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Electronic letters published:
![[Read Comment]](/icons/misc/sectionDOWN.gif){kind=icon}
A wake up call for employers!
Let's Help Women Improve Their Chances for Good Postpartum Health
Why is something so natural, so hard for society to understand?
De-medicalize labor and delivery but assess the health care needs of postpartum women.
RE: "Glad to see this" by Dr. Marily Culp
Inadequate postpartum support for U.S. mothers
Glad to see this
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Rada K Dagher, MPH, United States Doctoral Candidate, Health Services Research & Policy, University of Minnesota
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The research study by Dr. McGovern et al. constitutes an important contribution to the literature on employed postpartum women especially since only a few studies have been done on this particular population and those studies have usually utilized small sample sizes and focused on married, first time mothers. By contesting the traditional medical perspective of a 6 week recovery for postpartum women, this study has the potential to raise awareness not only among clinicians and health care providers but also among employers who are likely to encounter a good proportion of childbearing employees given the increasing proportion of mothers of infants in the US workforce. Given the general lack of federal policies in the US that specifically support employed postpartum women – except for the Family and Medical Leave Act which provides 12 weeks of unpaid leave and only covers employers with 50 employees or more– employers are encouraged to devise flexible policies to accommodate women employees after childbirth. These may include policies that enable postpartum women to take time off during the day to breastfeed or be able to attend to their baby, or flexible timing during the week to be able to take care of a sick baby or visit their health care provider (more frequently than the single time postpartum visit if need be). In fact, in preliminary longitudinal analyses that Dr. McGovern and I conducted using this dataset (I’m a doctoral student working with Dr. McGovern), we found that increased job flexibility decreased the risk of postpartum depression over the first 6 months after childbirth. Another strength of this study is that it not only focuses on postpartum symptoms but also on the mental and physical health of the mother, thus taking a holistic view of the woman that follows the WHO’s definition of wellbeing. The fact that postpartum women might not show symptoms of illness at work does not necessarily mean that they are healthy or in full productive capacity, a misconception that is held by many employers. If employers become more responsive to the needs of postpartum women for rest and recovery in the period following childbirth, they are likely to face increased productivity and higher retention of a crucial segment of their employee population! Competing interests: None declared |
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Carol Sakala, United States Director of Programs, Childbirth Connection, Maureen P. Corry, Executive Director, Childbirth Connection.
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We at Childbirth Connection (formerly, Maternity Center Association) welcome the research of McGovern and colleagues, who have assessed the health of 817 employed mothers at approximately 5 weeks postpartum, when some had already returned to their jobs. A major result, consistent with other research (http://www.childbirthconnection.org/article.asp? ck=10271&ClickedLink=200&area=2) and of particular significance given the steadily rising record-level U.S. cesarean rate, is that mothers who had had cesareans had poorer physical health than mothers who had given birth vaginally, with the moderate-to-large impact of mode of birth exceeding the impact of other variables. The authors recommend that physicians educate women about expected symptoms, duration of disability, and length of leave from work by type of birth. At Childbirth Connection, we are alarmed about the increasingly casual use of cesarean section in the large, primarily healthy population of childbearing women, who have reason to anticipate uncomplicated childbirth. We would go further and encourage women and the health professionals who care for them to pro-actively increase the likelihood of achieving safe, spontaneous vaginal birth. With the support and endorsement of many national non-profit organizations, including the Society of Teachers of Family Medicine, we have developed a booklet to help women make informed decisions about mode of birth (http://www.childbirthconnection.org/ article.asp?ClickedLink=279&ck=10164&area=27). The booklet includes a lengthy inventory of tips for increasing the likelihood of safe, spontaneous vaginal birth, which are supported by notable research. Tips include choosing a caregiver and place of birth with conservative use of interventions, having a companion who provides continuous supportive care throughout labor, working with caregivers to delay going into the hospital until active labor, avoiding electronic fetal monitoring and epidural analgesia, avoiding early artificial rupture of membranes, having access to vaginal birth after cesarean, and many other strategies. We want to let readers of Annals of Family Medicine know about our Postpartum Mothers survey. In January-February, 2006, we carried out our second national Listening to Mothers® survey, in partnership with Lamaze International and conducted by Harris Interactive® among women who gave birth in 2005. Results will be reported in fall 2006. We will again contact this group of mothers during the summer to explore many aspects of their postpartum experiences in greater depth, and will those report results in 2007. To learn about the Listening to Mothers surveys, and to read the report from the first Listening to Mothers survey, please visit: http:// www.childbirthconnection.org/article.asp? ClickedLink=205&ck=10068&area=2. Competing interests: None declared |
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Diane Harper, Hanover, USA Director Research
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McGovern et al have written a sound accounting of the pressures facing a new mother who seeks voluntarily or involuntarily to return to work after childbirth. Potentially instead of a speedy recovery regardless of delivery mode, we should focus on the concept of a 12 week sabbatical instead of the 6 week sabbatical. Some countries with a lower GNP, but some would argue higher quality of life, provide women with a full 9 months of benefits/pay after the birth of each child so that the early months of fatigue, readjustment and altering life styles can provide an extended period of time for stable infant growth and devlopment. These are both personal and societal values that always need revisiting. Competing interests: None declared |
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Barbara Yawn, Rochester, MN Director of Research, Olmsted Meical Center
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The work by Dr. McGovern and her colleagues is the important kind of research that can come from clinicians. It is a very nice addition and contrast to some of the policy and theoretical framework articles in this edition of the journal. As pointed out, in medicine we have measured the return to work period based on the requirements of one part of the body---the reproductive system. I salute the attention to the whole woman and the family. The first months of life are a critical time for infant development and babies need a parent that is able to provide not just physical care but the stimulation and emotional care that a tired woman who is struggling just to meet her and her infants needs is unlikely to be able to optimally provide if she must also fullfill the requirements of a job outside of the home. I hope this work stimulates other studies of the needs of postpartum families and that the work is not limited to postpartum depression or any other currently definable pathology. How can we use the important resources of family to help enhance child development? It has been said to require a village----and we in health care are part of that village. Competing interests: None declared |
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Pat M. McGovern, Minneapolis, MN, USA Associate Professor, U of MN
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Thank you for your comments, Dr. Culp. I, too, feel that there is a great need for more research on women's postpartum health. I think your suggestion of an investigation of issues pertinent to medical interns and residents is excellent given the long work hours and stress experienced by the medical profession. I also think there is a need for research on postpartum health for employed women of different race and ethnic backgrounds and economic circumstances as the demographics and economics of our sample (Twin Cities of Minnesota) obviously do not generalize to all urban areas in the US. Also, in regards to your comments on Caesarean delivery is a report just out (3/29/06) by the National Institutes for Health on a comparison of the risks and benefits of Caesarean delivery on maternal request vs. a planned vaginal birth. The panel of experts concluded that there is insufficient evidence to recommend for or against maternal-request Caesarean delivery. (http://consensus.nih. gov/2006/2006CesareanSOS027html.htm) Pat McGovern Competing interests: None declared |
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Kathleen A. Kendall-Tackett, Ph.D., IBCLC, Durham, NH, USA health psychologist, IBCLC, Family Research Lab, University of New Hampshire
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In a recent article, McGovern and colleagues describe the results of their prospective study of the health concerns of 817 new mothers. These mothers were middle-class, well-educated and employed. They were recruited from a part of the U.S. with an abundance of health care resources. Yet, these mothers were experiencing numerous difficulties. For example, 50% were still having nipple or breast pain at five weeks postpartum. That is an absolute scandal! Nipple pain is not normal, and indeed is entirely fixable. Often times, nipple pain is an indication of poor latch, and if not addressed, it can compromise the health of both mother and infant. For example, poor latch can mean that the baby is not transferring milk well, which can lead to excessive newborn jaundice, or even failure to thrive. For mothers, nipple trauma may lead to mastitis or even breast abscess (Mohrbacher & Kendall-Tackett, 2005). I was also alarmed at the number of risk factors that these mothers exhibited for postpartum depression. Severe fatigue, postpartum pain of all types, and breastfeeding difficulties have all been identified as risk factors for postpartum depression (Kendall-Tackett, 2005). The authors were rightly concerned about the difficulties mothers faced after cesarean birth, given their increasing rates in the U.S. But I would also like to stress the importance of paying attention to these factors as having a possible impact on maternal mental health. Finally, I would like for readers to consider the situation for new mothers in other parts of the world. In cultures that care for mothers after birth, mothers are allowed adequate rest, they have ongoing breastfeeding support from their care providers and family members, and their transition to motherhood is honored with rituals that celebrate this major life change. These cultures do not have the health care resources that mothers in the McGovern et al. study had. Yet, they often fare far better in the postpartum period (Stern & Kruckman, 1983). Care providers who want to optimize mother and infant health during the postpartum period might think about how some of what these cultures do can be integrated into care for mothers in the U.S. Kendall-Tackett KA. Depression in new mothers. Binghamton, New York: Haworth, 2005. Mohrbacher N, Kendall-Tackett KA. Breastfeeding made simple. Oakland CA: New Harbinger Publications, 2005. Stern G, Kruckman L. Multi-disciplinary perspectives on postpartum depression: An anthropological critique. Soc Sci Med 1983; 17: 1027-1041. Competing interests: None declared |
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Marilyn K. Culp, M.D., Tulsa, USA Family Medicine
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I am glad to see research like this. I don't think the recovery of a post-partum woman is very well appreciated. I would love to see research done on post-partum medical interns and residents. Personally, that was the hardest time of my life. Increasing awareness of the process of recovery especially after a C-section along with the care of an infant would increase support from employers and benefit families. Competing interests: None declared |
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