What is Occupational Therapy?
Occupational Therapy is known as the 'art and science' of enabling engagement in everyday living through occupation (Townsend & Polatajko, 2007). 'Occupation' can be understood as anything that 'occupies' your time, the things that you spend your time doing.
Occupational Therapists work from a top down approach, we believe that well-being and health is not just the absence of disease but also the ability to preform all occupations that we need to and want to in our day to day lives. All aspects (physical, emotional, psychological, social, occupational, environmental and spiritual) of a human are examined and where these aspects connect - well being and health exists. These aspects create a whole being, and thus our work is considered to be 'holistic' and client centered.
Check out this video below to understand how occupational therapists help people say "I can!" no matter their disability or barriers to their goals.
You see, it is a little difficult to explain what occupational therapy is and how we can serve our clients. This is also because every person is different, every activity is different, every reason for wanting or needing to do that occupation may be different and so on. Thus, we individualize our programming with each infant, parent, and family.
Your goals are OUR goals.
Occupational Therapy AND:
Maternal Mental Health
In Canada, pre-covid-19, 20% of women and 10% of men suffer from perinatal mental illness, which are the most common complications related to childbirth. New research has shown that this percentage has increased during covid-19, especially in regards to anxiety.
Our healthcare system almost exclusively focuses on babies; postpartum health of the mother is overlooked in many cases. There is no such thing as a doctor dedicated specifically to new mothers, other specialists to try to bridge this gap.
Unfortunately, poor mental health not only impacts the emotional and physical well-being of mothers but it also carries over to the unborn, newborn, and developing children, partners, family and friends.
Parental depression exposes a child to adverse childhood experiences creating toxic stress in the child’s developing brain, which increases the likelihood of poor mental and physical health outcomes later in life. Future behavioral problems such as binge drinking, smoking, emotional and physical abuse are all stronger risk factors for maternal depression and anxiety.
Occupational Therapists use holistic approaches that help to manage symptoms of postpartum depression and anxiety. For example, occupational re-engagement, exploring the new identity of motherhood, establishing new roles and routines, establishing co-occupations with baby to build bonding and confidence, fatigue management, mindfulness exercises, meditation, education and other mental health support strategies (such as cognitive behavioral therapy). Connectedness, hope, identity, meaning and empowerment are all areas that need to be addressed during the transition to motherhood. Group therapy offers a safe place to build a community and normalize the postpartum journey.
Transitioning to Motherhood
The transition into motherhood means acquiring a new identity; many women are jolted when they discover that they are not shifting into the motherly role as naturally as they anticipated. A sense of identity loss can occur, self-care routines and activities often are no longer a priority and difficulty with the new routines and co-occupations can occur. Many mothers can feel stress and exhaustion because they had unrealistic expectations.
Occupational therapy may be helpful to develop a realistic and sustainable routine plan. A plan that has strategies to better meet mother’s desired goals can help develop reassurance for a mother to feel confident in her new role and identity.
Often mothers are told to get as much sleep as they possibly can before the baby comes. It is not new news that the infant will wake to feed, require changing and need to be soothed back to sleep. This will happen many times through the night and it is a normal developmental expectation. The problem occurs when parents are unable to sleep between the infants waking and are struggling with day to day activities due to exhaustion. Stress, anxiety and anticipation for the next waking can occur and is more common than not. Chronic exhaustion impacts mental health, relationships, productivity and cognitive function. It is essential to get restorative sleep between the infant waking for overall health.
Occupational therapy understands how meaningful sleep is as an occupation and the significant impact it can have on a parent’s ability to function in the way they need to or want to. Occupational therapists can help problem solve sleep issues and provide tools and strategies to get through the day when exhaustion is occurring due to sleep disruptions.
It is not uncommon for a mom to have difficulty bonding with baby; in fact 20% of new moms report they struggle to connect with their newborn. It appears that this is not common knowledge and it often is overlooked, which could be due to stigma. The transition to motherhood is difficult and if a mom does not feel a bond she often experiences increased levels of stress. It is beneficial to get professional support to understand the transition into motherhood.
Occupational therapy can help by exploring different strategies to encourage bonding between mother and infant as well as empower the mother to see her successes through education and creation of self-compassion.
Return to Work
A transition back to work means that a new balance needs to be established between the new mothering role and work life. This can feel overwhelming and will likely require planning and support. In order to help ease the transition it would be beneficial to create a new schedule and identify emotional and physical supports that are necessary to help the transition go smoothly. Here in Canada, often a mother has been off work for 12-18 months, it may be necessary for a re-orientation to the role and organization and if necessary modifications to transition back to work slowly may be appropriate. It is important to remember that the first day of work will most likely be the mothers first full day away from her infant. Unfortunately in our society maternity leave is often viewed as a ‘vacation’, but there is significant healing that occurs both physically and mentally during the postpartum period and to jump back into regular duties on the first day back can be unrealistic.
Occupational therapists can help create a maternal return to work plan and if necessary have supportive discussions between employees and employers. Occupational therapists have a wealth of knowledge in occupational balance and creating a plan may help ease stress and confusion.
Infant Sleep Education
Occupational Therapists can help educate around the development of sleep, establish appropriate routines, especially bed time routines (it is never too early to establish a bedtime routine) and help establish an appropriate safe sensory environment for the infant.
Infant sleep is a hot topic on social media. There are all kinds of programs out there that claim they can ‘train’ your child to sleep. In my personal experience I was pulled to two extremes – train your child through methods such as “cry it out” or the opposite extreme of consistently responding to your child due to fear that attachment issues may arise. After extensive research it is important to note that understanding developmental sleep milestones is extremely important to aid your infant in their sleep development. Falling asleep, sleep duration, night wakings, naps and general sleep patterns change as baby ages in the first 12 months. Family, environment and routine also play a role in infant sleep.
Tongue Tie Therapy
Ankyloglossia (aka a “True Tongue Tie”) is a STRUCTURAL impairment that consists of a shortened lingual frenulum. The body of the tongue appears thinned and the borders of the tongue are elevated. The front center edge of the tongue may have a heart shaped indentation. There is a functional impact when the tongue tip cannot contact the upper surface of the mouth when the jaw is nearly closed.
PSUEDO Ankyloglossia is a FUNCTIONAL impairment where the body of the tongue is thick and retracted. The lingual frenulum has an appearance of a white fiber at the center of the tongue tip. This pattern responds best to THERAPY, not surgery.
So what does this mean?
The FUNCTIONAL impact of the lingual frenulum is what matters, not necessarily the appearance.
Oral motor interventions are an important part of oral motor skill development with both types of tongue tie (Ankyloglossia and pseudo Ankyloglossia). It will be necessary to help strengthen new areas of the mouth that have not been activated. After a surgery the tongue develops more movement (range of motion) but it does not necessarily mean that your infant or child will know how to use their new free tongue. A child is more likely to use their tongue exactly the same way as they did before the surgery.
The Breastfeeding Dyad:
The breastfeeding infant’s symptoms are JUST AS IMPORTANT as the mother’s symptoms. Most often women are told that if baby is gaining weight that is all that matters. But your symptoms as a mother matter too! Breastfeeding SHOULD NOT be painful. Painful breastfeeding is an indicator that more is going on; it could be issues with latch, a true tongue tie, a functional issue, an issue with overactive let down, etc. An oral motor therapist and lactation consultant can help identify the issue and provide tools and strategies to resolve the concerns.
One of the most important newborn and new caregiver tasks is early feeding. Not only does the task nourish the baby but it also promotes mother-infant bonding, self-regulation skills and early communication skills for the infant. Breastfeeding should not be a constant difficult task. Many parents have expressed that feeding difficulties have caused them stress, anxiety and feelings of guilt. Early intervention is vital to establish, increase, and maintain a mother’s supply.
An occupational therapist and lactation consultant are able to help problem solve breastfeeding difficulties.