Top

Published in:

01-12-2020 | Care | Research article

Professional support during the postpartum period: primiparous mothers’ views on professional services and their expectations, and barriers to utilizing professional help

Authors: Yiping Nan, Jingjun Zhang, Anum Nisar, Lanting Huo, Lei Yang, Juan Yin, Duolao Wang, Atif Rahman, Yan Gao, Xiaomei Li

Published in: BMC Pregnancy and Childbirth | Issue 1/2020

Abstract

Background

Primiparous mothers who lack of experience and knowledge of child caring, are usually overwhelmed by multifarious stressors and challenges. Although professional support is needed for primiparas, there is a gap between the necessary high-quality services and the currently provided poor services. This study aimed to explore Chinese primiparous mothers’ views on professional services, identify barriers to utilizing professional support, and further understand mothers’ expectations of and preferences for the delivery of professional services.

Method

A descriptive phenomenological study design was utilized in this study, and semi-structured interviews were conducted with 28 primiparous mothers who had given birth in the first year period before the interview and were selected from two community health centres in Xi’an city, Shaanxi Province, Northwest China. Each conversational interview lasted between 20 and 86 min. Colaizzi’s seven-step phenomenological approach was used to analyse the data.

Results

Three major themes were identified: (a) dissatisfaction with current professional services for postpartum mothers, (b) likelihood of health care professional help-seeking behaviour, (c) highlighting the demands for new health care services. The related seven sub-themes included being disappointed with current hospital services; distrusting services provided by community health centres, private institutes and commercial online platforms; preferring not seeking help from professionals as their first choice; hesitating to express their inner discourse to professionals; following confinement requirement and family burden prevents mothers from seeking professional help; experiencing urgent needs for new baby-care-related services; and determining the importance of mothers’ needs. The necessity of professional support in the first month after childbirth was strongly emphasized by the participants. Online professional guidance and support were perceived as the best way to receive services in this study.

Conclusion

The results of this descriptive phenomenological study suggested that the current maternal and child health care services were insufficient and could not meet primiparous mothers’ need. The results also indicated that identifying barriers and providing services focused on mothers’ needs may be an effective strategy to enhance primiparous mothers’ well-being, and further suggested that feasibility, convenience, and the cultural adaptability of health care services should be considered during the delivery of postpartum interventions.

Belsky J. The determinants of parenting: A process model. Child Dev. 1984;55:83-96. https://doi.org/10.1111/j.1467-8624.1984.tb00275.x.

Corrigan CP, Kwasky AN, Groh CJ. Social support, postpartum depression, and professional assistance: a survey of mothers in the midwestern United States. J Perinat Educ. 2015;24 (1):48-60. https://doi.org/https://doi.org/10.1891/1058-1243.24.1.48.

Coates R, Ayers S, de Visser R. Women’s experiences of postnatal distress: a qualitative study. BMC Pregnancy Childb. 2014;14:359. https://doi.org/10.1186/1471-2393-14-359.

Bornstein MH, editor. Handbook of parenting: Being and becoming a parent, vol. 3. 2nd ed. New York: Routledge; 2012.

Van Scheppingen MA, Denissen JJA, Chung JM, Tambs K, Bleidorn W. Self-esteem and relationship satisfaction during the transition to motherhood. J Pers Soc Psychol. 2018;114(6):973-991. https://doi.org/10.1037/pspp0000156.

Field T. Postpartum depression effects on early interactions, parenting, and safety practices: a review. Infant Behav Dev. 2010;33(1):1–6. https://doi.org/. https://doi.org/10.1016/j.infbeh.2009.10.005.CrossRefPubMed

Tatano C. State of the science on postpartum depression: what nurse researchers have contributed—part 1. MCN Am J Matern Child Nurs. 2008;33(2):121–6.CrossRef

O'Hara MW, McCabe JE. Postpartum depression: current status and future directions. Annu Rev Clin Psychol.2013;9:379-407. https://doi.org/10.1146/annurev-clinpsy-050212-185612.

Righetti-Veltema M, Conne-Perreard E, Bousquest A, Manzano J. Risk factors and predictive signs of postpartum depression. J Affect Disord. 1998;49(3):167–80. https://doi.org/. https://doi.org/10.1016/s0165-0327(97)00110-9.CrossRefPubMed

10.

Maria Elvira DC, Elisabetta S. The experience of pre- and post-partum in relation to support, stress, and parenthood representation. Procedia Soc Behav Sci. 2014;116:697-702. https://doi.org /https://doi.org/10.1016/j.sbspro.2014.01.282.

11.

Tsai SS, Wang HH. Role changes in primiparous women during ‘doing the month’ period. Midwifery. 2019;74:6-13. https://doi.org /https://doi.org/10.1016/j.midw.2019.03.007.

12.

Kurth E, Krähenbühl K, Eicher M, Rodmann S, Fölmli, Conzelmann C, et al. Safe start at home: what parents of newborns need after early discharge from hospital-a focus group study. BMC Health Serv Res. 2016;16:82. https://doi.org /https://doi.org/10.1186/s12913-016-1300-2.

13.

Negron R, Martin A, Almog M, Balbierz A, Howell EA. Social support during the postpartum period: Mothers’ views on needs, expectations, and mobilization of support. Matern Child Health J. 2013;17(4):616-623. https://doi.org/https://doi.org/10.1007/s10995-012-1037-4.

14.

Yim IS, Tanner Stapleton LR, Guardino CM, Hahn-Holbrook J, Dunkel Schetter C. Biological and psychosocial predictors of postpartum depression: systematic review and call for integration. Annu Rev Clin Psychol. 2015;11:99-137. https://doi.org/https://doi.org/10.1146/annurev-clinpsy-101414-020426.

15.

Beck CT. Predictors of postpartum depression: An update. Nurs Res. 2001;50(5):275–85.CrossRef

16.

Small R, Taft AJ, Brown SJ. The power of social connection and support in improving health: Lessons from social support interventions with childbearing women. BMC Public Health. 2011;11:S4. https://doi.org/https://doi.org/10.1186/1471-2458-11-S5-S4.

17.

Carty EM, Bradley CF. A randomized, controlled evaluation of early postpartum hospital discharge. Birth. 1990;17(4):199–204.CrossRef

18.

MacArthur C, Winter HR, Bick DE, Knowles H, Lilford R, Henderson C, et al. Effects of redesigned community postnatal care on womens’ health 4 months after birth: a cluster randomised controlled trial. Lancet. 2002;359:378-385. https://doi.org/https://doi.org/10.1016/s0140-6736(02)07596-7.

19.

Paul IM, Beiler JS, Schaefer EW, Hollenbeak CS, Alleman N, Sturgis SA, et al. A randomized trial of single home nursing visits vs office-based care after nursery/maternity discharge: the nurses for Infants Through Teaching and Assessment After the Nursery (NITTANY) Study. Arch Pediatr Adolesc Med. 2012;166(3):263–70. https://doi.org/. https://doi.org/10.1001/archpediatrics.2011.198.CrossRefPubMed

20.

Dennis CL, Kingston D. A systematic review of telephone support for women during pregnancy and the early postpartum period. J Obstet Gynecol Neonatal Nurs. 2008;37(3):301-314. https://doi.org/https://doi.org/10.1111/j.1552-6909.2008.00235.x.

21.

Hadfield H, Wittkowski A.Women’s Experiences of Seeking and Receiving Psychological and Psychosocial Interventions for Postpartum Depression: A Systematic Review and Thematic Synthesis of the Qualitative Literature. J Midwifery Womens Health. 2017;62(6):723-736. https://doi.org/https://doi.org/10.1111/jmwh.12669.

22.

Rossiter C, Fowler C, McMahon C, Kowalenko N. Supporting depressed mothers at home: their views on an innovative relationship based intervention. Contempory Nurs. 2012;41(1):90-100. https://doi.org/https://doi.org/10.5172/conu.2012.41.1.90.

23.

Fenwick J, Gamble J, Creedy D, Barclay L, Buist A, Ryding EL. Women’s perceptions of emotional support following childbirth: a qualitative investigation. Midwifery. 2013;29(3):217-224. https://doi.org/https://doi.org/10.1016/j.midw.2011.12.008.

24.

Schmied V, Cooke M, Gutwein R, Steinlein E, Homer C. Time to listen: strategies to improve hospital-based postnatal care. Women Birth. 2008;21(3):99–105. https://doi.org/. https://doi.org/10.1016/j.wombi.2008.04.002.CrossRefPubMed

25.

Shorey S, Yang YY, Cindy-Lee Dennis. A Mobile Health App–Based Postnatal Educational Program (Home-but not Alone): Descriptive Qualitative Study. J Med Internet Res. 2018;20(4):e119. https://doi.org/https://doi.org/10.2196/jmir.9188.

26.

Rudman A, Waldenström U. Critical views on postpartum care expressed by new mothers. BMC Health Serv Res. 2007;7:178. https://doi.org/https://doi.org/10.1186/1472-6963-7-178.

27.

McIntosh J. Postpartum depression: Women’s help-seeking behaviour and perceptions of cause. J Adv Nurs. 1993;18(2):178-184. https://doi.org /https://doi.org/10.1046/j.1365-2648.1993.18020178.x.

28.

O’Mahen HA, Flynn HA, Chermack S, Marcus S. Illness perceptions associated with perinatal depression treatment use. Arch Womens Ment Health. 2009;12(6):447–450. https://doi.org /https://doi.org/10.1007/s00737-009-0078-1.

29.

Ugarriza D, Brown S, Chang-Martinez C. Anglo-American mothers and the prevention of postpartum depression. Issues Ment Health Nurs. 2007;28(7):781-798. https://doi.org /https://doi.org/10.1080/01612840701413624.

30.

Fowles ER, Hsiu-Rong C, Milles S. Postpartum health promotion interventions: A systematic review. Nurs Res. 2012;61(4):269-282. https://doi.org /https://doi.org/10.1097/NNR.0b013e3182556d29.

31.

Chew-Graham C, Chamberlain E, Turner K, Folkes L, Caulfield L, Sharp D. GPs and health visitors views on the diagnosis and management of postnatal depression: A qualitative study. Br J Gen Pract. 2008;58:169-176. https://doi.org /https://doi.org/10.3399/bjgp08x277212.

32.

Whittaker A, Williams N, Chandler A, Cunningham-Burley S, McGorm K, Mathews G. The burden of care: A focus group study of healthcare practitioners in Scotland talking about parental drug misuse. Health Soc Care Community. 2016;24(5):72-80. https://doi.org /https://doi.org/10.1111/hsc.12249.

33.

Khan L. Falling through the gaps: perinatal mental health and general practice. UK: Centre for Mental Health; 2015.

34.

Xu FH. Demand for gynecological disease prevention and control of health education during pregnancy maternal analysis. Journal Of Practical Gynecologic Endocrinology. J Prac Gynec Endoc. 2016;3(13):25–28.

35.

Mao HJ, Li HJ, Chiu H, Chan WC, Chen SL. Effectiveness of Antenatal Emotional Self-Management Training Program in Prevention of Postnatal Depression in Chinese Women. Perspect Psychiatr C. 2012;48:218-224. https://doi.org/https://doi.org/10.1111/j.1744-6163.2012.00331.x..

36.

Kumar R. Postnatal mental illness: A transcultural perspective. Soc Psych Epi. 1994;29(6):250–64.CrossRef

37.

Halbreich U, Karkun S. Cross-cultural and social diversity of prevalence of postpartum depression and depressive symptoms. J Affect Disorders. 2006;91(2-3):97-111. https://doi.org/https://doi.org/10.1016/j.jad.2005.12.051.

38.

Fathi-Ashtiani A, Ahmadi A, Ghobari-Bonab B, Azizi MP, Saheb-Alzamani SM. Randomized trial of psychological interventions to preventing postpartum depression among Iranian first-time mothers. Int J Prev Med. 2015;6:109. https://doi.org/https://doi.org/10.4103/2008-7802.169078.

39.

Chan SWC, Williamson V, McCutcheon H. A comparative study of the experiences of a group of Hong Kong Chinese and Australian women diagnosed with postnatal depression. Perspect Psychiatr C. 2009;45(2):108-118. https://doi.org/https://doi.org/10.1111/j.1744-6163.2009.00211.x.

40.

Lau Y, Wang Y, Yin L, Chan KS, Guo X. Validation of the Mainland Chinese version of the Edinburgh Postnatal Depression Scale in Chengdu mothers. Int J Nurs Stud. 2010;47(9):1139–51. https://doi.org/. https://doi.org/10.1016/j.ijnurstu.2010.02.005.CrossRefPubMed

41.

Wan EY, Moyer CA, Harlow SD, Fan Z, Jie Y, Yang H. Postpartum depression and traditional postpartum care in China: Role of Zuoyuezi. Int J Gynecol Obstet. 2009;104(3):209-213. https://doi.org/https://doi.org/10.1016/j.ijgo.2008.10.016.

42.

Ornery A. Phenomenology: a method for nursing research. Adv Nurs Sci. 1983;5:49–63.CrossRef

43.

Husserl E. Cartesian meditations: an introduction to phenomenology. The Hague: Martinus Nijhoff Publications; 1960.CrossRef

44.

Moran D. Introduction to phenomenology. Milton Park: Routledge; 2000.

45.

Lopez KA, Willis DG. Descriptive versus interpretive phenomenology: their contributions to nursing knowledge. Qual Health Res. 2004;14:726-735. https://doi.org/https://doi.org/10.1177/1049732304263638.

46.

Colaizzi PF. Psychological research as the phenomenologist views. In: Valle R, King M, editors. Existential-Phenomenological Alternatives for Psychology. New York: Oxford University Press; 1978. p. 48–71.

47.

Lau Y, Wong DF. Are concern for face and willingness to seek help correlated to early postnatal depressive symptoms among Hong Kong Chinese women? A cross-sectional questionnaire survey. Int J Nurs Stud. 2008;45(1):51-64. https://doi.org /https://doi.org/10.1016/j.ijnurstu.2006.08.002.

48.

^. Status Analysis of Maternity Construction in Western China. Matern Child Health Care China. 2018; 33(24): 5682-5684. https://doi.org/https://doi.org/10.7620/zgfybj.j.issn.1001-4411.2018.24.04.

49.

Nagle U, Farrelly M. Women’s views and experiences of having their mental health needs considered in the perinatal period. Midwifery. 2018;66:79-87. https://doi.org /j.midw.2018.07.015.

50.

Yamashita T, Suplido SA, Llave C, Tuliao MT, Tanaka Y, Matsuo HU. Understanding Postpartum Healthcare Services and Exploring the Challenges and Motivations of Maternal Health Service Providers in the Philippines: a Qualitative Study. Trop Med Health. 2015;43(2):123-130. https://doi.org /https://doi.org/10.2149/tmh.2014-40.

51.

Noonan M, Jomeen J, Galvin R, Doody O. Survey of midwives’ perinatal mental health knowledge, confidence, attitudes and learning needs. Women Birth. 2018;31(6):e358-e366. https://doi.org /https://doi.org/10.1016/j.wombi.2018.02.002.

52.

Noonan M, Doody O, Jomeen J, Galvin R. Midwives’ perceptions and experiences of caring for women who experience perinatal mental health problems: An integrative review. Midwifery. 2017;45:56-71. https://doi.org/10.1016/j.midw.2016.12.010.

53.

Santora K, Peabody H. Identifying and treating maternal depression: Strategies and considerations for health plans. Washington, DC: National Institute for Health Care Management Issue Brief; 2010.

54.

Byatt N, Biebel K, Friedman L, Debordes-Jackson G, Ziedonis D. Women’s perspectives on postpartum depression screening in pediatric settings: A preliminary study. Arch Womens Ment Health. 2013;16(5):429-432. https://doi.org /https://doi.org/10.1007/s00737-013-0369-4.

55.

Dennis CL, Chung‐Lee L. Postpartum depression help‐seeking barriers and maternal treatment preferences: A qualitative systematic review. Birth. 2006;33:323-331. https://doi.org /https://doi.org/10.1111/j.1523-536X.2006.00130.x.

56.

Bilszta J, Ericksen J, Buist A, Milgrom J. Women's experience of postnatal depression - beliefs and attitudes as barriers to care. Aust J Adv Nurs. 2010;27(3):44–54 https://doi.org/0000-0001-9578-591x.

57.

Shorey S, Chan SW, Chong YS, He HG. A randomized controlled trial of the effectiveness of a postnatal psychoeducation programme on self-efficacy, social support and postnatal depression among primiparas. J Adv Nurs. 2015;71(6):1260-1273. https://doi.org /https://doi.org/10.1111/jan.12590.

58.

Naser E, Mackey S, Arthur D, Klainin-Yobas P, Chen H, Creedy DK. An exploratory study of traditional birthing practices of Chinese, Malay and Indian women in Singapore. Midwifery. 2012;28(6):e865-e871. https://doi.org /https://doi.org/10.1016/j.midw.2011.10.003.

59.

Huguet A, Rao S, McGrath PJ, Wozney L, Wheaton M, Conrod J, et al. A Systematic Review of Cognitive Behavioral Therapy and Behavioral Activation Apps for Depression. PloS One. 2016;11(5):e0154248. https://doi.org /https://doi.org/10.1371/journal.pone.0154248.

60.

Shorey S, Ng ED. Evaluation of a Technology-Based Peer-Support Intervention Program for Preventing Postnatal Depression (Part 2): Qualitative Study. J Med Internet Res. 2019;21(8):e12915. https://doi.org /https://doi.org/10.2196/12915.

61.

National Institute for Clinical Excellence. Depression: management of depression in primary and secondary care. Clinical Guideline 23; 2004. http://www.scamfyc.org/documentos/depresion%20NICE. pdf (accessed 16 June 2015).

62.

Shorey S, Ng YPM, Ng ED, Siew AL, Mörelius E, Yoong J, et al. Effectiveness of a technology-based supportive educational parenting program on parental outcomes (part 1): randomized controlled trial. J Med Internet Res. 2019;21(2):e10816. https://doi.org /https://doi.org/10.2196/10816.

63.

Chan S, Torous J, Hinton L, Yellowlees P. Towards a framework for evaluating mobile mental health apps. Telemedicine Journal and E-health. Telemed J E Health. 2015;21(12):1038-1041. https://doi.org /https://doi.org/10.1089/tmj.2015.0002.

64.

Gao G. Self and others: a Chinese perspective on interpersonal relationship. In: Gudykunst, WB, TingToomey S, Nishida T. (Eds.), Communication in Personal Relationships Across culture. SAGE Publications, Thousand Oaks; 1996.

65.

American Academy of Pediatrics & American College of Obstetricians and Gynecologists. Guidelines for perinatal care. 7th ed. Washington, DC: Author; 2012.

66.

Shorey S, Ng ED. Evaluation of Mothers’ Perceptions of a Technology-Based Supportive Educational Parenting Program (Part 2): Qualitative Study. J Med Internet Res 2019;21(2):e11065. https://doi.org /https://doi.org/10.2196/11065.

67.

Shaw E, Levitt C, Wong S, Kaczorowski J, McMaster University Postpartum Research Group. Systematic review of the literature on postpartum care: effectiveness of postpartum support to improve maternal parenting, mental health, quality of life, and physical health. Birth. 2006;33(3):210-220. https://doi.org /https://doi.org/10.1111/j.1523-536X.2006.00106.x.

68.

Pugh NE, Hadjistavropoulos HD, Dirkse DA. Randomised Controlled Trial of Therapist Assisted, Internet-Delivered Cognitive Behavior Therapy for Women with Maternal Depression. PLoS One. 2016;11(3):e0149186. https://doi.org /https://doi.org/10.1371/journal.pone.0149186.

Title: Professional support during the postpartum period: primiparous mothers’ views on professional services and their expectations, and barriers to utilizing professional help
Authors: Yiping Nan
Jingjun Zhang
Anum Nisar
Lanting Huo
Lei Yang
Juan Yin
Duolao Wang
Atif Rahman
Yan Gao
Xiaomei Li
Publication date: 01-12-2020
Publisher: BioMed Central
Keyword: Care
Published in: BMC Pregnancy and Childbirth / Issue 1/2020
Electronic ISSN: 1471-2393
DOI: https://doi.org/10.1186/s12884-020-03087-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Professional support during the postpartum period: primiparous mothers’ views on professional services and their expectations, and barriers to utilizing professional help

Abstract

Background

Method

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Method

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2020

Prevalence and factors associated with timely initiation of breastfeeding in Kilimanjaro region, northern Tanzania: a cross-sectional study

Post-breastfeeding stress response and breastfeeding self-efficacy as modifiable predictors of exclusive breastfeeding at 3 months postpartum: a prospective cohort study

Maternal ABVD chemotherapy for Hodgkin lymphoma in a dichorionic diamniotic pregnancy: a case report

Monozygotic dichorionic-diamniotic pregnancies following single frozen-thawed blastocyst transfer: a retrospective case series

Satisfaction in parturients receiving epidural analgesia after prenatal shared decision-making intervention: a prospective, before-and-after cohort study

SARS-COV-2 infection during pregnancy, a risk factor for eclampsia or neurological manifestations of COVID-19? Case report