|Two new studies led by researchers at the
University of California, Berkeley, suggest that taking maternity
leave before and after the birth of a baby is a good investment in
terms of health benefits for both mothers and newborns.
One study found that women who started their leave in the last
month of pregnancy were less likely to have cesarean deliveries, while
another found that new mothers were more likely to establish
breastfeeding the longer they delayed their return to work.
Both papers were part of the Juggling Work and Life During
Pregnancy study, funded by the Maternal and Child Health Bureau of the
U.S. Health Resources and Services Administration and led by Sylvia
Guendelman, professor of maternal and child health at UC Berkeley's
School of Public Health. The research takes a rare look into whether
taking maternity leave can affect health outcomes in the United
"In the public health field, we'd like to decrease the rate of
C-sections (cesarean deliveries) and increase the rate of
breastfeeding," said Guendelman. "C-sections are really a
costly procedure, leading to extended hospital stays and increased
risks of complications from surgery, as well as longer recovery times
for the mother. For babies, it is known that breastfeeding protects
them from infection and may decrease the risk of SIDS (Sudden Infant
Death Syndrome), allergies and obesity. What we're trying to say here
is that taking maternity leave may make good health sense, as well as
good economic sense."
The study on the use of antenatal leave - time off before delivery
with the expectation of returning to the employer after giving birth -
and the rate of C-sections is the first examination of birth outcomes
in U.S. working women, the researchers said. It will appear in the
January/February print edition of the journal Women's Health Issues.
The researchers analyzed data from 447 women who worked full-time
in the Southern California counties of Imperial, Orange and San Diego,
comparing those who took leave after the 35th week of pregnancy with
those who worked throughout the pregnancy to delivery. Only women who
gave birth to single babies with no congenital abnormalities were
included in the analysis. They adjusted for factors such as
gestational age, infant's sex, maternal race and ethnicity,
occupation, body mass index and height.
Using a combination of post-delivery telephone interviews and
prenatal and birth records, the researchers found that women who took
leave before they gave birth were almost four times less likely to
have a primary C-section as women who worked through to delivery.
The study authors pointed out that the United States falls behind
most industrialized countries in its support for job-protected paid
maternity leave. The federal Family and Medical Leave Act provides for
only unpaid leave of up to 12 weeks surrounding the birth or adoption
of a child.
The bulk of studies on leave-taking and health outcomes from other
countries suggest that taking leave prior to birth can be beneficial.
The authors point to a macroanalysis of 17 countries in Europe that
linked failure to take such leave with low birthweight and infant
mortality. Rates of pre-term delivery were lower among female factory
workers in France if the women took antenatal leave, and a study
conducted in several industrialized countries found that paid leave,
but not unpaid leave, significantly decreased low birthweight rates.
According to the U.S. Census, among working women who had their
first birth between 2001 and 2003, only 28 percent took leave from
their jobs before giving birth while an additional 22 percent quit
their jobs. Twenty-six percent of women took no leave before birth.
"We don't have a culture in the United States of taking rest
before the birth of a child because there is an assumption that the
real work comes after the baby is born," said Guendelman.
"People forget that mothers need restoration before delivery. In
other cultures, including Latino and Asian societies, women are really
expected to rest in preparation for this major life event."
The authors added that financial need may also deter women from
taking leave in the last month of pregnancy. Only five states -
California, Hawaii, New Jersey, New York, Rhode Island - and the
territory of Puerto Rico offer some form of paid pregnancy leave, and
none offer full replacement of the woman's salary.
The study on maternity leave and breastfeeding is in the January
issue of the journal Pediatrics. Using data from 770 full-time working
mothers in Southern California, researchers assessed whether maternity
leave predicted breastfeeding establishment, defined in this study as
breastfeeding for at least 30 days after delivery. Phone interviews
were conducted 4.5 months, on average, after delivery.
In this study, women who had returned to work by the time of the
interview took on average 10.3 weeks of maternity leave. Overall, 82
percent of mothers established breastfeeding within the first month
after their babies were born. Among women who established
breastfeeding, 65 percent were still breastfeeding at the time of the
Researchers found that women who took less than six weeks of
maternity leave had a four-fold greater risk of failure to establish
breastfeeding compared with women who were still on maternity leave at
the time of the interview. Women who took six to 12 weeks of maternity
leave had a two-fold greater risk of failing to establish
Having a managerial position or a job with autonomy and a flexible
work schedule was linked with longer breastfeeding duration in the
study. After 30 days, managers had a 40 percent lower chance of
stopping breastfeeding, while those with an inflexible work schedule
had a 50 percent higher chance of stopping.
Overall, the study found that returning to work within 12 weeks of
delivery had a greater impact on breastfeeding establishment for women
in non-managerial positions, with inflexible jobs or who reported high
psychosocial distress, including serious arguments with a spouse or
partner and unusual money problems.
"The findings suggest that if a woman postpones her return to
work, she'll increase her chances of breastfeeding success, especially
if she's got a job where she's on the clock and has less discretion
with her time," said Guendelman. "Also, women who are in
jobs where they have more authority may feel more empowered with how
they use their time."
The American Academy of Pediatrics (AAP) recommends that babies be
breastfed for at least the first year of life, and exclusively so for
the first four to six months.
According to the AAP, increased breastfeeding has the potential for
decreasing annual health costs in the U.S. by $3.6 billion and
decreasing parental employee absenteeism, the environmental burden for
disposal of formula cans and bottles, and energy demands for
production and transport of formula.
The study authors noted that just having maternity leave benefits
offered by an employer was not helpful in breastfeeding establishment
unless the leave was actually used, indicating the importance of
encouraging the use of maternity leave and making it economically
feasible to take it.
"These new studies suggest that making it feasible for more
working mothers to take maternity leave both before and after birth is
a smart investment," said Guendelman.
Other co-authors of the paper in Women's Health Issues are Michelle
Pearl and Steve Graham, senior research scientists at the Sequoia
Foundation, a California-based non-profit organization focused on
public health research; Alan Hubbard, UC Berkeley assistant professor
of biostatistics; Dr. Nap Hosang, lecturer at UC Berkeley's Maternal
and Child Health program and a practicing obstetrician; and Martin
Kharrazi, research scientist supervisor in the California Department
of Public Health Genetic Disease Screening Program.
In addition to Guendelman, Pearl, Graham and Kharrazi, the
Pediatrics paper was co-authored by Jessica Lang Kosa, research
associate, and Julia Goodman, former graduate student, both at UC
Berkeley's School of Public Health.
The study published in Women's Health Issues received additional
funding from the Center for Health Research at UC Berkeley. The paper
in Pediatrics also received support from the UC Labor and Employment
Research Fund and the UC Berkeley Institute for Research on Labor and