Importance of Postpartum Care - Essay Example

?Melissa Greenblatt Birthing Culture – HSOC 334 December 11, Importance of Postpartum Care Introduction The United s is a highly developed and leading nation in a number of industries such as technology, manufacturing and entertainment; however, when looking at the US birth process, we fail miserably. A majority of women in the US receive limited after care following birth, resulting in a more challenging postpartum recovery. As citizens of such an industrialized nation, we often do not realize how much there is to be learned from other countries and cultures regarding this issue. This unwillingness to look beyond our own knowledge and experience comes at a high price, as there is momentous statistical proof that mothers in industrialized nations experience a much higher incidence of postpartum difficulties compared to a number of other cultures and countries. This dichotomy is largely a result of industrialized nations disregarding the fact that the postpartum period is a very important time in a woman’s life (1). During this postpartum stage, new mothers are weak, tired and vulnerable, and are thus in need of special treatment. The thesis statement is that: Sufficient postpartum care is vital to a successful post-birth experience for both mother and child. Postpartum Period and its Challenges The postpartum period, also called the fourth trimester, is the period just after birth and subsequent six weeks that follow. Postpartum is regarded as a very important time, and must be acknowledged as distinct from normal life. While this is an enjoyable time as a mother and child are bonding, it is also very exhausting. There are numerous physical and emotional struggles faced by all new mothers after delivery that are intricately tied to five major physiological changes that occur postpartum (5). The physical side effects felt by most women that require healing include the uterus and the uterine wall regaining pre-pregnant size. Complete healing of the uterus requires six weeks or more of rest and relaxation for the area. Additionally, pelvic floor and vaginal muscles must be restored as they may tear or stretch during birth and the abdominal wall must rebuild as the elastic fibers get ruptured. On a more emotional basis, mother’s experience many bring changes in their hormone levels. After giving birth, a mother’s estrogen and progesterone levels are significantly lower than during pregnancy. These lower hormone levels may impact the mother’s mood, body functions, digestion and ability to sleep (5). It has been reported that a large reason for postpartum maternal morbidities are due to this fatigue or tiredness experienced by new mothers. Moreover, fatigue is found to correlate to postpartum depressive symptoms, breastfeeding problems, a mother’s ability to respond to the cry of her newborn, and her overall response time to her child’s needs (2). Poor maternal health, physically and emotionally, can also affect the child’s overall physical health and behavior. For example, it has been shown that a mother in poor physical health may have a child that throws more frequent tantrums or may have difficulty playing with other children (2). Post delivery, a mother is both emotionally and physically drained; and thus, needs adequate time and support to recuperate, recover and relax (1). The Role of Oxytocin Oxytocin, also known as the “love” hormone, released during labor and the postpartum period plays a very important role in the forming of the mother-child relationship. A study done by Shelley Taylor shows that oxytocin is linked to a female’s desire to tend to vulnerable offspring and to befriend with those around her. However, the environment that the mother is in greatly affects the production and function of this hormone. If a woman is unable to tend to her baby because she is not rested and taken care of, or if she does not have people around her to befriend, she will exhibit feelings and behaviors of distress. It has been proven that when in concurrence with positive contacts and relaxing surroundings, oxytocin attenuates psychological and biological stress responses; however, when a woman is in a hostile or unsupportive environment, oxytocin may work to exacerbate her stress responses. If stress responses are attenuated, oxytocin will increase the mother’s desire for physical proximity and increased maternal behavior. Not only is the environment important in controlling the function of oxytocin, but the environment also affects its production. All women produce oxytocin during labor and the first few days of the postpartum period, but if a woman breastfeeds the production of oxytocin will continue. However, breastfeeding is only possible if a woman is adequately taken care of, supported by those around her and given enough time to relax and recover herself. This is because breastfeeding requires a mother to be confident in her own abilities, and more importantly for her to have the time and energy to do so (13). Role of Breastfeeding Beyond the production of oxytocin that leads to the promotion of bonding between mother and child, breastfeeding plays an extremely vital role in the postpartum period. Breastfeeding works to increase the health of both mother and child. In the Infant, breastfeeding has been found to decrease risk of common conditions including acute otitis media, gastroenteritis, atopic dermatitis, and life-threatening conditions such as lower respiratory infections, and even sudden infant death syndrome (14). If an infant is not breastfed, negative health consequences continue even beyond the breastfeeding period; for example the child may suffer from health effects later in life, such as increased risk of obesity, type 1 and 2 diabetes, asthma and childhood leukemia (14). For the mother, the health consequences associated with not breastfeeding consist of increased risk of type 2 diabetes, breast cancer, ovarian cancer and postpartum depression. Unfortunately, most mothers in the United States do not meet recommended breastfeeding guidelines according to the Centers for Disease Control, although the percentage is on the rise. In 2008 only about 45 percent of women were breastfeeding their infants at six months (15). This failure can be attributed to a number of factors. In the United States, it has been reported that mothers feel a great amount of social pressure against nursing due to both social and professional commitments. These social and professional commitments that make breastfeeding complicated can consist of embarrassment when feeding in public, constraints on time due to work, difficulty accessing tools to learn how to breastfeed and lack of knowledge of the overall health benefits breastfeeding promotes. However, this low percentage can also be attributed to the lack of care and support mothers in the United States themselves receive, which hinders their ability to care for their baby. Role of Environment The importance of the new mother’s environment is greatly understood by many countries and cultures around the world. The postpartum period is treated as equally if not more important as the prenatal period. Entire families and communities come together to care for a new mother, ensuring she has enough rest, food, herbs, comfort and assistance to recover and tend to her child (5). For example, in the Chinese culture, a new mother is treated like a queen for an entire month after labor. Her mother and mother-in-law handle all housework and care for her other children, while the new mother is expected to eat, sleep and nurse. As the Chinese believe a woman loses a lot of heat during childbirth, she is provided with warming foods and healing teas to return her body to homeostasis. In some Indian cultures, female family members take turns doing the housework, caring for the newborn and preparing special foods, as the mother is forbidden to touch the ground for six weeks after birth, and is provided with massages for comfort and warm food for restoring body heat (5). Beyond the support provided to new mothers by close family members, many other cultures also understand the importance of continued healthcare after labor. For example, in all northern and western European countries, new mothers are provided home visits by trained health care professionals. In the Netherlands, even after a normal, routine pregnancy, a woman is provided with a 1-week continuous home care program covered by insurance. These programs care for the new mother and child, and also take care of the woman’s housework duties. Role of Support System Beyond direct support given to the new mother, the support system of the new mother is a vital part of her recovery and positive postpartum experience. Thus, education and encouragement should be provided to the partner and those who will be caring for the mother in this period. Emotional and palpable support provided to the new mother by those around her was positively linked to an increase in the mother’s mental health. Her supporters should also learn massage techniques that will work to relax the new mother, which promotes a better environment for bonding as well as quicker physical recovery. A mother should also receive support from family and friends who have gone through the experience themselves, in order to help the new mother find her maternal identity. If a mother does not have such a support system, it should be the job of her doctor’s and nurses to fill these gaps. Whether it is frequent visits from social workers, or nurses themselves, a mother must feel the presence of support. They should also be informed of support groups that they could attend, in order to go through this experience with others in their same situation (20). Lack of Postpartum Care in the United States In the United States, immense amount of time and energy is placed on prenatal care; while, postpartum healthcare is largely overlooked. In the United States, according to a number of surveys, new mothers feel that focus moves quickly to the infant in the postnatal period, leading her to feel neglected and anxious. New mothers expresse their desire for more in-home care, education and resources post birth. In the United States, following hospital discharge, it is possible that a new woman may not see or even speak to a midwife or obstetrician for up to 42 days following her birth; which are the 42 days most vital to her recovery and relationship with her child. Just as Martha Ysha Oakes points out, the health of the new mother the first 42 days after childbirth may affect her and her child’s health for the next 42 years (4). In the United States however, the follow-up care begins after this vital six-week period, after the hardest and most important obstacles have been already overcome. In some areas, women don’t even attend this follow-up appointment. The problem however, is not just when the care occurs, but the types of care new mothers are provided with. More frequent, sooner visits will not necessarily solve this problem of neglect felt by new mothers. When meeting with a physician, the Western culture puts a large emphasis on science, technology and efficiency. These parameters are not dropped during the postpartum period leading western women, who should be getting in touch with emotion and relaxation, to often feel their doctor visits constrained by these other societal limitations. The biomedical culture in the United Sates is a vital tool for a large number of healthcare issues, but should not be applied to the postpartum period. Nonexistent Attention to Physical Recovery Physical recovery is a major source of overall recovery for a new mother. Good physical recovery allows a mother to better tend to her child, it helps with a mother’s fatigue, and leads to an overall more positive experience. In the United States, attention to physical recovery during this postpartum period is almost nonexistent. For example, in France, new mothers are provided with pelvic floor rehabilitation, which aids in curing incontinence. Incontinence in the United States is a major issue suffered by women postpartum. In France, the government provides free physical therapists that are well trained in pelvic floor function, pregnancy and postpartum rehabilitation to new mothers early on in the period. The United States healthcare does provide physical therapy to new mothers in most cases; however, the major issue is the lack of knowledge that new mothers have regarding necessary means for physical recovery, and the lack of time they are provided with to attain such means (21). Hospital Experience after Birth A prime example of postpartum neglect new mother’s in the United States face is the hospital experience immediately following the birth. Hospital stay following vaginal births in the United States has decreased to 1.1 days. Disadvantages of early discharge beyond the negative feelings expressed by mothers, is inability to establish breastfeeding patterns until the third or later postpartum day; a number of conditions are not recognized in this short span; and, time spent on in-hospital teaching regarding breastfeeding, infant and mother care is greatly reduced. Moreover, discharge before 48 hours is associated with increased likelihood of readmission during the first 2 weeks of life. With readmission, there is increased risk of negative psychological effects due to mother-newborn separation and increased risk of nosocomial infection that can be acquired throughout hospitalization. On a cognitive level, mothers are much less able to absorb information given to them in the first 24 hours postpartum than on average, which greatly impacts the infant’s well being in the next several days (16). The effects of early delivery do not only affect the infant but also has a psychological and physical impact on the mother. Women reported that after early delivery, they suffered from fatigue, insomnia, breast pain and constipation. Moreover, women discharged before 48 hours were more likely to be depressed at 5-6 months postpartum (18). The length of hospital stay post delivery should be a reflection of a number of factors, rather than a followed protocol. For example, hospital stay should be extended if a woman lacks support in her home after discharge, if she is unaware of complications that may arise, and if she does not have adequate access to health-care services (17). Working Moms Suffrage from Lack of Postpartum Care Postpartum care and parenting becomes all the more daunting when it comes to working mothers. Earning money and being stable in life makes the working woman enter into a world of challenges related to motherhood. They want to be looked after like other normal women, but have to face a lot of issues when they step out of their homes, leaving children behind or at day cares, and coming back home late in the evenings, finding their families waiting for them. In United States, working mothers have to divide their lives in a myriad of portions, of which parenting, caring for husbands, and looking after the household are some of the most important ones. This makes postpartum care a big challenge for them, because they have to manage everything just like stay-at-home moms, and because they cannot let down the expectations that their families have from them. And if they let down, they are considered as failed. They find themselves in constant guilt because they feel that they have not been taking care of their children because of putting their work ahead of them. They have to arrange for childcare, which takes away much of their salaries. They stay stressed. Their husbands do not spare them for not doing house work; and, their children suffer from not having them around them when they need them. Hence, it also concludes that the emotional relationship between working mothers in the U.S. and their children is not as good as the relationship between stay-at-home moms and their children. Why working mothers of newborns cannot leave their jobs is because they have built their careers over the years, and they cannot take the risk of losing the opportunities they have gained with their hard work. They have to return to their jobs because they know that in U.S., even after the establishment of some laws in their favor, like the FMLA (Family Medical Leave Act), employers do not like to give any relaxation to them when they want to spend some time off with their newly born children. So, they have to arrange for childcare and return to work. This makes them spend a good portion of the day away from their infants, which diminishes their importance for the little ones, who learn to stay without them and depend on some other caregiver. Child neglect and lack of proper postpartum care takes its toll on the relationship between the mother and the child, which expresses itself when the children grow older into their teenage. They become emotionally distant, because they have been physically distant from their mothers. How Postpartum Neglect Gets Expressed In the United States, this improper or lack of postpartum care is manifested in a number of physical and emotional ways. It was reported that at 2 months postpartum, 76% of women in the United States felt a serious prevalence of fatigue (2). Fatigue has been proven to correlate with postpartum depressive symptoms, breastfeeding problems and a number of other complications. New mothers use these first 2 months postpartum to establish their maternal identity, which requires learning, support and energy. If a mother is left to take care of herself during this postpartum period, she will most likely feel alone, unsupported and fatigued, thus having a hard time establishing this new identity. If a mother has a hard time getting in touch with this new identity, causing greater fatigue, this cycle will only be exacerbated. Postpartum depression is a serious problem for many new mothers in the United States; and, may lead to a woman feeling negatively towards herself and her child. It may get her shy away from interactions with her child, and possibly even feel anger toward her child. These behaviors from the mother also greatly affect the child leading him or her to exhibit behaviors such as fear of examiners, avoidance of attachment, less responsiveness to persons, lower energy and more. Beyond the emotional consequences of a poor postpartum period, many women in the United States report suffering physical pain. For example, women complain of hemorrhoids, constipation, urinary incontinence, disturbed sleep, sleeping disorders, lack of sexual desire and painful intercourse, which all only work to further intensify any existing emotional struggles (2). Importance of Maternity Leave The United States follows the Family and Medical Leave Act, which mandates a maximum of 12 weeks of unpaid leave to new mothers, but is limited to firm’s 50 employees or more. Maternity leave is similar to paternity leave being offered in many companies. Planning a maternity leave is very important for mother-to-be, because it saves them from unexpected financial pressures and burden of family responsibilities. Many companies include benefits of short-term disability and sick leave in maternity leave, so that the mother gets the benefit of paid leave. In other words, mothers are offered to use up their vacations or other personal days, as the maternity leave, in order to make the leave paid. Mothers plan to start their maternity leave a few weeks prior to delivery, so that they get enough time to make preparations for the new baby. Maternity leave can also be started just before the expected date of delivery so that mothers can spend most of their leave with the baby. However, it is important, according to FMLA (The Family and Medical Leave Act) to provide a notice to the manager, 30 days prior to the delivery This will be unpaid leave. The maximum leave that a mother can get is a leave of 12 months in a year. The FMLA leave applies both to the mother and the father, who can utilize this leave in the same period like overlapping each other’s leaves, or in consecutive periods, so that one of the two parents is available to the child and the rest of the family. Unfortunately the United States Department of Labor reported that in 1999 – 2000, 3.4 million people needed leave but were not able to take it due to economic concerns. Maternity leave is very important as it substantially increases childcare impacting the health of the newborn; for example, it has been proven that each month of reduced maternity leave increased the risk of impaired performance on a motor and social development scale for children less than two years old. Maternity leave also allows the mother to both physiologically and psychologically recover. It was reported that mother’s given 15 weeks leave had positive maternal mental health such as reduced depression, and those given 20 weeks of leave had an overall increase in maternal function. Women given 12 weeks leave or less reported increased feelings of depression, stress, poor health and overall family stress in comparison (19). Additionally, doctor’s constantly pressure a mother to breastfeed her newborn up to 6 months as it is healthier for her baby, but the mother is simultaneously expected to return to work in 12 weeks, thus, making it very difficult for a mother to meet the criteria recommended and to even establish a breastfeeding pattern at all. Hence, one of the largest dichotomies present in postpartum care that exists among other countries and the United States is parental leave. While new mothers in the United States are receiving 12-week unpaid leaves, many other countries treat new mothers as valuable, if not more valuable than their current workers. They understand that parental leave, leads to children being breastfed for longer and their life expectancy increasing. More than 120 countries around the world provide their new mothers with paid maternity leave and health benefits. For example, in Sweden, new parents can take up to a 1-year leave at 80% of their salary (2). While many countries around the world do not offer the length of time provided to Swedish employees, there are at least 178 countries around the world that guarantee paid leave for moms, and more than 50 countries that provide wage benefits for fathers. This allows a mother to relax comfortably during her time off, tend to her child fully, and not have to worry about cutting her leave short to begin earning money again. The United States not only offers the shortest length of time recorded for developed countries across the world, but this time is also unpaid. Recommendations Since the postpartum care provided to new mothers in the United States fails in many respects, hence changes must be made, as this period is vital to both the mother and child. Postpartum care should not exclusively provide physical examinations, but also mothers should be screened for common health problems, mental disorders, and progress of the new mothers’ role acclimatization. Often times even if aware of such issues, mothers lack the knowledge to fix them. If needed, women should be provided with referrals to available educational programs and/or mental health professionals. Moreover, changes must be made to the insurance policies regarding time limits set for providing postpartum care. Rather than visits being limited to 6 weeks, they should be extended to at least 1-year post delivery, as a number of issues don’t arise until after this 6-week period. Furthermore, the visits should be individually tailored to the new mother’s needs, as every postpartum experience is extremely different and requires support in different areas. As of now, the majority of visits that are provided to new mothers take place out of the home, either in the hospital or the physician’s office. In European countries on the other hand, health-care professionals provide new mothers with home visits. These home visits have been linked to fewer subsequent pregnancies and births, longer intervals between births, and shorter duration reliance on welfare and food stamp programs (20). Making it a Family Pregnancy Pregnancy and parenting bring new joys to the whole family. A new addition is very exciting for all members of the family. Although, the 9-month pregnancy demands much patience and care from the mother-to-be, the rest of the family must play their role in comforting the mother, and preparing for the new comer. The dad-to-be should try to spend extra time with his wife to soothe her, and should take care of her if she is in pain or any sort of discomfort that may come with pregnancy. If there are other children, parents should inform them about the new baby, and should mentally prepare them so that they accept him when he arrives at home. This time should be enjoyed at its fullest. The mother-to-be should take care of her diet because she is not only feeding herself, but is also feeding the life nurturing inside her. If it is possible, and if this is her first pregnancy, then she should start taking parenting classes with her husband, so that both of them are equipped with sufficient knowledge before the baby arrives. She should also arrange for a caregiver, like her mom or sister, who should be present with her on the day of delivery and after the baby is born. This is because she will not be able to handle the challenges of motherhood without the help of a female. Hence, involving whole of the family in the daunting task of preparation for baby will make it a family pregnancy. Annotated Bibliography 1. Kendall-Tackett, Kathleen. "How Other Cultures Prevent Postpartum Depression Social Structures That Protect New Mothers’ Mental Health." Uppitysciencechick. N.p., n.d. Web. -This article points to the fact that postpartum period is extremely vital to a woman and her mother child relationship and as an industrialized nation such as ourselves we are extremely insufficient in our care during this time. The paper discusses other cultures in comparison to the majority of the united states and the differences we can see as a result of these differences. 2. Cheng, Ching Yu, Eileen R. Fowles, and Lorraine O. Walker. "Postpartum Maternal Health Care in the United States: A Critical Review." The Journal of Perinatal Education 15.3 (2006): 34-42. Web. -Care for women post birth is largely neglected by a number of health care systems. We can see this lack of care through our limited national health objectives and lack of data available relating to maternal health. This article looks at the importance of postpartum maternal health, the problems associated with a lack of health related care and the differences between cultures/countries and the care they provide their women postpartum 3. Oates, Margaret R. "Postnatal Depression Across Countries and Cultures: A Qualitative Study." The British Journal of Psychology 184 (2004): S10-16. Bjp.rcpsych.org. Web. -Postpartum depression is a condition faced by many women throughout the world. However, the question in study is if the depression or lack there of amongst women could be linked to certain cultural practices. This study took place in 15 centers in 11 countries and analyzed groups to see if we can find a link. 4. Groff, Jade. "Revisioning Postpartum Care in The United States: Global Perspectives." Philadelphia University's Midwifery Program. N.p., 2011. Web. -As postpartum care is extremely limited in the US many women feel unprepared when entering the world of parenthood as there is little emphasis on postpartum and newborn care issues. Women are extremely vulnerable during this period of time and while other countries and cultures seem to recognize this period, the US doesn’t. provides a lot of quantitative data as well that will be valuable in my paragraph that will work to statistically prove the dichotomy between the US and other cultures. 5. Grant, Pilar. "Mothering the Mother." Mothering - the Home for Natural Family Living. N.p., 02 Nov. 2011. Web. -This website addresses the more physical importance of postpartum care for new mothers, for example restoration of the uterus, abdominal muscles, pelvic floor mothers, breastfeeding and more. It discusses the approach of other countries in comparison to ours here in the US. Moreover, how a number of common problems faced by women following birth could be easily reversed with good postpartum care. 6. Sui-Zan Zhou, Xiao-Li Wang and Yan Wang. Design of a Questionnaire for Evaluating the Quality of Life of Postpartum Women (PQOL) in China. Quality of Life Research , Vol. 18, No. 4 (May, 2009), pp. 497-508 -This article is a questionnaire for evaluating the quality of life of postpartum women in china, and questioning them regarding what it is they want and what it is they receive in their post birth year and what they find most important and valuable. 7. Ramona T. Mercer. Postpartum: Illness and Acquaintance-Attachment Process. The American Journal of Nursing , Vol. 77, No. 7 (Jul., 1977), pp. 1174-1178 -This article addresses the feelings of a mother immediately after birth and how this is such a vital time for her to form an attachment with her infant. If a mother is not able to care for her child in the first few postpartum days it is very hard for her to form a connection with her child. Thus it addresses the importance of this “4th trimester follow-up. 8. Sines, Erin, Uzma Syed, Steve Wall, and Heidi Worley. "Postnatal Care: A Critical Opportunity to Save Mothers and Newborns." Population Reference Bureau. Save the Children, Jan. 2007. Web. -This website talks about the vulnerability of mothers and their newborns in this period and the approaches that should be implemented in order to provide appropriate care for the mother and child during this time. This care is necessary in order to inform and empower families in the nurturing process. 9. WHO. "WHO Technical Consultation on Postpartum and Postnatal Care." Whqlibdoc.who.int. World Health Organization - Department of Making Pregnancy Safer, 2010. Web. -The recognition that in many developed countries this period of time is largely neglected and yet it is an extremely important period. The WHO puts out guidelines for future change and hopefully an intervention leading to appropriate care after childbirth. It points out the weakness of last Postpartum issue published by the WHO and is looking to better their standards. 10. Waldenstrom, U., Brown, S., McLachlan, H., Forster, D. and Brennecke, S. (2000), Does Team Midwife Care Increase Satisfaction with Antenatal, Intrapartum, and Postpartum Care? A Randomized Controlled Trial. Birth, 27: 156–167. -This article gives descriptive studies of the different experiences of women during their birth experience and discusses their likes and dislikes in terms of care 11. Bondas-Salonen, T. (1998), New mothers' experiences of postpartum care — a phenomenological follow-up study. Journal of Clinical Nursing, 7: 165–174. -This article discusses the importance of the postpartum period and how postpartum care has been shown to take low priority in both practice and research 12. Gun EM Fredriksson. (2003), Postpartum care should provide alternatives to meet parents’ need for safety, active participation and ‘bonding.’ Midwifery. Volume 19, Issue 4: 267-276 -This article too works to understand the meaningful yet overwhelming period for the new mother and father; moreover how in such a sensitive time the care environment is essential in a good experience for new mothers and the newborns. The article takes place in Sweden and thus works to provide information about other cultures view and approach towards postpartum care. 13. Tend and befriend 14. http://www.aafp.org/about/policies/all/breastfeeding-support.html 15. http://www.cbsnews.com/news/cdc-more-us-mothers-are-breast-feeding-but-overall-rates-still-low/ 16. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3336902/?report=reader 17. http://www.cdc.gov/mmwr/preview/mmwrhtml/00036988.htm 18. http://www.scielo.br/pdf/reeusp/v45n3/v45n3a30.pdf 19. http://healthland.time.com/2011/07/21/study-why-maternity-leave-is-important/ 20. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1595301/ 21. http://connectionsincare.com/2012/03/a-lesson-from-the-french-in-postpartum-care/ Read More