Friday, December 13, 2013

Length of Maternity Leave and Postpartum Depression: A Connection?

The topic of maternity leave can get quite heated between certain groups of people. Some feel it is an important period that provides multiple benefits to mother and child, while others feel it is an entitlement and a luxury. Sure, they argue, moms need to have some time to recover from childbirth, particularly if it is a c-section, but extended maternity leaves are just a time to stay away from work without expectations.

So, are maternity leaves important or a luxury? I have to admit that, as a Canadian, I have a very different experience with maternity leave than do many of my colleagues in the United States. And, since I was working clinically as a nurse when I had my children, I even had a different experience than many of my fellow Canadian mothers at the time.

Over 26 years ago, when I had my first (of three) children, Quebec nurses received 20 weeks of 93% of their salary in maternity leave benefits. After that, we could take up to a total of two years from our position, unpaid, and be guaranteed our job or an equivalent one on our return. Other women in Canada who did not have a similar type of union agreement, received 15 weeks of maternity leave, at about 60% of their salary. The first two weeks were unpaid, so it came out to 17 weeks off work.*

I had no idea back then that my US colleagues had no such similar rights to maternity leave. I began to hear stories of women returning to work when their infants were six or seven weeks old because they had used up all their sick leave and holiday time. I couldn’t imagine leaving my babies that young. Some mothers may bounce back right away, but I sure didn’t after my first delivery, my son who was over 9 pounds. He was starving all the time and he didn’t sleep through the night for a long time, which made for a pair of very tired parents.

Now, in 2013, all across Canada, new mothers can take anywhere from 17 weeks to a full year from their job and they are guaranteed their job (or equal equivalent) upon their return. If they’re eligible, they get 15 weeks income of about 55% of their wages from the national employment insurance program (for birth or adoption). Union or contract arrangements can top up the sum, as it did for me back in 1987. A few years ago, changes were made in the program so fathers could benefit from this leave as well, sharing it with the mother.

Sadly, things don’t seem to have improved all that much in the U.S. for new mothers. According to FMLA, the federal Family and Medical Leave Act, childbirth is included in a list of medical conditions that allows for up to 12 weeks of unpaid leave, but even this isn’t available to all as small employers are not required to provide this. Anecdotally, I’ve had colleagues tell me horror stories of how they had to fight for maternity leave - without pay - returning to work when their babies were three months old or younger. And how many can afford to take that time off without any form of income?

Maternity leave is not a luxury. It is important that society realizes that it’s a vital part of keeping our families healthy.

There has been a lot in the news over the past few years about postpartum depression. Sadly, we hear about it most with sensationalist news stories of mothers who murder their children and commit suicide as they can no longer cope with the burden of the depression. A study published in the journal JAMA Psychiatry earlier this year found that 40.1% of 10,000 women experienced depression within the first year of childbirth and 19.3%, almost one fifth, of these women had thoughts of self-harm. Other studies have found a connection between mothers with postpartum depression and child development.

Returning to work before you are physically and/or psychologically ready can increase your risk of developing postpartum depression, says the authors of a study published this week in the Journal of Health Politics and Law. The researchers examined the results of a survey of more than 800 new mothers. The survey asked questions about their return to work and their mental and physical health at six weeks after delivery, 12 weeks, six months, and 12 months. Seven percent of the mothers went back to work by the time their infants were six weeks old, 46% by the time they were 12 weeks old, and 87% by the time they were six months old.

The researchers found that the longer a woman was home with her baby, the lower the depression scores, as were measured on a scale called the Edinburgh Postnatal Depression Scale.

"In the United States, most working women are back to work soon after giving birth, with the majority not taking more than three months of leave," said study co-author Dr. Rada K. Dagher in a press release. "But our study showed that women who return to work sooner than six months after childbirth have an increased risk of postpartum depressive symptoms."

When dealing with an issue as serious as postpartum depression, this needs to be taken seriously. Currently, the U.S. is only one of three countries of 181 that does not offer paid maternity leave. The other two are Papua New Guinea and Switzerland.

Maternity leave isn’t a chance to sit at home and do nothing while being paid. It’s providing both mother and child the best possible start, possibly preventing other costly health issues down the road.

*Nurses were paid by the hospital/government 93% of the salary for the two-week waiting period. For the next 15 weeks, employment insurance pay out was topped up, and this was followed by an additional hospital/government payout of 93% for the last three weeks, for a total of 20 weeks.