A comparison of the mothers in our study vs. women in the same county (21
) is presented in . The mean age of the mothers in our study was 30.3 years (sd 5.6 years). By design, the racial distribution was well-matched to the county distribution with 30% Black and 70% non-Hispanic white mothers. County-level proportions presented reflect those of women aged 15 – 50 years who had a birth in the past 12 months in Forsyth County, NC (21
). In comparison, our study participants were more highly educated than the general population of recent mothers, with 47% having a college degree or higher vs. 22% of women in the county. More women in our study were married (77% vs. 61%, respectively). By design, women in our study were employed full-time, working on average 39.5 hours/week.
Comparison of study sample vs. county data.
The majority of women in our study reported receiving their prenatal care from an obstetrician (91.2%). The remainder of the care was provided by family physicians (5.1%), midwives (1.4%), nurse practitioners (0.9%), or “other” (0.9%).
Approximately 60% of study participants reported having had a RTW discussion with their prenatal healthcare providers (). In bivariate analyses, such discussions were more common among Black mothers (p=0.003), mothers below the poverty threshold (p=0.01), and single mothers (p=0.02). In contrast to mothers using family members or formal daycare arrangements, fewer mothers using “other” childcare arrangements had a RTW discussion with their prenatal care providers (p=0.05) (). “Other” childcare arrangement typically involved relying on informal babysitters or multiple childcare arrangements. The average length of maternity leave did not differ between those having vs. not having a RTW discussion with a prenatal care provider (62.0 vs. 65.2 days, respectively; p=0.28). Results from a multivariate logistic regression model indicated that Black mothers (OR 2.6; p=0.006) and those meeting the 2007 poverty threshold (OR 3.6; p=0.047) were more likely than non-Hispanic white mothers and those above the poverty threshold, respectively, to have a RTW discussion with their prenatal care provider. Marital status and childcare arrangements were no longer significant in multivariate analysis.
Characteristics differentiating working mothers having a return to work (RTW) discussion with their prenatal healthcare provider
Over one-half (57.6%) of study participants reported having a RTW discussion with their infants' healthcare provider. Mothers with a college degree or higher (p<0.0001) and those among the highest income quartiles (p=0.05) more often reported having had a RTW discussion with their infants' healthcare providers (). Mothers who had a RTW with their infant's healthcare provider reported having a longer maternity leave than those who did not have a RTW discussion with their infant's healthcare provider (66.0 vs. 59.4 days; p=0.03). Trend-level evidence (p < .10) suggested that mothers who exclusively breastfed and those above the 2007 poverty threshold were also more likely to report having had a RTW discussion with their infant's healthcare provider. Maternal education was the only variable that survived multivariate analysis; the odds of having a RTW discussion with the infant's healthcare provider was greater only mothers with a college degree or higher (OR 2.7; p=0.001) in contrast to those with less than a college degree.
Characteristics differentiating working mothers having a return to work (RTW) discussion with their infant's healthcare provider
The majority of mothers, 83.4% (181/217), believed that prenatal care providers should discuss returning to work with pregnant women (). Among those having a RTW discussion with their prenatal care providers, such conversations were typically (61%) initiated by the women, not the healthcare providers. The frequencies of such discussions were as follows: 41.2% had a single discussion, 48.1% had 2-3 discussions and 10.7% had more than 3 discussions; similar data were not collected about the infants' healthcare providers.
Characteristics of return to work discussions with prenatal and infant's healthcare provider.
The majority of women having a RTW discussion with their prenatal providers felt the discussion was somewhat useful (39.7%), while 24.4% felt it was very useful and 35.9% felt the discussion was not useful at all. Similarly, the majority of women having a RTW discussion with their infants' healthcare providers felt the discussion was somewhat useful (49.2%) while 29% felt the discussion was very useful and 21.8% felt the discussion was not useful at all ().
There was substantial variation in the content of women's RTW discussions with healthcare providers (). The content of nearly half (46.3%) of the RTW discussions with the prenatal healthcare providers focused on neither maternal health and well-being nor infant health or development. Indeed, only 19.5% of mothers had a RTW discussion focused on maternal health (i.e., physical or mental), 10.6% discussed their infants' health or development, while 23.6% discussed both of these topics. The content of RTW discussions with the infant's healthcare provider was more focused. Fully one-third (33.6%) reported that the RTW discussion with their infants' healthcare providers centered on infant health or development, whereas 8.4% of mothers had a discussion about maternal health (i.e., physical or mental) and 22.7% reported discussing both issues relevant to maternal and child health. Slightly more than one-third of RTW discussions (35.3%) with infants' healthcare providers covered neither maternal nor child health.