Some new moms return to work
with lingering symptoms
Postpartum is different
for everyone
This study on women’s health in the postpartum period gives credence to what obstetricians and midwives have long known: For a new mother contemplating her return to the workplace, six weeks of recovery is minimal; more time is often better.
However, every new mother is different, and there is no way to accurately predict exactly how much recovery time a particular woman will need. We do know that recovery from childbirth is important, and there are physiological reasons why. During pregnancy and after delivery, every organ system is undergoing changes and increased demands, which can cause such seemingly abnormal symptoms as shortness of breath, rapid heart rate and chemical imbalances in the brain.
How long is recovery?
Obstetricians and midwives traditionally monitor postpartum patients with one visit six weeks after a baby is born. At six weeks, we want to make sure the uterus is back to its normal size and evaluate how well the patient is healing, especially if she reports a symptom such as persistent bleeding or if she had a procedure such as an episiotomy — a surgical procedure that avoids trauma to vaginal tissue. We also want to perform a pap smear and a breast exam, since it has usually been about a year since a new mother has had these routine screenings. We discuss any physical changes, talk about exercise, and give recommendations on contraception and intercourse.
But some women have significant postpartum symptoms beyond six weeks — which is when many women go back to work, whether by choice or because of limitations in the amount of time their employer allows.
Lingering postpartum symptoms
Most women will experience minor symptoms in the first few weeks after a baby’s birth, particularly fatigue, breast pain and soreness from surgery. However, I would encourage a woman to call her doctor if she experiences severe or lingering symptoms, especially if she can’t function properly. If a new mom is experiencing an unusual amount of fatigue, excessive anxiety or emotional instability, it is important that she talk to her doctor about the possibility of postpartum depression.
Postpartum depression can be caused by changing hormone levels, psychological adjustments, an unsupportive environment, discomfort and overstimulation. It becomes a problem when there is a decrease in levels of serotonin, the chemical in the brain that provides the capacity to cope. This can bring on a clinical depression that can be treated with counseling and, in some cases, selective serotonin reuptake inhibitors (SSRIs). SSRIs are a type of antidepressants which, when given in small doses for a few weeks or months, can be an effective treatment.
Lingering postpartum symptoms such as headaches and back pain generally don’t lead to serious medical conditions, but these symptoms are still real, and they can make a new mother feel cranky and tired at a time when she is adjusting to life with a new baby and possibly returning to work. A doctor can often provide relief by prescribing medication or recommend other therapy.
Going back to work
One of the most significant issues for new moms who work outside the home is when to return to their job. It is important for women to accept the fact that having a baby is one of life’s most significant events, and that it can lead to a great deal of stress. One of the interesting findings in this study is the association between the preconception and postpartum periods as far as health and support. That tells us that women contemplating pregnancy would be wise to take a close look at their employment situation, understand the benefits their company offers, and develop a support system before having a baby. And once the baby is born, women should keep their doctor informed of postpartum difficulties.
Dr. Silidker is an attending obstetrician/ gynecologist at Yale-New Haven Hospital and clinical professor in obstetrics and gynecology at Yale School of Medicine. He is a partner of Obstetrics-Gynecology and Infertility Group, PC.
April 2008
New mothers have been returning to work in record numbers — most of them by three months after delivery, according to national estimates.
However, many employed mothers still complain of lingering health problems — such as fatigue and mental and physical symptoms, according to researchers at the University of Minnesota.
“Postpartum is the medical term for the period of time after childbirth when reproductive organs return to their non-pregnant state.”
The authors, who published the study in the November/December 2007 issue of Annals of Family Medicine, concluded there is a need to re-examine the definition of postpartum health.
Defining postpartum
Postpartum is the medical term for the period of time after childbirth when the reproductive organs return to their non-pregnant state. That recovery usually takes four to six weeks. During that time, most mothers have a follow-up visit with their health care provider.
Reports of fatigue, pain
University of Minnesota researchers followed 661 women age 18 years and older — 30 years on average — who were admitted to one of three community hospitals in the Minneapolis-St. Paul area to have babies. All of the new mothers gave birth to healthy single infants, and were employed and planning to return to work. Perinatal nurses enrolled the subjects while they were still in the hospital, and the staff conducted telephone interviews with them at 5 and 11 weeks postpartum.
In general, the researcher found that symptoms such as fatigue, headaches, back and neck pain, difficulty breathing and sexual symptoms declined over time. They also noted that women who breastfed experienced a decline in breast discomfort over time.
Preconception health plays a role
Two previous studies from the University of Minnesota have also found positive associations with longer leaves. The new study went a few steps further by looking at the role played by social support and job stress. While preconception health is most consistently associated with better mental and physical maternal health, other factors included the absence of prenatal mood problems, having a spouse or partner, low job stress, greater control over daily activities, co-worker support and having a baby without colic.
The new study went a few steps further by looking at the role played by social support and job stress.
The study authors recommend obstetricians evaluate postpartum patients for fatigue and be especially aware of their patients’ moodiness, risk for depression and other mental disorders during both the prenatal and postpartum periods. In addition, they concluded new mothers may benefit from counseling on techniques for developing social support — a factor significantly associated to better postpartum mental health — coping with job stress and exploring options for a delayed or intermittent return to work.
For more information on this topic:
- Mothers’ Health and Work-Related Factors at 11 Weeks Postpartum, Annals of Family Medicine, November/December, 2007
- After the Baby is Born: Fact Sheets and Resources, U.S. Department of Health and Human Services,
- Postpartum Depression, Medline Plus, a service of the U.S. National Library of Medicine and the National Institutes of Health
Other women's health resources
- Maternity Services, Yale-New Haven Hospital
- Women's Heart Program, Yale-New Haven Hospital
HealthLINK-Women's health archive