Interventions for Women With Postpartum Depression Symptoms

Abstract

Using the stress-buffering hypothesis as a guide, this integrative review aims to identify how human resource development (HRD) professionals can address the issues faced by working women who are experiencing postpartum depression symptoms, in addition to identifying gaps in HRD research on this emerging topic. Most of the studies reviewed came from the nursing and psychology literature; none were found in the HRD literature. This review was undergirded by the stress-buffering hypothesis, which posits that social support can moderate the effect of a stressful event. Studies pointed to social support, especially from coworkers and supervisors, as having a positive effect on postpartum depression symptom scores. Overall, the findings of this study are entry points into HRD research and practice about how employers can support working women who are experiencing postpartum depression symptoms. Further research should examine the type of social support that is effective in helping working mothers.

Keywords

postpartum depression awareness working mothers interventions HR practices

Postpartum depression symptoms can occur in new mothers after the birth of a child. Women who experience postpartum depression symptoms exhibit a depressed mood or loss of interest or pleasure along with three or more of the following symptoms: significant weight loss or gain, lack of sleep or too much sleeping, overstimulation or delay in reactions, fatigue or loss of energy, feelings of worthlessness or guilt nearly every day, diminished ability to think or concentrate, or recurrent thoughts of death or suicide (with or without a plan; American Psychiatric Association, 2013). Postpartum depression symptoms pose a health concern for working mothers and the organization with which they are employed. Although there are no figures to estimate the direct cost of depression with postpartum onset, depression accounts for a higher incidence of absenteeism (time taken off from work) and a lack of presenteeism (ability to produce effectively; Greenberg et al., 2003; Lerner et al., 2012). The lack of productivity and time taken off from work account for $51.5 billion lost in wage-based value (A. Beck et al., 2011).

Women make up 57.7% of the labor force (U.S. Bureau of Labor Statistics, 2014). Of these women, 60.7% have children below 3 years old, 64.7% have children below 6 years old, and 76.01% have children between ages 6 and 17 years (U.S. Bureau of Labor Statistics, 2014). Because women, especially mothers, make up a large part of the workforce, organizational researchers and practitioners should be prepared to help women with postpartum depression symptoms, not only for their own health but also because of its effect on employee productivity.

At 6 weeks postpartum, women usually obtain medical clearance from their doctors and are able to resume normal activities, including work (McGovern et al., 1997). Even so, a medical clearance does not mean a woman is necessarily free of postpartum depression symptoms. The Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association, 2013) informs that the onset of postpartum depression symptoms is within the first 4 weeks after the birth of a child; however, several studies have shown that the highest risk for the onset of depression is within the first 3 months after delivery (Andrews-Fike, 1999; Horowitz & Goodman, 2004; Stowe, Hostetter, & Newport, 2005). Other researchers have found that the risk of onset is elevated through the first 6 months after delivery (Beeghly et al., 2002; Stuart, Couser, Schilder, O’Hara, & Gorman, 1998). These discrepancies make it difficult to fully understand when postpartum depression begins and what triggers the onset. However, one thing is very clear; a woman who is left untreated is likely to be depressed well into, and in some case, after, her child’s first year of life (Carpiniello, Parante, Serri, Costa, & Carta, 1997; O’Hara & Zekoski, 1988).

According to a recent U.S. Department of Commerce report, 28.3% of women return to work within 3 months of having a child, 26.7% return within 3 to 5 months, 7.4% return within 6 to 11 months, and 37.6% never return to their previous employers (Laughlin, 2010). Although the majority of women are returning to work well past the 4-week onset period described by the DSM-5 (American Psychiatric Association, 2013), many women are still returning to work well within the period identified by researchers as high risk for postpartum onset (Andrews-Fike, 1999; Beeghly et al., 2002; Horowitz & Goodman, 2004; Stowe et al., 2005; Stuart et al., 1998). For human resource development (HRD) professionals, this means that of the two out of every three new mothers who return to work, each new mother has a 25% chance of developing postpartum depression symptoms (O’Hara & Swain, 1996).

Work leave programs allow women to recover from childbirth and bond with their new baby, but what happens once it is time to go back to work? The literature surrounding the maternity leave and subsequent return-to-work transition focuses on the following areas: breastfeeding cessation (Chuang et al., 2010; Skafida, 2012; Wells, 2012), reduced earning capacity after leave (Aisenbrey, Evertsson, & Grunow, 2009; Baker, 2011), work–life balance for new mothers (Alstveit, Severinsson, & Karlsen, 2011; Buzzanell et al., 2005; Feldman, Sussman, & Zigler, 2004; Spiteri & Xuereb, 2012), likelihood of returning to work after the birth of a child (Coulson, Skouteris, Milgrom, Noblet, & Dissanayake, 2010; Stomp-van den Berg et al., 2007), and policy issues (Buzzanell & Liu, 2005; Hofferth & Curtin, 2006; Wiese & Ritter, 2012). A gap exists in the literature in reference to the association between postpartum depression symptoms and significant organizational outcomes like job performance, organizational commitment, and turnover intent. This literature gap extends to little information about how to support women with postpartum depression symptoms, or women who are within the 6-month period of high onset risk, in transitioning back into their role of employee.

Acknowledging that as a form of depression, postpartum depression is a significant workplace issue because of its potential harm to not only the mother but also the organization, the need to skillfully and sensitively deal with the issue in workplace settings should be a concern to everyone, especially managers and mental health and human resource professionals. Because managers and other organizational professionals need to learn about the relevance of postpartum depression symptoms for new mothers and how it can negatively affect important organizational outcomes, HRD researchers and practitioners seem best suited to lead efforts to assist organizations to deal correctly with the issue. HRD researchers and practitioners can design and implement training and development activities, for example, to help sensitize managers and coworkers to the debilitating nature of postpartum depression, its etiology, and current best practices in handling the situation. Likewise, HRD researchers could design research to investigate how and why it impacts organizational outcomes like performance and, more importantly, investigate creative new ways to assist mothers to successfully navigate the back-to-work transition, and thereby mitigate possible productivity losses. For this reason, although this could be a mental health or human resource management issue in general, we focus on HRD because it has the most promise to lead organizations through research and training and development activities in dealing most effectively with this vexing and troubling issue in workplace settings.

Purpose Statement

Using the stress-buffering hypothesis by Cohen and Wills (1985) as a guide, this integrative review literature (Torraco, 2005) uses peer-reviewed research from various fields to identify how HRD professionals can address the issues faced by new mothers who are returning to work while experiencing postpartum depression symptoms, in addition to identifying gaps in HRD research on this emerging topic. To begin, there is an explanation of the stress-buffering hypothesis. Next, there is an explanation of the research design, which limits the literature review to studies conducted in the United States. The rationale is that the United States is lacking in supporting new working mothers, especially in comparison with other industrialized nations do (e.g., paid maternity leave; Appelbaum & Milkman, 2015). This is followed by a review of the literature, and finally a discussion of how this study contributes to HRD theory and research.

Conceptual Framework

The major risk factors for postpartum depression symptoms include depression and anxiety while pregnant, an unplanned or unwanted pregnancy, poor marital relationship, lack of social support, low socio-economic status, and stressful life events including child care factors (C. T. Beck, 2001; O’Hara & Swain, 1996; Robertson, Grace, Wallington, & Stewart, 2004). The last two factors are directly related to the workplace, and therefore it is important to understand the decisions women make about work and work leave while they are pregnant, and especially after a child is born. If a mother chooses to take time off of work during her pregnancy or after the birth of her child, her income will likely be affected (a risk factor) as only 39% of male and female workers report having access to paid leave (The Council of Economic Advisers, 2014). If she does return to work, she will have to decide who will care for her child while she works (another risk factor; C. T. Beck, 2001; O’Hara & Swain, 1996; Robertson et al., 2004).

Social support can be categorized into two types: received (enacted) support and perceived support. Received (enacted) support refers to actions taken by friends and family during stressful situations, while perceived support is based on a person’s belief that they will receive effective support (Lakey & Orehek, 2011). The stress-buffering hypothesis, which undergirds this study, focuses on enacted support while a competing module, the relational regulation theory, focuses on ordinary social interaction to mediate stress (Lakey & Orehek, 2011). For example, a new mother who is returning to work with postpartum depression symptoms may be experiencing anxiety about her return to work. The stress-buffering hypothesis posits that receiving help to cope with the impending return to work could buffer the effects of the related stress. However, the relational regulation theory would posit that having regular daily interactions that do not revolve around conversations of returning to work could mitigate the related stress effects. Both theories have been used in psychology to explain how social support is related to mental health outcomes.

The researchers chose to explore the application of the stress-buffering hypothesis to the problem of women experiencing postpartum depression symptoms at work because of its application in previous studies about postpartum depression symptoms (Dagher, McGovern, Alexander, Dowd, Ukestad, & McCaffrey, 2009; Thoits, 2011) and its applicability to the field of HRD. The crux of the stress-buffering hypothesis centers on giving social support to a person at pivotal moments before and during a stressful situation (Cohen & Wills, 1985). Social support is categorized into four types: emotional (demonstrations of love and caring), informational (providing facts or advice that can help to solve problems), instrumental (offering assistance with practical tasks or problems), and appraisal (providing feedback about a person’s view of their situation; Thoits, 2011). Importantly, HRD professionals are able to provide at least three types of support (information, instrumental, and appraisal) to employees who have recently had a child and may be experiencing postpartum depression symptoms.

Cohen and Wills’s (1985) stress-buffering hypothesis (1985) has five stages, which begin with the occurrence of a potentially stressful event. A stressful event refers to a situation that has the potential to elicit a negative effect, physiological response, and behavioral adaptation (Cohen & McKay, 1984). In this study, the first potentially stressful event is returning to work after the birth of a child.

The next stage of the stress-buffering hypothesis is appraisal of the stressful event. If there is an intervention at this point, either before there is a reaction to the stress reaction to the event or during the anticipation of said event, then there is a possibility that a stress appraisal response can be avoided (Cohen & Wills, 1985). In other words, if a new mother is anticipating that returning to work will be a stressful event then, before the event occurs, others can intervene to help her change her perception.

In the third stage, when social support from others does not intervene, the event is appraised as stressful. Lack of support could mean that the new mother has decided that returning to work will have negative outcomes for her and her child. The fourth stage posits that the new mother will experience an emotionally linked physiological response or behavioral adaptation, such as anxiety or sadness. At this point, social support from others could help the mother reappraise the stressful event and also her response to it. However, without social support, the emotional response is followed by the illness or illness behavior (depression), which is the fifth stage of the hypothesis, and, as we posit, it can ultimately lead to work impairment (i.e., increased absenteeism and decreased presenteeism).

This theory supports the notion that HRD professionals have two opportunities to help new mothers in their return-to-work transition. The first opportunity is just before the new mother is returning to work after leave. The theory postulates that at this point, offering social support (e.g., locating online support resources or helping a new mom locate reliable child care) could help ease the stress of returning to work, which could therefore mitigate any further negative outcomes. The second point where an HRD professional could help is once the new mother has already returned to work. In this case, the HRD professional could support offering social support through allowing new moms to network with other mothers in the organization or training supervisors or managers to check in regularly with new moms to help the new mother reappraise the situation. If the social support is successful in resulting in a positive reappraisal, illness or illness behaviors and posited subsequent work impairment may be inhibited.

Research Design

Because the issues related to HRD span multiple disciplines (e.g., business, psychology, education, and social sciences), the following large databases were searched: Academic OneFile, Academic Search Complete, ProQuest, PsycINFO, and Social Sciences Citation Index. The search term “postpartum depression or postnatal depression” was combined with each of the following terms individually to search each database: workplace, job, employee, employee assistance program, and human resources. The literature search was not delimited necessarily by a time frame; however, this article only includes English language, full-text available, empirical studies available through July 23, 2015. The search was limited to peer-reviewed articles, published in English in the United States. After removing 300 duplicates, 124 articles were available for selection. Table 1 represents the number of available articles for the aforementioned descriptors in each of the five databases.

Table 1.

Findings of Research Databases.

Database	Results
Academic OneFile	37
Academic Search Complete	20
PsycINFO	95
ProQuest	250
Social Science Citation Index	22
Subtotal	424
Repeated articles	300
Total	124

The second stage of this review consisted of a staged review (Torraco, 2005), wherein the researchers reviewed the abstracts of each of the 124 studies. Studies that were not related to HRD practices, work, employment status, and postpartum depression in women were excluded. For example, an article about men’s peripartum mental health was excluded (Singley, 2015) as well as several articles investigating clinical treatments and procedures (D’Angelo, Williams, Harrison, & Ahluwalia, 2012; Leddy, Haaga, Gray, & Schulkin, 2011; Stuebe, Grewen, Pedersen, Propper, & Meltzer-Brody, 2012). This narrowed the number of relevant articles to 22. Ten studies were excluded because the purposes were not narrowly focused on postpartum maternal mental health in the context of the workplace. This brought the sample down to 12 articles. No articles were directly related to HRD practices, nor were any published in HRD journals. Notwithstanding, the remaining 12 articles were selected because they discussed postpartum maternal mental health in the context of the workplace. Table 2 gives an overview of the fields where the 12 selected articles were published.

Table 2.

Findings by Field of Publication.

Field	Results
Medicine	2
Psychology	4
Public Health	6
Total	12

All 12 articles were printed and individually stapled. The researchers read each article and highlighted emerging key words and topics. An emphasis was placed on key words and topics that were directly related to the recommendations of the stress-buffering hypothesis. For example, according to the stress-buffering hypothesis, the first point when an HRD professional should intervene is just before the new mother returns to work. Therefore, there was an emphasis placed on looking for key words and topics related to maternity leave or returning to work. The second opportunity for an HRD professional to intervene is once a new mother has returned to work; therefore, a focus point of this study was to identify articles that contributed to knowledge around what stressors occur during this period, either at home or work.

The first page of each article was used to note the key words and the overarching research topic, such as maternity leave. From this process, four topic areas emerged. The packets were grouped by their respective topics. Then, each article was re-read and compared with the other articles grouped within the same topic area to ensure that they were in fact related. No discrepancies occurred, but if there had been a discrepancy, the key words would have been utilized to compare the nuances of the article with those in other groups. We would have either regrouped the article or created a separate group if the article did not fit one of the other topic areas.

Throughout the study of the 12 remaining articles, the researchers focused on the findings that could be leveraged by HRD professionals to provide social support at the two crucial stages posited by the stress-buffering hypothesis, that is, (a) before the new other returns to work and (b) once she has returned to work.

The 12 articles reviewed for this study spanned in publication date from 1990 to 2013. Nine articles were published at the rate of at least one per year from 2007 to 2013, except for 2010. Although there seemed to be little movement in this research area in the United States, these findings preliminarily indicate that there is at least some scholarly interest in the topic of maternal employment and postpartum mental health.

Literature Review

The articles reviewed for this study were grouped into four main areas of interest with relation to postpartum maternal mental health and work: leave time, role congruence and role quality, physical and personal stressors, and work-related stressors. This section will explain the findings of the research studies in each group in an attempt to isolate factors that may contribute to a working mother’s overall postpartum mental health.

Maternity Leave Length and Maternal Mental Health

The Family and Medical Leave Act (FMLA; 2006) prevents parents from losing their jobs when they take time off to care for a new child. To be protected by FMLA, the parent must work for a covered employer, that is, an employer that meets the following criteria: The employer must be a private-sector employer (with 50 or more employees), a public agency, or a private or public elementary or secondary school. Parents’ jobs are secured for up to 12 weeks through FMLA; though, it is an unpaid leave. Only about 60% of workers report having access to FMLA leave (The Council of Economic Advisers, 2014; Jorgensen & Appelbaum, 2014). Of those, 20% were new mothers (The Council of Economic Advisers, 2014).

McGovern et al. (1997) evaluated the effect of maternal leave on mental health. The researchers found that time off from work had a positive effect on vitality when a new mother had more than 12 weeks off, which surpasses the current FMLA regulation. More than 15 weeks off from work had a positive effect on maternal mental health, and more than 20 weeks had a positive effect on role function. For this study, 854 women were identified from birth records obtained from the Minnesota Department of Health from October 1991 through February 1992. Eligibility criteria consisted of having had a live birth, keeping the infant versus putting up for adoption, being an English speaker, living in the Twin Cities, and working continuously for 1 year prior to the child’s birth for a minimum of 20 hr per week. Women who were deemed higher risk for postpartum depression based on neonatal complications, medical risk factors, and single mothers were over sampled to gain sufficient subjects for this group. At 5 months after childbirth, 654 women were identified for this study. Data for the study were obtained through telephone interviews conducted between 6 and 9 months after birth. The findings of this study suggested that new mothers experienced the lowest levels of general well-being at 7 months postpartum. The researchers suggested that this decrease in well-being may have been due to the cumulative effect of several infectious and non-infectious symptoms being experienced by the majority of the mothers around this time. Those symptoms included things like stiff joints, back and neck pain, colds, and flus. This creates a cause for concern because the postpartum recovery period is generally considered to last only 6 weeks, and as previously mentioned, FMLA only protects mothers from job loss up to 12 weeks. These findings suggest that a follow-up well after the 6-week traditional recovery period may be needed.

A similar study by Chatterji and Markowitz (2012) used secondary data obtained from the Early Childhood Longitudinal Study–Birth Cohort (ECLS-B) to examine the association between family leave length (leave taken by mothers and fathers after childbirth) and mental and overall health among new mothers. The data included a nationally representative sample of 14,000 children born in 2001 who were followed until they began kindergarten. The survey used in this measured depressive symptoms within the week just before the survey response, along with other self-reported health data. The study was narrowed down to 2,200 mothers after applying the following criteria: mother must (a) be the biological or adoptive mother, (b) have worked full- or part-time during pregnancy, and (c) have returned to work either part-time or full-time within 9 months. The findings of this study indicated that mothers who worked prior to childbirth and who returned to work in the first year had higher depression scores when they had less than 12 weeks of maternity leave. Mothers’ overall health had a “statistically significant, detrimental” decline if they had less than 8 weeks of paid maternity leave (Chatterji & Markowitz, 2012, p. 70).

The Study of Early Child Care and Youth Development (SECCYD) is a longitudinal study conducted by the National Institute of Child Health and Human Development of 1,127 children and their families. Beginning in 1991, birth records from Arkansas, California, Kansas, Massachusetts, North Carolina, Pennsylvania, Virginia, Washington, and Wisconsin were used to select potential participants. Those mothers were then screened at the hospital within 48 hr of childbirth. Two weeks later, families received a phone call for consent to participate, and at 1 month, they were interviewed in person. Participants were then interviewed again at 6, 15, 24, and 36 months.

Researchers used this secondary data to examine the effect of maternal employment on maternal mental and overall health, self-reported parenting stress, and parenting quality at 3 and 6 months postpartum (Chatterji, Markowitz, & Brooks-Gunn, 2013). They found that longer work hours were positively associated with depressive symptoms and parenting stress at 3 months postpartum. Parenting stress was affected by any number of work hours, while depressive symptoms were exacerbated in mothers who work full-time. A small decline in overall health was present in full-time working mothers at 6 months postpartum. The findings led the researchers to conclude that transitioning back to work was difficult for the average new mother, especially if they were returning full-time.

These studies indicate that maternity leave more than 12 weeks, especially around the 15-week mark, is beneficial to a maternal mental health (Chatterji & Markowitz, 2012; Chatterji et al., 2013; McGovern et al., 1997). Eight weeks of paid maternity leave or more has a positive effect on maternal depression scores (Chatterji & Markowitz, 2012), whereas at 6 months postpartum, new mothers may experience a decline in overall health (Chatterji et al., 2013). Furthermore, around 7 months postpartum, physicians should follow-up with new mothers, especially those who have returned to work, to make sure they have returned to previous levels of function (McGovern et al., 1997).

Another study selected for this review showed that the length of maternity leave did not have any effect on mental health (measured using The Center for Epidemiologic Studies Depression Scale) at 12 weeks postpartum (Klein, Hyde, Essex, & Clark, 1998). The researchers used data from the Wisconsin Maternity Leave and Health Project, which included 570 participants who were recruited from obstetrics and family practice clinics in two Midwestern clinics. Potential participants were identified in their second trimester and were required to meet the following criteria: (a) older than 18 years; (b) not disabled in any way that could change functioning as a parent; (c) living with the father, though not necessarily married; (d) one parent must be employed; and (e) mother was either employed or a full-time homemaker (i.e., not self-reported as unemployed or student). The women were interviewed in person during their second trimester, then again at 1 month, 4 months, and 1 year after delivery. In addition to a lack of findings that related maternity leave to mental health decline at 12-weeks postpartum, the researchers also indicated that there were no differences among homemakers and women employed part-time and full-time. Instead, the researchers pointed to the importance of role quality (i.e., the difference between a job that offers opportunity for advancement and recognition versus one that does not; Usdansky, Gordon, Wang, & Gluzman, 2012) as being the main influence on a working mother’s mental health (Klein et al., 1998). This was in contrast to simply having a job or not, which was not nearly as important.

Maternal Role Congruence and Role Quality

Role congruence refers to a woman’s preference for working or staying at home and her actual status (Klein et al., 1998). Some women may feel that they prefer one role (to be employed), but may also feel they must fulfill the traditional role of the “stay at home mother” (Hock & DeMeis, 1990). The literature in this section examines this potential conflict and its role in maternal mental health.

Hock and DeMeis (1990) examined role congruence in two longitudinal studies. The first study consisted of 209 first-time mothers who were recruited from three large metropolitan hospitals. The new mothers were contacted in the maternity ward 48 hr after the birth of their child. Researchers obtained their consent to participate and collected demographic information. The women were then contacted to complete a survey at 12 months postpartum and divided into four groups based on their employment status and employment preference. Group 1 consisted of women who were employment preferring/employed status, Group 2 were employment preferring/home status, Group 3 were home preferring/employed status, and Group 4 were home preferring/home status. The survey consisted of measures of maternal separation anxiety, stress, and depression. The findings of this study indicated that women who preferred to be at home and were at home were significantly more anxious about separating from their children than employment preferring/employed mothers. Only the Group 2 women (preferred employment, but were home) reported significantly higher symptoms of depression than the other groups.

A second study was conducted to replicate the first and consisted of 164 first-time mothers. In addition to the measures from Study 1, this study included a measure for maternal role investment and another for career salience. As in the first study, the new mothers were contacted in the maternity ward 48 hr after the birth of their child. Researchers collected demographic information and, in addition in Study 2, administered the two new measures. The new mothers then received the same survey as Study 1, but when they were 8 months postpartum instead of 12 months postpartum. The findings of this study were similar to those of Study 1. The members of Group 2 (preferred employment, but were home) also reported higher symptoms of depression than the other groups. Groups 1 and 4 (employment preference/employed and home preference/home, respectively) were similar in terms of levels of stress and depression.

Usdansky et al. (2012) also used the secondary data from the SECCYD to examine how maternal mental health is affected by the interaction between employment status, job quality, and preferred employment status. Like the previous study, researchers found that women who were not employed, but preferred to be, had elevated depression scores. They also found that high-quality jobs benefited maternal mental health regardless of whether or not a mother prefers to be employed. Mothers who were employed in low-quality jobs experienced higher depressive symptoms regardless of their employment preferences. This study was the first to examine how job quality benefits mothers irrespective of their employment preferences. It also offers the perspective of repeated measures of mental health, job status, and job quality longitudinally.

The results of these studies are significant to HRD professionals because they shed light on the importance of acknowledging women’s preferences and psychological differences when discussing maternal employment. In other words, no assumptions should be made about what mothers prefer in terms of maternity leave, child care, or employment. Each mother needs the flexibility to be able to choose the path that fits her psychological needs and well-being.

Working Mother’s Physical and Personal Stressors

An 817-participant cohort study conducted in Minnesota offered the data used in the following three studies in this section (Dagher, McGovern, Dowd, & Lundberg, 2011; McGovern et al., 2011; McGovern et al., 2007). A fourth study conducted using this data (Dagher et al., 2009) will be discussed in the next section of this article. The participants were recruited at the hospital and then interviewed at 5 weeks, 11 weeks, 6 months, and 12 months postpartum. All mothers selected were 18 years or older, gave birth to a healthy singleton infant, spoke English, was employed, and planned to return to the same employer.

The first study published from this data evaluated the personal and work-related factors associated with postpartum health at 5 and 11 weeks postpartum (McGovern et al., 2007). Of the 817 participants selected for the study, 716 agreed to participate at 5 weeks postpartum. That number went down to 638 at the time of the 11-week postpartum interview.

The study showed that better preconception health, higher level of coworker support during pregnancy, having a vaginal delivery, and not breastfeeding each contributed to better physical health. The effects for better preconception health were seen at both 5 and 11 weeks, while the effects for vaginal delivery and no breastfeeding tapered off before 11 weeks. Higher level of coworker support influenced better physical health at 11 weeks postpartum. Better mental health was attributed at 5 and 11 weeks to better preconception health, absence of perinatal mood problems, social support from family and friends, and perceived control over home and work. The effects of lower job stress were only seen at the 11-week mark. Postpartum depression symptoms were mitigated by better preconception health, absence of perinatal mood problems, and having an infant without colic issues at both the 5- and 11-week marks. At the 11-week mark, additional positive influences were attributed to being married or partnered and being non-white.

An examination into total workload alongside the previously mentioned factors was the focus of the second study from this data set (Dagher et al., 2011). Total workload was described as the total hours spent on paid and unpaid duties (i.e., working for pay and domestic chores). The second study also expanded the time frame to include data from 6 months postpartum. Total workload increased over the 6-month postpartum period. Women were working more hours, while their unpaid hours decreased. Worse depression scores were associated with higher total workload, lower job flexibility, lower social support, an infant with sleep problems, and breastfeeding.

At 12 months postpartum, the total daily workload increased to a statistically significant amount (McGovern et al., 2011). The third study conducted using this data set included the 12-month postpartum data and showed that (consistent with the other studies) total workload, available social support, perceived control over work and home activities, and infant care giving influence maternal mental health.

In essence, when it comes to physical and personal stressors that influence maternal health, HRD researchers may need to be looking at factors that can be moderated such as total workload, social support of family and friends, and job stress to best assist new mothers.

Work-Related Stressors

The last study from the cohort study previously mentioned focuses on examining the correlates of postpartum depression (measured by the Edinburgh Postnatal Depression Scale) at 11 weeks postpartum (Dagher et al., 2009) by applying the job demand-control-support model of workplace stress. This model suggests that women under high psychological job demands and limited degree of control can result in negative effects on health. Consistent with findings in the previous studies, job demands were positively associated with higher depression scores. Decision latitude (degree of control over work tasks) was not associated with postpartum depression scores and did not moderate the effect of job demand. Under conditions of low psychological demands, coworker support and decision latitude were contributing factors in reduced depression scores. Schedule autonomy and coworker support were positively associated with perceived control over work and family. This study was the first to examine the application of demand-control-support model to postpartum depression symptomatology. The researchers concluded that in comparison with perceptions of control over work and family, the job-demand-control model did not explain postpartum depression symptomatology.

Shift working has been applied by new parents as a strategy for avoiding child care costs (Perry-Jenkins, Goldberg, Pierce, & Sayer, 2007). Dual-earning parents take on schedules that are opposite and non-overlapping of each other so that one parent is always available to care for the child. Researchers examined whether shift work was related to depressive symptoms and relationship conflict.

Data for this study came from a longitudinal study of 132 working couples recruited from prenatal classes in a hospital in Western New England. Participants were interviewed 5 times as they transitioned into new parenthood. The first interview occurred during the third trimester of pregnancy, then 1 month after the baby’s birth, and 1 month after the mother’s return to work. At 6 months postpartum, participants received a mailed survey; a final face-to-face interview was conducted when the baby was 1 year old. All couples met the following eligibility criteria: (a) both parents were employed full-time, (b) both members of the couple planned to return to full-time within 6 months of the child’s birth, (c) both members were employed in an unskilled or semiskilled job and had no higher than an associate’s degree, (d) both members of the couple were expecting their first child, and (e) the couple was married or living together.

In general, the mothers in this study experienced a decrease in depressive symptoms immediately after the baby’s birth, but then they increased as the year progressed. The fathers experienced no statistically significant change in depressive symptoms. Both mothers and fathers reported significant increases in relationship conflict across the first year; yet, for mothers only, the conflict began to level out near the end of the first year.

Higher levels of depressive symptoms were predicted by working evening or night shifts in both mothers and fathers and also by higher levels of relationship conflict. Depression symptom scores for individuals were unaffected by the shifts their partners worked. The researchers found that workplace stress and overload were not factors of shift work that contributed to depressive symptoms. This finding left the researchers puzzled as to what could be the factor of shift work that causes the depressive symptomatology to increase, pointing to the need for more research to refine understandings of the possible links between shift work and depression symptoms.

The same group of researchers, using the same data collection method, published a study testing individual responses to working class job conditions and relationship between job conditions and new parents’ mental health (Perry-Jenkins, 2011). This study showed that some workers in low-status occupations reported higher levels of autonomy, which in turn created positive perceptions about job conditions. High job urgency and low coworker support contributed to an increase in depressive symptoms in fathers. Higher coworker support in a high job urgency setting created a decrease in fathers’ depressive symptoms. For mothers, low-urgency jobs were linked to declines in depressive symptoms; however, supportive coworkers in a high-urgency setting served to benefit their mental health. Supportive work settings appear to have a mitigating effect on urgent and stressful job conditions. Supportive work settings included reports of general feelings of emotional support, including receiving offerings of love, caring, esteem, encouragement, and sympathy (Cohen & McKay, 1984; Thoits, 2011) and instrumental support, including receiving help from others with practical tasks or problems or offering material assistance (Cohen & McKay, 1984; Thoits, 2011).

Recommendations for HRD Practice

HRD professionals may find it difficult to understand where they fit in helping employees with postpartum depression symptomatology. After all, they are not counselors or therapists, yet these studies present some insights into areas where HRD professionals may make a meaningful difference in the way women handle their depression at work.

The stress-buffering hypothesis posits that there are two points during which social support can make an impact in helping a woman returning to work with postpartum depression symptoms (Cohen & Wills, 1985). Those points are before the potentially stressful even occurs (before a woman returns to work) and once a woman has returned to work and is experiencing the effects of stress. The following recommendations emerged from this review for the first point of potential intervention.

Transitioning back to work is a difficult event for new mothers (Chatterji et al., 2013). HRD professionals can create a return-to-work transition plan to ease the stress levels of new mothers. As having a higher level of coworker support has been linked to less stress and better physical health (Dagher et al., 2009; McGovern et al., 2007), especially in high-urgency jobs (Perry-Jenkins, 2011), HRD professionals can foster social support in the workplace by helping new mothers connect with each other through mentorship. The mentorship with other mothers may serve to provide social support through empathy, information, helping a new mom to understand the positive effects of returning to work, and instrumental support on work-related tasks. Another way to ease the back-to-work transition is to ensure that pregnant employees are properly informed of their FMLA options, including the option to gradually return to work with reduced hours or fewer work days. This recommendation is based on the finding that the length of maternity leave did not have any effect on mental health (Klein et al., 1998). This points to a need for women to know what their options are so that they are able to decide what works best for their particular situation.

Empirical research suggests that new mothers experience their lowest levels of well-being at around seven months postpartum (McGovern et al., 1997), when most women have been back to work for several months. One opportunity for HRD professionals to assist back-to-work transition is to develop and implement a training program that would alert supervisors and managers to the issue of postpartum depression symptoms in working women, its potential human and organizational negative effects, and how to avoid potential loss of employee productivity. Training should include recommendations for helping a woman experiencing postpartum depression symptoms in line with benefits offered by the organization, such as employee assistance programs (EAPs).

Finally, HRD professionals can also encourage supervisors to be appropriately flexible by allowing new mothers at least some control over their workload while transitioning back to work. Better mental health was attributed at 5 and 11 weeks to perceived control over home and work (Dagher et al., 2011; Klein et al., 1998). The flexibility offered could indeed mitigate the effects of job stress (McGovern et al., 2007).

Recommendations for HRD Research

Based on the findings related to social support and its link to maternal mental health, it appears that the stress-buffering hypothesis (Cohen & Wills, 1985) supports guiding future research and informing the application of social support to helping women with postpartum depression symptoms at work. The studies examined in this literature review offered perceived lack of support upon returning to work as a potential stressor in the lives of new mothers (Chatterji & Markowitz, 2012; Chatterji et al., 2013; McGovern et al., 1997). The research reviewed for this study indicates that returning to work is a stressful event for new mothers. The stress-buffering hypothesis posits that this catalyzing event can lead to work impairment in women with postpartum depression symptoms if social support does not intervene. Social support has been shown to have positive effects on overall maternal mental health (Dagher et al., 2009; McGovern et al., 2007; Perry-Jenkins et al., 2007). This can lead to a reappraisal of returning to work as a non-stressful event, in turn inhibiting physiological and emotional consequences in new mothers, which can eventually lead to work impairment. The four functions of social support cited in the social support literature are emotional, instrumental, informational, and appraisal support (Cohen & McKay, 1984; Thoits, 2011). HRD research into the applications of the stress-buffering hypothesis should be modeled around the most effective form of social support that coworkers, supervisors, and organizations can offer new mothers and how each affects not only overall work impairment but also other important organizational outcomes like job satisfaction, turnover intent, and job performance.

Several questions remain after reviewing the literature presented in this article. Studies showed that breastfeeding caused an increase in depressive symptomatology in working women (Dagher et al., 2011; McGovern et al., 2007). The reasons for this are not assessed in the studies and, therefore, as suggested by McGovern et al. (2007), further research is necessary regarding this topic. Breastfeeding mothers could be facing a higher level of stress because of the physical and time commitments of breastfeeding. This stress may be contributing to their overall total workload, which contributes to higher depression scores. Another reason could be that although employers are mandated to have a private location for breastfeeding mothers to express breast milk, the mothers may not feel this benefit is adequate (McGovern et al., 2007), thereby implying the organization is not providing the instrumental form of social support so necessary for a successful back-to-work transition as suggested by the stress-buffering hypothesis (Cohen & McKay, 1984; Thoits, 2011). HRD research into how to reduce mothers’ stress related to physical and time commitments of breastfeeding might include investigating the association between negative comments from supervisors about taking the time to pump, taking time off for pumping, and lack of cleanliness and privacy in designated areas, and their links to stress. HRD researchers could extend our knowledge about how this stress, in turn, is associated with work impairment.

The studies that examine role quality (Hock & DeMeis, 1990; Klein et al., 1998; Usdansky et al., 2012) clearly indicated that women who desire employment and remain unemployed are likely to suffer a decline in mental health. In each of these studies, the women surveyed were employed prior to giving birth. Barring job loss during to maternity leave, the question remains as to why they would not go back to work if they had an employment opportunity? Perhaps some women felt a strong psychological conflict between traditional motherhood roles and their desire to work (Hock & DeMeis, 1990). HRD research into the nature and etiology of this conflict and its possible short- and long-term effects on the mothers’ postpartum depression symptoms on turnover intent should be examined in further research.

The last remaining question with respect to this literature review comes from the research on shift work (Perry-Jenkins et al., 2007; Perry-Jenkins,2011). The studies were unable to ascertain a reason for the decline in mental health of parents who worked opposite schedules, as it could not be attributed to job stress or job overload. HRD research in this area could determine whether shift work is truly a viable option for new parents who are looking to have parent caregivers, versus other family members or daycare, while one or the other parent is working.

No studies in this literature review were found using the term employee assistance program coupled with postpartum depression. This suggests that there is no research with regard to what EAPs are doing, if anything, for women with postpartum depression symptoms. It is possible that postpartum depression symptoms are being addressed in the same way as clinical depression by EAPs; however, there are complex issues experienced by new mothers that are not experienced by employees with depression. For example, this literature review showed that new moms who struggled with managing their total workload could have higher depression scores (Dagher et al., 2011). In addition, infant care giving was a source of stress for some new mothers (McGovern et al., 2011). EAPs may need to focus not only on helping new mothers get treatment for the depression symptoms but also in helping them address some of the return-to-work transitioning factors that contribute to the elevated depression symptoms.

A review of international studies and policies are also needed to assess what findings may be generalizable to new mothers in the United States. It is widely criticized that the United States is lacking in providing mandated paid leave for new mothers when other industrialized nations support the practice (Appelbaum & Milkman, 2015). HRD research about how maternal mental health in the United States compares to that of competing nations. HRD research might extend the literature by testing the notion that U.S. policies of unpaid maternity may be negatively linked to the maternal mental health of American women.

Conclusion

There is a clear need for HRD researchers to investigate the implications of postpartum depression symptoms, and its interventions, in the workplace. The literature reviewed points to factors in the transition back-to-work after maternity, role quality, role congruency, and work-stressors as points of concern. HRD professionals are in a position to facilitate change in the way women experience returning to work after a baby, and should especially be interested in facilitating a smooth transition for women who are experiencing postpartum depression symptoms.

The next step for this field of study relies heavily on HRD researchers and professionals to sensitize the field by recognizing that maternal mental health is an important factor in the work impairment of new mothers. As evidenced by this literature review, HRD researchers need to conduct new research to find links between postpartum depression symptoms and important organizational outcomes like turnover intent and job performance. Research into possible viable interventions for new working mothers with postpartum depression symptoms seems vital as well. In addition, in continuing to ignore the issue of maternal mental health at work, as consequence, we may burden their partners who are also in the workforce with new worries, in turn causing their own work impairment. Maternal mental health is an issue that not only affects women but also their partners, families, and, especially, their children. Mothers are the biggest population of our current workforce (U.S. Bureau of Labor Statistics, 2014). As HRD professionals, it is a disservice to our employees and the organizations in which they work to ignore such a salient yet misunderstood issue that could potentially affect the mental health and productivity of so much of our workforce.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Author Biographies

Cyntianna C. Ledesma Ortega holds a doctorate in the adult education and human resource development from Florida International University. Her research interests include interventions for postpartum depression symptoms in the workplace, online support groups, online education, and educational technology.

Thomas G. Reio Jr. is associate dean of graduate studies and professor of adult education and human resource development at Florida International University in Miami, Florida. He is immediate past editor of New Horizons in Adult Education and Human Resource Development and associate editor of Human Resource Development Quarterly. His research concerns curiosity and risk-taking motivation, workplace socialization processes, workplace incivility, entrepreneurship, and workplace learning.

References

Aisenbrey

Evertsson

Grunow

(2009). Is there a career penalty for mothers’ time out? A comparison of Germany, Sweden and the United States. Social Forces, 88, 573-605.

Alstveit

Severinsson

Karlsen

(2011). Readjusting one’s life in the tension inherent in work and motherhood. Journal of Advanced Nursing, 67, 2151-2160.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

Andrews-Fike

(1999). A review of postpartum depression. Primary Care Companion: Journal of Clinical Psychiatry, 1, 9-14.

Appelbaum

Milkman

(2015). Leaves that pay: Employer and worker experiences with paid family leave in California. Employment Policy Research Network. Retrieved from http://50.87.169.168/OJS/ojs-2.4.4-1/index.php/EPRN/article/viewFile/1909/1906

Baker

(2011). Maternity leave and reduced future earning capacity. Family Matters, 89, 82-89.

Beck

Crain

A. L.

Solberg

L. I.

Unützer

Glasgow

R. E.

Maciosek

M. V.

Whitebird

(2011). Severity of depression and magnitude of productivity loss. Annals of Family Medicine, 9, 305-311.

Beck

C. T.

(2001). Predictors of postpartum depression: An update. Nursing Research, 50, 275-285.

Beeghly

Weinberg

Olson

Kernan

Riley

Tronick

(2002). Stability and change in level of maternal depressive symptomatology during the first postpartum year. Journal of Affective Disorders, 71, 169-180.

10.

Buzzanell

P. M.

Liu

(2005). Struggling with maternity leave policies and practices: A poststructuralist feminist analysis of gendered organizing. Journal of Applied Communication Research, 33, 1-25.

11.

Buzzanell

P. M.

Meisenbach

Remke

Liu

Bowers

Conn

(2005). The good working mother: Managerial women’s sensemaking and feelings about work–family issues. Communication Studies, 56, 261-285.

12.

Carpiniello

Parante

C. M.

Serri

Costa

Carta

M. G.

(1997). Validation of the Edinburgh Postnatal Depression Scale in Italy. Journal of Psychosomatic Obstetrics & Gynecology, 18, 280-285.

13.

Chatterji

Markowitz

(2012). Family leave after childbirth and the health of new mothers. Journal of Mental Health Policy and Economics, 15, 61-76.

14.

Chatterji

Markowitz

Brooks-Gunn

(2013). Effects of early maternal employment on maternal health and well-being. Journal of Population Economics, 26, 285-301.

15.

Chuang

C. H.

Chang

P. J.

Chen

Y. C.

Hsieh

W. S.

Hurng

B. S.

Lin

S. J.

Chen

P. C.

(2010). Maternal return to work and breastfeeding: A population-based cohort study. International Journal of Nursing Studies, 47, 461-474.

16.

Cohen

McKay

(1984). Social support, stress and the buffering hypothesis: A theoretical analysis. In Baum

Taylor

S. E.

Singer

J. E.

(Eds.), Handbook of psychology and health (pp. 253-267). Hillsdale, NJ: Erlbaum.

17.

Cohen

Wills

T. A.

(1985). Stress, social support, and the buffering hypothesis. Psychological Bulletin, 98, 310-357.

18.

Coulson

Skouteris

Milgrom

Noblet

Dissanayake

(2010). Factors influencing the planning undertaken by women during pregnancy for their return to work after maternity leave. The Australian and New Zealand Journal of Organisational Psychology, 3, 1-12.

19.

The Council of Economic Advisers. (2014, March). Economic report of the president. Washington, DC: Executive Office of the President.

20.

Dagher

R. K.

McGovern

P. M.

Alexander

B. H.

Dowd

B. E.

Ukestad

L. K.

McCaffrey

D. J.

(2009). The psychosocial work environment and maternal postpartum depression. International Journal of Behavioral Medicine, 16, 339-346.

21.

Dagher

R. K.

McGovern

P. M.

Dowd

B. E.

Lundberg

(2011). Postpartum depressive symptoms and the combined load of paid and unpaid work: A longitudinal analysis. International Archives of Occupational and Environmental Health, 84, 735-743.

22.

D’Angelo

D. V.

Williams

Harrison

Ahluwalia

I. B.

(2012). Health status and health insurance coverage of women with live-born infants: An opportunity for preventive services after pregnancy. Maternal and Child Health Journal, 16, 222-230.

23.

Family and Medical Leave Act of 1993, 29 U.S.C. §§ 2601–2654 (2006).

24.

Feldman

Sussman

A. L.

Zigler

(2004). Parental leave and work adaptation at the transition to parenthood: Individual, marital, and social correlates. Journal of Applied Developmental Psychology, 25, 459-479.

25.

Greenberg

P. E.

Kessler

R. C.

Birnbaum

H. G.

Leong

S. A.

Lowe

S. W.

Berglund

P. A.

Corey-Lisle

P. K.

(2003). The economic burden of depression in the United States: How did it change between 1990 and 2000? Journal of Clinical Psychiatry, 64, 1465-1475.

26.

Hock

DeMeis

D. K.

(1990). Depression in mothers of infants: The role of maternal employment. Developmental Psychology, 26, 285-291.

27.

Hofferth

S. L.

Curtin

S. C.

(2006). Parental leave statutes and maternal return to work after childbirth in the United States. Work and Occupations, 33, 73-105.

28.

Horowitz

J. A.

Goodman

(2004). A longitudinal study of maternal postpartum depression symptoms. Research and Theory for Nursing Practice, 18, 149-163.

29.

Jorgensen

Appelbaum

(2014). Documenting the need for a national paid family and medical leave program: Evidence from the 2012 FMLA Survey (No. 2014-10). Center for Economic and Policy Research. Retrieved from http://www.cepr.net/index.php/publications/reports/documenting-the-need-for-a-national-paid-family-and-medical-leave-program-evidence-from-the-2012-fmla-survey

30.

Klein

M. H.

Hyde

J. S.

Essex

M. J.

Clark

(1998). Maternity leave, role quality, work involvement, and mental health one year after delivery. Psychology of Women Quarterly, 22, 239-266.

31.

Lakey

Orehek

(2011). Relational regulation theory: A new approach to explain the link between perceived social support and mental health. Psychological Review, 118, 482-495.

32.

Laughlin

(2010). Who’s minding the kids? Child care arrangements: Spring 2005/Summer 2006. U.S. Department of Commerce, Bureau of the Census. Retrieved from http://www.census.gov/prod/2013pubs/p70-121.pdf

33.

Leddy

Haaga

Gray

Schulkin

(2011). Postpartum mental health screening and diagnosis by obstetrician-gynecologists. Journal of Psychosomatic Obstetrics & Gynecology, 32, 27-34.

34.

Lerner

Adler

Hermann

R. C.

Chang

Ludman

E. J.

Greenhill

Rogers

W. H.

(2012). Impact of a work-focused intervention on the productivity and symptoms of employees with depression. Journal of Occupational and Environmental Medicine, 54, 128-135.

35.

McGovern

Dagher

R. K.

Rice

H. R.

Gjerdingen

Dowd

Ukestad

L. K.

Lundberg

(2011). A longitudinal analysis of total workload and women’s health after childbirth. Journal of Occupational and Environmental Medicine, 53, 497-505.

36.

McGovern

Dowd

Gjerdingen

Dagher

Ukestad

McCaffrey

Lundberg

(2007). Mothers’ health and work-related factors at 11 weeks postpartum. Annals of Family Medicine, 5, 519-527.

37.

McGovern

Dowd

Gjerdingen

Moscovice

Kochevar

Lohman

(1997). Time off work and the postpartum health of employed women. Medical Care, 35, 507-521.

38.

O’Hara

M. W.

Swain

A. M.

(1996). Rates and risk of postpartum depression—A meta-analysis. International Review of Psychiatry, 8, 37-54.

39.

O’Hara

M. W.

Zekoski

E. M.

(1988). Postpartum depression: A comprehensive review. In Kumar

Brockington

I. F.

(Eds.), Motherhood and mental illness: Vol. 2. Causes and consequences (pp. 17-63). London, England: Wright.

40.

Perry-Jenkins

(2011). Working-class jobs and new parents’ mental health. The Journal of Industrial Economics, 59, 1117-1132.

41.

Perry-Jenkins

Goldberg

A. E.

Pierce

C. P.

Sayer

A. G.

(2007). Shift work, role overload, and the transition to parenthood. Journal of Marriage and Family, 69, 123-138.

42.

Robertson

Grace

Wallington

Stewart

D. E.

(2004). Antenatal risk factors for postpartum depression: A synthesis of recent literature. General Hospital Psychiatry, 26, 289-295.

43.

Singley

D. B.

(2015). And daddy makes three: Spotlight on men’s peripartum mental health. International Journal of Childbirth, 30, 19-24.

44.

Skafida

(2012). Juggling work and motherhood: The impact of employment and maternity leave on breastfeeding duration: A survival analysis on growing up in Scotland data. Maternal and Child Health Journal, 16, 519-527.

45.

Spiteri

Xuereb

R. B.

(2012). Going back to work after childbirth: Women’s lived experiences. Journal of Reproductive and Infant Psychology, 30, 201-216.

46.

Stomp-van den Berg

S. G.

Van Poppel

M. N. M.

Hendriksen

I. J.

Bruinvels

D. J.

Uegaki

De Bruijne

M. C.

Van Mechelen

. (2007). Improving return-to-work after childbirth: Design of the Mom@Work study, a randomised controlled trial and cohort study. BMC Public Health, 7, Article 43.

47.

Stowe

Z. N.

Hostetter

A. L.

Newport

D. J.

(2005). The onset of postpartum depression: Implications for clinical screening in obstetrical and primary care. American Journal of Obstetrics & Gynecology, 19, 522-526.

48.

Stuart

Couser

Schilder

O’Hara

Gorman

(1998). Postpartum anxiety and depression: Onset and comorbidity in a community sample. Journal of Nervous and Mental Disease, 186, 420-424.

49.

Stuebe

A. M.

Grewen

Pedersen

C. A.

Propper

Meltzer-Brody

(2012). Failed lactation and perinatal depression: Common problems with shared neuroendocrine mechanisms? Journal of Women’s Health, 21, 264-272.

50.

Thoits

P. A.

(2011). Mechanisms linking social ties and support to physical and mental health. Journal of Health and Social Behavior, 52, 145-161.

51.

Torraco

R. J.

(2005). Writing integrative literature reviews: Guidelines and examples. Human Resource Development Review, 4, 356-367.

52.

U.S. Bureau of Labor Statistics. (2014, May). Women in the labor force: A data book. Retrieved from http://www.bls.gov/opub/reports/cps/womenlaborforce_2013.pdf

53.

Usdansky

M. L.

Gordon

R. A.

Wang

Gluzman

(2012). Depression risk among mothers of young children: The role of employment preferences, labor force status and job quality. Journal of Family and Economic Issues, 33, 83-94.

54.

Wells

C. A.

(2012). Breast milk down the drain. The American Journal of Nursing, 112(12), 11.

55.

Wiese

B. S.

Ritter

J. O.

(2012). Timing matters: Length of leave and working mothers’ daily reentry regrets. Developmental Psychology, 48, 1797-1807.