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Providing Social Support for Postpartum Women Through a 4th Trimester Group

#1 · January 31, 2024, 1:12 pm

Quote from Jessa VonFeldt on January 31, 2024, 1:12 pm
Written by Dr. Aubrey Jones, PhD., MSW & Diana Frankenburger, MSN, RNC-OB, CCE, CLS

This guest blog explores the experience of two dedicated maternal health professionals setting up a 4th trimester support group at UK HealthCare in Lexington, KY.  New mothers can register for a free weekly virtual class on the UK HealthCare Childbirth Classes registration page.

Background

Those of us involved in childbirth education spend many hours preparing women and their partners for this life-changing event. We specialize in helping women breastfeed and teaching families how to physically care for their new infants. But little time is spent in preparing them for the postpartum period, emotionally and physically. Many women find themselves far from family with a new baby and are often at home alone soon after their baby’s birth. While Family Medical Leave has allowed some partners to stay home longer postpartum, many partners return to work soon after baby’s birth for financial reasons.

In 2022 I attended a training on Perinatal Mood and Anxiety Disorders (PMAD) by Postpartum Support International. This organization provides webinars and shorter trainings to help providers and educators learn more about PMAD and how to help women find resources. While obstetrical care increases to weekly appointments in the last month of pregnancy, once baby is born, some new mothers may not be seen by their obstetrician for 6 weeks. The recent increases in maternal morbidity and mortality have led many organizations to put greater emphasis on perinatal and postpartum screening. Many pediatric offices are also screening for postpartum depression during well child visits. But even if women are identified through testing like the Edinburgh Postpartum Depression scale, as showing signs of PMAD, resources are not readily available, and women often wait weeks and even months for an open appointment. Obstetricians feel comfortable beginning SSRIs, but often have limited information on therapists available. Studies show that the most effective treatment, in cases not involving a previous history of depression or other psychiatric issues, should start with therapy and then move to medication as needed (Guille et al., 2013).

Around this time, I was approached by Dr. Aubrey Jones, Assistant Professor of Social Work at University of Kentucky, about sharing information on postpartum depression with my childbirth classes. She had experienced postpartum depression with her first pregnancy and has done research in this area. She has found that social support is a protective factor against postpartum depression. We both agreed that women in the immediate postpartum period feel isolated and question their abilities as new moms. This began a partnership to develop a support group called the 4th Trimester.

Creating a Virtual Space

Providing a place for new moms to interact with others without leaving home is a viable solution to the isolation many women describe feeling after giving birth. Because we schedule all the Childbirth Education classes through the University of Kentucky HealthCare’s website, we were able to add registration for the 4th Trimester Group to the same place. Our marketing department also publicized it in our newsletters and on their webpages. It is offered as free, meeting for one hour weekly.

The Zoom platform is an easy virtual platform that can be used via phones or laptops. We chose this platform so that women could join from home with their babies, without feeling they had to travel with a newborn. We planned to ask that women turn on their cameras whenever possible, to help the group feel more connected. We discussed the importance of respect for the opinions of other participants and decided that the opportunity would be given to each new attendee to share their birth story. We believe this is important to help them process their experience and hear about the experiences of others in a safe environment.

Studies show that how new mothers and partners perceive the birth event can influence their satisfaction with the experience, and influence their relationship moving forward (Corner et al., 2023). A birth event viewed as traumatic can also create post-traumatic stress symptoms that influence the postpartum period, even if true Post-Traumatic Stress Disorder does not fully develop. Many of the events those of us in healthcare view as everyday may be viewed traumatically by new mothers and their partners (Corner et al., 2023). This is important for healthcare providers to understand and respect as they listen to and respond to women’s perceptions of their birth experience.

Group Formation & Structure

We discussed whether to have a structured agenda and decided instead to have topics available but allow the women to discuss what they were interested in discussing. We also wanted to be sure we talked openly and frequently about PMAD, allowing women to interject their own feelings in a safe environment. We continue to provide resource lists for our area.

Our first meeting had 3 participants. One was 8 weeks postpartum, and two were approximately 3 weeks postpartum. The women started by sharing their birth stories. One woman shared that she had experienced a birth complicated by preeclampsia and postpartum hemorrhage. She said she remembered little about her birth experience, but that her husband burst into tears when they arrived home. He had been convinced she was going to die during the experience. Another shared that her long induction followed by a cesarean section had left her feeling like her body had failed her. Breastfeeding was also not going well, and she couldn’t get her baby to latch. As the woman who was 8 weeks postpartum shared some of the things she had learned, we literally saw the other participants lean forward in interest. They asked multiple questions and appeared to relax more as the interaction continued. These women returned weekly and were soon joined by others. When needed, we refer to professionals in our area, for instance lactation assistance or mental health services.

While we had anticipated women would begin attending in the first few weeks postpartum, some women began attending more than a month out. Research shows that women have higher symptoms of post-traumatic stress disorder (PTSD) further out than the first few weeks, with percentages actually near double at 6 months postpartum (Vesel and Nickasch, 2015). We have now grown to a typical weekly attendance of 16-20 women ranging from only days to over a year postpartum. We did not anticipate women staying with the group that long but have found that many of the women further along the postpartum journey have become wonderful supports for those just beginning it. Women have made time for our group even after returning to work. We commonly see women holding sleeping newborns, changing diapers, pumping, or sitting at their desks during group. And now, we even see some toddlers who have been with us since their newborn days.

We have begun meeting for lunch every 2-3 months for those living nearby. Others have begun walking together in a local arboretum when the weather permits. Not all our participants live in our area. Some attend from other states, and we have helped them link into groups for new parents in their area. One woman actually started her own postpartum group in another state after attending ours.

Facilitating

We believe having two facilitators is beneficial to help with the flow of the group and allow for unforeseen scheduling conflicts; having facilitators with experience in group dynamics and a background in childbirth education is also helpful, as some discussions require this knowledge base. We have conducted anonymous surveys on our topics and looked for suggestions for group improvement. We use these as guidelines and introduce subjects requested. We have also had guests. We have had two pelvic floor physical therapists after many of the women shared physical issues they had postpartum. We have also had a therapist trained in PMAD attend. A lactation consultant also attended. They share some of their expertise and allow women to ask questions.

Our potential topics vary each week. We have discussed emotions and hormones postpartum, including hypervigilance, obsessive worry over baby, and intrusive thoughts. We have discussed family dynamics, and shared how difficult the adjustment is for couples and relationships. We have talked about physical changes that were never discussed before birth. Women share tips for traveling with a newborn, how to handle unsolicited advice, and even what to look for in a daycare. Some of our participants have a toddler at home and have shared how difficult adjusting to the new baby is for toddlers. Women make recommendations of products, or activities for babies in the area. We send a synopsis of the day’s discussion to women who have registered for the group, even if they didn’t attend that day. Several women who are no longer able to attend have requested to continue receiving the emails with topics discussed.

Results

The group as a whole has expressed that they didn’t really understand the enormity of change that would accompany childbirth. Some women have shown interest in sharing their experience and what they have learned with expectant parents and even providers. Two of the women have attended childbirth classes and shared their experiences, encouraging parents to give themselves and each other grace as they bring babies home.

Overall, our journey to providing support for new moms began with a drive to do something more for postpartum women. What began with 3 attendees has grown to 20. Each week brings something new. We would like to encourage others involved in childbirth education to consider starting a support group like this. We believe your participants will greatly benefit from this added support.

To conclude, we would like to leave you with a beautiful insight from one of our participants on becoming a mother:

With a new baby, a mom is born. This new role means exploring new ways of doing things, pushing yourself out of your comfort zone and finding solutions you may not have considered before. Sometimes you miss the old you and your former life. While some of the “old you” remains, this “new you” is a work in progress—a triumph of becoming the mother of another.

--G. Barnes.

Thank you for allowing us to share our experience.

About the Authors:

Diana Frankenburger is the Prenatal Education Coordinator for UK HealthCare in Lexington, KY. Diana has a Masters in Nursing Education from Benedictine University, and a BSW from Morehead State University. She holds certificates in Obstetrical Nursing, Childbirth Education, and Lactation. Diana developed and teaches all childbirth and lactation preparation for expectant parents in UK HealthCare’s system, and has been trained in Centering Pregnancy. She established a collaborative with Safe Kids, to provide education for pregnant teens in an alternative school. She also provides prenatal support and education for Pathways, a holistic approach to caring for pregnant women with Substance Use Disorder and developed curriculum for Path Home, targeting pregnant women in recovery throughout Central and Eastern Kentucky. Diana is a volunteer Regional Support Coordinator for Postpartum Support International. In April of 2022, Diana and Dr. Aubrey Jones, Associate Professor of Social Work at University of Kentucky, began the 4th Trimester Group, to provide support for postpartum women through a weekly zoom group. For more information, please reach out to Diana at [email protected]

Dr. Aubrey Jones is an Assistant Professor in the College of Social Work at the University of Kentucky. She holds an affiliate faculty position in the Appalachian Studies program at the University of Kentucky. Her research addresses the health and well-being of reproductive-age women and factors affecting access to healthcare and mental health. She is primarily interested in maternal mental health. Jones also researches to better understand the needs of rural communities and the social worker's role in rural communities. Before joining the University of Kentucky, Aubrey worked in crisis intervention for youth and families. She also has experience working in a skilled nursing facility and with youth in juvenile detention and residential programs. Aubrey is a mother to four children and enjoys shuffling them to their various activities and spending quality time as a family.

Related InJoy Products:

Understanding Postpartum Health & Baby Care: Your Guide to the 4th Trimester

Understanding Postpartum Health & Baby Care Book + Guided Learning Web App

Blog References

Barnes, G. (2023). Personal comment, 4th Trimester Group, November 30, 2023.

Corner, G., Rasmussen, H., Khaled, M., Morris, A., Khoddam, H., Barbee, N.,Herzig, S., Brasby, Y., Seibert, E., Sellery, P. Margolin, G., & Saxbe, D. (2023). The Birth of a Story: Childbirth experience, meaning-making, and postpartum adjustment, Journal of Family Psychology, 37(5): 667-679. https://doi.org/10.1037/fam0001062

Guille, C., Newman, R., Fryml, L., Lifton, C., & Epperson, N. (2013). Management of postpartum depression, Journal of Midwifery Women’s Health, 58(6): 643-653. doi: 10.1111/jmwh.12104.

National Institute of Health (2021). What are some common complications of pregnancy? Retrieved from: https://www.nichd.nih.gov/health/topics/pregnancy/conditioninfo/complications

Vesel, J. & Nickasch, B. (2015). An evidence review and model for prevention and treatment of postpartum posttraumatic stress disorder, Nursing for Women’s Health, 19(6): 504-522.

Written by Dr. Aubrey Jones, PhD., MSW & Diana Frankenburger, MSN, RNC-OB, CCE, CLS

This guest blog explores the experience of two dedicated maternal health professionals setting up a 4th trimester support group at UK HealthCare in Lexington, KY.  New mothers can register for a free weekly virtual class on the UK HealthCare Childbirth Classes registration page.

Background

Those of us involved in childbirth education spend many hours preparing women and their partners for this life-changing event. We specialize in helping women breastfeed and teaching families how to physically care for their new infants. But little time is spent in preparing them for the postpartum period, emotionally and physically. Many women find themselves far from family with a new baby and are often at home alone soon after their baby’s birth. While Family Medical Leave has allowed some partners to stay home longer postpartum, many partners return to work soon after baby’s birth for financial reasons.

In 2022 I attended a training on Perinatal Mood and Anxiety Disorders (PMAD) by Postpartum Support International. This organization provides webinars and shorter trainings to help providers and educators learn more about PMAD and how to help women find resources. While obstetrical care increases to weekly appointments in the last month of pregnancy, once baby is born, some new mothers may not be seen by their obstetrician for 6 weeks. The recent increases in maternal morbidity and mortality have led many organizations to put greater emphasis on perinatal and postpartum screening. Many pediatric offices are also screening for postpartum depression during well child visits. But even if women are identified through testing like the Edinburgh Postpartum Depression scale, as showing signs of PMAD, resources are not readily available, and women often wait weeks and even months for an open appointment. Obstetricians feel comfortable beginning SSRIs, but often have limited information on therapists available. Studies show that the most effective treatment, in cases not involving a previous history of depression or other psychiatric issues, should start with therapy and then move to medication as needed (Guille et al., 2013).

Around this time, I was approached by Dr. Aubrey Jones, Assistant Professor of Social Work at University of Kentucky, about sharing information on postpartum depression with my childbirth classes. She had experienced postpartum depression with her first pregnancy and has done research in this area. She has found that social support is a protective factor against postpartum depression. We both agreed that women in the immediate postpartum period feel isolated and question their abilities as new moms. This began a partnership to develop a support group called the 4th Trimester.

Creating a Virtual Space

Providing a place for new moms to interact with others without leaving home is a viable solution to the isolation many women describe feeling after giving birth. Because we schedule all the Childbirth Education classes through the University of Kentucky HealthCare’s website, we were able to add registration for the 4th Trimester Group to the same place. Our marketing department also publicized it in our newsletters and on their webpages. It is offered as free, meeting for one hour weekly.

The Zoom platform is an easy virtual platform that can be used via phones or laptops. We chose this platform so that women could join from home with their babies, without feeling they had to travel with a newborn. We planned to ask that women turn on their cameras whenever possible, to help the group feel more connected. We discussed the importance of respect for the opinions of other participants and decided that the opportunity would be given to each new attendee to share their birth story. We believe this is important to help them process their experience and hear about the experiences of others in a safe environment.

Studies show that how new mothers and partners perceive the birth event can influence their satisfaction with the experience, and influence their relationship moving forward (Corner et al., 2023). A birth event viewed as traumatic can also create post-traumatic stress symptoms that influence the postpartum period, even if true Post-Traumatic Stress Disorder does not fully develop. Many of the events those of us in healthcare view as everyday may be viewed traumatically by new mothers and their partners (Corner et al., 2023). This is important for healthcare providers to understand and respect as they listen to and respond to women’s perceptions of their birth experience.

Group Formation & Structure

We discussed whether to have a structured agenda and decided instead to have topics available but allow the women to discuss what they were interested in discussing. We also wanted to be sure we talked openly and frequently about PMAD, allowing women to interject their own feelings in a safe environment. We continue to provide resource lists for our area.

Our first meeting had 3 participants. One was 8 weeks postpartum, and two were approximately 3 weeks postpartum. The women started by sharing their birth stories. One woman shared that she had experienced a birth complicated by preeclampsia and postpartum hemorrhage. She said she remembered little about her birth experience, but that her husband burst into tears when they arrived home. He had been convinced she was going to die during the experience. Another shared that her long induction followed by a cesarean section had left her feeling like her body had failed her. Breastfeeding was also not going well, and she couldn’t get her baby to latch. As the woman who was 8 weeks postpartum shared some of the things she had learned, we literally saw the other participants lean forward in interest. They asked multiple questions and appeared to relax more as the interaction continued. These women returned weekly and were soon joined by others. When needed, we refer to professionals in our area, for instance lactation assistance or mental health services.

While we had anticipated women would begin attending in the first few weeks postpartum, some women began attending more than a month out. Research shows that women have higher symptoms of post-traumatic stress disorder (PTSD) further out than the first few weeks, with percentages actually near double at 6 months postpartum (Vesel and Nickasch, 2015). We have now grown to a typical weekly attendance of 16-20 women ranging from only days to over a year postpartum. We did not anticipate women staying with the group that long but have found that many of the women further along the postpartum journey have become wonderful supports for those just beginning it. Women have made time for our group even after returning to work. We commonly see women holding sleeping newborns, changing diapers, pumping, or sitting at their desks during group. And now, we even see some toddlers who have been with us since their newborn days.

We have begun meeting for lunch every 2-3 months for those living nearby. Others have begun walking together in a local arboretum when the weather permits. Not all our participants live in our area. Some attend from other states, and we have helped them link into groups for new parents in their area. One woman actually started her own postpartum group in another state after attending ours.

Facilitating

We believe having two facilitators is beneficial to help with the flow of the group and allow for unforeseen scheduling conflicts; having facilitators with experience in group dynamics and a background in childbirth education is also helpful, as some discussions require this knowledge base. We have conducted anonymous surveys on our topics and looked for suggestions for group improvement. We use these as guidelines and introduce subjects requested. We have also had guests. We have had two pelvic floor physical therapists after many of the women shared physical issues they had postpartum. We have also had a therapist trained in PMAD attend. A lactation consultant also attended. They share some of their expertise and allow women to ask questions.

Our potential topics vary each week. We have discussed emotions and hormones postpartum, including hypervigilance, obsessive worry over baby, and intrusive thoughts. We have discussed family dynamics, and shared how difficult the adjustment is for couples and relationships. We have talked about physical changes that were never discussed before birth. Women share tips for traveling with a newborn, how to handle unsolicited advice, and even what to look for in a daycare. Some of our participants have a toddler at home and have shared how difficult adjusting to the new baby is for toddlers. Women make recommendations of products, or activities for babies in the area. We send a synopsis of the day’s discussion to women who have registered for the group, even if they didn’t attend that day. Several women who are no longer able to attend have requested to continue receiving the emails with topics discussed.

Results

The group as a whole has expressed that they didn’t really understand the enormity of change that would accompany childbirth. Some women have shown interest in sharing their experience and what they have learned with expectant parents and even providers. Two of the women have attended childbirth classes and shared their experiences, encouraging parents to give themselves and each other grace as they bring babies home.

Overall, our journey to providing support for new moms began with a drive to do something more for postpartum women. What began with 3 attendees has grown to 20. Each week brings something new. We would like to encourage others involved in childbirth education to consider starting a support group like this. We believe your participants will greatly benefit from this added support.

To conclude, we would like to leave you with a beautiful insight from one of our participants on becoming a mother:

With a new baby, a mom is born. This new role means exploring new ways of doing things, pushing yourself out of your comfort zone and finding solutions you may not have considered before. Sometimes you miss the old you and your former life. While some of the “old you” remains, this “new you” is a work in progress—a triumph of becoming the mother of another.

--G. Barnes.

Thank you for allowing us to share our experience.

About the Authors:

Diana Frankenburger is the Prenatal Education Coordinator for UK HealthCare in Lexington, KY. Diana has a Masters in Nursing Education from Benedictine University, and a BSW from Morehead State University. She holds certificates in Obstetrical Nursing, Childbirth Education, and Lactation. Diana developed and teaches all childbirth and lactation preparation for expectant parents in UK HealthCare’s system, and has been trained in Centering Pregnancy. She established a collaborative with Safe Kids, to provide education for pregnant teens in an alternative school. She also provides prenatal support and education for Pathways, a holistic approach to caring for pregnant women with Substance Use Disorder and developed curriculum for Path Home, targeting pregnant women in recovery throughout Central and Eastern Kentucky. Diana is a volunteer Regional Support Coordinator for Postpartum Support International. In April of 2022, Diana and Dr. Aubrey Jones, Associate Professor of Social Work at University of Kentucky, began the 4th Trimester Group, to provide support for postpartum women through a weekly zoom group. For more information, please reach out to Diana at [email protected]

Dr. Aubrey Jones is an Assistant Professor in the College of Social Work at the University of Kentucky. She holds an affiliate faculty position in the Appalachian Studies program at the University of Kentucky. Her research addresses the health and well-being of reproductive-age women and factors affecting access to healthcare and mental health. She is primarily interested in maternal mental health. Jones also researches to better understand the needs of rural communities and the social worker's role in rural communities. Before joining the University of Kentucky, Aubrey worked in crisis intervention for youth and families. She also has experience working in a skilled nursing facility and with youth in juvenile detention and residential programs. Aubrey is a mother to four children and enjoys shuffling them to their various activities and spending quality time as a family.

Related InJoy Products:

Blog References

Barnes, G. (2023). Personal comment, 4th Trimester Group, November 30, 2023.

Corner, G., Rasmussen, H., Khaled, M., Morris, A., Khoddam, H., Barbee, N.,Herzig, S., Brasby, Y., Seibert, E., Sellery, P. Margolin, G., & Saxbe, D. (2023). The Birth of a Story: Childbirth experience, meaning-making, and postpartum adjustment, Journal of Family Psychology, 37(5): 667-679. https://doi.org/10.1037/fam0001062

Guille, C., Newman, R., Fryml, L., Lifton, C., & Epperson, N. (2013). Management of postpartum depression, Journal of Midwifery Women’s Health, 58(6): 643-653. doi: 10.1111/jmwh.12104.

National Institute of Health (2021). What are some common complications of pregnancy? Retrieved from: https://www.nichd.nih.gov/health/topics/pregnancy/conditioninfo/complications

Vesel, J. & Nickasch, B. (2015). An evidence review and model for prevention and treatment of postpartum posttraumatic stress disorder, Nursing for Women’s Health, 19(6): 504-522.