Returning to Work after Childbirth in Europe: Well-Being, Work-Life Balance, and the Interplay of Supervisor Support

Returning to work after maternity leave: a systematic literature review

PURPOSE

Working women often experience difficulties associated with balancing family and career, particularly if they choose to have children. This systematic literature review aimed at investigating women's experience in returning to work after maternity leave.

METHODS

The review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The literature search led to the identification of 52 articles, which underwent data extraction and qualitative analysis.

RESULTS

Results were organized in 5 categories: (1) Work-life balance; (2) Women's mental and physical health; (3) Job-related wellbeing and working experience; (4) Breastfeeding. Women's both mental and physical health seem connected to a longer maternity leave and a greater coworkers' and supervisors' support. Returning to work seems to constitute one of the most important barriers for exclusive breastfeeding or breastfeeding continuation. A shorter duration of maternity leave, a higher workload and the lack of occupational policies supporting breastfeeding seem to be hindering factors. Partner and family support, and the opportunity for fathers to work under a flextime system after childbirth seem to increase both breastfeeding initiation and duration. Women who continue breastfeeding after returning to work seem to experience more family-to-work conflict and overload.

CONCLUSIONS

This paper show that there are still many understudied aspects in exploring women's experience of returning to work after maternity leave. This represents an important gap in the literature, since returning to work represents a particularly critical time in women's personal and occupational life, in which challenges and barriers may arise, potentially affecting their experience in the immediate future and years to come.

'Breakdown and healing' - adaptation experiences of postpartum nurses returning to work: a descriptive phenomenological study

BACKGROUND

Promoting the work adaptation of nurses returning to work after childbirth is key to improving their physical and mental health and ensuring the quality of nursing care. Although postpartum nurses have reported high work stress and poor adaptation after returning to work, little is known regarding the experiences, problems and further needs. This study aimed to explore the adaptation experiences of postpartum nurses returning to work.

METHODS

This was a qualitative study with descriptive phenomenological approach. Individual semi-structured interviews were conducted between March and May 2023 in four tertiary hospitals in Changsha, mainland China, which were selected using convenience sampling. A total of 16 postpartum nurses returning to work within one year were recruited using purposive sampling and maximum variation sampling. The interviews were analysed using the Colaizzi's 7-step method.

RESULTS

'Breakdown and healing' is a strong thread in postpartum nurses' work adaptation. It links 13 subthemes in the interview data, which can be grouped under three overarching themes: (a) changes and challenges of multiple roles; (b) self-coping and social support; and (c) further needs after returning to work. The phrase 'breakdown and healing' reflects the mutual relationship between stress and coping among postpartum nurses. The changes and challenges associated with being required to fulfil multiple roles of mothers, wives and nurses make the subjects feel on the verge of 'breakdown'. When returning to work, most of them move slowly towards 'healing' through positive self-management and support from their partners, families, supervisors and colleagues. Moreover, their ongoing demands and unsolved problems - such as their desire for a workplace that is friendly and serves their needs - were generated by the constant process of 'breakdown and healing'.

CONCLUSIONS

Understanding how postpartum nurses returning to work perceive adaptation experiences is essential for nursing managers, who can use the findings to implement targeted measures to shorten postpartum nurses' maladaptation period after returning to work and promote their work adaptation. This study underscores the critical importance of personalized return-to-work training, flexible work arrangements, support from colleagues and managers, well-established maternal facilities and services, and targeted policy efforts in enhancing postpartum nurses' work adaptation.

Barriers to Accessing Paid Parental Leave Among Birthing Parents With Perinatal Health Complications: A Multiple-Methods Study

INTRODUCTION

Even in the small number of U.S. states with paid parental leave (PPL) programs, studies have found awareness of PPL remains low and unevenly distributed among parents. Moreover, little is known about whether parents with perinatal health complications have unmet needs in obtaining information about and support for accessing parental leave during that time. This study aims to address this research gap. Given the strong evidence linking paid leave with improvements in maternal and infant health, it is critical to evaluate access among vulnerable populations.

METHODS

We used a multiple methods approach, including a subset of the 2016-2017 Bay Area Parental Leave Survey of Mothers (analytic sample = 1,007) and interview data from mothers who stayed at a neonatal intensive care unit in 2019 (n = 7). All participants resided at that time in California, a state that offers PPL. The independent variable for the survey analysis was a composite measure of perinatal complications, quantified as binary with a value of 1 if respondents reported experiencing any of the four complications: poor maternal mental health during or after pregnancy, premature birth, or poor infant health. Dependent variables for the survey analysis measured lack of support or information for accessing PPL. We used linear probability models to assess the relationship between perinatal complications and PPL support. Thematic analysis was conducted with the interview data to understand how perinatal complications shape the process of accessing PPL.

RESULTS

Survey results revealed that parents with perinatal complications had a lower understanding of PPL benefits and low overall support for accessing leave, including from employers, compared with parents without perinatal complications. From interviews, we learned that perinatal complications present unique challenges to parents navigating PPL. There were multiple entities involved in managing leave and providing information, such as the benefits coordinator and employers. Supervisors were reported as providers of critical emotional and financial support.

CONCLUSIONS

Taken together, the findings from surveys and interviews suggest that health care and human resources personnel should be better equipped to provide information and support, particularly to those who experience perinatal complications and might struggle to complete paperwork while facing health challenges.

Association Between Economic Activity and Depressive Symptoms Among Women With Parenting Children

BACKGROUND

Balancing parenting and work life poses challenges for women with children, potentially making them vulnerable to depression owing to their dual responsibilities. Investigating working mothers' mental health status is important on both the individual and societal levels. This study aimed to explore the relationship between economic activity participation and depressive symptoms among working mothers.

METHODS

This study was a cross-sectional study and used data from the Korea National Health and Nutrition Examination Survey collected in 2014, 2016, 2018, and 2020. The participants in the study were women aged 19 to 50 who were residing with their children. In the total, 3,151 participants were used in the analysis. The independent variable was economic activity, categorized into two groups: 1) economically active and 2) economically inactive. The dependent variable was the depressive symptoms, categorized as present for a Patient Health Questionnaire-9 score of ≥ 10 and absent for a score < 10. Multiple logistic regression analysis was performed to assess the association between economic activity and depressive symptoms, and sensitivity analyses were performed based on the severity of depressive symptoms.

RESULTS

Among women with children, economically active women had reduced odds ratio of depressive symptoms compared with economically inactive women (odds ratio [OR], 0.54; 95% confidence interval [CI], 0.36-0.80). In additional analysis, women working as wage earners had the lowest odds of depressive symptoms (OR, 0.43; 95% CI, 0.28-0.66). Women working an average of 40 hours or less per week were least likely to have depressive symptoms (OR, 0.42; 95% CI, 0.25-0.69).

CONCLUSION

Economic activity is significantly associated with depressive symptoms among women with children. Environmental support and policy approaches are needed to ensure that women remain economically active after childbirth.

Quality of Life of Mothers and Fathers 4 to 6 Months After Birth: The Effect of a Very Preterm Delivery

OBJECTIVES

The sparse literature on the effect of a preterm delivery on parents' quality of life (QoL) yields inconsistent results, restricting their analysis to mothers. The present study aimed to assess the effect of a very preterm delivery on parents' gender-specific perception of QoL, 4 to 6 months after birth.

METHODS

A total of 117 parents of very preterm infants hospitalized at birth in a level III Neonatal Intensive Care Unit, and 214 parents of never hospitalized full-term infants born in a public maternity, both located in the North of Portugal, participated in the study, 4 to 6 months after delivery (November 2013-June 2015). The Portuguese version of the World Health Organization Quality of Life - BREF Inventory was applied and scores were transformed to reflect a 0 to 100 scale.

RESULTS

The mean [standard deviation (SD)] of overall QoL ranged between 72.1 (13.3) among mothers of full-term infants and 74.6 (12.5) among mothers of very preterm infants. The perception of QoL was not significantly different among parents of very preterm and full-term infants, according to gender. The highest scores were observed in the psychological and physical dimensions, for both mothers and fathers.

CONCLUSIONS FOR PRACTICE

The lack of differences on the perception of QoL among mothers and fathers of very preterm and full-term infants, highlights the need to deeply understand and explore the influence of accommodation mechanisms, the extended family/community and health policies on parental QoL trajectories.

Uncovering the Experience: Return to Work of Nurses After Parental Leave

INTRODUCTION

To understand the experiences of emergency nurses who have returned to work after parental leave, specifically relating to the return to work transition, work-life balance, work engagement, and opportunities to continue human milk expression.

METHODS

Nurses (N = 19) were recruited from 5 emergency departments within 1 hospital system in the United States Midwest. Nurses (n = 11) were eligible to participate in a one-on-one interview if they had returned from parental leave within 6 months of the interview date. Nurses (n = 8) were eligible to participate in a focus group if they had returned from parental leave within 2 years of the interview date. Interviews were structured and data collection concluded when researchers believed data saturation was reached. Interviews were audio recorded and transcribed verbatim. Data were analyzed using Braun and Clarke's qualitative thematic analysis 6-phase framework.

RESULTS

Three major themes from the data were identified: (1) work engagement, (2) lactation, and (3) childcare. Work engagement was broken down into the subthemes: lack of communication, perceived engagement expectations, and actual engagement. Lactation was broken down into the subthemes: the act of pumping, lactation breaks, and lactation rooms. The coronavirus disease 2019 pandemic impact on return-to-work is described under each major theme.

DISCUSSION

Our findings provide insight into the unique challenges and experiences of nurses navigating parental leave and return-to-work in the emergency department. Strategies such as provision of managerial check-ins, return to work reorientation, lactation break coverage, enhanced supplementary lactation support, and leadership-provided accommodation may lighten the burden of these challenges and improve the returning nurse's job satisfaction.

Women's Health and Working Life: A Scoping Review

Women's health matters for participation in working life. The objective of this study was to explore female physiology in a work-life context and to investigate possible associations between women's health, sickness absence and work ability. A scoping review was conducted to develop a systematic overview of the current research and to identify knowledge gaps. The search strategy was developed through a population, concept and context (PCC) model, and three areas of women's health were identified for investigation in the context of work. A total of 5798 articles were screened by title and abstract and 274 articles were screened by full text; 130 articles were included in the review. The material included research from 19 countries; the majority of the studies used quantitative methods. The results showed an impact on the occupational setting and an association between sickness absence, work ability and all three areas of women's health, but a holistic and overall perspective on female biology in the work context is missing. This review calls for more knowledge on health and work and possible gender differences in this regard. Women's health and working life involve a complex connection that has the potential to develop new knowledge.

Incidence of Fracture Hospitalization and Surgery in Women Increases Steadily During the Puerperal and Lactation Period: A Retrospective Register-Based Cohort Study in Finland From 1999 to 2018

This retrospective cohort study assesses the incidences of major fractures and surgery in women during the puerperium and the lactation period in Finland between January 1, 1999, and December 31, 2018. Using nationwide data from the Finnish Care Register for Health Care and the Finnish Medical Birth Register, all women aged between 15 and 49 years with a fracture hospitalization within 12 months of delivery between 1999 and 2018 were included. During the study period, a total of 3140 fractures after delivery and 152,800 fractures of the female normal population of similar age were hospitalized. The incidence rate after delivery increased from 219/100,000 person-years during the first 4 months to 310 fractures/100,000 person-years during the latter 8 months of the first year after delivery. Altogether, 29% (n = 904/3140) of these fractures were treated operatively. The most common fractures were ankle and distal radius fractures, which made up one-third of all fractures. The incidence of pelvic fracture hospitalization was 15/100,000 person-years at 4 months after delivery, with an operation rate of 22%. Over half of all fractures occurred between 6 and 12 months after delivery (mean 6.6 months). The incidence of fracture hospitalization after delivery increased steadily during the puerperium and the lactation periods but remained lower than in the general population (age-adjusted incidence 554/100,000 person-years) with an incidence rate ratio of 0.51. However, a higher proportion of pelvic fractures were observed in the first months after delivery. Surgical rates were in line with the general population. Fractures of the wrist and ankle made up most of the fractures. © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).

Developing Indicators to Evaluate Instructor Management of Sports Centers for the People With Disabilities Based on Universal Design Principles in South Korea

This study was conducted to develop evaluation indicators for instructor-led management of sports centers for the disabled using universal design (UD) principles in South Korea. These indicators have been developed through Delphi technique to identify the effectiveness of an instructor's management skills. There were 11 documents related to UD used in the literature review, and seven were related to the evaluation index. Through reading and analyzing the relevant contents of the collected literature and many rounds of the Delphi technique, we selected the method and criteria for deriving the evaluation index. In this study, we developed a method that constitutes an evaluation index. The index comprises one evaluation criterion and four evaluation indices. First, for the sub-items of the “recruitment” category, four principles of UD and one supplementary principle of product performance program (PPP) were applied to create items for the evaluation index. Second, the sub-items of the “education” category comprise three evaluation criteria and 10 evaluation indicators. These were applied to the fourth principle of UD and the first and second by-supplementary principles of PPP. The third category, “welfare,” comprised two evaluation criteria and six evaluation indices, and the first by-supplementary principle of PPP was applied to the evaluation indices. The index created for evaluating instructors in sports centers using the method elucidated in this study was adequately reliable. Following a similar method, more evaluation indicators should be developed for evaluations of other functions (such as programs, public relations, safety, and finance) based on the principles of UD.

Perceived Support Profiles in the Workplace: A Longitudinal Perspective

This research examines how employee’s perceptions of three sources of support in the workplace (i.e., organization, supervisor, and colleagues) combine within specific profiles and the nature of the relations between these profiles and indicators of employees’ psychological health (i.e., stress, sleep problems, psychosomatic strains, and depression). Furthermore, this research examines the within-sample and within-person stability of the identified support profiles over the course of an 8-month time interval. Latent profile and latent transition analyses conducted on a sample of 729 workers indicated six identical profiles across the two measurement occasions: 1, moderately supported; 2, weakly supported; 3, isolated; 4, well-supported; 5, supervisor supported; and 6, highly supported. Profile membership was very stable over time for most profiles, with the exception of the isolated profile which was only moderately stable. Furthermore, the isolated and supervisor-supported profiles presented the lowest levels of psychological health, while the well-supported and moderately supported profiles presented the highest levels of psychological health. Of particular interest, results suggested that some risks might be associated with the highly supported profile, although this result could be a simple reflection of the women-dominant composition of this profile. This research has implications for theory and practice, which will be discussed in the article.

The Interplay of Socioecological Determinants of Work-Life Balance, Subjective Wellbeing and Employee Wellbeing

Today's workers are struggling to achieve a balance between their work and personal life roles because of both specific needs and limited resources. This study explored the socioecological factors that influence work-life balance (WLB) and how they operate. The relationships between WLB, subjective wellbeing, employee wellbeing and quality time allocation were examined. A total of 1063 responses were received, using an online survey. The results show that relational, community and societal factors directly influenced the individual factors and were indirectly associated with perceived WLB. Individual factors (i.e., personal feelings, behaviours and health) were found to be the crucial determinants of an individual's perceived WLB. It was found that WLB positively correlated with employee wellbeing and quality and quantity of personal life-time. Subjective wellbeing was found to be a significant moderator in the relationship between WLB and its outcomes. This study demonstrated the process of how workers determine their own WLB by applying the socioecological framework for categorising the determinants and suggested new avenues that improve the whole wellbeing of workers and also foster long-term development of organisations.

Contextualising work–life balance: a case of women of African origin in the UK

Purpose

The existing gender gap in the workplace, that affects job satisfaction and career advancement of women, creates a need to understand further the causes and effects of the gender gap phenomenon. Although, there are many challenges that affect women’s job satisfaction and advancement in the workplace, this paper aims to investigate work–life balance using multiple theoretical lenses.

Design/methodology/approach

In total, 15 semi-structured interviews were conducted with women from Nigeria and Ghana residing in the UK, they were selected using a purposive sampling method.

Findings

The findings show four main factors that explain the choices these women make in relation to work–family. These are cultural sensitivities, current phase in family and work–life, personality types and other influences such as policies and financial commitment. Results also show how these women make these work–family choices using networks and services.

Practical implications

The paper postulates the need for organisation’s to pay attention to the acculturation and enculturation of these women, which would indicate observing their cultural behaviour’s, values, knowledge and identities to understand how they integrate, assimilate and to also prevent separation and marginalisation. In addition, the use of (internal and external) networks as support systems for these women can create the opportunity for informal learning. Finally, organisation’s should create structure that support workplace learning and should include activities such as decision-making, communication, career advancement planning and flexible work patterns.

Originality/value

This study contributes to theory using multiple theories (work-family, gender inequality and Theories X and Y in explaining the work–family construct of women of African origin in the UK.

How Is Ethical Leadership Linked to Subordinate Taking Charge? A Moderated Mediation Model of Social Exchange and Power Distance

Extant literature has suggested that leadership styles have a significant impact on subordinate taking charge. However, the effect of ethical leadership on subordinate taking charge is still insufficiently explored. Drawing on social exchange theory, we developed a moderated mediation model in which social exchange was theorized as a mediating mechanism underlining why subordinates feel motivated to take charge with the supervision of ethical leadership. Moreover, power distance was supposed to be a relevant boundary condition to moderate such a relationship. Two hundred thirty-nine independent leader–subordinate dyads in China were used to test the model. Results showed that subordinates’ social exchange mediates the relationship between ethical leadership and subordinate taking charge, and such a relationship was found to be stronger among subordinates who had lower levels of power distance rather than higher levels. Theoretical and practical implications concerning enhancement of subordinate taking charge in organizations where ethical leaderships exist are discussed.