Maternal health matters: support for mothers through pregnancy and postpartum with occupational therapy

Experiences during pregnancy, childbirth, and postpartum profoundly influence the physical, emotional, and psychosocial health of both mother and child (1). However, challenges faced by the perinatal and maternal population in Canada are often overlooked (2), highlighting the ongoing struggle to access quality maternal healthcare.

The benefits of occupational therapy in maternal health remain largely unrecognized (3), when in fact occupational therapists (OTs) are uniquely equipped to address physical, psychosocial, emotional, and environmental concerns during pregnancy and postpartum.

OTs can evaluate and intervene in the daily tasks and responsibilities during the perinatal period and beyond. They address physical and psychosocial needs in preparation for and following cesarean and vaginal births, and can recommend equipment to support function, as well as optimizing nursing positions and postures. OTs enable you to perform self-care tasks independently, such as showering, toileting, and getting in and out of bed.

Three ways occupational therapy can support maternal health

Optimize your pelvic health

The pelvic bowl, comprising bony landmarks like the hips, pubic bone, sitz bones, and tailbone, contains three layers of muscles forming the pelvic floor. Pregnancy and childbirth are associated with pelvic floor disorders, with urine leakage affecting about one third of women in the first three months post-delivery and fecal incontinence reported by one in five women one year after childbirth (4,5). Pelvic pain, body image concerns, and sexual intimacy issues are other common postpartum experiences (6,7).

As therapists embrace a trauma-informed approach, we prioritize assessing factors like the mother's lived experiences, such as birth trauma or social isolation, which can affect pelvic floor function. Pelvic health encompasses far more than just the three layers of the pelvic floor.

Occupational therapists, with our holistic approach and expertise in daily activities, play an important role in addressing these intimate pelvic health issues that are seldom discussed.

Your occupational therapist can provide:

• Education: Understand your pelvic floor’s function, get guidance on vulvar and perineal care, normalize common postpartum pelvic floor issues, and learn more about sexual health.

• Rehabilitation: Retrain your bladder and bowel, reconnect and strengthen your core, practice therapeutic exercises, and learn about pain management and lifestyle modification.

• Ergonomics: Get guidance on optimal body mechanics and equipment to prevent pelvic floor strain during caregiving and other activities.

• Mental health support: Learn stress management strategies to regulate your nervous system and address psychosocial aspects of pain with intimacy.

• Collaborative solutions: Your OT can work with other healthcare professionals to ensure comprehensive pelvic floor care.

Address postpartum hand and wrist pain

Hand and wrist pain are common musculoskeletal issues during pregnancy and postpartum. Hormonal changes, fluid retention, and repetitive hand movements can lead to conditions like De Quervain tendinitis (8), which is characterized by pain and swelling at the thumb side of the wrist, as well as difficulty with thumb movement. Factors like repeatedly lifting and holding a baby in awkward, static positions for nursing contribute to its development. This condition, along with carpal tunnel syndrome and trigger finger, can develop in pregnancy, persist in postpartum, and limit daily parenting activities.

Your occupational therapist can provide:

• Custom splints for tendon healing

• Ideas for how to modify your activities to minimize strain

• Equipment recommendations

• Education on non-surgical interventions such as corticosteroid injections

• Gentle muscle stretching and strengthening(9)

Mental health care for mothers

Perinatal mood and anxiety disorders (PMADs) are among the most common post-pregnancy complications (10), which and can affect multiple aspects of a mother’s life. OTs in maternal health are trained to recognize PMADs and can help you adjust to the changes that come with parenting your new child.

Your occupational therapist can provide:

• Support during this role transition

• Ideas for how to manage new family dynamics

• Time management skills

• Practical support for resuming daily routines

• Help to find social support through local and online resources

• Referrals to other healthcare practitioners that can provide direct psychological treatment

No matter what challenges you’re experiencing in your prenatal, pregnancy, or postpartum life, a maternal health occupational therapist can help.

The Canadian Association of Occupational Therapists (CAOT) provides a searchable national directory of occupational therapists for all Canadians to find the occupational therapy services they need. You can search for an OT who can provide maternal health services.

Find an OT now in your area for further assistance.

Author Bio

Karina Jackson is an occupational therapist and entrepreneur based in Montreal, Quebec, specializing in maternal health, pelvic health, and hand therapy. Drawing from her extensive experience in the public health sector, she is passionate about providing quality care in private and community-based settings.

References

1. Mudiyanselage, S. B., Wanni Arachchige Dona, S., Angeles, M. R., Majmudar, I., Marembo, M., Tan, E. J., Price, A., Watts, J. J., Gold, L., & Abimanyi-Ochom, J. (2024). The impact of maternal health on child's health outcomes during the first five years of child's life in countries with health systems similar to Australia: A systematic review. PloS one, 19(3), e0295295. https://doi.org/10.1371/journal.pone.0295295

2. Dalhousie University. (n.d.). Maternity Matters: An Occupational Therapy Perspective on Women's Health. Retrieved from https://cdn.dal.ca/content/dam/dalhousie/pdf/diff/ace-women-health/2/b/ACEWH_maternity_matters.pdf

3. Meekins AR, Siddiqui NY. Diagnosis and management of postpartum pelvic floor disorders. Obstet Gynecol Clin North Am 2020;47(3):477-86.

4. Woodley SJ, Lawrenson P, Boyle R, Cody JD, Mørkved S, Kernohan A, et al. Pelvic floor muscle training for preventing and treating urinary and faecal incontinence in antenatal and postnatal women. Cochrane Database Syst Rev 2020;(5):CD007471.

5. Wu YM, McInnes N, Leong Y. Pelvic floor muscle training versus watchful waiting and pelvic floor disorders in postpartum women: a systematic review and meta-analysis. Female Pelvic Med Reconstr Surg 2018;24(2):142-9.

6. Luthander C, Emilsson T, Ljunggren G, Hammarström M. A questionnaire on pelvic floor dysfunction postpartum. Int Urogynecol J 2011;22(1):105-13. Epub 2010 Aug 27.

7. Afshar, A., & Tabrizi, A. (2021). Pregnancy-related Hand and Wrist Problems. The archives of bone and joint surgery, 9(3), 345–349. https://doi.org/10.22038/abjs.2020.50995.2531

8. Postpartum Support International. (n.d.). Canada. Retrieved from https://www.postpartum.net/canada/

9. Wagner, A. (2019). Upper Extremity Pain in Breastfeeding Mothers: A Narrative Review of the Literature. Journal of Hand Therapy, 32, 560-561.

10. Taiwo, T. K., Goode, K., Niles, P. M., Stoll, K., Malhotra, N., & Vedam, S. (2024). Perinatal Mood and Anxiety Disorder and Reproductive Justice: Examining Unmet Needs for Mental Health and Social Services in a National Cohort. Health equity, 8(1), 3–13. https://doi.org/10.1089/heq.2022.0207