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
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
strategies is your midwifery practice using to maximize postpartum maternal
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