Postpartum Health and Maternity Leave Duration

Rada K. Dagher, Ph.D. Assistant Professor, University of Maryland School of Public Health Department of Health Services Administration College Park, MD Interview with:
Rada K. Dagher, Ph.D.
Assistant Professor, University of Maryland School of Public Health
Department of Health Services Administration
College Park, MD 20742 What are the main findings of the study?

Dr. Dagher: The main finding of this study is that taking leave from work up to six months after childbirth is associated with a decrease in maternal postpartum depressive symptoms; thus longer maternity leaves may protect against the risk of postpartum depression. We conclude that the 12 week leave duration provided by the Family and Medical Leave Act (FMLA) of 1993 may not be sufficient for women who are at risk or experiencing postpartum depression. Moreover, the unpaid nature of the FMLA makes it harder for mothers with limited financial means to take longer leaves; thus, many of these mothers may have to take leaves that are much shorter in duration than 12 weeks. Were any of the findings unexpected?

Dr. Dagher: We did not expect that additional leave days after 6 months postpartum will be associated with an increase in postpartum depressive symptoms. This reversal in the relationship between leave duration and postpartum depressive symptoms at six months after childbirth may be related to women’s feelings of low control over housework and infant-related tasks at home, and missing the supportive relationships at their workplaces and the sense of accomplishment derived from the achievements and rewards of paid work. However, we caution that in our sample of women, 87% were back to work by 6 months postpartum and 92% were back to work by 12 months. Thus, it is difficult to accurately estimate the impact of leave durations that are longer than 6 months on women’s postpartum depressive symptoms. What should clinicians and patients take away from your report?

Dr. Dagher: Our findings point to the possibility of a protective effect of maternity leave up to six months after childbirth on the risk of postpartum depression. Expectant and new mothers should discuss their plans to return to work after childbirth with their primary care and occupational health providers. Some women may need intermittent leave a benefit provided by the FMLA that allows mothers the opportunity to return to work on a gradual, part-time basis. However, this benefit is only provided with medical certification that a woman is incapacitated by a serious health condition by law and it is the role of primary care and occupational health providers to assess women and discuss with them their eligibility for this benefit.

Expectant and new mothers who have to return to work soon after childbirth (for e.g., due to financial reasons) should explore with their employers the possibility of using flex-time and telecommuting options, including reduced hours upon re-entry to work. Moreover, expectant and new mothers should actively seek social support from their families, friends, and those experiencing depressive symptoms should seek mental health counseling. Moreover, they can join local postpartum support groups and seek support from postpartum support organizations such as postpartum support international (<>), which has volunteers in every state in the U.S. What recommendations do you have for future research as a result of this study?

Dr. Dagher: Taking time off from work after childbirth provides time for mothers to rest and recover from pregnancy, labor, and delivery. Research has consistently found an association between postpartum fatigue and postpartum depression; therefore, it may be that taking leave from work after childbirth helps mothers attend to their fatigue symptoms which may in turn decrease their risk for postpartum depression. Future studies should examine the mechanisms through which taking time off after childbirth influences postpartum depressive symptoms, one potential mechanism being postpartum fatigue.


Maternity Leave Duration and Postpartum Mental and Physical Health: Implications for Leave Policies 

Dagher RK, McGovern PM, Dowd BE.
J Health Polit Policy Law. 2013 Dec 4. [Epub ahead of print]

Last Updated on December 20, 2013 by Marie Benz MD FAAD