Thursday, May 23, 2024

May is Maternal Mental Health Month. It needs to be 12 months a year.

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Reach out to women in your life who have recently had a baby to provide emotional support during this vulnerable time.

The United States has a higher maternal death rate than any other high-income country and the majority of these deaths occurs between day 7 and 365 after giving birth. This is clearly unacceptable. Postpartum depression, or PPD, affects 1 in 7 women and often goes untreated.

In my experience as an occupational therapy practitioner working with new moms, this is due to several factors including short maternity leaves and quick return to work, limited knowledge about the postpartum period, potential risk factors (pre-pregnancy health, drug and alcohol use, pre-eclampsia, and depression or postpartum depression following previous pregnancy), limited postnatal visits with healthcare providers, and reduced social supports.

A 2022 Centers for Disease Control and Prevention report found that while hemorrhage, cardiac/coronary conditions, and infections were high ranking causes of maternal death, mental health conditions was the predominant cause, leading to almost 35% of maternal deaths. According to the report, over 84% were preventable and approximately 9% of deaths were caused by suicide.

A study in the Journal of Women’s Health suggests that suicides may account for up to 20% of postpartum deaths. Maternal suicide has a long-lasting and devastating effect on the new baby as well as all family members.

The fourth trimester is critical

We often think about the importance of supporting women during pregnancy but the months following delivery, are critical. According to “Postpartum Care: An Approach to the Fourth Trimester,” published by the National Institutes of Health, the fourth trimester, also referred to as the postpartum period, is defined as the first three months after delivery. Women go through a tremendous amount of change to their bodies, hormones, and occupations (activities of daily living) during this time and they may not be equipped to navigate these changes alone.

I am working with a postnatal mom who recently had her second child. She reported that she was having difficulty sleeping, often wore the same clothes for several days, and cried most of the time. I had her complete the Edinburgh Postnatal Depression Scale and her score of 21 indicated that it was highly likely that she was suffering from postpartum depression.

Some common postnatal issues reported by new moms are lack of time for self-care, postpartum depression, and pelvic floor dysfunction.

The role of occupational therapy

Occupational therapy is the optimal discipline to meet maternal needs after birth through a holistic approach. It maximizes health, well-being, and quality of life for all people through effective solutions that facilitate participation in activities of everyday living, or “occupations.”

After the birth of a baby, first time moms transition into a new occupation, new co-occupations (with baby, spouse, family, and others) and new roles and responsibilities. Even experienced moms face a shift in occupations, roles, and responsibilities with each subsequent birth.

I have now worked with the mom I mentioned earlier for six months. We began by focusing on determining what tasks and activities were most important (meeting baby and preschooler’s basic needs, meeting her basic needs for sleep, nutrition, and self-care, and completing necessary course work to finish the semester with a passing grade). We also looked at the tasks that she could “let go.” I also referred her back to her OB/GYN for an evaluation for postpartum depression and she was placed on an antidepressant to help her manage the symptoms.

During our most recent meeting, she feels confident in her ability to meet her needs as well as her children’s, and she even joined a gym that offers childcare so that she can return to a valued occupation. On the EPDS, she reports that her sleep has improved, she only cries occasionally, and her overall score, 11, no longer places her in the likely to suffer from PPD range.

Some solutions for mothers

The U.S. Department of Health and Human Services Healthy 2030 includes maternal care as one of the top priorities and lists reducing maternal deaths and increasing the number of women screened for postpartum depression as objectives and leading health indicators.

Resources like The American Occupational Therapy Association can direct women to help and understanding. Health care practitioners too can benefit from understanding how to partner with occupational therapy practitioners.

Reach out to women in your life who have recently had a baby to provide emotional support during this vulnerable time. If you find that they have more significant needs, advocate for intervention by an occupational therapist. And, use your voice to vote for women’s health care policy. It matters.

Dr. Jessica McHugh Conlin has a B.A. in elementary, early childhood, and special education from the University of Iowa, an M.S. in occupational therapy from the University of South Dakota, and a Ph.D. in occupational Ttherapy from Texas Woman’s University. She is a member of the American Occupational Therapy Association.

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