A new study in the November/December 2007 issue of the Annals of Family Medicine takes a much-needed look at the postpartum health of working mothers. The study looked at moms who return to the workplace 11 weeks after childbirth and found that they continue to need evaluation of their fatigue levels and mental and physical symptoms beyond the normal 6-week postpartum checkup.
"At 11 weeks postpartum these employed mothers continued to experience several childbirth-related symptoms, indicating a need for ongoing rest and recovery. Postpartum evaluations should include screening for anxiety and depression and evaluation of fatigue and other physical symptoms, including those related to job stress."
The study recommended that women showing continued symptoms should receive counsel on strategies to decrease job stress and increase social support at work and home, and that physicians should talk with them about the possible need for intermittent leave under the Family and Medical Leave Act to help them manage symptoms.
One of the most fascinating comments was this, from Pat McGovern, PhD, MPH at the School of Public Health at the University of Minnesota in Minneapolis, and her colleagues who wrote the study:
"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 nonpregnant state, a process that takes approximately 6 weeks. Many physicians perceive this time as one requiring little assistance other than the recommended single postpartum visit …"
All new mothers know this is true but I don’t think I’ve ever seen it stated so plainly. Our healthcare professionals are essentially focused on making sure our uteruses (or is it "uteri"?) are in working order … but the rest of us? Not so much.
Dr. Laurie Barclay writes on Medscape.com:
"Because of the increased prevalence in the workplace of mothers with infants, greater understanding of factors that could improve postpartum health and facilitate return to work is greatly needed. Recovery from childbirth and successful return to work may be affected by personal factors such as preexisting health status, parity, breast-feeding, and social support from family and friends; as well as work-related factors including the timing of return to work, job stress, and support in the workplace."
Honestly, I think the results of this study apply equally to women who don’t go back to work. All new mothers suffer a compounding list of stresses that make it difficult to cope with daily responsibilities, and there is no specific group of healthcare professionals who has taken on the task of monitoring our whole health.
Which group of clinicians will make sure women are properly evaluated and counseled? The study specifically cites the need for screening new moms for anxiety and depression, but who will do it? At the moment, no group of doctors taken on the job of providing that safety net. I sometimes wonder whether they’re all hoping someone else will step up to the plate so they can be relieved of the duty. Sure, there are pockets of doctors and nurses in different places throughout the country who have recognized the importance of paying more attention to the health of new moms over a more extended period of time, but as a general rule many ignore it, and I wonder if some of the larger physicians’ groups aren’t actually against it.
The OB/GYNs are concerned with taking responsibility for the process of pregnancy and childbirth. The pediatricians are primarily focused on the health of the baby. Your primary care physician may not see you for months unless you come down with the flu, so they may never know if you’re having problems. They all say they don’t have time, they don’t have the proper training, they aren’t reimbursed for it, they worry about the legal ramifications, etc. And they’re right on all those points. Yet mental health screenings and treatment remain completely necessary if we care about having healthy mothers in this country.
New moms are just not very likely to wander by the office of a mental health professional and drop in to say hello. These people are specialists, for whom you generally need a referral. We need a comprehensive nationwide process to get mothers mental healthcare if they need it, where the doctors responsible for screening and referral have buy-in and there is a clear line of sight. Somebody is going to HAVE to take responsibility for this, so we need to work together to begin developing workable solutions. Hopefully the MOTHERS Act will help to address this when it is passed, and it becomes federal law that all women are screened for postpartum depression and anxiety. Notice I sad when, not if.
(crossposted at BlogHer.com)
