A longitudinal analysis of total workload and women's health after childbirth

Changes in maternal psychological symptom profiles from 2 to 6 months postpartum: an application of latent transition analysis

To identify subgroups of postpartum women with different psychological symptom profiles at 2 and 6 months postpartum and to examine how they transition between symptom profiles over time using latent transition analysis (LTA). We used secondary data from the Family Life Project (N = 1,117) and performed LTA based on observed variables (depression, anxiety, somatization, and hostility). We examined transition probabilities and changes in latent status prevalence from 2 to 6 months postpartum. Considering the known influences of social determinants of health on psychological symptoms, bivariate analyses were conducted to describe the characteristics of different transition patterns. A 3-class model with better fit indices, entropy, and interpretability was selected. Based on symptom severity, the identified profiles were Profile 1: Low, Profile 2: Moderate, and Profile 3: High. From 2 to 6 months postpartum, the prevalence of low symptom profile decreased (82 to 78.2%) while the prevalence increased for moderate (15.8 to 17.5%) and high symptom profiles (2.2 to 4.4%). For all profiles, it was most likely for postpartum women to stay in the same profile from 2 to 6 months (low to low, moderate to moderate, and high to high). Those in persistent or worsening transition patterns were significantly younger or had less social support or education. Postpartum women in moderate or high symptom profiles at 2 months were most likely to stay in the same profile at 6 months postpartum, indicating persistent symptom burden. Clinicians should consider providing early, targeted support to prevent persistent symptom burden.

Examination of Social Determinants of Health Characteristics Influencing Maternal Postpartum Symptom Experiences

Postpartum women experience multiple, co-occurring postpartum symptoms. It is unknown if social determinants of health (SDOH) influence postpartum symptom typologies. This secondary analysis used the Community and Child Health Network study data. Participants included for analysis varied depending on the availability of the SDOH data (N = 851 to 1784). Bivariate and multiple regression analyses were conducted to examine the association between SDOH and previously identified postpartum symptom typologies. Area under the receiver operating characteristics curve (AUROC) was calculated to examine if adding SDOH variables contributes to predicting postpartum symptom typologies. The adjusted odds (aOR) of being in high symptom severity or occurrence typologies were greater for participants who had less than high school education (aOR = 2.29), experienced healthcare discrimination (aOR = 2.21), used governmental aid (aOR = 2.11), or were food insecure (aOR = 2.04). AUROC improved after adding SDOH. Considering experiences of different social-economic hardships influence postpartum symptom typologies, future practice and research should address SDOH to improve postpartum symptom experiences.

Major Occupations and Private Insurance of Working Postpartum Women in Poverty in the United States, 2019

Background

Although working postpartum women in poverty still have unmet medical needs, relevant research is lacking. Thus, we aimed to determine the five most frequent occupations of U.S. postpartum women in poverty and further examine whether the most frequent occupations are associated with poverty/being uninsured by an employer.

Methods

This is a cross-sectional study. We included women who had a job and gave birth within the last 12 months from a 2019 American Community Survey Public Use Microdata Sample. To examine the associations between the most frequent occupations and being in poverty/uninsured through an employer/union, we used age- and race-adjusted and multivariable-adjusted logistic regression models.

Results

A total of 14.3% of working postpartum women lived in poverty, and their most frequent major occupations were sales and related work, followed by food preparation and serving-related work, office and administrative support work, health care support work, and cleaning and ground maintenance. A total of 51.2% of women in the most frequent major occupations were uninsured through an employer/union. Compared with women in other occupations, women in the most frequent major occupations had fewer working hours and weeks that included paid leave. In particular, cleaners and ground maintenance workers and food preparation and serving-related workers were most likely to be in poverty and uninsured through an employer/union.

Conclusions

Compared with other occupations, the most frequent occupations were more likely to be insecure and less likely to provide health insurance. Our U.S.-based study suggested that current policies regarding employee benefits needed to be improved especially for the most frequent major occupations.

Identification of postpartum symptom subgroups and associated long-term maternal depressive symptoms and well-being

Many postpartum women experience postpartum symptoms which often occur in clusters (i.e., three or more co-occurring symptoms that are related to each other). To date, research has focused on individual symptoms, which limits our understanding of how postpartum symptom clusters manifest and influence health. This secondary analysis used the Community and Child Health Network study data (N = 1784). No patient or public directly participated or contributed to the current analysis. Guided by the Symptom Management Theory, latent class analysis was performed to identify subgroups of postpartum women with different symptom experiences using observed variables at 6 months postpartum: anxiety (MINI-anxiety), general stress (PSS-10), posttraumatic stress (PCL-C), postpartum depression (EPDS), sleep disturbance (PSQI-sleep disturbance), and sleep duration (PSQI-sleep duration). Bivariate and multiple regression analyses were conducted to examine the association between subgroups and (a) individual characteristics and (b) long-term depressive symptoms (CES-D-9) and well-being at 18 and/or 24 months postpartum. Five subgroups were selected that had better-fit indices, entropy, and interpretability. Subgroups were labeled as (1) Minimum overall, (2) Mild-moderate overall, (3) Moderate-high sleep symptoms, (4) High psychological symptoms, and (5) High overall. After adjusting for covariates, postpartum women in Subgroups 4 and 5 had higher CES-D-9 scores at 18 and 24 months and lower well-being scores at 24 months. More postpartum women in Subgroups 4 and 5 experienced a history of depression or unemployment. Clinicians should provide targeted interventions for postpartum women in high-symptom subgroups.

The Role of Work as a Social Determinant of Health in Mother's Own Milk Feeding Decisions for Preterm Infants: A State of the Science Review

In the United States, 10% of infants are born preterm (PT; <37 weeks gestational age) each year and are at higher risk of complications compared to full term infants. The burden of PT birth is borne disproportionately by Black versus non-Black families, with Black mothers significantly more likely to give birth to a PT infant. One proven strategy to improve short- and long-term health outcomes in PT infants is to feed mother's own milk (MOM; breast milk from the mother). However, mothers must make decisions about work and MOM provision following PT birth, and more time spent in paid work may reduce time spent in unpaid activities, including MOM provision. Non-Black PT infants are substantially more likely than Black PT infants to receive MOM during the birth hospitalization, and this disparity is likely to be influenced by the complex decisions mothers of PT infants make about allocating their time between paid and unpaid work. Work is a social determinant of health that provides a source of income and health insurance coverage, and at the same time, has been shown to create disparities through poorer job quality, lower earnings, and more precarious employment in racial and ethnic minority populations. However, little is known about the relationship between work and disparities in MOM provision by mothers of PT infants. This State of the Science review synthesizes the literature on paid and unpaid work and MOM provision, including: (1) the complex decisions that mothers of PT infants make about returning to work, (2) racial and ethnic disparities in paid and unpaid workloads of mothers, and (3) the relationship between components of job quality and duration of MOM provision. Important gaps in the literature and opportunities for future research are summarized, including the generalizability of findings to other countries.

Determinants of depressive symptoms among postpartum mothers: a cross-sectional study in Ethiopia

OBJECTIVE

This study aims to assess the determinants of depressive symptoms among postpartum mothers.

DESIGN

A community-based cross-sectional study was conducted.

SETTING

Ten randomly selected rural kebeles of Meket district of Ethiopia.

PARTICIPANTS

A random sample of 232 mothers with infants 5-10 months was included in this study.

DATA ANALYSIS

Forward multivariable logistic regression analysis.

RESULTS

The factors significantly associated with increased odds of maternal postpartum depressive symptoms were: moderate (adjusted OR (AOR) 4.44, 95% CI 1.34 to 14.72) and severe (AOR 12.98, 95% CI 5.24 to 32.14) household food insecurity; infant underweight (AOR 2.99, 95% CI: 1.21 to 7.37) and infant acute respiratory infection (ARI) (AOR 7.0, 95% CI: 3.09 to 15.99). Maternal education, workload and age, household socioeconomic status, distance to the health facility, and child stunting, diarrhoea and fever were not significantly associated with postpartum depressive symptoms in adjusted logistic regression.

CONCLUSION

Household food insecurity, infant ARI and infant underweight had significant associations with postpartum depressive symptoms. Therefore, interventions that address infant nutrition and health and household food insecurity within the framework of the productive safety net programmes (PSNPs) as well as programmes focused on preventing, detecting and solving maternal mental health challenges may be helpful to improve maternal mental well-being and promote graduation from the PSNP.

Examining the Relationship Between Return to Work After Giving Birth and Maternal Mental Health: A Systematic Review

INTRODUCTION

The negative impacts of mental health disorders on the well-being of women and their infants are clear. However, less is known about the relationship between returning to work after giving birth and mental health. Previous reviews examined the relationship between maternity leave and mental health, but we defined return to work as the process of returning to part-time or full-time work after giving birth and caring for infant. This systematic review aims to: (1) describe operational definitions for return to work and (2) describe the evidence on the relationship between return to work and maternal mental health.

METHODS

We searched PubMed, PsycINFO, CINAHL, and Web of Science for peer-reviewed studies. Articles were selected if they were published within the past 20 years, examined at least one mental health condition (e.g., depression, anxiety), and included a study sample of U.S. working mothers.

RESULTS

We identified 20 articles published between 2001 and 2020. We found conflicting evidence from longitudinal and cross-sectional data demonstrating that return to work was associated with improvements and negative consequences to mental health. Work-related predictors of mental health included: access to paid maternity leave, work-family conflict, total workload, job flexibility, and coworker support.

DISCUSSION

This review provides evidence that return to work and mental health are related, though the study samples have limited generalizability to all U.S. working mothers. More research is needed to understand the direction of this relationship throughout the perinatal period and how return to work affects other mental health conditions (e.g., anxiety, stress).

Is strain due to household and family work associated with a subjective need for rehabilitation among employees? A cross-sectional study

BACKGROUND

The gender-specific unequal distribution of paid employment and unpaid household and family work may entail specific implications for women's and men's health and work ability. Medical rehabilitation is provided to maintain or restore work ability and to prevent disability pensioning. However, more than half of the employees who receive disability pension have not utilized any pre-retirement rehabilitation services. The study was conducted to examine associations between strain due to unpaid work and the subjective need for rehabilitation among employees with an increased risk of early retirement due to adverse health conditions.

METHODS

Cross-sectional data from the "Third German Sociomedical Panel of Employees" (GSPE-III) were analysed. The sample comprises 1,908 German employees aged between 42 and 56 years. Logistic regression analyses were conducted separately for women and men to explore the association between the strain level and the subjective need for rehabilitation.

RESULTS

Overall, women reported a higher strain level compared to men. Strain due to housework was not associated with the subjective need for rehabilitation in men and women. However, after adjustment for socio-demographic, work- and health-related characteristics the odds for a subjective need for rehabilitation were three times higher for women (OR=2.9, p <0.001) and two times higher for men (OR=2.0, p=0.027) with a high level of strain due to family work compared to persons with a low strain level.

DISCUSSION

This study analysed the strain of unpaid work in the context of the utilization of medical rehabilitation services. Although women report a gender-specific higher strain due to unpaid work, a high strain level due to family work seems to be an additional and independent factor influencing the subjective need for rehabilitation for both genders equally.

CONCLUSION

To prevent disability pensioning, more consideration should be given to the strain factors associated with unpaid family work when designing and organising interventions to promote access to medical rehabilitation services.

Effects of a health education program targeted to Chinese women adhering to their cultural practice of doing the month: A randomized controlled trial

BACKGROUND

"Doing the month" is a prevalent Chinese postpartum custom which is believed to restore health after delivery. However, some traditional practices are potentially harmful for women's health.

OBJECTIVES

To examine the effect of an evidence-based health education program on Chinese postpartum women's adherence to traditional practices of doing the month and the effect of adherence to doing the month on maternal physiological and psychological health.

METHODS

A randomized controlled trial was conducted. During December 2016-July 2017, we recruited postpartum women at a tertiary hospital. Women randomized to the intervention group received evidence-based health education within 1 week after returning home and received a second visit 1 month later. The control group received routine postpartum home visits. Adherence to doing the month was measured by the Adherence to Doing-the-Month Practices questionnaire (ADP). Maternal physical health was measured by the Chair Stand Test and Postpartum Symptom Checklist. Maternal psychological health was measured by the Edinburgh Postnatal Depression Scale (EPDS). Descriptive statistics, t-test, and chi-squared test were used to analyze the differences in scores and symptoms of the two groups.

RESULTS

We recruited 124 eligible postpartum women and 108 of them (54 intervention group, 54 control group) completed this study. The ADP score of the intervention group was significantly lower than that of the control group (p < 0.001). The number of participants in the experimental group with poor appetite and indigestion was significantly lower than that of control group. No significant differences were found in numbers of symptoms and average EPDS scores between the 2 study groups (p > 0.05).

CONCLUSIONS

Evidence-based health education can reduce postpartum women's adherence to some traditional practices of doing the month and improve women's physical health.

The relationship between employment status and depression symptomatology among women at risk for postpartum depression

Approximately 13%–19% of new mothers report depression during the postpartum period. Returning to work after childbirth is associated with depression; however, it is unclear if this finding applies to women who are at high risk for postpartum depression. The purpose of this study was to examine the relationship between employment status and depression symptomatology among women at risk for postpartum depression (defined as personal or maternal history of depression). This study was a post hoc analysis from a previously conducted randomized controlled trial. Participants (n = 124; ages 18–42) were 7 months postpartum and had participated in a randomized trial examining the efficacy of an exercise intervention for the prevention of postpartum depression (study was conducted from January 2010 through November 2011). Participants completed questionnaires examining demographic characteristics and psychosocial variables at 6 weeks and 7 months postpartum. The Edinburgh Postnatal Depression Scale was administered at 7 months postpartum to assess depression symptomatology. Sixty-eight percent of the participants reported that they were employed at 7 months postpartum. Employment at 7 months postpartum was associated with lower depression symptomatology (as measured by the Edinburgh Postnatal Depression Scale) after controlling for condition assignment, marital status, and having other children. Among women who worked outside of the home, there were no differences between those who worked full-time versus part-time on depression symptomatology. Employment may be a protective factor for postpartum depression symptomatology; however, we cannot infer causation given this study’s cross-sectional design. Postpartum women at risk for depression who are contemplating employment should consider the possible protective effect of employment on depression.

Interventions for Women With Postpartum Depression Symptoms

Using the stress-buffering hypothesis as a guide, this integrative review aims to identify how human resource development (HRD) professionals can address the issues faced by working women who are experiencing postpartum depression symptoms, in addition to identifying gaps in HRD research on this emerging topic. Most of the studies reviewed came from the nursing and psychology literature; none were found in the HRD literature. This review was undergirded by the stress-buffering hypothesis, which posits that social support can moderate the effect of a stressful event. Studies pointed to social support, especially from coworkers and supervisors, as having a positive effect on postpartum depression symptom scores. Overall, the findings of this study are entry points into HRD research and practice about how employers can support working women who are experiencing postpartum depression symptoms. Further research should examine the type of social support that is effective in helping working mothers.

A mixed-method examination of maternal and paternal nocturnal caregiving

OBJECTIVES

The study objectives were to describe and compare causes of, and activities during, postpartum parents' nocturnal awakenings.

METHODS

Twenty-one primiparous postpartum couples were studied for 1 week with qualitative and quantitative methods.

RESULTS

Mothers reported more awakenings per night (3.3 ± 1.1) and more wake time after going to sleep (116.0 ± 60.0 minutes) compared to fathers (2.4 ± 0.5 and 42.7 ± 39.4 minutes, respectively). "Actions taken" during maternal nocturnal awakenings were primarily for infant feeding (49.0%), general infant care (18.5%), and infant changing (12.0%). "Actions taken" during paternal nocturnal awakenings were primarily "passive awakenings" (35.9%), for self-care (18.4%), and for infant feeding (9.4%).

CONCLUSIONS

Qualitative analyses revealed ways that new families can optimize the sleep of both parents while also providing optimal nocturnal infant care.

Maternal depressive symptoms, employment, and social support

OBJECTIVE

The purpose of this study was to characterize the relationship between maternal depressive symptoms and employment and whether it is mediated by social support.

METHODS

We used data from a nationally representative sample of 700 US women who gave birth in 2005 and completed 2 surveys in the Listening to Mothers series, the first in early 2006, an average of 7.3 months postpartum, and the second an average of 13.4 months postpartum. A dichotomous measure of depressive symptoms was calculated from the 2-item Patient Health Questionnaire, and women reported their employment status and levels of social support from partners and others. We modeled the association between maternal employment and depressive symptoms using multivariate logistic regression, including social support and other control variables.

RESULTS

Maternal employment and high support from a nonpartner source were both independently associated with significantly lower odds of depressive symptoms (adjusted odds ratio [AOR], 0.35 and P = .011, and AOR, 0.40, P = .011, respectively). These relationships remained significant after controlling for mothers' baseline mental and physical health, babies' health, and demographic characteristics (AOR, 0.326 and P = .015, and AOR, 0.267 and P = .025, respectively).

CONCLUSIONS

Maternal employment and strong social support, particularly nonpartner support, were independently associated with fewer depressive symptoms. Clinicians should encourage mothers of young children who are at risk for depression to consider ways to optimize their employment circumstances and "other" social support.

Sleep and sleepiness among first-time postpartum parents: a field- and laboratory-based multimethod assessment

The study aim was to compare sleep, sleepiness, fatigue, and neurobehavioral performance among first-time mothers and fathers during their early postpartum period. Participants were 21 first-time postpartum mother-father dyads (N = 42) and seven childless control dyads (N = 14). Within their natural environment, participants completed 1 week of wrist actigraphy monitoring, along with multi-day self-administered sleepiness, fatigue, and neurobehavioral performance measures. The assessment week was followed by an objective laboratory-based test of sleepiness. Mothers obtained more sleep compared to fathers, but mothers' sleep was more disturbed by awakenings. Fathers had greater objectively measured sleepiness than mothers. Mothers and fathers did not differ on subjectively measured sleep quality, sleepiness, or fatigue; however, mothers had worse neurobehavioral performance than fathers. Compared to control dyads, postpartum parents experienced greater sleep disturbance, sleepiness, and sleepiness-associated impairments. Study results can inform social policy, postpartum sleep intervention development, and research on postpartum family systems and mechanisms that propagate sleepiness.

Effect of Postpartum Practices of Doing the Month on Chinese Women’s Physical and Psychological Health

The purpose of the study was to describe Chinese women’s postpartum physiological and psychological health and adherence to “doing-the-month” practices. A descriptive repeated measures design was used, with data collected at 3 days and 6 weeks postpartum. The convenience sample consisted of 198 healthy childbearing women with a term birth. Maternal physical health was measured by the Six-Minute Walk (endurance), Chair Stand test (muscle strength), severity of physical symptoms, and physical health subscales of SF36v2. Maternal psychological health was measured by the Edinburgh Postnatal Depression scale. Adherence was measured by the Adherence to Doing-the-Month Practices questionnaire. Aerobic endurance and lower-body muscle strength improved significantly across time ( p < .001) but remained suboptimal for maternal age. Women who delivered by Cesarean section had significantly poorer physical health than those who had a vaginal delivery. Physical functioning significantly increased, but general health and role limitations due to physical health significantly decreased over time. Postpartum physical symptoms decreased in number and severity. Depression increased over time ( p < .001). Adherence to doing the month was negatively correlated with aerobic endurance and positively correlated with depression at 6 weeks ( p < .05). These findings challenge the assumption that practices of doing the month are healthy for Chinese women’s recovery after childbirth. Research-based evidence needs to be integrated into doing-the-month practices. Education of Chinese women and families, whether living at home or abroad, is needed about the adverse health effects of doing the month. Routine screening for postpartum depression is also advised.

Postpartum Doula and Peer Telephone Support for Postpartum Depression

Objectives: This research provides the first test of feasibility of recruiting postpartum doulas and depressed mothers for a peer support intervention study and begins to evaluate the benefit of postpartum doula support and peer telephone support for at-risk mothers. Methods: The authors recruited postpartum doulas from national doula organizations, peer telephone supporters from nursing referrals, and mothers with depressive symptoms from 3 local hospitals, local medical practices, Web sites, and community organizations. Participating mothers were randomized to 3 groups—postpartum doula, peer telephone support, and control group. Surveys were completed at 0, 3, and 6 months postenrollment. Results: Thirty-nine mothers with depressive symptoms, 6 postpartum doulas, and 6 peer telephone supporters participated. The postpartum doula group, compared with the other 2 groups, had a higher proportion of women with a previous history of depression, and similarly, a higher proportion of women who were depressed and receiving depression treatment at the 6-month follow-up. Satisfaction with study-sponsored support was greater in the postpartum doula group than in the telephone support group. Conclusions: It is feasible to recruit postpartum doulas, peer telephone supporters, and mothers with depressive symptoms for a peer support intervention trial. Mothers were more satisfied with postpartum doulas than peer telephone support. The authors recommend further research to assess the benefit of postpartum doula support for postpartum depression as adjunctive or alternative therapy.

Postpartum depressive symptoms and the combined load of paid and unpaid work: a longitudinal analysis

PURPOSE

To investigate the effects of total workload and other work-related factors on postpartum depression in the first 6 months after childbirth, utilizing a hybrid model of health and workforce participation.

METHODS

We utilized data from the Maternal Postpartum Health Study collected in 2001 from a prospective cohort of 817 employed women who delivered in three community hospitals in Minnesota. Interviewers collected data at enrollment and 5 weeks, 11 weeks, and 6 months after childbirth. The Edinburgh Postnatal Depression Scale measured postpartum depression. Independent variables included total workload (paid and unpaid work), job flexibility, supervisor and coworker support, available social support, job satisfaction, infant sleep problems, infant irritable temperament, and breastfeeding.

RESULTS

Total average daily workload increased from 14.4 h (6.8 h of paid work; 7.1% working at 5 weeks postpartum) to 15.0 h (7.9 h of paid work; 87% working at 6 months postpartum) over the 6 months. Fixed effects regression analyses showed worse depression scores were associated with higher total workload, lower job flexibility, lower social support, an infant with sleep problems, and breastfeeding.

CONCLUSIONS

Working mothers of reproductive years may find the study results valuable as they consider merging their work and parenting roles after childbirth. Future studies should examine the specific mechanisms through which total workload affects postpartum depressive symptoms.