happens in rushed or fragmented systems.
It happens through time, continuity and relationship.
Expert consultant-led obstetric care at Central Health London
At Central Health London, obstetric care is designed around continuity, accessibility and personalised support throughout pregnancy, birth and the postpartum period.
Women under the care of Dr Kenga Sivarajah and our other leading obstetricians benefit from consultant-led maternity care with expertise in:
High-risk pregnancy
Maternal medicine
Birth after caesarean
Perinatal mental health
Obstetric risk management
Personalised birth planning
Continuity-based maternity care
To learn more about Central Health London’s maternity services, visit our private obstetrics care page or contact our team directly for any specific enquiries.
