Postpartum Health of Employed Mothers 5 Weeks After Childbirth

Pat McGovern; Bryan Dowd; Dwenda Gjerdingen; Cynthia R. Gross; Sally Kenney; Laurie Ukestad; David McCaffrey; Ulf Lundberg

doi:10.1370/afm.519

Article Figures & Data

Tables

Additional Files

View popup

Table 1.

Measures of Independent Variables

Independent Variables (Coding)	Item Description, Reference, and Data Source
* Data collected in person at enrollment in the hospital.
† Data collected by telephone at the 5-week interview.
Personal Factors
Age (years)	Abstracted from the medical chart
Race (1 = white, 0 = non-white)	Adapted from Census 2000³⁴*
College educated (1 = yes; 0 = no)	Adapted from National Health Interview Survey³⁵*
Marital status (1 = married; 0 = no)	Adapted from National Health Interview Survey³⁵*
Primiparous (1 = yes; 0 = else)	Adapted from National Health Interview Survey³⁵*
Annual household income ($)	Adapted from National Health Interview Survey³⁵*
Prenatal smoking (1 = yes; 0 = no)	Item assessed smoking during pregnancy³⁶*
Perceived control (1 = none/very little, 2 = some, 3 = a lot, 4 = complete)	“Before this pregnancy how much control did you have over the time and effort spent caring for family, doing home chores or paid work?”³⁷*
Social support (5-item scale with summary score: 5 = none of the time to 25 = all of the time)	“How often are the following kinds of support available to you, if needed: someone to: (1) confide in or talk about your problems, (2) get together with for relaxation, (3) help with daily chores if you are sick, (4) turn to for suggestions about how to handle personal problems, and (5) someone to love and make you feel wanted”³⁸*
Perinatal Factors
Chronic health problems (1 = some problems; 0 = none)	Presence/absence of hypertension, diabetes, cardiac disease, renal disease, asthma; abstracted from medical records
Preconception health (1 = poor/fair, 2 = good, 3 = very good, 4 = excellent)	“How would you rate your health in general before this pregnancy?” item adapted from SF-12³³*
Prenatal mood disturbances (1 = yes; 0 = no)	“During this pregnancy did you ever have a problem with your mood, such as feeling depressed or anxious?”¹¹*
Labor and delivery complications (1 = some problems; 0 = none)	Presence/absence of anesthetic complications, excessive bleeding, lacerations, seizures, eclampsia, abruptio placenta or infections; abstracted from medical chart
Cesarean delivery (1= yes, 0 = no)	Abstracted from medical chart
Infant girl (1= yes, 0 = no)	Abstracted from medical chart
Colicky baby (1 = yes, 0 = no)	Item developed and validated by investigators⁶: “Has your baby had fussy, irritable behavior that lasts for at least 2 days or had colic?” †
Postpartum Factors
Breastfeeding (1 = yes, 0 = no)	Item developed and validated by investigators,⁶ “Which of the following are you feeding your baby: breast milk, formula, milk (cow or soy), other? “ (Multiple response options allowed) †
Health services used ($)	Measure of price-weighted volume of health care services used after hospital discharge from childbirth through 5-wk interview. Services included emergency department visits, number of hospital days, outpatient surgeries/procedures, doctor office/urgent care visits, mental health visits; the number of encounters was multiplied by the unit price/encounter using claims data for women of reproductive years from Blue Cross Blue Shield Minnesota, 2001. All costs were summed for a price-weighted volume of services used³⁹
Time elapsed since childbirth (days)	Computed from infant birth date and interview date
Employment characteristics
Employment status (1 = working, 0 = on leave from work)	Item adapted from Cantor et al⁴⁰*
Occupational classification (blue collar/service = 1; else = 0; clerical = 1; else = 0; professional = reference)	Taken from US Census⁴¹^†
Prenatal hours worked/week (hr)	Average work hours past 12 mo*
Prenatal job stress (2-item summary score of 2 = almost never to 10 almost always)	Items taken from Mardburg et al³⁷ and validated⁶; “How often do you have too much to do? How often do you experience stress from your job?” *
Prenatal job satisfaction (1 = very to somewhat satisfied; 0 = very to somewhat dissatisfied)	Global job satisfaction item taken from Quinn and Staines⁴²*
Prenatal supervisor support (1 = strongly disagree, 2 = disagree, 3 = agree, 4 = strongly agree)	Item adapted from Bond et al⁴³ and validated⁶; assesses maternal perception of supervisor’s helpfulness during pregnancy^†

View popup

Table 2.

Important Differences Between Women by 5-Week Interview Status

	Mean No. (SD)
Variables	Full Interview n = 716	Mini Interview n = 30	No Interview n = 71	*Significance of F Test Using ANOVA or t TestP Value**
Continuous
Maternal age, y	29.9 (5.30)	27.2 (5.8)	27.9 (6.1)	.001
Annual household income, $	71,741 (38,018)	51,930 (27,122)	66,262 (39,902)	.012
Days from childbirth until 5-wk interview	33.42 (6.32)	42.73 (11.3)	N/A	<.001
Physical health (PCS) score	51.4 (7.2)	49.4 (11.3)	N/A	Not significant*
Mental health (MCS) score	49.6 (7.9)	49.4 (7.6)	N/A	Not significant*

	No. (%)			Significance of χ²
PCS = physical component summary of the SF-12³³; MCS = mental component summary of the SF-12³³; N/A denotes that information is missing for enrolled subjects given their interview status at 5 weeks postpartum.
Note: Variables not significantly different between groups included the proportion of women who smoked while pregnant, were primiparous; experienced prenatal mood problems, labor and delivery complications, cesarean deliveries; and reported prenatal prenatal job satisfaction. There were no differences between groups on the mean levels of perceived control and preconception overall health and prenatal job stress. The proportion of women on leave vs returned to work at 5 weeks did not vary between women completing the full interview and those completing the mini interview because of time constraints.
* t Test used to evaluate the differences in mean PCS and MCS scores between women completing the full interview and those completing the mini interview.
Discrete
White	615 (86)	13 (43)	53 (75)	<.001
Married	531 (74)	14 (47)	38 (54)	<.001
College educated	331 (46)	7 (23)	16 (23)	<.001
One or more chronic health problems	116 (16)	10 (33)	15 (21)	.040

View popup

Table 3.

Characteristics of Women Completing the Full 5-Week Interview (n = 716)

Variables	Value Mean No. (SD)
Continuous
Maternal age, y	29.9 (5.30)
Annual household income, $	71,741 (38,018)
Prenatal perceived control (1 = little control to 4 = complete control)	3.04 (0.72)
Available social support (summary score 5 = none of the time to 25 = all of the time)	20.7 (3.68)
Preconception health (1 = poor/fair to 4 = excellent)	3.09 (0.79)
Health services used, $	191 (1,119)
Days elapsed from childbirth until 5-wk interview, No.	33.42 (6.32)
Prenatal time worked, h/wk	38.1 (8.50)
Prenatal job stress (1= never to 8 = always)	4.35 (1.73)
Prenatal supervisor support (1 = strongly disagree to 4 = strongly agree)	0.89 (0.31)

	No. (%)
Discrete
White	615 (86)
Married	531 (74)
College educated	331 (46)
Primiparous	333 (47)
Smoking during pregnancy	97 (14)
Experienced prenatal mood disturbances	333 (47)
One or more labor and delivery complications	103 (14)
One or more chronic health problems	116 (16)
Cesarean delivery	123 (17)
Infant girl	350 (49)
Colicky baby	109 (15)
Some breastfeeding at 5-wk postpartum	480 (67)
Very or somewhat satisfied with prenatal job	637 (89)
Occupational classification
Service/blue collar	103 (14)
Clerical	281 (39)
Professional	158 (47)
Employment status (back to work at 5-wk postpartum)	51 (07)

View popup

Table 4.

Frequency of Specific Postpartum Symptoms (n = 716)

Symptoms	No. (%)
Fatigue	457 (63.8)
Breast discomfort	432 (60.3)
Decreased desire for sex	375 (52.4)
Nipple irritation or soreness	358 (50.0)
Headaches	355 (49.6)
Back or neck pain	310 (43.3)
Decreased appetite	224 (31.3)
Constipation	196 (27.4)
Runny or stuffy nose	189 (26.4)
Hemorrhoids	169 (23.6)
Excessive sweating	165 (23.0)
Sore throat, cough, or cold	164 (22.9)
Abdominal pain including indigestion (heartburn and cramps)	149 (20.8)
Acne	129 (18.0)
Dizziness	104 (14.5)
Numbness or tingling of hands	102 (14.2)
Hot flashes	85 (11.9)
Sinus trouble	84 (11.7)
Diarrhea or stomach flu	54 (7.5)
Rash	53 (7.4)
Fever >100°F	51 (7.1)
Breast infection/mastitis treated with antibiotics	45 (6.3)
Asthma	41 (5.7)
Hair loss	34 (5.0)
Uterine infection treated with antibiotics	19 (2.7)
Irregular heartbeats	15 (2.1)
High blood pressure treated by a physician	13 (1.8)
Bronchitis or pneumonia treated by a physician	4 (0.6)

View popup

Table 5.

Selected Results from Estimations of Maternal Postpartum Health Equations With 2-Stage Least Squares (n = 716)

	2SLS Coefficients (P Value)
Independent Variables	*Physical Health¹**	Mental Health^†	Symptoms
2SLS = 2-stage least squares.
* Physical health was measured with the PCS (physical component summary of the SF-12) score.
† Mental health was measured with the MCS (mental component summary of the SF-12) score.
‡ Statistically significant t test on the estimated 2SLS regression coefficient.
Preconception overall health (scaled 1 to 4)	2.35 (<.001)^‡	0.79 (.04)^‡	−0.69 (<.001)^‡
Prenatal moods (1 = yes)	0.10 (.86)	−3.67 (<.001)^‡	1.19 (<.001)^‡
Cesarean delivery (1 = yes)	−5.96 (<.001)^‡	0.60 (.45)	−0.19 (.59)
Infant sex (1 = female)	−0.24 (.64)	−2.27 (<.001)^‡	−.03 (.91)
Perceived control (scaled 1 to 4)	0.83 (.03)^‡	0.84 (.06)^‡	−0.23 (.27)
Social support (scaled 5 to 25)	0.06 (.42)	0.49 (<.001)^‡	−0.03 (.42)
Breastfeeding (1 = yes)	−1.32 (.67)	−1.49 (.68)	4.63 (.00)^‡
Infant colic (1 = yes)	0.69 (.39)	−1.25 (.17)	0.89 (.04)
Time elapsed since childbirth, d	0.14 (.03)^‡	.02 (.77)	−.02 (.44)

View popup

Table 6.

Significant Differences in Postpartum Symptoms by Women’s Breastfeeding Status

Postpartum Symptoms	Breastfeeding No. (%) (n = 480)	Not Breastfeeding No. (%) (n = 236)	P Value of t Test or χ²
* The mean difference in total symptoms and nonbreastfeeding symptoms (ie, all symptoms except breast discomfort, nipple soreness, and breast infection) by breastfeeding status was evaluated by t test.
† The difference in the frequency of women reporting any symptom by breastfeeding status was evaluated by χ² test.
Continuous variables*
Mean number of total symptoms	6.6	5.1	<.001
Mean number of nonbreastfeeding symptoms	5.2	4.5	.003
Discrete variables^†
One or more breast symptoms (discomfort, nipple soreness, infection)	377 (78.0)	115 (48.7)	<.001
Fatigue	323 (67.3)	134 (56.8)	.006
Decreased desire for sex	284 (59.2)	91 (38.6)	<.001
Back or neck pain	223 (46.5)	87 (36.9)	.015
Constipation	152 (31.7)	44 (18.6)	<.001
Hemorrhoids	134 (27.9)	35 (14.8)	<.001
Excessive sweating	126 (26.3)	39 (16.5)	.004
Hot flashes	67 (14.0)	18 (7.6)	.008
Decreased appetite	136 (28.3)	88 (37.3)	.020
Runny/stuffy nose	115 (24.0)	74 (31.4)	.040

Additional Files

Tables

The Article in Brief

Background Most employed new mothers return to work within 1 to 3 months of giving birth. This study reports symptoms experienced by new mothers 5 weeks after birth and examines factors that influence their health.

What This Study Found Five weeks after giving birth, women still experience symptoms related to childbirth, particularly women whose infants were delivered by cesarean section or who breastfeed. Symptoms include fatigue, never or rarely feeling refreshed after waking in the morning, breast discomfort, and a decreased desire for sex. Women whose infants were delivered by cesarean section had significantly worse physical health than women who gave birth vaginally.

Implications

With many new mothers returning to work soon after childbirth, there is a need to reexamine and broaden the definition of postpartum health, particularly for employed women.
In examining new mothers, doctors should assess fatigue, as well as other physical and mental symptoms, including those related to breastfeeding.
There is a need for ongoing support for new mothers and for ongoing rest and recovery beyond the traditional period that is common in the United States.