After Birth: Women's Health and Return to Work at 11 Weeks Postpartum
By Pat McGovern, Ph.D
Professor
Division of Environmental Health Sciences,
University of Minnesota
School of Public Health
(See McGovern, P., Dowd, D., Gjerdingen, D., Dagher, R., Ukestad, L., McCaffrey, D., and Lundberg, U. Employed women’s health at eleven weeks postpartum. Forthcoming. Annals of Family Medicine.)
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Over the last five decades there has been a dramatic increase in labor force participation by new mothers, from 34% in 1950 to 54% in 2005. Moreover women are returning to work relatively soon after giving birth. National estimates from Census data reveal that among first-time mothers employed and giving birth between 1996 and 2000, 60% had returned to work by three months after delivery. Given the increased participation of new mothers in the workplace, it is important to understand the factors that promote women’s recovery from childbirth, facilitate their postpartum health and ability to successfully merge work and parenting roles.
The traditional medical perspective of the postpartum period refers to the time after childbirth that is required for the reproductive organs to return to their non-pregnant state, a process of approximately four to six weeks. Many health care providers perceive this time as one that needs little assistance other than the recommended single postpartum visit. However, many women experience mild to moderate discomforts beyond six weeks postpartum (e.g., fatigue, breast soreness, cesarean-section or episiotomy discomfort) and some face serious conditions, such as postpartum depression, that may limit daily function for months.
Women’s recovery from childbirth and resumption of work and family commitments is likely to be influenced by personal factors, such as preexisting health status and the availability of social support from family and friends, and work-related factors such as job stress and workplace support. However, few studies have examined these factors in association with women’s postpartum health. This gap in the literature was, in part, the impetus for the current study.
The Minnesota Postpartum Health Study
We conducted a prospective cohort study of employed postpartum women. Three community hospitals from Minneapolis-St. Paul, Minnesota were selected as study sites. Given their ethnic diversity, the demographics of birth mothers from these hospitals were anticipated to be comparable to those of women delivering elsewhere in the seven county metropolitan area. Study participants were recruited from the population of women 18 years and older admitted to these hospitals for childbirth in 2001. The comparability of the study population to national data was reported in an earlier paper.
To be included in our study women had to reside in the seven county metropolitan area, give birth to a singleton infant (rather than twins or triplets) without neonatal complications, speak English and be employed. Women were enrolled in the study by perinatal nurses while hospitalized for childbirth. University staff subsequently conducted telephone interviews with women at 5 and 11 weeks after childbirth.
Women’s postpartum health was measured as their general physical and mental health and the presence of childbirth-related symptoms. We examined both personal factors (e.g., demographics, parity, family income, preconception health, breastfeeding status, infant gender, infant colic, available social support from family and friends), and work factors (e.g., status as working or on leave from work, occupational class, job-related psychological demands and decision latitude, and supervisor and coworker support) for their association with maternal health using multivariate models.
Principal Findings
At eleven weeks postpartum, 661 participants (81% of 817 enrollees) completed a full interview.
On average, these mothers were 30 years old; 86% were Caucasian, 89% were married or partnered, 52% were breastfeeding and 50% had returned to work by 11 weeks after childbirth.
These mothers reported an average of 4 childbirth-related symptoms, which was a decrease from the average of 6 symptoms reported at 5 weeks postpartum. Fatigue was the most frequent symptom, experienced by 43%. Other common symptoms included headaches (42%), back or neck pain (38%), sexual symptoms (37%), respiratory symptoms (36%), and breast discomfort (19%). The majority of symptoms declined between 5 weeks and 11 weeks postpartum with the exception of respiratory symptoms which increased over the same time period.
Findings from comprehensive research models revealed that better preconception health was the most consistent factor associated with better maternal health, influencing levels of general physical and mental health and the number of childbirth-related symptoms. Factors associated with better health on one or more measures included the absence of prenatal moods problems (e.g., anxiety and depression), being married or partnered, having higher levels of social support at home and at work, having less job stress, reporting more control over daily activities at work and home, and having a baby without colic.
Discussion
These mothers continued to experience childbirth-related symptoms at 11 weeks postpartum, with fatigue being the most frequent. While most mothers have declining levels of fatigue over the first two weeks postpartum, some may experience relentless fatigue. For these women, an intervention aimed at encouraging rest and quiet time may be essential for preventing postpartum depression, one of the most serious complications of childbirth.
Better preconception health was associated with better postpartum health across all health outcome measures. This result is consistent with national recommendations to promote women’s health before conception and to improve childbirth-related outcomes. It is estimated that one-third to one-half of women have more than one primary care provider. Thus all providers who treat women have an important role to play in improving women’s preconception health and health care.
Prenatal mood problems were an important correlate of poorer postpartum mental health and increased childbirth-related symptoms. Primary care providers should be prepared to evaluate, treat or facilitate treatment of mental disorders during prenatal and postpartum visits.
Social support from family and friends was significantly related to better postpartum mental health. Not all women may feel comfortable asking for help and research is needed to assess the effectiveness of clinicians educating women about the nature of support, its importance to well-being, and how to access support in times of need.
Mothers’ postpartum health was also associated with several work-related variables including low levels of job stress, perceived control over work (and home) activities and coworker support. The relationship between mothers’ general mental health and lower levels of job stress suggests a need for research to identify factors associated with job stress. The finding of greater levels of perceived control and significantly better mental health suggests a need to identify the factors that may enhance women’s sense of control at work and home.
Some new mothers may adapt better upon return to work with an intermittent rather than straight-time family and medical leave. Intermittent leave under the federal Family and Medical Leave Act (FMLA) allows mothers whose postpartum problems meet the FMLA’s regulatory definition of a serious health condition to return to work on a gradual, part-time basis. Research is needed to identify if women with fatigue or postpartum symptoms that limit daily activities find intermittent leave helpful.
Conclusions
The findings suggest postpartum women need to be evaluated regarding their fatigue levels, and mental and physical symptoms. Women whose fatigue or postpartum symptoms limit daily role function may find it helpful to have health care providers counsel them on strategies to decrease job stress, increase social support at work and home, and certify their use of intermittent family and medical leave to help them manage their symptoms.
Note: If you are interested in learning more about women’s reproductive health, including the the research described above, please consider attending “A Lifespan Approach to Reproductive Health: Getting it Right, A Preconception Conference”, October 5, 2007 held at the Minnesota Department of Health, Snelling Office Park, St. Paul Minnesota. It is co-sponsored by the Minnesota Department of Health, the March of Dimes, the University of Minnesota, School of Public Health, School of Nursing, and the Powell Center for Women’s Health, and Medica.
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References
U.S. Department of Labor. Employment characteristics of families summary. News, Bureau of Labor Statisics. Washington DC: US Department of Labor; 2006. Accessed April 27, 2006 at: www.bls.gov/news.release/famee.nr0.htm.
U.S. Census Bureau. Women 15 to 44 Years Old Who Had a Child in the Last Year and their Percentage in the Labor Force: Selected Years, 1976 to 2004. Washington, DC: US Census Bureau, Fertility and Family Statistics Branch, 1990-2004. Accessed May 31, 2006 at http://www.census.gov/ population/ socdemo/ fertility/tabH5.xls.
3 Overturf Johnson J, Downs B. Maternity Leave and Employment Patterns: 1961-2000. Current Population Report, P70-103(p.14). Washington DC: US Census Bureau.
McGovern PM, Dowd BE, Gjerdingen DK, Gross CR, Kenny SJ, Ukestad LK, McCaffrey DJ, Lundberg U. Postpartum health of employed mothers 5 weeks after childbirth. Ann Fam Med. 2006: 159-167.
MMWR. Recommendations to improve preconception health and health care. A Report of the CDC/ATSDR Preconception Care Work Group and the Select Panel on Preconception Care United States. MMWR. Vol. 55 No. RR-6; 2006, April:1-23
Last modified on Friday Sep 28, 2007