Until relatively recently, perinatal mental health was not a key focus in the United States. "Nearly two decades ago, postpartum care was less mother-centric," says Dr. Jennifer L. Barkin, a reputed researcher, innovator, and creator of the Barkin Index of Maternal Functioning (BIMF). "Perinatal care today is more balanced, weighing the needs of the mother and the child concurrently. But there is still much work left to be done in supporting pregnant and postpartum mothers."
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"It's exciting that the world is finally seeing solutions that go beyond just treating symptoms, but also give women agency in how they navigate these stages. And that sense of agency, in today's world, is pivotal."
Barkin's own work has been a part of that shift. The Barkin Index of Maternal Functioning, a proprietary assessment tool, reframes how postpartum health is understood and measured, and focuses on optimizing daily functioning in the postpartum period. The Barkin Index lends itself to therapeutic skill building, and that may be why it is of interest to occupational therapists.
"The BIMF is like a canvass across the relevant domains of maternal functioning, including maternal self-care, and helps to identify both strengths and also areas that could be optimized with appropriate support," says Barkin.
To build the Barkin Index, Barkin interviewed several new mothers, asking them to describe what low-functioning, midrange-functioning, and high-functioning days look like. High-functioning days often involved balance, where mom's and baby's needs were both met to varying degrees.
"What really weighs on me," Barkin shares, "is that mothers tend to prioritize infant care, and appropriately so. But often at the expense of taking care of themselves. This deficit in self care can impact the entire family. It's also important for children to witness a mother who is attentive but also models self care. This is a powerful signal."
She describes the potential for "emotional inflammation" in the postpartum period, where a gradual build-up of stress, fatigue, and heightened emotions goes unnoticed by women until it becomes overwhelming. "The problem with self-care is that it requires awareness," she says. "You need to recognize that you're burning out, and that's already asking a lot from someone juggling a newborn, a household, and often work responsibilities."
Barkin emphasizes that pragmatic self-care doesn't always require money or elaborate planning. She recalls one mother who worked at a grocery store and would buy discounted flowers nearing expiration. "She told me she and her daughter would spend time arranging them together at home. It didn't cost much, or require a baby sitter, but it was a form of self-soothing."
Other low-cost practices Barkin points to include mindfulness, Yoga, breathing exercises, visualization, and short bursts of exercise, all strategies that can be done without needing childcare or significant financial investment.
Still, she acknowledges the limits. "Self-care options expand or shrink depending on your resources, time, finances, and social support. A single mother working four jobs may not have the luxury of sitting quietly to reflect on burnout. That's why we need systemic solutions, not just individual strategies," Barkin explains.
Keeping this systemic solution in mind, Barkin envisions a future where postpartum care is accompanied by tailored support. "Imagine a center devoted to helping women optimize functioning," she says. "A place where you could break down the domains of the Barkin Index, including sleep, social interaction, self-care, and identify what's strong and what needs support. Almost like a functional tune-up."
Yet, despite this vision, Barkin believes that some challenges continue to persist, and one of them lies in accessibility. "The real question stems from how to extend these tools to the women who need them most," she says. And these women encapsulate the full spectrum, from mothers who have abundant resources to those without reliable childcare, family and social support, or even adequate time.
"The ultimate goal is to create systems where women feel seen, supported, and equipped to care for themselves just as much as their families," Barkin concludes. "The long game with the BIMF was to eventually pair it with therapeutic skill building—a functional tune-up, if you will. When women feel they are moving through their day in a way they can be proud of, it increases their feeling of self efficacy which has a trickle down effect on their family."
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