Occupational Therapy and Maternal Wellness: Support Through Co-Occupation
By Suzanne Cohen OTR/L, PMH-C & Emily Scott OTR/L, IBCLC, RYT
Originally published on: https://wearerobyn.co/learn/OT-maternal-wellness
Occupational Therapy (OT) is a holistic practice and health profession that focuses on everyday life tasks and activities like sleep, eating, play and work. As much as these “occupations”, as we call them, seem to be built into the fabric of our daily life, they actually require many physical and mental aspects to be in place to be completed. When a part of someone’s life changes, so does their ability to complete these activities. Occupational therapists are able to analyze, modify, and adapt all aspects of occupations so they can be executed easily and efficiently.
People need occupational therapy for a myriad of reasons - a chronic illness, recovering from surgery, or dealing with a temporary physical condition. In the case of a new mom, the inevitable postpartum body changes mean daily activities might need to shift. Plus, sleep is disrupted, self-care is hard to attain, social support may seem limited and new routines are difficult to establish. Occupational therapists help new moms with all of this, in a different kind of way than a family member would.
New moms aren’t the only one that may need occupational therapy services, sometimes infants need OT too. A premature infant may exhibit low postural tone, delayed reflexes and trouble feeding. Even some full term babies can have trouble reaching milestones for any number of reasons. OTs are specially trained to address infant and pediatric needs and help them stay on track to develop necessary skills for a good quality of life.
What is co-occupation?
From the moment a woman becomes pregnant, everyday occupations may drastically change. Simple activities such as sleeping, eating, and dressing can become increasingly difficult. In addition to the previously stated occupations, mothers begin performing something called co-occupations with their babies. A co-occupation comes from occupational science and refers to two people performing a task, each influencing the other. The task involves aspects of shared physicality, shared emotionality, and shared intentionality.
For example, dressing an infant is a co-occupation. Mom and baby share the space and must work together physically. The mom is required to move her body to dress the baby, possibly having to hold the infant or toddler still in what can often be a difficult task, moving the baby’s body in a way that will allow her to be dressed. The baby’s body must be able to move to allow dressing to take place, and she must tolerate being touched and moved. Dressing is an intimate activity that sparks emotion in both mom and baby. If the baby dislikes being dressed, she may feel upset or frustrated, in turn making mom upset or frustrated. On the flip side, if the mother successfully dresses the baby for the first time, she may feel pride, while the baby feels happy with the attention she’s receiving from her mother. Ultimately, mom and baby share the intention of completing this meaningful activity.
Baby care tasks
Mothers and babies work together throughout the day in a series of near constant, basic childcare co-occupations: dressing, changing diapers, bathing, lifting, and carrying. How mom and baby engage in these tasks together changes as the baby develops new skills and grows larger. A mother’s ability to engage in these tasks is impacted by her physical abilities, her competing daily demands, the equipment she uses, and her environment.
During the early postpartum period, post-operative recovery from a Cesarean section or injuries related to a vaginal birth can make even simple movements, like picking the baby up from the crib, challenging. The repetitive nature of these frequent baby caregiver activities often cause pain and stress on a mom’s joints, for example Carpal Tunnel syndrome or DeQuervain’s tendonitis. Hormones present in postpartum women make their joints more flexible, putting them at higher risk for pain and injuries. It takes time to rebuild core strength after pregnancy as well. OTs are trained in evaluating a mother’s strength, joint motion, pain, functional movement and how any of these issues might impact caring for their baby. They can identify signs of common postpartum joint injuries and provide mom with therapeutic exercises, pain management strategies, and new ways to physically perform these basic tasks to increase mom’s healthcare and her ability to care for her baby in a pain-free way.
While a younger baby might not be able to “help” with any of these occupational performance tasks, their ability to tolerate the sensory stimulation and physical movements of the tasks impact mom and baby’s overall experience. For example, a colicky baby who wants to be held or carried frequently might have difficulty laying on the changing table for dressing or diapering.
Occupational therapy services can teach parents strategies to soothe or calm the baby during these activities, or change the way the activity is performed for the baby to better tolerate it. As babies grow older and are more active, it can place even greater strain on a mother’s body to care for them. OTs can help moms change how they perform these activities and teach them best body mechanics with bending, lifting, and carrying their babies to prevent and manage pain or other health problems.
Infant feeding is one of the most clear examples of a mom-baby co-occupation, where mom and baby’s experience closely influence one another. Feeding a newborn or young baby requires a parent to be very observant and respond appropriately to their infant’s cues and communication - recognizing when a baby is hungry, when they need to be burped, or when it’s time to stop the feeding. Physically, a mom and baby need to be positioned in a way that’s comfortable for both and conducive to safe and efficient feeding for the baby. Changes made during feeding, such as the type of bottle, position the baby is in, or where the baby is being fed, can influence the baby's feeding behavior. Any dysfunctions with the baby's ability to achieve a calm and awake state for feeding, strength and endurance, or sucking and swallowing coordination naturally impacts the feeding experience.
When breastfeeding, baby and mom’s bodily systems are closely linked. The baby’s hunger behaviors and sucking abilities trigger the mother’s hormonal and neurological systems to make and release milk for the baby. A variety of factors can pose challenges to this feeding cycle. Babies who have difficulty sucking appropriately may not stimulate mother’s milk production adequately. Physical illness or health issues can impact mom’s ability to make milk or stress can interfere with the mom’s milk release. The daily routine of a mother who is exclusively breastfeeding or pumping revolves tightly around the timing of her baby’s feeding. For example, a working mother must make sure she is emptying her breasts sufficiently and frequently enough to maintain her milk supply and keep breasts healthy.
Occupational therapists are primed to support both mom and baby with a vast array of factors impacting the feeding co-occupation. OTs trained in infant feeding and development can identify any strength or coordination challenges impacting physical feeding abilities, and in response can recommend changes to baby’s position, type of bottle used, or parental feeding techniques. OTs are trained in the use of calming strategies to help soothe babies or to also manage a mother’s stress or impairment. These can help a colicky baby whose fussing is impacting their feeding abilities, or a distressed breastfeeding mother who is having difficulty letting down her milk during a feeding. OTs can help mothers manage wrist or shoulder pain, by exploring a variety of feeding positions, providing an appropriate exercise program, or recommending equipment such as feeding pillows or wrist braces. By assisting with time management, facilitation, organization, or delegation, an OT care provider can help mom find strategies to balance many competing demands in her day to manage frequent feeding or pumping needs.
Mom and baby’s sleep is strongly interconnected, as the old saying “sleep when baby sleeps,” suggests. Sleep can be considered a co-occupation for mom and baby, as they very often share a sleep space with a shared purpose of reaching a prolonged period of deep, restorative sleep. Challenges with sleep for both mom and baby are unfortunately accepted as commonplace. Postpartum women are at higher risk for challenges with sleep, particularly if they are also struggling with a postpartum mood or anxiety disorder. Hormonal changes and physical discomfort related to postpartum physical recovery also impacts mom’s sleep. A newborn baby often has reversed day and night wake patterns, as well as a developmental need for several nighttime feedings for the first months. These factors paired together create many challenges for sleep for both mom & baby.
Case studies and data collection confirms that mom and baby’s sleeping patterns affect each other significantly. Poor sleep for new moms has been associated with worse daytime cognitive functioning and increased risk for depressive symptoms. Adequate sleep for newborns is known to be critical for neurological development, physical growth, and optimal feeding. Unfortunately, poor sleep for mom and baby can lead to a cycle where an overtired and fussy baby places increased demands on an overtired mother who has less opportunities and ability to engage in her own self-care.
Fortunately, occupational therapists are able to offer a variety of support and early interventions to assist both mom and baby with sleep. OTs are trained to recognize signs of mental illness or health disorders, such as depression and anxiety, which place women at higher risk for sleep problems, and can help connect moms with appropriate local mental health professionals, clinical practices or support groups.
Occupational therapy interventions can assist mothers with sleep techniques including modifying daily activities and routines with the baby to promote improved sleep cycles. For mom, this may include designing a daily routine with sufficient physical activity and wind down time to promote sleepiness at a target bedtime. For babies, this may include teaching mom about age appropriate wake and sleep states for babies, how to recognize and respond best to early sleep cues, or how to modify baby’s activities or routine to meet their developmental sleep needs. OTs can also do a thorough questionnaire and assessment of the sleeping environment for both mom and baby and suggest changes to level of light and noise, or help find the right type of swaddle to best transition into & maintain a sleeping state. They can help mom to explore modified sleeping positions or equipment to minimize pain and disrupted sleep associated with common postpartum physical discomforts such as hemorrhoids, post-surgical pain after Cesarean section, and upper body or back pain. OTs also conduct follow ups to see if what they suggested is now working for mom and baby.
Why are co-occupations important for new moms and babies?
As you can see, co-occupations, the ‘dance’ between mothering and baby, are meaningful occupations to their relationship, and the well-being of both. If mom is struggling emotionally or physically, she may not feel successful as a mother. But, if mom and baby participate in co-occupations successfully, secure attachment can be achieved. OTs are skilled in addressing the emotional, sensory, and physical aspects of tasks mom and baby engage in together, as well as understanding the unique developmental needs of baby and postpartum needs of mom. By supporting co-occupations, they can be instrumental in promoting wellness for both, and ultimately ensuring a strong mother-baby bond.