Search

Objective: The COVID-19 pandemic saw universal, radical, and ultra-rapid changes to UK National Health Services (NHS) maternity care. At the onset of the pandemic, NHS maternity services were stripped of many of the features which support woman and family centred care. In anticipation of unknown numbers of pregnant women and maternity staff potentially sick with COVID-19, services were pared back to the minimum level considered to be required to keep women and their babies safe. The aim of this survey was to understand the impact of COVID-19 public health messaging and pandemic-related service changes on users of maternity care in the UK during the pandemic., Methods: We conducted an online survey to explore user's experiences of COVID-19 public health messaging and 'socially-distanced' maternity care across the UK. The study population consisted of women who had experienced pregnancy after the 11th March 2020 (when the WHO declared a pandemic), whether or not they were still pregnant. We collected data between June and September 2020. We used framework analysis for the free-text data and generated descriptive statistics., Findings: Women were generally happy to adopt a precautionary approach and stringently social distance in the context of a relatively unknown pathogen and in an environment of extreme anxiety and uncertainty, but were acutely aware of the negative impacts. The survey found that the widespread changes to services caused unintended negative consequences including essential clinical care being missed, confusion over advice, and distress and emotional trauma for women. COVID-19 restrictions have resulted in women feeling their antenatal and postnatal care to be inadequate and has also come at great emotional cost to users. Women reported feeling isolated and sad in the postnatal period, but also frustrated and upset by a lack of staff to help them care for their new baby., Key Conclusions: With growing evidence of the impact of the virus on pregnant women and an increased understanding of the unintended consequences of unclear public health messaging and overly precautious services, a more nuanced, evidence-based approach to caring for women during a pandemic must be prioritised., Implications for Practice: All maternity services should ensure they have clear lines of communication with women to keep them updated on changing care and visiting arrangements. Services should ensure that opportunities to provide safe face-to-face care and access for birth partners and visitors are maximised., Competing Interests: Declaration of Competing Interest None declared., (Copyright © 2021. Published by Elsevier Ltd.)

Objective: To explore what first time mothers in England expect from postnatal care while they are pregnant, what they would ideally like, where they get their information on postnatal care, and their views on the sufficiency of this information., Design: A qualitative descriptive interview-based study., Setting: England PARTICIPANTS: A maximum variation sample of 40 women who were currently in the third trimester of pregnancy; aged 16 or over; planning to give birth in England and had not given birth previously., Methods: Semi structured interviews were carried out between October 2017 and March 2018, by telephone (n = 32) and face to face (n = 8). Interviews were analysed using thematic analysis., Results: There were six themes and twelve subthemes. The themes were: (1) 'Piecing together snippets of information' containing subthemes 'Incomplete official sources' and 'Other mothers' stories'; (2) 'Planning ahead or going with the flow' containing subthemes 'Wanting more information' and 'Postnatal care not a priority'; (3) 'Judgement or reassurance' containing subthemes 'Real: Being judged', 'Ideal: Reassurance and non-judgmental advice'; (4) 'Focus of care' containing subthemes 'Real: A focus on checks and feeding', 'Ideal: More focus on mother's wellbeing'; (5) 'A system under pressure' containing subthemes 'Real: Busy midwives, reactive care', 'Ideal: Reliable, proactive information'; (6) 'Deciding about discharge', containing subthemes 'Real: Confusion about decision-making', 'Ideal: More control over length of hospital stay'., Key Conclusions: First time mothers' experience of the transition to parenthood could be improved by antenatal access to comprehensive information about the timing, location, content and purpose of postnatal care. Information should take a woman-centred perspective and cover all settings (hospitals, birth centres, home, community), including the roles and responsibilities of all the professionals who may be involved., Implications for Practice: Clear and comprehensive information about postnatal care should be provided to all women in ways that are accessible at any stage of pregnancy or the postnatal period. As women pregnant for the first time worry about being judged if they seek professional advice and reassurance postnatally, information about postnatal care should aim to address this., (Copyright © 2020. Published by Elsevier Ltd.)

Objective: To explore the quality of life (QOL) and related factors in early postnatal women., Design: A descriptive, cross-sectional study., Setting: Liwonde, Malawi., Participants: Women who underwent a normal vaginal birth (N = 173) were included from August to September 2018., Measurements: The QOL of participants was assessed using a World Health Organization QOL instrument. Demographic, obstetric, and health variables were collected using a structured questionnaire. Childbirth fear and depression were respectively assessed using the Wijma Delivery Experience Questionnaire and the Edinburgh Postnatal Depression Scale. A multiple linear regression was used to examine factors associated with the QOL., Results: The mean age of participants was 29 (standard deviation 6.7) years. The overall QOL and health were satisfactory. The mean score of the QOL was highest in the psychological health and social relationships domains, followed by the environmental and physical health domains. A higher educational level was negatively related to the physical health of QOL (p ≤ 0.01), with physician care positively related (p = 0.01). The employment status was positively related to psychological health and the environmental QOL (p ≤ 0.01). Furthermore, a higher income, and physician care were positively related to the environmental QOL (p ≤ 0.05). High levels of childbirth fear and depressive symptoms were negatively related to all domains of the QOL (p ≤ 0.05), except for the social relationships domain., Conclusion and Implications for Practice: The physical health QOL was lower in postnatal mothers in Malawi. Measures to improve physical health aspects and address women's fears and depressive symptoms during postpartum care are warranted. The findings should alert the health providers of the importance of assessing and improving women's physical health and psychological well-being during postpartum care., Competing Interests: Declaration of Competing Interest No conflict of interest is declared by the authors., (Copyright © 2020. Published by Elsevier Ltd.)

Decision-making power and access to and control over resources are key elements of women's bargaining power within a household, and plays an important role in improving healthcare seeking behaviours for women and their children, which in turn augment maternal and child health outcomes. We examined the relationship between intra-household bargaining power and utilization of postnatal and child healthcare services within 6 months after delivery, based on cross-sectional survey data from Kyenjojo district, Tooro sub-region of Western Uganda. We assessed independent associations between women's intra-household bargaining autonomy and postnatal care attendance using a modified Poisson approach for common outcomes. We found that women who contributed to the decision-making processes on child healthcare, personal healthcare, and how to raise money for healthcare of family members were about 20% more likely to attend postnatal and child healthcare within 6 months of delivery, compared with women who were unable to make such decisions. Therefore, contributing to efforts that empower women to have greater control over child and personal healthcare through gender transformative approaches and policy engagements in important., Competing Interests: Declaration of Competing Interest All the authors declare no conflict of interest., (Copyright © 2020. Published by Elsevier Ltd.)

Background: Early initiation of breastfeeding and exclusive breastfeeding can reduce infant mortality. Breastfeeding support interventions such as counselling may improve adherence to recommended practices. However, it is not known if these interventions work at the population level., Objective: The aim of this study was to assess the relationship between early postnatal breastfeeding support and recommended breastfeeding practices., Design/setting: We pooled data from 11 Demographic and Health Surveys in Africa (n = 7), South East Asia (n = 2), the Americas (n = 1), and Europe (n = 1) to analyse these associations at the population level., Participants: We limited the data to the most recent live births in the two years before the survey, including 41,431 births., Analysis: We fitted three multivariable logistic regression models to estimate the relationship between early postnatal breastfeeding support (a newborn postnatal check within an hour of birth plus counselling and observation of breastfeeding within two days) and three breastfeeding outcomes (early initiation of breastfeeding, absence of prelacteal feeding, and exclusive breastfeeding), adjusting for sociodemographic characteristics and birth-related factors., Findings: Early breastfeeding support was associated with a 24% increase (OR=1.24 95%CI=1.11,1.39) in the odds of initiating breastfeeding within one hour of birth. No relationships were found between breastfeeding support and prelacteal feeding in the first three days or exclusive breastfeeding at six months., Key Conclusion: While postnatal breastfeeding counselling and observation may improve early initiation of breastfeeding, impact is not persistent for longer term breastfeeding outcomes., Implication for Practice: Improved training for breastfeeding support and an enabling policy environment are required to improve breastfeeding practices for women and newborns., Competing Interests: Declaration of Competing Interest The authors declare that they have no conflicts of interest. The contents expressed in the article are those of the authors and do not necessarily reflect the policies or views of the organisations they are affiliated with., (Copyright © 2019. Published by Elsevier Ltd.)

Background: The goal of postnatal care is to provide the highest possible quality of care and medical safety with the least possible intervention in order to optimize health and wellbeing of the new family. The aim of the study was to describe mothers´ experiences in relation to a new postnatal home-based model of midwifery care., Methods: The current study uses a cross-sectional mixed method design to assess a new postnatal home-based model of midwifery care in Sweden. Healthy women with an uncomplicated pregnancy and childbirth, and with a healthy baby answered an online questionnaire one week after birth. Data were collected during one year (2017-2018) and analyzed using descriptive and inferential statistics for quantitative data, and manifest content analysis for qualitative data., Findings: In total, 180 mothers with one to six children were included. They were most likely to have been discharged between six and 12 h after childbirth (56%) and 90% reported that the time for their discharge was good. The postnatal check-ups included were telephone contact (100%), home visit(s) (94%) and hospital visit(s) (98%). Most mothers had a positive postnatal care experience from using the new postnatal model of midwifery care (mean VAS 8.74, Std. Deviation 1.438). For 75%, of the participants, home-based postnatal care would be preferred for their next childbirth., Conclusion: Home-based postnatal care is well accepted by mothers who were discharged early after childbirth. Mothers with a positive experience of the new postnatal model of midwifery care would prefer home-based postnatal care for their next childbirth. Midwifery care should include home-based postnatal care., (Copyright © 2019. Published by Elsevier Ltd.)

Objective: We aimed to explore midwives' perspectives on post-abortion care (PAC) in Uganda. Specifically, we sought to improve understanding of the quality of care., Design: This was a qualitative study using individual in-depth interviews and an inductive thematic analysis., Setting and Participants: Interviews were conducted with 22 midwives (the 'informants') providing PAC in a public hospital in Kampala, Uganda. The narratives were based on experiences in current and previous workplaces, in rural and urban settings., Findings: The findings comprise one main theme - morality versus duty to provide quality post-abortion care - and three sub-themes. Our findings confirm that the midwives were committed to saving women's lives but had conflicting personal morality in relation to abortion and sense of professional duty, which seemed to influence their quality of care. Midwives were proud to provide PAC, which was described as a natural part of midwifery. However, structural challenges, such as lack of supplies and equipment and high patient loads, hampered provision of good quality care and left informants feeling frustrated. Although abortion was often implied to be immoral, the experience of PAC provision appeared to shape views on legality, leading to an ambiguous, yet more liberal, stance. Abortion stigma was reported to exist within communities and the health workforce, extending to both providers and care-seeking women. Informants had witnessed mistreatment of women seeking care due to abortion complications, through deliberate care delays and denial of pain medication., Key Conclusion and Implications for Practice: Midwives in PAC were dedicated to saving women's lives; however, conflicting morality and duty and poor working conditions seemed to impede good-quality care. Enabling midwives to provide good quality care includes increasing the patient-midwife ratio and ensuring essential resources are available. Additionally, efforts that de-stigmatise abortion and promote accountability are needed. Implementation of policies on respectful post-abortion care could aid in ensuring all women are treated with respect., (Copyright © 2019. Published by Elsevier Ltd.)

Objective: to identify the emotional and support needs of pregnant multigravida women who have experienced adverse responses associated with a previous childbirth experience., Setting: four maternity hospitals in North-West England., Design: 100 surveys were distributed at an anomaly scan clinic in each of four maternity hospitals (total n=400). The survey included an adapted version of a Post-Traumatic Stress Disorder Symptom Scale to explore trauma responses at two broad time points: (a) following a previous birth and (b) during the current pregnancy. Participants were also asked about the optimal time to receive support post-birth, and the type and provider of support they had accessed/would have liked to access. Descriptive and inferential statistics were undertaken on the quantitative data. The qualitative data were analysed using a basic thematic approach., Participants: multigravida pregnant women aged 18+ years., Findings: the overall response rate was 28% (n=112); 43% (n=46) of the women had experienced negative/trauma responses associated with a previous birth, 74% of whom (n=34) continued/re-experienced adverse responses in their current pregnancy. Most commonly reported trauma responses were difficulties in recalling the previous birth(s), avoiding memories associated with it, and the distress associated with these memories when they were recalled. Approximately 54% (n=25) had received some form of support post-birth, and variations in preferred timing of postnatal support provision were reported. Information on available support and opportunities to discuss the birth with a maternity professional were identified most frequently as preferred support options., Conclusion and Implications for Practice: women's views about what might work should form the basis for effectiveness studies in this area. Among the participants in this study there was evidence of unmet support needs relating to negative or traumatic responses to a previous birth. The range of preferred timing and types of support indicate that flexible needs-based support options should be provided. Further research should assess if these findings are reinforced in a more diverse sample with a higher response rate., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Objective: to examine the psychometric properties of a newly developed Postpartum Women's Health Quotient Scale (PWHQS) for Chinese post partum women., Design: a cross-sectional survey of post partum women was conducted.Categorical confirmatory factor analysis (CCFA) models were applied to examine the factorial structure of the PWHQS; test information function (TIF) was used to examine reliability of PWHQS subscales; and measurement invariance was examined by testing differential item functioning (DIF) using a multiple indicators multiple causes (MIMIC) model., Setting: two large hospitals with a level 3A designation in Suzhou, Jiangsu Province, China., Participants: a convenience sample of 395 post partum women was recruited from April to September 2014., Measurement: the PWHQS consists of 31 items with 5 subscales: health consciousness (HC, 6 items), maternal health knowledge (MHK, 8 items), infant health knowledge (IHK, 6 items), maternal health care ability (MHCA, 5 items), and infant health care ability (IHCA, 6 items)., Findings: PWHQS has a valid factorial structure with five dimensions as theoretically designed. Each of its subscales has adequate reliability that is particularly high over the lower-moderate range of the factor score scale. Measurement non-invariance in PWHQS is very limited as only two of the 31 items displayed DIF related to one grouping variable (Age)., Key Conclusion: PWHQS is a valid and reliable instrument that can be readily used as a screening tool to assess health quotient (HQ) among Chinese post partum women. PWHQS will also be useful for the development of interventions to help post partum women maintain and improve maternal and infant health. Further research to confirm the findings of the present study is desirable., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Objective: this study aims to contribute to the development of a conceptual framework that will inform maternity care improvements for expectant mothers with intellectual and developmental disabilities (IDD) by exploring the structure, functions, and perceived quality of social support received by women with IDD during pregnancy and childbirth., Design/setting: using a grounded theory approach, we conducted an exploratory study set in Ontario, Canada in 2015., Participants: the sample included four adult women with IDD who had given birth in the last five years., Measurements: data were collected using semi-structured interviews., Findings: the structure of social support received by women with IDD consisted of both formal and informal sources, but few or no friendships. Women with IDD reported high levels of informational and instrumental support and low levels of emotional support and social companionship. However, a high level of available support was not always perceived as beneficial. Emergent core categories suggest that social support is perceived as most effective when three conditions are met: (1) support is accessible, (2) support is provided by individuals expressing positive attitudes towards the pregnancy, and (3) autonomy is valued., Key Conclusions and Implications for Practice: our study confirms and identifies important gaps in the social support received by expectant mothers with IDD. Women with IDD currently lack accessible informational support, emotional support, and social companionship during pregnancy and childbirth. Additional findings regarding the structure and functions of social support are presented, and a preliminary conceptual framework of effective social support during pregnancy and childbirth, as perceived by women with IDD is also proposed. Findings suggest that increasing support accessibility should be a social and clinical priority; however, maternity care providers should be aware of stigmatizing attitudes and respect the autonomy of pregnant women with IDD as they prepare for motherhood., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Background: more than two decades after the launch of the '10 steps' for successful breast feeding, there is still concern that implementation is suboptimal. Commonly, studies assess the level of implementation based on self-assessments from maternity staff and more rarely based on the mothers' own experience. To date, there has been only anecdotal evidence with regards to the implementation of the '10 steps' in Cyprus while there is general lack of research data on breast feeding in this country., Aim: this study assessed breast feeding self-efficacy among mothers during the first 48hours after birth and explored their views with regards to the implementation of the '10 steps' across public and private maternity units in Nicosia, Cyprus., Method: this is a descriptive study with a consecutive sample of 216 mothers, aged at least 18, who gave birth to a full-term healthy infant between January and April 2014. Two data collection tools were used: Section 4 of the BFHI (Baby Friendly Hospital Initiative) questionnaire referring to mothers' self-assessment of maternity unit practices and the BSES-SF (Breast feeding Self-Efficacy Scale - Short Form) which measures perceived self-efficacy in bryeast feeding., Results: midwifery assistance for breast feeding skills development along with encouragement of breast feeding on demand (steps 5 and 8) were identified by mothers as the steps they were more likely to have experienced. In addition, there appeared to be relatively good adherence to the International Code of Marketing of Breast-milk Substitutes. In contrast, it seems that step 7(rooming-in), step 9 (no pacifiers) and step 10 (breast feeding support after discharge) were not systematically practiced. While a higher percentage of mothers in public maternity units reported being informed about the importance of skin-to-skin contact compared to the private sector (51.5% versus 25.7%), there does not appear to be much difference in terms of its actual practice which is generally low (29.0% versus 25.4%). Exclusive breast feeding (step 6) was low (21.7%) while the mean score of breast feeding self-efficacy at 48hours was 3.33 (0.87SD) on a 5-point Likert scale., Conclusions: it appears that mothers in Cyprus had limited experience of the '10 steps' during their stay Nicosia maternity units. This, along with the fact that exclusive breast feeding and breast feeding self-efficacy were rather low, suggests the need for interventions that will enhance breastfeeding self-efficacy and empower mothers to initiate breast feeding while at the maternity unit. In particular, the limited information to mothers upon leaving the maternity unit highlights the lack of maternal support services in the community., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Objective: the aim of this study was to investigate new parents׳ experiences of early postnatal discharge., Design: a meta-synthesis including 10 qualitative studies was conducted using Noblit and Hare׳s method of meta-synthesis development., Setting: qualitative studies performed in western countries from 2003-2013 were included., Participants: the 10 included studies involved 237 mothers and fathers, first time parents as well as multiparous., Findings: we identified four overlapping and mutually dependent themes reflecting the new parents׳ experiences of early postnatal discharge: Feeling and taking responsibility; A time of insecurity; Being together as a family; and Striving to be confident. The mothers׳ and fathers׳ experiences of responsibility, security and confidence in their parental role, were positively influenced by having the opportunity to be together as a family, receiving postnatal care that included both parents, having influence on time of discharge, and getting individualised and available support focused on developing and recognising their own experiences of taking care of the baby., Conclusions and Implications for Practice: the new parents׳ experiences of early discharge and becoming a parent were closely related. Feeling secure and confident in the parental role was positively or negatively influenced by the organisation of early discharge. This underscores the importance of the way health professionals support new mothers and fathers at early postnatal discharge., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Objective: to explore the perceptions of primiparas on the contents, delivery and personal impact of postnatal psychoeducation programme., Design and Settings: a descriptive qualitative study was conducted in a public tertiary hospital in Singapore in 2013., Participants: 18 primiparas who were able to read and speak English were recruited from the intervention group of a randomised controlled trial., Measurements: a semi-structured interview guide was used to interview participants' perceptions on a postnatal psychoeducation programme at participants' home, which was developed based on the principles of self-efficacy and social exchange theories, between six and nine weeks post partum. The programme comprised of a 90-minute home visit, three weekly telephone follow-up and an educational booklet., Findings: the qualitative interviews revealed that the participants faced many challenges such as negative emotions and difficulties in breast feeding and support issues in the early postpartum period especially after the hospital discharge. However, all the participants in the intervention group perceived the postnatal psychoeducation programme to be helpful in increasing their confidence in newborn care, fostering help-seeking behaviour, improving emotional well-being and increasing their knowledge in newborn and self-care as well as in breast feeding. Suggestions for programme improvements included more home visits, more telephone follow-up and web-based psychoeducation as well as recommending postnatal psychoeducation programme to be offered as a routine care. Overall, there was a high satisfaction and acceptability with the programme., Conclusions: our findings indicate that the programme is beneficial for maternal well-being and confidence in maternal roles and, therefore, is promising to be introduced to the multiracial primiparas in Singapore., Implications for Practice: the challenges mothers experience during the postnatal period suggest that it would be worthwhile to devote more resources in providing follow-up support to the mothers in the early postpartum period. Midwives could incorporate a self-efficacy enhancing intervention with a family-centred approach to enable women to have a smooth transition to motherhood., (Copyright © 2014. Published by Elsevier Ltd.)

Objectives: to explore the emotional adjustments that women make when their baby's chronic illness or disability threatens breastfeeding., Methods: qualitative descriptive study and exploratory secondary analysis of narratives from five breastfeeding women in the UK whose babies experienced a chronic condition., Findings: three key themes were discerned: (1) 'Overwhelmed'--feelings of shock and helplessness. Engagement in the practical issues of breastfeeding, relying on others and receiving emotional support from them helped. (2) 'Under acknowledged'--women spoke of not being listened to or taken seriously. Focus on the medical condition de-valued the contribution of breastfeeding. (3) 'Striving for normality'--reframing the situation and readjusting goals and expectations helped adjustment to a 'normal' life., Discussion: varying levels of emotional adjustment were experienced by the women, and a process or path reflected their efforts to cope. Adjustments are discussed in terms of practical issues of coping and biographical disruption, thereby raising awareness of challenging aspects. Breastfeeding provided a sense of control and purpose. Understanding issues around breastfeeding an ill or disabled child can help health-care providers offer more appropriate care to women who wish to breast feed in spite of chronic illness., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Objective: to explore the postpartum experiences of Cambodian born migrant women who gave birth for the first time in Victoria, Australia between 2000 and 2010., Design: an ethnographic study with 35 women using semi-structured and unstructured interviews and participant observation; this paper draws on interviews with 20 women who fit the criteria of first time mothers who gave birth in an Australian public hospital., Setting: the City of Greater Dandenong, Victoria Australia., Participants: twenty Cambodian born migrant women aged 23-30 years who gave birth for the first time in a public hospital in Victoria, Australia., Findings: after one or two home visits by midwives in the first 10 day postpartum women did not see a health professional until 4-6 weeks postpartum when they presented to the MCH centre. Women were home alone, experienced loneliness and anxiety and struggled with breast feeding and infant care while they attempted to follow traditional Khmer postpartum practices., Implications for Practice: results of this study indicate that Cambodian migrant women who are first time mothers in a new country with no female kin support in the postpartum period experience significant emotional stress, loneliness and social isolation and are at risk of developing postnatal depression. These women would benefit from the introduction of a midwife-led model of care, from antenatal through to postpartum, where midwives provide high-intensity home visits, supported by interpreters, and when required refer women to professionals and community services such as Healthy Mothers Healthy Babies (Victoria Department of Health, 2011) for up to 6 weeks postpartum., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Objective: to describe perceptions of participating in a study testing the effectiveness of a perinatal emotional support intervention (Promoting Resilience in Mothers Emotions; PRIME) by women identified as experiencing emotional distress after birth., Design: qualitative descriptive approach. Semi-structured telephone interviews with 33 women recruited as part of a larger RCT to test the efficacy of a counselling intervention (PRIME). Women who received either (1) the intervention (counselling (or PRIME)) (n=16), (2) active control (Parenting support) (n=12), or (3) matched control (standard care) (n=5), were interviewed at 12 months postpartum. Thematic analysis of data was used., Findings: 'promoting reflection' and 'feeling cared for', were phrases that all participants used to describe their experience in the project regardless of group allocation. Women receiving PRIME reported 'getting in touch with (their) feelings' and 'moving on' as beneficial outcomes. Two women who received counselling reported 'having things left unresolved' indicating that their needs had not been met. Some women in both the active control and intervention identified that contact was 'nice but not hugely helpful or needed'., Implications and Conclusions: positive outcomes of PRIME were evident and most participants desired postpartum contact. Some women needed additional follow up and targeted assistance. Findings support the importance of providing personalised postnatal care that addresses women's emotional health needs., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Background: studies have shown that women are more likely to be satisfied with intrapartum rather than postpartum care. The structure and organisation of care seems to be a barrier to good-quality postpartum treatment, Objective: to explore the perceived reality and the subjective importance of early postnatal care provided in hospital, and to study women's satisfaction with different models of early postnatal care and the factors that are most strongly associated with being 'very satisfied' with the postnatal care received., Method: a regional survey was conducted with 1240 women recruited in mid-pregnancy and followed-up two months after childbirth., Results: a statistically significant difference existed between the subjective importance and the perceived reality for all studied variables, with a greater subjective importance than perceived reality for all statements. The length of postnatal stay and the content of care were related to satisfaction, while the model of postnatal care was not. The most important variables for being 'very satisfied' with postnatal care were that the infant received the best possible check-ups/medical care, and that the woman received sufficient support from staff., Conclusion: further studies are needed to assess the best model of postnatal care that gives the best opportunities to provide satisfactory care for women and their families., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

Objectives: to identify women's feelings after early contact with their newborn infants in the delivery room, and to identify how health professionals involved in mother and infant care behave in the intrapartum setting., Design: a qualitative approach using semi-structured interviews and observation. Content analysis was used to derive the three themes that emerged from the interviews., Setting and Participants: 23 postpartum women and their caregivers in a public maternity hospital in Ribeirão Preto, Brazil., Findings: three thematic categories emerged from the interviews: heightened fear, severe pain and intense conflict. The professionals' actions revealed that they have theoretical and practical abilities for humanisation of care, but their actions are fragmented., Final Considerations: women can feel lonely, fearful and conflicted in the delivery room, and they also experience pain. Giving birth is a major event in a woman's life, so it is important to facilitate a positive experience. Health professionals were found to display interventionist and impersonal attitudes; these influenced the potential choices of women at their first contact with their infant., Implications for Practice: the focus of health care needs to extend beyond the institution. This means fewer normative actions performed by health professionals, enabling women to enjoy their early contact with their newborn infants., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

Objective: postnatal care has gone through remarkable changes, such as reducing the length of hospital stay and increasing the parents' responsibility. Focusing on dissatisfaction, this study describes how new parents experience postpartum care., Design: cross-sectional, population-based study, based on questionnaires., Participants: 1474 parents., Measurements and Findings: the questionnaires, posted six months after childbirth, addressed how parents experienced postnatal care. The data were analysed with descriptive statistics and content analysis., Key Conclusions: a main finding was that the close emotional attachment between the parents was not always supported by staff. The father was treated as an outsider and the care was described as 'a woman's world'. The asymmetric encounter between parents and staff was pronounced with respect to decision-making, and some designated this as 'paternalism'. A great deal of the discontent with health care may be due to organisational failure, and the postnatal care should be more prioritised in the health-care organisation., Implications for Practice: midwives should acknowledge that parents, irrespective of gender, should have equal opportunities as parents during postpartum care as parenting is a joint project., (Copyright 2008 Elsevier Ltd. All rights reserved.)

Objective: to explore women's experiences of caesarean section., Design: a qualitative study using a grounded theory approach. Data were collected using unstructured, tape-recorded interviews which took place between 1999 and 2000., Setting: the South West of England., Participants: twenty-one women who had experienced a caesarean section-either by choice or of necessity-and who were first- or second-time mothers., Findings: four main categories emerged: expectations and reality, being in control, feelings of failure as a woman and feeling different. These all linked to the core category of achieving normality. Women strove to achieve normality after having a caesarean section. If they did not gain this sense of normality, the status passage to motherhood appeared to be more difficult., Implications for Practice: it is important for health-care professionals to identify and acknowledge the emotional and physical needs of women who experience a caesarean section. Improving communication and support antenatally and postnatally may have positive benefits for maternal well-being.

Objective: to describe patterns of women's postpartum behaviour in the period of 'doing the month' in a Northern rural area in China; and to determine the degree of difference between postpartum behaviour and daily behaviour., Design: a retrospective cross-sectional survey was conducted in May 2004, using a questionnaire previously developed in pilot studies., Setting: Laishui County, Hebei Province, China., Participants: a random sample of 1813 rural women., Findings: women's traditional postpartum behaviours assessed by our postpartum behaviour questionnaire showed that most women adhered to traditional customs, drastically changing their practices in eating, sanitation, dress, activity, and household chores during the period of 'doing the month.' The analysis of variance analysis indicated that a woman's age had no effect on the change of behavioural patterns, and that a women's education had no significant effect., Conclusions: traditional postpartum behaviours are still very popular in rural areas of Northern China. Fearful of suffering illness in later years, many women closely adhere to traditional postpartum practices.

Objective: To describe new parents' choice of the type of maternity care they wanted to receive, the family suite (FS) or an early discharge (ED), and to gain a better understanding of parents' experiences of different postnatal care alternatives., Design: A qualitative study using semi-structured interviews. The interviews were analysed by content analysis., Setting and Participants: Eleven couples and one mother, including both first-time and experienced parents. Six families received care at a FS while the others chose an ED within 24 hours after birth., Measurements and Findings: The postpartum period was experienced as an unpredictable time for new parents, when the need for safety, participation in decision-making, and 'bonding' was felt to be central and decisive to their choice of care. The type of care that the parents felt best met their needs varied according to the mother's assessment of her own and the baby's health status, the parents' requirements and experience and the way in which they, as parents, handled the opportunities and demands of different environments. However, the opportunities for the parents to choose the form of care they considered best for their family were limited., Practical Implications: To best fulfil parents' wishes and needs in postnatal care alternative care forms are needed. Also, a way to treat the family as a whole on an individual family basis must be found and parents of newborn babies should be allowed to choose the form of care they consider best.

Objective: to describe the power that 'place' holds over the postnatal-care experiences of women., Design: a study informed by phenomenology within a feminist framework was undertaken to examine the experiences of women electing early postnatal discharge. Three extended conversations with each woman participating in the study were audiotaped and transcribed. Journal notes made by the researcher added to the audiotaped data. Thematic analysis revealed major structures of experience., Setting: data were obtained from conversations with women in their respective homes., Participants: five women, parity 1-3, living in the Sydney metropolitan area and birthing in their local hospitals participated in the study., Findings: four major constructs of experience were revealed through analysis and include spatiality, corporeality, temporality and relationality. In this paper, components of spatiality expressed through the power place exerts in matters of physical environment,control, confidence, safety, time, talk and the heart of the matter are presented., Key Conclusions: the experiences of women entering the foreign place of hospital to birth their children were those of alienation and disempowerment while the familiar territory of home offered stronger feelings of security and support., Implications for Practice: failing to recognise the impact of place on the experiences of postnatal women reduces the likelihood that midwives will be able to offer sensitive and appropriate care.

Objective: to explore and describe women's experiences of antenatal care., Design: semi-structured interviews, dialogical interviews and non-participant observation in two phases both during and after pregnancy were analysed according to Colaizzi's phenomenological method., Setting: four maternity clinics in one rural and one urban primary health care centre and one outpatient maternity clinic at a central hospital in Finland., Participants: in the first phase a purposive sample of nine women were interviewed at 36 weeks gestation, three weeks, three months and two and a half years after birth. In the second phase, data were collected for further breadth and depth and 31 women, who were going through different stages of pregnancy, delivery and the puerperium participated. Data were collected by means of interviews supplemented by non-participatory observation. In the total sample of 40 Finnish women, one half was primigravidae and the other half multigravidae., Findings: a main thread running through the women's experiences of antenatal care were their needs and wishes that concerned the health of the unborn baby, but also the health and dignity of themselves and their family. The pregnant women wanted to share their pregnancy and childbirth story in a confident relationship based on humaneness and interest in a peaceful atmosphere. They needed protection safeguarded through scientifically based and humane surveillance, and professional competence was expected. They wanted to continuously participate in the new situations through knowledge in dialogues and they wanted to involve their family in the care on their own terms. The childbirth preparation groups had an important multidimensional role in the care., Implications for Practice: the findings challenge the antenatal care that so far has been focused on the physical health, the needs of the primigravida and a blurred family perspective. The family perspective implies knowing both the pregnant woman and her partner in terms of the pregnancy, the birth and a new parenthood. Humane, scientifically based perinatal care can be developed by innovations from these findings, especially considering the multidimensional role of the parent groups., (Copyright 2002 Elsevier Science Ltd. All roghts reserved.)

Objective: to investigate maternal satisfaction with two pilot schemes based on the Changing Childbirth initiative (DoH 1993) and to compare this with a traditional model of care. In addition, a limited number of clinical outcome measures were also assessed., Design: a retrospective between-group design was used. Questionnaire data were collected from three groups (two pilot and one control) about the antenatal, labour and postnatal periods to establish both satisfaction with key objectives of the Changing Childbirth initiative (DoH 1993), and basic clinical outcomes., Setting: a large Trust (see definition in main article) in Central England, that covered a wide range of socio-economic strata., Participants: the two pilot groups comprised 112 and 103 women respectively and were randomly drawn from GP practices within the Trust's catchment area. The third group of 118 women (Control) was selected from the Trust's obstetric unit. Women at high obstetric risk were excluded from this study., Measurement: a five-part questionnaire was devised that covered: (1) preferences for type of care, health-care professional, venue etc; (2) details of antenatal care provision and the participants' satisfaction with this; (3) labour, including clinical outcomes, labour and birth details and satisfaction with care; (4) postnatal care information, including satisfaction scores; and (5) information and advice given throughout the ante, delivery and postnatal periods and satisfaction with this. The questionnaires were administered six weeks postnatally., Findings: although the two pilot groups had been set up to follow a one-to-one midwifery care model, the second group naturally evolved into providing care from within a small group of midwives. This variation did not lead to any differences in any of the outcome measures. The women in the obstetrician-led group were not dissatisfied with the care, information and treatment they received, but they were significantly less satisfied than either of the two pilot groups. The pilot groups also rated more highly the information and choice that they had, and felt that the midwives acted as partners in the process. These findings applied to the antenatal, delivery and postnatal periods. No differences in clinical outcomes were observed between the groups., Conclusions: midwifery-led care was much preferred to obstetrician-led care and did not lead to any deficits in clinical outcomes. The pilot scheme that adapted the initiative into small-group provision showed no reduction in satisfaction levels or other outcome measures. Since burn-out and stress have been identified as features of one-to-one midwifery provision, this model might have potential for offsetting this problem, while still maintaining the spirit of the Changing Childbirth policy. From the perspective of maternal well-being, both physical and psychological, the initiative reported here appears to have been highly successful., (Copyright 2001 Harcourt Publishers Ltd.)

Objective: To investigate the similarities and differences between teenage and adult mothers and their level of self-esteem and satisfaction with social support at six weeks and six months postpartum., Design: A two group comparative study., Setting: Maternal child health, immunisation and midwives' clinics in New South Wales, Australia., Participants: 173 adult mothers and 72 adolescent mothers who had experienced a normal pregnancy, labour and delivery and delivered a healthy baby near term., Measurements and Findings: Rosenberg's Self-esteem Scale, Brown's Support Behavior Inventory and a personal information form were used. Irrespective of age, breast-feeding rates and satisfaction with social support decreased significantly during the early months postpartum. Furthermore, a significant inverse relationship was noted between maternal age and satisfaction with support and a positive relationship was identified between maternal age and self-esteem., Key Conclusions and Clinical Implications: Maternal self-esteem may be challenged by the demands of motherhood and dissatisfaction with social support could contribute to the decline in breast-feeding practices. Developing a postnatal support plan, including fathers in education programmes and offering courses and workshops designed to enhance self-esteem and parentcraft may assist mothers to assume baby care responsibilities and increase their satisfaction with support.

Objective: To describe the experience of postpartum care among Thai women in Melbourne, Australia., Design: Ethnographic interviews and participant observation with women in relation to postpartum care and practices., Setting: Melbourne Metropolitan Area, Victoria, Australia., Participants: 26 Thai born women who gave birth in Australia., Findings: The Thai women had varying views about the length of time they should spend in hospital and the care they received. Ten of the twelve women who had had a caesarean birth stayed in hospital for six or more days, consistent with the hospital practice. However, most of those who had had a vaginal delivery opted to go home earlier than the standard hospital practice of four days stay. This was because they were unhappy about specific hospital practices, the hospital environment, or because there are several Thai confinement customs, which, traditionally, a new mother must observe in order to maintain good health and avoid future ill health and which they were not able to follow in hospital. Nevertheless, most women were satisfied with their postpartum care. Most women were aware of the Thai cultural beliefs and practices. However, they showed varying ways of coping with the hospital environment in relation to their varying social situations., Implications for Practice: Thai women are diverse in their needs, perceptions and experience of postpartum care. Therefore, it is appropriate neither to stereotype all Thai women as requiring to follow traditional confinement practices nor to require them to adjust to standard hospital practices. Rather an environment of caring concern whereby each woman's individual needs can be solicited, understood and, where possible, attended to as required. The challenge is in achieving this.

Objective: To discover the expectations and experiences of childbirth preparation and childbirth of Swedish men in order to contribute to a basis of reflections in the midwifery profession., Design: Three tape-recorded interviews were performed: before and after childbirth preparation, and between one and three weeks after the baby was born., Setting: Swedish maternity care., Participants: Eleven men who participated with their partners in antenatal classes., Measurements and Findings: The interviews were analysed in several steps and included co-assessments by co-workers. Finally, an interpretation based on the concept 'vital involvement' was undertaken. Indications of vital involvement as well as various levels of involvement or distance were found. The participation in childbirth was more demanding than expected for the eleven men. They felt unprepared for an unpredictable process, the experience of time and pain, the woman's action, and their own reactions. The men who were regarded by the authors as vitally involved seemed to manage overwhelming feelings of helplessness during childbirth, to support the women, and experience the meeting with the baby positively., Key Conclusion: It seems important for midwives to meet men individually, design childbirth preparation from men's perspective, follow up interpretations of the content, discuss expectations with regard to the men's role, and assess their experiences during the birth process.

Objective: To assess Filipino, Turkish and Vietnamese women's views about their care during the postnatal hospital stay., Design: Interviews were conducted with recent mothers in the language of the women's choice, 6-9 months after birth, by three bilingual interviewers., Participants: Three hundred and eighteen women born in the Philippines (107), Turkey (107) and Vietnam (104) who had migrated to Australia., Setting: Women were recruited from the postnatal wards of three maternity teaching hospitals in Melbourne, Australia, and interviewed at home., Findings: Overall satisfaction with care was low, and one in three women left hospital feeling that they required more support and assistance with both baby care and their own personal needs. The method of baby feeding varied between the groups, with women giving some insight into the reason for their choice. A significant minority wanted more help with feeding, irrespective of the method. The need for rest was a recurrent theme, with women stating that staff's attitudes to individual preferences, coupled with lack of assistance, made this difficult. The majority of comments women made regarding their postnatal stay focused on the attitude and behaviour of staff and about routine aspects of care. Issues related to culture and cultural practices were not of primary concern to women., Conclusion: Maternity services need to consider ways in which care can focus on the individual needs and preferences of women.

Objective: to determine the characteristics of a sample of women giving birth in one hospital in South Australia and these women's perceptions of the usefulness of the advice and care that they were given during the puerperium, Design: survey using questionnaires, incorporating Lipsett's (1984) questions, administered before the women left hospital and at six weeks postdelivery., Setting: one hospital in South Australia., Participants: a sample of convenience of 235 women completed the hospital questionnaire and 222 (95%) returned the six weeks postpartum questionnaire., Findings: the women's ages ranged from 17-44 years, 86% were living in a stable relationship and 42% were primiparous. Most women (74%) made comments on the helpfulness of midwives. The midwife provided emotional support (57%), answered questions (32%) and gave information (30%). However, midwives' attitudes were perceived as insensitive (18%) and judgemental (9%). Midwives gave conflicting advice (10%) and 40% of the women made one or more comments about midwife unhelpfulness. Sixteen per cent of the women made no comment on the helpfulness of the midwife., Implications for Practice: contact with midwives in the early postnatal period is an ideal time for helpful advice and support to be given but midwives are not always perceived as fulfilling this part of their role. There is a need to address the issue of conflicting advice.

Thirty-two Asian women living in East London were interviewed about their experiences of childbirth. A significant part of their accounts concerned their experiences in the postnatal wards. They reported fewer difficulties with infant feeding than their non-Asian counterparts in other studies, but there were indications of similar tensions between mothers and staff about how much responsibility mothers should take for their baby's care. Asian women raised several additional issues. Some centred on communication difficulties for Asian women who did not speak fluent English. Others point to their different ideologies around the care of the mother and baby and the nature of early mother-infant relations. Asian women viewed the opportunity to rest and recover postnatally as more central to their postnatal care than they considered hospitals did. Women had less to say and seemed less familiar with the discourse on bonding, and were less preoccupied with the establishment of close mother-infant relationship. The implications for ideas about 'normal' maternal behaviour and the quality of care are discussed.