The flexibility to have an extra person at home, even for a few days, offers significant postpartum benefits, new research shows.
The weeks after a mother gives birth are a universally vulnerable period. She is recovering physically and mentally, while dealing with sleep deprivation, round-the-clock caregiving and possibly breast-feeding. Yet after a day or a few days in the hospital, she often doesn't see a doctor for six weeks.
A new study suggests a way to make a significant difference in mothers' postpartum health: Give the other parent paid leave, and the flexibility to use it on days the mother needs extra support, even if it just means a couple of days at home.
The researchers, Maya Rossin-Slater and Petra Persson, economists at Stanford, studied the effects of a 2012 Swedish law that allows fathers to take up to 30 days, as needed, in the year after a birth, while the mother is still on leave. In the first six months postpartum, there was a 26 per cent decrease in anti-anxiety prescriptions compared with mothers who gave birth just before the policy went into effect. There was a 14 per cent reduction in hospitalisation's or visits to a specialist and an 11 per cent decrease in antibiotic prescriptions.
"A lot of focus has been on what we can do in the hospital immediately following childbirth, but less on mothers' home environment, which is where the vast majority of women spend most of their postpartum time," Rossin-Slater said. "What we're saying is one important component of that home environment is the presence of the father or another adult caretaker."
The United States is the only rich country with no mandated paid leave. American maternal mortality — which includes childbirth-related deaths in the year after a birth — has increased 50 per cent in a generation, and there is a growing movement to help mothers during this critical period.
The American College of Obstetricians and Gynaecologists last year issued new guidelines for more involved postpartum health care. On the campaign trail, many Democratic presidential candidates have pushed for paid leave and for improving maternal health care.
At the same time, the Labor Department recently indicated that it would review the Family and Medical Leave Act, in part to reduce "burdens on employers." The law gives American workers who meet certain qualifications 12 weeks of unpaid leave. James Sherk, a labour adviser to President Donald Trump, has argued that elements of the act are burdensome and abused by workers.
The new study shows how paid time off for family members can improve care for both babies and mothers, experts who were not involved with the research said.
"In those first couple months, you're essentially getting POW-level sleep deprivation," said Neel Shah, an obstetrician and assistant professor at Harvard Medical School. "Especially if it's your first baby, you're probably existentially terrified. And if you're in our country, you're probably trying to earn a living wage at the same time. When you look at what makes our country stand out compared to other countries that have much lower maternal mortality, it's less access to health care and social support."
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The key in Sweden was that the policy allowed fathers to take intermittent, unplanned days of paid leave. The researchers — who used Sweden's vast administrative data, including birth records, leave claims and medical records — were able to see that fathers often used their leave on days that mothers sought health care. The fathers' presence could have averted the need for more serious medical care, such as by enabling mothers to sleep, seek preventive care or get antibiotics early in an infection, they said.
The working paper included data on parents who had their first baby between 2008 and 2012 and focused on comparing those born in the last three months of 2011 and the first three months of 2012, when fathers could take the flexible leave. The effects were strongest in women with histories of medical problems. The researchers looked at two other areas and did not see a change: antidepressant and painkiller prescriptions.
Previously, Sweden required that mothers' and fathers' leaves not overlap (with the exception of 10 days around the birth). The goal, which other countries like Norway and Canada have also pursued, was to promote father-baby bonding and gender equity. There's evidence that when fathers are solely responsible for a baby, they remain more involved with their children and with household tasks for years to come.
But there was an unforeseen consequence. Mothers' health seems to suffer when fathers are prevented from being home in the months after birth (a period sometimes referred to as the fourth trimester because the infant is still so needy and the mother's body is still going through so many changes).
Sweden's paid parental leave policy is among the most generous of any country. It gives new parents 16 months of leave to divide between them, which can be used until the child is 12 or to work part time. The US states that offer paid leave — Connecticut just passed a bill that would make it the seventh state to do so — give much less, between four and 12 weeks.
Yet even a few days of paternity leave can make a large difference for mothers' postpartum health, the Swedish study shows. The typical father in Sweden took only a couple of extra days. It wasn't the length that seemed to matter most, but his flexibility to take time when the mother needed it.
"The number of additional days dads were taking was very small, and yet it seems to have reasonably big effects," said Emily Oster, author of a book about parenting research, "Cribsheet," and an economist at Brown. "There are just some days in which it's very important to have two people — if you've been a new parent, it's easy to think about those."
The second person at home need not be a father — it could be a relative or a same-sex parent, for example. In Sweden, the study pointed to the benefits of grandparent support.
For policymakers, Rossin-Slater said, lessons include the importance of offering leave that is not limited to the baby's primary caregiver and that can be used without advance planning.
Mothers need care, she said, not just the baby. And when the mother is healthy, it ultimately benefits the baby, too.
Written by: Claire Cain Miller
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