Currently in Australia, 80% of women are employed during first pregnancy, and 40% resume employment in the postpartum. The first aim of this study was to identify which of a broad range of factors, including maternal preferences, maternal separation anxiety and maternity entitlements, contributed to maternal employment in the first 10 postpartum. The second aim was to identify the contribution of women’s satisfaction with employment arrangements to their psychological well-being. Participants were 165 employed pregnant women over 18 years of age and with sufficient English for completion of study materials, systematically recruited in the third trimester of pregnancy. Data were collected in pregnancy and at 3 and 10 months postpartum. Maternal preferences, not or no longer breastfeeding and lower maternal separation anxiety were associated with significantly increased likelihood of resuming postpartum employment when maternal age, educational attainment and occupational status were controlled for. A constellation of adverse employment conditions made independent contributions to measurably worse maternal mood including experiencing sexual discrimination in pregnancy, no maternity entitlements when known determinants of poorer maternal well-being were controlled in regression analyses. These findings provide evidence about the relevance of structural determinants to maternal well-being, and highlight the urgency of a national paid parental leave scheme in Australia.

Mothers are especially vulnerable to the onset or recurrence of psychological symptoms during the postpartum period. However, protective psychosocial factors may provide a stress buffering effect and promote a positive adjustment trajectory. In this series of studies, qualitative, mixed, and psychometric development methods were utilized to examine the nature, process, and measurement of perceived social support among mothers disproportionately parenting in the context of low economic opportunity. Study 1 utilized narrative interviews to explore themes related to maternal adjustment. Thematic analysis uncovered three key developmental processes: 1) “Stretching Identity; Transitioning Roles”, 2) “Navigating Stressors; Approaching Self-Efficacy”, and 3) “Changing Relationships; Strengthening Support.” Negative maternal self-attributions emerged as a key target for supportive intervention. Study 2 utilized a mixed methods triangulation design to obtain complementary qualitative and quantitative data related to perceived maternal social support, and between-group comparisons according to economic opportunity were conducted. Notable patterns emerged; namely, mismatches between the type of functional support elicited (e.g., emotional support) and a supportive individual’s response style (e.g. problem solving), resulted in conflict and maternal distress. In addition, perceptions of the support provided by healthcare providers differed based on economic opportunity, with participants from the higher economic opportunity group perceiving interactions as emotionally and instrumentally supportive, and participants from the lower economic opportunity group perceiving interactions as instrumentally supportive only. Study 3 contributed to the psychometric development of a novel, brief, and visually legible measure of perceived maternal social support originally developed for use in neonatal intensive care unit settings. Among mothers delivering at term, the measure demonstrated acceptable internal reliability, and a weak yet significant association with an established measure of perceived social support. Though trending in the expected directions, the measure demonstrated weak, nonsignificant discriminant validity when compared via correlational analyses with established mental health measures. The measure demonstrated stability across ranges of economic opportunity and cognitive ability. These studies address gaps in understanding of the nature, process, and measurement of perceived maternal social support during the postpartum period. Collective findings highlight targets for supportive intervention to facilitate postpartum adjustment, and implications for research and practice.

Background Up to 34% of perinatal individuals experience childbirth as traumatic. These individuals are at increased risk for developing depression, anxiety, and posttraumatic stress disorder (PTSD) after the traumatic event. The objective of this study was to elicit the perspectives of individuals with a traumatic birth experience on barriers and facilitators to receiving mental health support in the postpartum period after a traumatic delivery. Methods Individuals who delivered within the last three years and perceived their birth experience to be traumatic (n=32) completed an hour-long semi-structured phone interview. The interview included screening for PTSD, depression, and anxiety with validated instruments including the Posttraumatic Stress Disorder Checklist for DSM-V (PCL-5), the Patient Health Questionnaire depression scale (PHQ-8), and the Generalized Anxiety Disorder scale (GAD-7), respectively. Qualitative data was analyzed using a modified grounded theory characterizing participants’ barriers and recommendations for mental health support after traumatic births. Results Among participants, 34.4% screened positive for PTSD, 18.8% screened positive for major depressive disorder, and 34.4% screened positive for anxiety. Qualitative themes revealed multi-level barriers involving lack of communication, education, and resources which prevented obstetric professionals from recognizing and supporting patients’ mental health needs after a traumatic birth. Recommendations from participants included that 1) obstetric professionals should acknowledge trauma experienced by any individual after childbirth, 2) providers of multiple disciplines need to be integrated into postpartum care, and 3) mental health support is needed before the ambulatory postpartum visit. Conclusions There are multi-level barriers toward detecting and responding to individuals’ mental health needs after a traumatic birth. Obstetric professionals need to use a trauma-informed approach and proactively follow-up and assess mental health care in the postpartum period.