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The Birth of a Mother: An Innovative Model for Providing Midwifery Care to Women in the Postpartum Period

By Jenifer Fahey, CNM, MSN, MPH, Assistant Professor, University of Maryland School of Medicine

As I reviewed the final draft of the article I had prepared for the upcoming postpartum special issue of the Journal of Midwifery & Women’s Health, it became clear that while I had briefly touched on the psychosocial needs of women following the birth of a child, I had focused almost exclusively on physical recovery. I sat at my computer, contemplating my final edits prior to submission, and realized that what I had assembled was, in essence, a well-referenced laundry list of potential postpartum complications and how to manage them.

While physical recuperation from childbirth is a key component of a healthy postpartum, this narrow physiologic lens provides an incomplete view of this critical time in a woman’s life, which is a period of immense transition with significant implications for the health of the mother and her family. We must constantly remember that what is happening in the cells and tissues is but one component of a much larger, more important responsibility we have as providers, which is to care for the whole woman, including the emerging mother within her. The ability to do this is at the heart of what distinguishes the care we provide as midwives.

The year that follows the birth of a child is a period of adaptation in nearly every aspect of a woman’s life. Thinking back to this time in my own life brings to mind the complicated and tangled web of emotions that characterize life as a new mother – exhilaration and exhaustion, fear and fulfillment. Equally easy to remember is the longing for guidance and assurance that can seem so inaccessible in the fog of early motherhood. I hear the same jumble of emotions and sense that same longing from many of the women I see in those quick 10-20 minute postpartum visits.

I want to provide care to women in a way that helps them achieve not only the healthiest birth possible, but the healthiest motherhood possible. I do not feel that I am quite there yet. Certainly maternity care in the United States is not there. In fact, the United States just fell for the third straight year in the WHO international statistics for maternal mortality (from 41st to 50th to 58th) and has the worst such outcomes in the developed world. What’s more, in the recent Listening to Mothers III Survey more than half the mothers (55%) who met screening criteria for depression in both the initial and follow-up surveys failed to report getting any help.

I realized that the manuscript I had prepared was not going to bring me, or anyone else, closer to the goal of healthy motherhood. So, I decided to scrap it and start again.

At the urging of a public health colleague who became my co-author, I changed perspective. My colleague lent me a small but influential text on preventative medicine by Dr. Geoffrey Rose, which led me to a shift from disease-prevention to health-promotion in the year following childbirth. Putting a wide-angle lens on this time period allowed me to unearth a rich body of work from many disciplines, including Rubin’s classic writings on motherhood that describe factors associated with a mom’s health following the birth of a baby.

From this, we assembled a framework that can help provide an understanding of how to best help mothers achieve optimal well-being for themselves and their families. The Perinatal Maternal Health Promotion Model has 4 life skills to enable women to control their health and the health of their families: mobilization of social support, positive coping skills, self-efficacy, and realistic expectations. These skills not only improve healthy behaviors of new mothers but serve as powerful buffers from the stressors of this time.

The final article includes detailed descriptions of each of these core skills and provides some examples of strategies clinicians can utilize to help women build these skills. It is my hope that, at the very least, the model will help spark conversations on how we can re-conceptualize the care we provide so that we are truly promoting the health of moms. I look forward to being a part of some of these conversations and to hearing what strategies my fellow midwives plan to use, or are already using, to help women in this critical period.

What innovative strategies is your midwifery practice using to maximize postpartum maternal well-being?

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Posted By Barbra Elenbaas | 12/11/2013 5:39:50 PM



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