“I’m an Occupational Therapist working in maternal health” *cue the curious raised eyebrows, confused furrowed brow and slightly cynical “argh”* of the woman who is now regretting asking the question “so what do you do?”

Yep it’s true. Occupational Therapy is the new kid in maternal health town.

We are not the profession most commonly associated with this space but we are here, passionate and ready to serve. And in case you have no idea what we bring to the maternal health and indeed the women’s health table, read on as I share 10 reasons why Occupational Therapy is the perfect fit.

1. Person centred approach

There are a few core beliefs that occupational therapy practice is grounded in. Being person or client centred would have to be at the top.

This means the client stands at the center of care determining the priorities and direction of service provided. It recognises that the client is an expert in themselves and that we  are resources for that client in their journey to a destination determined by them. We have a diverse set of skills that are all underpinned by a knowledge and approach that puts that client their needs, priorities, motivations and challenges first.

In maternal health this means it’s the woman who stands at the centre of care. It is her wishes, motivations, priorities, goals and aspirations that we focus on. From there we apply any one (or combination of) our diverse range of skills to assist, from education to counselling to advocacy to therapy to equipment prescription to home modifications…the list continues.

It’s what women in this space need. To be put first.

2. Person – environment – occupation framework

Occupational therapists work from a framework that a client (person) does not exist in isolation. That person (made up of their physical, mental, emotional and spiritual self) exists in the context of their environment (social, cultural and physical surroundings) and their occupations (the activities of self care, leisure and productivity they do in their everyday life).

We are a truly holistic profession.

We understand wellbeing in the context of being able to participate in activities that are meaningful to the person.

We know a person can have a disability and still live in a state of wellbeing. We know that people can function “well” in some environments but not others. We know it is a synergy between the person, their environment and the activities they do that is vital in wellbeing. We also know that wellbeing isn’t a destination, it’s more of a journey. And that life transitions and changes can impact wellbeing profoundly.

In maternal health it means we look at the women’s wellbeing as her body, mind and occupations are changing. As her environment may be harder to negotiate or may in fact be impacting her emotional wellbeing.

For example, it may be that she is experiencing back pain so we look at her physical state (her alignment, how she sits, stands and moves). Her environment (where she sits, how supportive her work culture is). And her occupations (what tasks cause her pain and which don’t etc).

If she is experiencing stress we look at her emotional state (what causes stress, how she copes etc). Her environment (the external factors contributing to stress like family or cultural pressures) and her occupations (what in her life is she not able to do and what she is doing well).

3. Meaningful occupations and valued roles are core philosophies

What is quality of life to you? Is it being healthy? Can you be healthy and still not have quality of life? What if you are healthy but have no fulfilling relationships or activities that you enjoy doing? Is this quality of life?

Occupational Therapists believe that wellbeing requires participation in meaningful occupations (activities) and valued roles.

Meaningful occupations as previously mentioned include self care activities (personal hygiene, physical, mental, emotional and spiritual activities that are required for wellbeing). Leisure activities (done for personal enjoyment) and productivity activities (school, paid and unpaid work, volunteering etc). Some of these may fall into more than one category for you. The point is also that its deeply personal and unique to each person.

Valued roles are the parts we play in everyday life such as mother, partner, worker, aunty, sister, daughter, friend, teammate, woman etc. These roles may be chosen, acquired or we are simply born into them. Many will have different meanings to each of us. We also have ideas as to what it takes to fulfill these roles, what it should look like and what shouldn’t be part of them.

The degree or quality of participation in both meaningful occupations and valued roles is also important. Dysfunction can occur if a person is unable to participate or can’t participate fully or in a way they would like to.

In maternal health these factors are vital for wellbeing. It’s a time of immense change for women which also includes the occupations and roles they participate in. Women may be going from full time career woman to full time mother, from a partner and daughter to a mother, from a mother of 1 to a mother of 2 and so on, from looking after only themselves to caring for every need of a newborn. It’s a time when these changes, upheavals and transitions must be considered as part of the overall wellbeing of the woman.

4. Focus on self determination and empowerment

Occupational therapists fundamentally believe that people need to be able to control their own destiny.

In a less dramatic way of putting it, people need to be deciding their own path, or destination. Whether it’s their own goals in an occupational therapy session, their own choices in a birth plan. Or perhaps their decision to say no to advice from a health professional during birth – it must be their choice.

This comes back partly to our belief in client centred care and also from our framework and philosophies. If we are truly client centred and we believe that people are the experts in themselves and that their participation in occupations and roles meaningful to them are core to wellbeing ….then we cannot possibly be the ones to make the decisions about that person. And sometimes that decision is not what we would recommend but part of being truly client centred is to also support that client to make the decision that they must live with.

Empowering our clients is also a major part of our role.

Empowering them to have all the information they require to make the best decision they can for themselves. Empowering them to ask questions and to be critical of “advice” (yes, even ours). Empowering them to ask for evidence, to challenge caregivers and, most importantly, to listen to their instincts (their gut, their heart, their inner voice….whatever sings to you).

In maternal health this may be supporting a client to say “no” to their caregiver. It may be providing resources and information to further their knowledge regarding their pregnancy wellness, birth choices or the 4th trimester. It may also be saying goodbye to a client who decides they no longer wish or need to work with us. Or they may not be in a space where they can see the value that we can offer. And that’s ok.

5. Adaptable and flexible profession

Occupational therapy is a health profession that many (including many occupational therapists) struggle to define. A common question we get asked is “what does an occupational therapist do?”. And it often depends on what area an occupational therapist works in as to what definition will be given.

The downside to this is no one knows what we do. The upside to this is that is demonstrates (in not an ideal way) that occupational therapy is flexible and adaptable. We all have the core beliefs, philosophies and frameworks from which to work that are then applied to a variety of settings.

We are not confined to working with body parts, or just mental health, we don’t diagnose and we don’t aim to “cure”. We are about maximising wellbeing through working with the person on things most important to them. We facilitate problem solving, we inspire curiosity, we explore our client with our client and we support them to move forward. Ambiguous enough?

The wonderful thing about this is that we are truly adaptable and flexible. We are often the ones that are called when no one knows who else can help.

Now I have written that, it sounds a little sad.

But seriously, we are the profession that can tie all the elements of a person and their life together. We can to form a picture and shine light on where dysfunction is lurking. Occupational therapists can therefore work in all areas with a variety of people in any setting.

Though maternal health is relatively new for occupational therapy we are finding the fit ….just perfect.

In fact many of us wondered why we haven’t been working in this area from the start. For a women in her reproductive years wanting children there is no role more important than mother. And there are no occupations more more important than birthing and those connected with mothering. We just “get” how all these things are interconnected. And we continue to evolve as a profession to the changes in our environment and occupations.

6. Holistic skill set and knowledge base

With core beliefs centreing on looking at the person as a whole we have to know about the whole person; physical, mental, emotional, spiritual, occupational, environment, social ….etc. But more than that is our skill set that also allows us to learn.

We observe, assess, interview, counsell, investigate, support, advocate, inform, guide, listen, research and learn from our clients. We can be silent, sit with emotions, we can work interprofessionally, problem solve, facilitate, goal set, measure outcomes and we can inspire our clients. Occupational Therapists can see relationships and interactions, we refer, seek support, reflect, challenge our clients and we can hold space when they need it.

In maternal health we offer our clients all we have to give above plus our knowledge of women’s health in pregnancy, labour, birthing and motherhood.

7. Understanding of transitions and continuity of care

Occupational therapists thrive in a space where there are transitions.

We understand that transitions can bring uncertainty, discomfort or pain, fear, occupational dysfunction etc. And the power of ensuring that a person receives good continuity of care through these transitions cannot be underestimated.

In maternal health this means that we know that all the changes that come with pregnancy, labouring, birthing and motherhood as well as the transitions that happen from one stage to the next are potential points of dysfunction. These physical, emotional, occupational and environmental changes can be difficult and affect different women differently.

Continuity of care simply refers to care that is complete or consistent. For women from pregnancy through to the postnatal period receiving care that is complete and consistent is very reassuring. It is also not necessarily everyone’s experience.

8. Interprofessional

Occupational therapists are natural collaborators.

It’s in our training, it’s in our philosophy. And given we are a holistic profession who also reflect on our own skills and abilities we know that we don’t have all the answers. We recognise that there is value and necessity in other professions. Though I will save the difference between multidiscipline, interprofessional and transdiscipline for another day (perhaps over a riveting game of trivial pursuit and a glass of wine) let’s just go with the term interprofessional. And lets define it as working in collaboration with other professionals in order to meet the needs of a client.

Coming back to our love of continuity of care, for occupational therapy it also means trying to keep this complete and seamless for the client. This may mean we make a referral and send a report detailing our observations / assessment findings or we may attend a session with our client as they see another health professional. We make it our business to know what other health professionals and complementary therapists there are locally to refer to, ask advice from or share information with (non confidential information).

9. Integrative

This term essentially means to “combine” or “bring together”

In this case I am referring to occupational therapy’s ability to exist in the medical world as well as that of complementary therapies. This depends on the individual occupational therapist, their skill, experience and where they work. Given the flexibility and adaptability of our profession there are occupational therapists who can bring together these worlds to offer what their client needs.

Occupational therapy is a registered health profession with a strong belief in evidence based practice. We also understand, however, that evidence exists in more forms than just randomised, double blind clinical trials. We know that often valuable information or techniques are not researched for reasons that have nothing to do with its effectiveness. We are also critical thinkers and analysers of information. We rely on our clinical reasoning or judgement when it comes to providing advice.

In maternal health this is a valuable approach.

Some women need counselling and some need mindfulness, some need Hypnobirthing and some just need some evidence based education. Some women need alignment work and some need a physiotherapist. Some need Chinese medicine and some need a chiropractor. Some need a movement program and some need yoga. Some of these things occupational therapy can offer and some they can either refer to or work with to provide the information.

Being integrative means we are not territorial about our own offerings nor are we siloed. We make it our business to know what and who else can add value to our client’s experience. And if we are not the best fit right now for that client, that’s ok. We know we are a resource for the client to meet their needs. And if those needs are outside our scope, then we will happily help them find a more appropriate fit.

An occupational therapists job is always to do ourselves out of a job.

10. Valuing Co-Occupation

“Co-occupation is a dance between the occupations of one individual and another that sequentially shapes the occupations of both persons.”

Co-occupation is a term that still prompts a lot of discussion and debate. But essentially it describes the intertwined nature of occupation, particularly relevant to mothers and baby’s.

Labour and birthing are occupations that both mother and baby do. Their roles within that occupation and what actually happens differ but they are interconnected with one depending on the other. Given the dependant nature of babies, many of the occupations that a mum will undertake are in fact co-occupations. For example breastfeeding, nappy changing, even sleeping.

“There is no such thing as a baby, there is a baby and someone” (Donald Winnicott – English Psychologist).

Having this understanding occupational therapists know that there can be no wellbeing for mum without wellbeing for baby and vice versa. In this “and” is the relationship between mum and baby. It’s so important for the development of a secure nurturing attachment that will set the foundation for the wellbeing of baby in the future.

In maternal health this means as we work with mum we also consider baby. If we are helping mum prepare for the co-occupations of labour and birth we understand how to work with mum to keep her nervous system in its calm state. We know extreme fear and distress can distress the baby. We also strive to ensure mum has all the information she requires she make informed decisions about her birth. We know what impact her decisions may have on future co-occupations such as breastfeeding.

Actually we are the old kid in a new town

Occupational Therapy is actually an old profession. Some say occupational therapy was used in ancient Greek times to treat mental and emotional disorders. It emerged as a profession in 1917 and was officially named in 1920. And has been serving a diverse range of clients of varying abilities and challenges since. As we have demonstrated the benefits of our approach and skills we have broadened our client base.

So we no longer ask “why would occupational therapy be working in maternal health” we now ask “why wouldn’t we?”

If you are still reading this, you are a either an occupational therapist punching the air celebrating the awesomeness of our profession. Or you’re probably a mum seeking a holistic approach to maternal wellbeing. Whatever your situation is I hope you have found some food for thought on these pages.

Occupational therapists have so much to offer this space. In time we will see it become more populated by our profession which will give women more choice and a some new approaches to wellbeing.

References and more information

If you are interested in more about Occupational Therapy and maternal health, you might like this blog “Labour. Physiological or Co-occupation?”