While postpartum depression, a condition which affects about 1 in 9 women, has exacted much of the recent attention related to post-childbirth mental wellness, there are other areas worthy of concern, such as postpartum anxiety and maternal functioning. The case for assessment of functioning is a straightforward and intuitive one initially made by Ware et al. (Medical Care, 1996) who state that, ‘‘the goal of medical care for most patients today is to obtain a more ‘effective life’ and to preserve functioning and well-being.” Applied to women’s mental health, this means that most women don’t approach their doctor hoping to achieve a specific score on a depression assessment — what they really want is to function more effectively, or perform better, in their daily lives. This ability to function well is particularly important to new mothers, and mothers in general, who have other human beings depending on them both physically and emotionally. The demand is high and that can be scary.
To address this need, researchers at the University of Pittsburgh developed a questionnaire, titled, “the Barkin Index of Maternal Functioning,” that captures how a woman is functioning in the postpartum period. The questionnaire was first published by the Journal of Women’s Health in 2010 and has been used in multiple settings and countries. So how is maternal functioning defined within? Stated differently, what does optimal functioning look like in new moms?
In order to answer these questions, the research team conducted focus groups with 31 women who had recently given birth, from Allegheny County in Pennsylvania, which surrounds the city of Pittsburgh. The goal was to let the women define the range of functioning, as they were currently experiencing new motherhood and therefore were most knowledgeable on the subject. Allowing the population who is experiencing the condition of interest (in this case, new motherhood) to have substantial input is referred to as a “patient-centered” feature. This feature is desirable and can lead to higher levels of patient engagement in medical evaluation.
So how did the women define postpartum maternal functioning? The participants identified seven key areas related to new motherhood — maternal self-care, infant care, mother-child interaction (bonding), psychological well-being (of the mother), social support, management, and adjustment. These seven domains informed the definition of optimal functioning: “A woman who has adequate social support, and is able to take care of her own physical and mental needs, take care of her infant, attach to her infant, juggle her various responsibilities, and adapt over time is functioning optimally.” These results were also reported in the Journal of Women’s Health (2010).
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I know what you are thinking … tall order! You would be correct. Remember, this is what women defined as perfect functioning and it is unlikely that even the best parents and multitaskers are operating at this level. The physical aspects of infant care are usually where women excel, often sidelining their own needs. So how can you boost your overall maternal functioning? Get help. Social support is a major contributor to postpartum health and health in general. If your family network isn’t strong near your home, consider building your own network. Replicating family support is difficult, but I’ve seen people come close. Some churches have extensive children’s programs, providing parents with the opportunity to spend time with other adults while their kids are safely occupied. You could also join a peer group with other mothers or utilize online options that allow for more anonymous discussion. If you are struggling with feelings of depression or anxiety, Postpartum Support International offers free phone sessions each week where you can connect with other parents. Self-care is also essential. When you engage in activities that restore your energy, you have more mental and physical reserve to manage family life. Self-care can be solitary like reading, massage, or a trip to the gym (or even the grocery store). Alternatively, it can be restorative to spend time with your child in ways that are relaxing. The important part is to remember that as a human being and a caregiver, you are expending a tremendous amount of energy and that energy needs to be replaced.
Jennifer L. Barkin, M.S., Ph.D., is an assistant professor of Community Medicine and Obstetrics and Gynecology at Mercer University medical school.