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Background: Peer support may help mothers to feel satisfied with their breastfeeding and to continue breastfeeding. However, previous researchers have not examined the influence of peer support on the three breastfeeding-satisfaction domains., Research Aim: We aimed to examine the influence of telephone-based peer support on the following three domains of breastfeeding satisfaction among Japanese mothers: maternal satisfaction, perceived benefit to the infant, and lifestyle compatibility with breastfeeding., Methods: Breastfeeding mothers were recruited at four maternity hospitals in Japan to participate in a randomized controlled trial. Data were collected 1 month and 4 months postpartum. Among all of the participants ( N = 114), those in the intervention group ( n = 60) received telephone-based peer support until 4 months postpartum, and participants in the control group ( n = 54) received conventional support. Breastfeeding satisfaction was measured using the short version of the revised Japanese Maternal Breastfeeding Evaluation Scale. Generalized estimating equations and effect size analyses were used to examine the influence of the intervention., Results: On the subscale measuring lifestyle compatibility, participants with peer support had a higher score than those without peer support: regression coefficient 1.54 (95% confidence interval [0.03, 3.04]). The effect size was 0.40 standard deviations among participants with low and mid-level scores at baseline., Conclusion: Although peer support did not change maternal satisfaction or perceived benefit to the infant, it did increase lifestyle compatibility with breastfeeding among these Japanese mothers. This is evidence in favor of increasing the use of peer support.

Objective: To hear the voices of women, their partners, and nurses about expectations and priorities during the postpartum hospitalization., Design: Focus groups using semistructured interview questions., Setting: A 12-bed labor-delivery-recovery-postpartum unit at a small urban hospital in the U.S. Northeast., Participants: Women who planned to or had given birth, their partners, and the maternity nurses who cared for them., Measurements: Qualitative thematic analysis of focus group transcripts., Results: Thematic analysis produced the following themes for women's priorities: Need for individualized attention to maternal physical and emotional care; Fear of providing inadequate care for the newborn, including establishing infant feeding; and Transitioning to parenting as a new mother versus as an experienced mother. Themes for nurses' priorities included Safety issues around sleep and breastfeeding, Transitioning to parenting with an emphasis on maternal self-care, and Addressing barriers to effective discharge education. Response comparisons between the women/partners and nurses suggest that there is a disconnection between women's and nurses' priorities and expectations for care during the postpartum period., Conclusion: Women and nurses identified unmet needs in the postpartum period, consistent with the current literature. Providing standardized education during the transitional period around discharge from the hospital to home may not be optimal and may even detract from meeting the needs for rest and connection with family and the health care team. Nursing care that extends beyond the maternity hospitalization may be needed to individualize care and meet previously unmet needs., (Copyright © 2019. Published by Elsevier Inc.)

Objectives: To report on women's and families' expectations and experiences of hospital postnatal care, and also to reflect on women's satisfaction with hospital postnatal care and to relate their expectations to their actual care experiences., Design: Systematic review., Setting: UK., Participants: Postnatal women., Primary and Secondary Outcomes: Women's and families' expectations, experiences and satisfaction with hospital postnatal care., Methods: Embase, MEDLINE, PsycINFO, Applied Social Sciences Index and Abstracts, Cumulative Index to Nursing and Allied Health (CINAHL Plus), Science Citation Index, and Social Sciences Citation Index were searched to identify relevant studies published since 1970. We incorporated findings from qualitative, quantitative and mixed-methods studies. Eligible studies were independently screened and quality-assessed using a modified version of the National Institutes of Health Quality Assessment Tool for quantitative studies and the Critical Appraisal Skills Programme for qualitative studies. Data were extracted on participants' characteristics, study period, setting, study objective and study specified outcomes, in addition to the summary of results., Results: Data were included from 53 studies, of which 28 were quantitative, 19 were qualitative and 6 were mixed-methods studies. The methodological quality of the included studies was mixed, and only three were completely free from bias. Women were generally satisfied with their hospital postnatal care but were critical of staff interaction, the ward environment and infant feeding support. Ethnic minority women were more critical of hospital postnatal care than white women. Although duration of postnatal stay has declined over time, women were generally happy with this aspect of their care. There was limited evidence regarding women's expectations of postnatal care, families' experience and social disadvantage., Conclusion: Women were generally positive about their experiences of hospital postnatal care, but improvements could still be made. Individualised, flexible models of postnatal care should be evaluated and implemented., Prospero Registration Number: CRD42017057913., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Aims: In October 2017, the 'Prenatal and Postnatal Health Care Service in Nara (PPHSN)' has piloted the introduction of a new telephone consultation service to support prenatal and postnatal health care and childcare. This study aimed to document the feasibility, acceptability and satisfaction with the service provided by a trained nurse specialist who can access to clinician support when necessary., Methods: The pilot study was conducted between November 2017 and February 2018. Japanese women who are undergoing a health checkup at the Nara Medical University hospital for delivery and post-partum women who had recently (<1 year) given birth at this hospital (they are raising a child) were invited to participate in the study. They called a free mobile phone number, and spoke to a trained nurse to consult maternal and newborn care practices. The PPHSN project also provided information for supporting raising a child. The postal survey of the PPHSN service was conducted in March 2018., Results: A total of 26 participants were enrolled. The questionnaire was answered by 23 (88.5%) participants, of which over half (52.2-95.7%) of participants declared they were 'strongly agree' plus 'agree' regarding 'patient-centered care', 'communication and information', 'technical quality', 'efficiency', 'access and convenience (feasibility)', and 'willing to use the service again (acceptability)'. The majority (95.7%) of respondents reported being willing to use the service again for a similar health problem., Conclusion: This study provided the first evidence of satisfaction with telephone or social networking consultation service by nurse specialists in Japan., (© 2019 Japan Society of Obstetrics and Gynecology.)

Nurses and maternity staff work creatively to support a group of women experiencing long-term hospitalization during the antepartum period., (Copyright © 2019 AWHONN. Published by Elsevier Inc. All rights reserved.)

Objective: To explore and understand postpartum inpatient experiences in a Canadian context., Methods: Inpatients at BC Women's Hospital & Health Centre were invited to complete a questionnaire during their postpartum stay. Completed responses were obtained from 178 women, representing 44% of all postpartum inpatients during the survey period., Results: Overall, women had positive experiences during their postpartum stay: 93% rated their experience as "excellent" or "very good"; 78% felt that nurses never seemed rushed or too busy to care for them; and 85% of women found the nurses to be very helpful with breastfeeding. Two-thirds of the women had concerns about going home that were related to infant feeding, feeling overwhelmed, and not knowing how to settle their baby. Other areas of improvement pertained to the hospital environment being less restful than desired. Certain groups needed additional support, such as primiparous women, women who had Caesarean deliveries, and women from certain ethnic groups., Conclusion: This exploration of women's inpatient postpartum experiences in a Canadian hospital provides valuable information for improving service delivery, including assessing hospital routines, providing information/education, and improving discharge planning. Given that postpartum experiences are not uniform across demographic groups, an alternative or augmented approach to postpartum care may be warranted for some women., (Copyright © 2018 Society of Obstetricians and Gynaecologists of Canada. Published by Elsevier Inc. All rights reserved.)

In this study, the predictors of satisfaction with postpartum care at a government hospital were evaluated. The descriptive research sample included 300 mothers in their postpartum period. Data were collected using a questionnaire and the Postpartum Nursing Care Evaluation Scale. The regression analysis undertaken showed that mothers who received prenatal care had a significantly higher evaluation score (compared to those who had not received prenatal care), as had mothers who had a caesarean delivery (compared to vaginal birth), as well as those who had received support from friends and relatives during their postpartum period (compared to those who did not receive such support). Our recommendation is that postpartum nursing care be improved for mothers who deliver vaginally, have not received prenatal care, were unintentionally pregnant, and have problems with breastfeeding. The results will help nurses who work with an international population of postpartum women to give professional, systematic, and patient-centered care to postpartum mothers in order to increase patient satisfaction., (© 2017 John Wiley & Sons Australia, Ltd.)

Objectives Group prenatal care results in improved birth outcomes in randomized controlled trials, and better attendance at group prenatal care visits is associated with stronger clinical effects. This paper's objectives are to identify determinants of group prenatal care attendance, and to examine the association between proportion of prenatal care received in a group context and satisfaction with care. Methods We conducted a secondary data analysis of pregnant adolescents (n = 547) receiving group prenatal care in New York City (2008-2012). Multivariable linear regression models were used to test associations between patient characteristics and percent of group care sessions attended, and between the proportion of prenatal care visits that occurred in a group context and care satisfaction. Results Sixty-seven groups were established. Group sizes ranged from 3 to 15 women (mean = 8.16, SD = 3.08); 87 % of groups enrolled at least five women. Women enrolled in group prenatal care supplemented group sessions with individual care visits. However, the percent of women who attended each group session was relatively consistent, ranging from 56 to 63 %. Being born outside of the United States was significantly associated with higher group session attendance rates [B(SE) = 11.46 (3.46), p = 0.001], and women who received a higher proportion of care in groups reported higher levels of care satisfaction [B(SE) = 0.11 (0.02), p < 0.001]. Conclusions Future research should explore alternative implementation structures to improve pregnant women's ability to receive as much prenatal care as possible in a group setting, as well as value-based reimbursement models and other incentives to encourage more widespread adoption of group prenatal care.

Background: Breast engorgement is a major cause of pain and weaning in the early postpartum period. While protocols reinforce the need for anticipatory engorgement advice and continued outpatient health professional breastfeeding support, there remains limited information on the efficacy of focused postdischarge engorgement education. This study sought to explore if outpatient postpartum engorgement education changed mothers' home management and if mothers found instruction on specific massage and hand expression techniques helpful., Materials and Methods: This was a prospective descriptive cohort study. Subjects received engorgement-specific postpartum support from a healthcare professional at the posthospital discharge (PD) newborn visit. Email surveys at 1, 2, and 12 weeks postpartum collected data on engorgement home management, clinical course, and postpartum education., Results: After the office visit, mothers changed their engorgement home management. Significantly more mothers utilized massage toward the axillae (25% versus 1%, p ≤ 0.001), reverse pressure softening (18% versus 3%, p = 0.001), and feeding more frequently (32% versus 16%, p = 0.04). Sixty-one percent would not have used massage and hand expression before education in the office. At 12 weeks, 96% of women reported massage and hand expression instruction as helpful. Mothers reported engorgement peaked at a median of 5 days postpartum, corresponding well to the office visit at a median of 4 days postpartum., Conclusions: Maternal engorgement symptoms are commonly present at the PD newborn visit. Education on engorgement, massage, and hand expression at this visit significantly changes home management strategies. Mothers find massage and hand expression instruction helpful.

Objective: To evaluate the efficacy, safety, and maternal satisfaction of a newly established integrative postpartum community-based clinic providing comprehensive support for mothers during the first month after discharge from the hospital. Our primary interests were breastfeeding rates, readmission and patient satisfaction., Methods: A randomized controlled trial was conducted in Ottawa, Canada, where 472 mothers were randomized via a 1:2 ratio to either receive standard of care (n = 157) or to attend the postpartum breastfeeding clinic (n = 315). Outcome data were captured through questionnaires completed by the participants at 2, 4, 12 and 24 weeks postpartum. Unadjusted and adjusted logistic regression models were conducted to determine the effect of the intervention on exclusive breastfeeding at 12 weeks (primary outcome). Secondary outcomes included breastfeeding rate at 2, 4 and 24 weeks, breastfeeding self-efficacy scale, readmission rate, and satisfaction score., Results: More mothers in the intervention group (n = 195, 66.1%) were exclusively breastfeeding at 12 weeks compared to mothers in the control group (n = 81, 60.5%), however no statistically significant difference was observed (OR = 1.28; 95% CI:0.84-1.95)). The rate of emergency room visits at 2 weeks for the intervention group was 11.4% compared to the standard of care group (15.2%) (OR = 0.69; 95% CI: 0.39-1.23). The intervention group was significantly more satisfied with the overall care they received for breastfeeding compared to the control group (OR = 1.96; 95% CI: 3.50-6.88))., Conclusion: This new model of care did not significantly increase exclusive breastfeeding at 12 weeks. However, there were clinically meaningful improvements in the rate of postnatal problems and satisfaction that support this new service delivery model for postpartum care. A community-based multidisciplinary postpartum clinic is feasible to implement and can provide appropriate and highly satisfactory care to mother-baby dyads. This model of care may be more beneficial in a population that is not already predisposed to breastfeed., Trial Registration: ClinicalTrials.gov NCT02043119.

Background: The concept of maternal satisfaction is challenging, as women's and clinicians' expectations and experiences can differ. Our aim was to investigate women's experiences of maternity care in an urban tertiary obstetric setting, to gain insight into conceptualization of satisfaction across the childbirth continuum., Methods: This mixed method study was conducted at a public maternity hospital in Western Australia. A questionnaire was sent to 733 women two weeks post birth, which included an invitation for an audio-recorded, telephone interview. Frequency distributions and univariate comparisons were employed for quantitative data. Thematic analysis of interview transcripts was undertaken to extract common themes., Results: A total of 54% (399 of 733) returned the questionnaire. Quantitative results indicated that women were less likely to feel: involved if they did not have a spontaneous vaginal birth (P = 0.020); supported by a midwife if they had a caesarean (P = <0.001); or supported by an obstetrician if they had a spontaneous vaginal birth (P = <0.001). Qualitative findings emerged from 63 interviews which highlighted the influence that organization of care, resources and facilities had on women's satisfaction. These paradigms unfolded as three broad themes constructed by four sub-themes, each illustrating a dichotomy of experiences. The first theme 'how care was provided' encompassed: familiar faces versus a different one every time and the best place to be as opposed to so disappointed. The second theme 'attributes of staff' included: above and beyond versus caring without caring and in good hands as opposed to handled incorrectly. The third theme 'engaged in care' incorporated: explained everything versus did not know why and had a choice as opposed to did not listen to my needs., Conclusions: Quantitative analysis confirmed that the majority of women surveyed were satisfied. Mode of birth influenced women's perception of being involved with their birth. Being able to explore the diversity of women's experiences in relation to satisfaction with their maternity care in an urban, tertiary obstetric setting has offered greater insight into what women value: a sensitive, respectful, shared relationship with competent clinicians who recognise and strive to provide woman focused care across the childbirth continuum.

Background: Continuity of care by a primary midwife during the antenatal, intrapartum and postpartum periods has been recommended in Australia and many hospitals have introduced a caseload midwifery model of care. The aim of this paper is to evaluate the effect of caseload midwifery on women's satisfaction with care across the maternity continuum., Methods: Pregnant women at low risk of complications, booking for care at a tertiary hospital in Melbourne, Australia, were recruited to a randomised controlled trial between September 2007 and June 2010. Women were randomised to caseload midwifery or standard care. The caseload model included antenatal, intrapartum and postpartum care from a primary midwife with back-up provided by another known midwife when necessary. Women allocated to standard care received midwife-led care with varying levels of continuity, junior obstetric care, or community-based general practitioner care. Data for this paper were collected by background questionnaire prior to randomisation and a follow-up questionnaire sent at two months postpartum. The primary analysis was by intention to treat. A secondary analysis explored the effect of intrapartum continuity of carer on overall satisfaction rating., Results: Two thousand, three hundred fourteen women were randomised: 1,156 to caseload care and 1,158 to standard care. The response rate to the two month survey was 88% in the caseload group and 74% in the standard care group. Compared with standard care, caseload care was associated with higher overall ratings of satisfaction with antenatal care (OR 3.35; 95% CI 2.79, 4.03), intrapartum care (OR 2.14; 95% CI 1.78, 2.57), hospital postpartum care (OR 1.56, 95% CI 1.32, 1.85) and home-based postpartum care (OR 3.19; 95% CI 2.64, 3.85)., Conclusion: For women at low risk of medical complications, caseload midwifery increases women's satisfaction with antenatal, intrapartum and postpartum care., Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN012607000073404 (registration complete 23rd January 2007).

To complement standard measures of maternity care outcomes, an assessment of women's satisfaction with care is needed. The aim of this study was to elicit the perspectives and experiences of Iraqi women about childbirth and postnatal care services. The study participants were a sample of 37 women of different educational and socioeconomic status who had given birth during the previous 6 months. Q-methodology was used for data collection and analysis. Three distinct viewpoints and experiences of childbirth and postnatal care services were identified: a general perception of poor childbirth and postnatal care with lack of appropriate interpersonal care and support; a high satisfaction and positive experience with childbirth and postnatal care services among the confident and well-supported women; and poor satisfaction with the childbirth and postnatal care services in terms of meeting traditional cultural practices. Needs assessment around providers' skills and attitudes and the wider sociocultural environment of childbirth and postnatal care is necessary in Iraq.

To explore important domains of women's postpartum experiences as perceived by postpartum mothers and obstetricians/midwives, and to investigate how postpartum care could enhance patient preparation for the postpartum period. Qualitative research study was conducted to explore women's and clinicians' perceptions of the postpartum experience. Four focus groups of postpartum women (n = 45) and two focus groups of obstetric clinicians (n = 13) were held at a large urban teaching hospital in New York City. All focus groups were audio recorded, transcribed, and analyzed using grounded theory. Four main themes were identified: lack of women's knowledge about postpartum health and lack of preparation for the postpartum experience, lack of continuity of care and absence of maternal care during the early postpartum period, disconnect between providers and postpartum mothers, and suggestions for improvement. Mothers did not expect many of the symptoms they experienced after childbirth and were disappointed with the lack of support by providers during this critical time in their recovery. Differences existed in the major postpartum concerns of mothers and clinicians. However, both mothers and clinicians agreed that preparation during the antepartum period could be beneficial for postpartum recovery. Results from this study indicate that many mothers do not feel prepared for the postpartum experience. Study findings raise the hypothesis that capturing patient-centered domains that define the postpartum experience and integrating these domains into patient care may enhance patient preparation for postpartum recovery and improve postpartum outcomes.

Objectives: The main objective of this study was to examine the level of patient satisfaction with the care rendered by community midwives in the area of Poznań., Material and Methods: A patient survey was distributed using face-to-face recruitment and with mail collection. Eight hundred new mothers were asked to participate in the study by filling out the questionnaire after eight weeks of the postpartum period. One hundred seventy seven (22.12%) returned completed questionnaires which were then analyzed., Results: This paper provides information on the high level of patient satisfaction with the services provided by community midwives and the important role community midwives play in caring for and supporting women in the post partum period., Conclusions: The results of this study indicate that women in the area of Poznań, are satisfied with the care they receive from midwives. They also indicate a lack of association of patient satisfaction scores between groups of patients based on demographic data and reason for using community midwife services. It was also found that the overall patient satisfaction score depends most heavily on the time frame of receiving community midwife services.

Background: The aim of this study was to determine whether personality and/or psychological functioning affect mothers' perceptions of postnatal communication and their level of satisfaction with their postnatal care. Mothers' perceptions of the communication with health professionals prenatally and during birth may be affected by their personality traits and psychological functioning and are linked to the level of satisfaction they have in their healthcare. Little is known about factors that are associated with perceptions of communication within postnatal care and the impact this may have on satisfaction with care., Methods: A cross sectional survey recruited 71 first-time mothers, who had given birth vaginally in the U.K., within the previous 12 months. The questionnaire assessed personality traits using the Big 5 Mini Marker set, levels of anxiety and depression using HADS, perceptions of communication experienced with health professionals and overall levels of satisfaction with postnatal care via the Satisfaction with Care Scale. Covariates such as demographic factors were investigated., Results: Higher ratings of communication were found to be directly correlated with higher satisfaction, as were the personality traits; agreeableness, conscientiousness and emotional stability. Depression significantly lowered participants' ratings of communication experienced with health visitors and total satisfaction. Mothers who breastfed had significantly lower communication and satisfaction ratings. Multiple regression analysis revealed communication ratings explained 71.8% of the variance in the level of satisfaction and none of the remaining predictors significantly directly affected satisfaction ratings., Conclusion: Future research should focus on the utility of these findings for improving care for primiparous mothers.

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.)

Background: Postnatal care is the neglected area of pregnancy care, despite repeated calls to improve it. Changes would require assessment, which should include women's views. No suitable satisfaction questionnaire exists to enable this., Aim: To develop a multidimensional psychometric postnatal satisfaction self-completion instrument., Setting: Ten maternity services in south west England from 2006-2009., Method: Sources for questions were literature review, fieldwork, and related published instruments. Principal components analysis with varimax rotation was used to develop the final WOMen's views of Birth Postnatal Satisfaction Questionnaire (WOMBPNSQ) version. Validity and internal reliability were assessed. Questionnaires were mailed 6-8 weeks postnatally (with one reminder)., Results: The WOMBPNSQ comprises 36 seven-point Likert questions (13 dimensions including general satisfaction). Of 300 women, 166 (55.3%) replied; of these 155 (95.1 %) were white, 152 (93.8%) were married or cohabiting, 135 (81.3%) gave birth in a consultant unit, 129 (78.6%) had a vaginal delivery; and 100 (60.6%) were multiparous. The 12 specific dimensions were: support from professionals or partner, or social support; care from GP and health visitor; advice on contraception, feeding baby, the mother's health; continuity of care; duration of inpatient stay; home visiting; pain after birth. These have internal reliability (Cronbach's alpha varying from 0.624 to 0.902). Various demographic and clinical characteristics were significantly associated with specific dimensions., Conclusion: WOMBPNSQ could be used to assess existing or planned changes to maternity services or as a screening instrument, which would then enable in-depth qualitative assessment of areas of dissatisfaction. Its convergent validity and test-retest reliability are still to be assessed but are an improvement upon existing postnatal satisfaction questionnaires.

The Care of Next Infant (CONI) programme is offered through health services to provide extra support to families with babies born following a cot death. Audit of centrally collected data about families registered with the programme and feedback from parents show that compared with national data, families on CONI have more factors associated with an increased risk of cot death, confirming that a history of cot death identifies a particularly high-risk group. The programme, first offered to parents in 1988, remains attractive and helpful to parents in the 21st century. The CONI programme, including provision of a movement monitor, enables health visitors to deliver a targeted programme of extra care to a vulnerable group of babies.

Background: Studies consistently highlight in-patient postnatal care as the area of maternity care women are least satisfied with. As part of a quality improvement study to promote a continuum of care from the birthing room to discharge home from hospital, we explored women's expectations and experiences of current in-patient care., Methods: For this part of the study, qualitative data from semi-structured interviews were transcribed and analysed using content analyses to identify issues and concepts. Women were recruited from two postnatal wards in one large maternity unit in the South of England, with around 6,000 births a year., Results: Twenty women, who had a vaginal or caesarean birth, were interviewed on the postnatal ward. Identified themes included; the impact of the ward environment; the impact of the attitude of staff; quality and level of support for breastfeeding; unmet information needs; and women's low expectations of hospital based postnatal care. Findings informed revision to the content and planning of in-patient postnatal care, results of which will be reported elsewhere., Conclusions: Women's responses highlighted several areas where changes could be implemented. Staff should be aware that how they inter-act with women could make a difference to care as a positive or negative experience. The lack of support and inconsistent advice on breastfeeding highlights that units need to consider how individual staff communicate information to women. Units need to address how and when information on practical aspects of infant care is provided if women and their partners are to feel confident on the woman's transfer home from hospital.

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.)

Introduction: This study considered the views and experiences of 85 rural women, most of whom gave birth in two regional South Australian hospitals., Method: This descriptive survey used a validated questionnaire, modified for use in rural South Australia, which included open-ended questions to invite further comment. Women were invited to participate while in hospital after giving birth and those who agreed (n = 136) were mailed a questionnaire 6-8 weeks after the birth. Data were collected on demographic and other information including: age, smoking status, model of antenatal and birth care, birth method, women's views of their care in pregnancy, labour and after the birth, breastfeeding uptake and continuance rates, and prevalence of possible depression after birth using the Edinburgh Postnatal Depression Scale. Non-identifiable data were described using descriptive statistics and analysed using t-tests, 2 x 2 contingency tables and relative risks, as appropriate. Where available, comparisons were made with other rural and South Australian data. Qualitative data were themed by consensus., Results: Eighty-five women (63%) returned a completed questionnaire. Rates of spontaneous vaginal birth were significantly lower in the study than for 5257 South Australian rural residents who gave birth in 2006 (n = 38, 45% vs 3057, 58%). While caesarean rates overall were similar, elective caesarean rates were higher (25% vs 15%), while fewer study women smoked throughout pregnancy (9% vs 24%). Overall, women in the study rated their care as 'very good' for antenatal care(59%), for labour and birth care (73%) and postnatal care (53%). More women stayed in hospital for 5 days or more than South Australian women overall (53% vs 40%). Open-ended comments confirmed reasons that were related to their choice. Breastfeeding was commenced by 95% of the women and 69% were breastfeeding at 6 weeks., Conclusions: The findings confirm Victorian rural women's ratings, and further highlight that in the postnatal period women often feel left to manage on their own, and are less than happy with their care.

Background: Previous randomized controlled studies in several different settings demonstrated the positive effects of continuous labor support by an experienced woman (doula) for low-income women laboring without the support of family members. The objective of this randomized controlled trial was to examine the perinatal effects of doula support for nulliparous middle-income women accompanied by a male partner during labor and delivery., Methods: Nulliparous women in the third trimester of an uncomplicated pregnancy were enrolled at childbirth education classes in Cleveland, Ohio, from 1988 through 1992. Of the 686 prenatal women recruited, 420 met enrollment criteria and completed the intervention. For the 224 women randomly assigned to the experimental group, a doula arrived shortly after hospital admission and remained throughout labor and delivery. Doula support included close physical proximity, touch, and eye contact with the laboring woman, and teaching, reassurance, and encouragement of the woman and her male partner., Results: The doula group had a significantly lower cesarean delivery rate than the control group (13.4% vs 25.0%, p = 0.002), and fewer women in the doula group received epidural analgesia (64.7% vs 76.0%, p = 0.008). Among women with induced labor, those supported by a doula had a lower rate of cesarean delivery than those in the control group (12.5% vs 58.8%, p = 0.007). On questionnaires the day after delivery, 100 percent of couples with doula support rated their experience with the doula positively., Conclusions: For middle-class women laboring with the support of their male partner, the continuous presence of a doula during labor significantly decreased the likelihood of cesarean delivery and reduced the need for epidural analgesia. Women and their male partners were unequivocal in their positive opinions about laboring with the support of a doula.

Providing nursing care to meet the needs of mothers may be unsuccessful because most nurses perceive and prioritize maternal needs differently from how mothers do. In this study, 140 mothers of infants in each neonatal intensive care unit of three hospitals in southern Thailand were interviewed using questionnaires on maternal needs, need responses, and need response satisfaction. Significant differences in mean total scores and mean subscale scores of needs, need responses, and need response satisfaction were found among the three groups of mothers. Significant differences in mean differences of total needs, need responses, and need response satisfaction were found when comparing mothers in each group. The mean rankings of maternal needs, need responses, and need response satisfaction were identified. This study supported the idea of individualized maternal needs and priorities. In providing effective nursing care to meet the needs and satisfaction of mothers, nurses should be concerned with the needs of individuals, their responses to those needs, and need response satisfaction because the satisfaction of these needs is essential for infant well-being.

Purpose: The aim was to study new parents' satisfaction with postnatal care and to estimate the proportion of fathers who were given the option of spending the night at the postnatal ward., Procedures: A questionnaire was mailed to new parents 6 months after the birth of their child in a Swedish hospital. The main outcome was overall satisfaction with postnatal care., Findings: Two hundred and ninety-four new mothers and 280 new fathers completed the questionnaire. Thirty-four percent of the mothers were dissatisfied with the overall postnatal care. The strongest associated factors for new mothers' dissatisfaction were: unfriendly and unhelpful staff (RR 10.3; 3.2-32), lack of support from staff (RR 6.4; 2.3-17.5), new fathers not permitted to stay overnight (RR 5.2; 1.8-14.5), dissatisfaction with postnatal checks of the woman herself (RR 2.6; 1.1-6.3) and dissatisfaction with practical breast-feeding support (RR 1.6; 1.2-2.1). Sixty-three percent of the fathers were given the option of spending the night at the postnatal ward. The fathers who chose not to spend the night on the ward were older, had other children and were dissatisfied that they were not allowed to play a greater role in the care of their newborn baby., Main Conclusions: In order to increase patient satisfaction, the needs of the new family must be highlighted and more support and help provided to new parents on the postnatal ward. It is essential to have family oriented postnatal care and to give fathers the opportunity to stay overnight and involve them in the care of their newborn baby.

Objective: To assess the maternal recall of the neonatal discharge letter instructions with and without nurse and mother signing the document in addition to the physician signature., Methods: Maternal recall of the discharge letter instructions was assessed by telephone interviews conducted 2-3 weeks following discharge. One hundred and nine mothers who signed the discharge letter following a change of information delivery policy at discharge were compared with 110 mothers who gave birth when their signature was not yet required. The impact of the discharge form on maternal recall was evaluated by stepwise regression analysis adjusted for obstetric, perinatal and demographic variables., Results: Recall of specific instructions verified by the discharge notes and satisfactory understanding of the discharge letter as graded by the mother were higher among 109 mothers who signed the discharge letter (82% and 88%, respectively) than among 110 mothers who did not add their signature (58% and 73%, respectively), the differences being statistically significant (p=0.002 and 0.022, respectively). The statistical difference was maintained also following adjustment with independent variables., Conclusion: Signing the neonatal discharge letter by both nurse and mother may improve maternal comprehension and recall of the delivered information. A prospective controlled study is necessary to validate this hypothesis.

Background: The Belgian and Dutch societies present many similarities but differ with regard to the organisation of maternity care. The Dutch way of giving birth is well known for its high percentage of home births and its low medical intervention rate. In contrast, home births in Belgium are uncommon and the medical model is taken for granted. Dutch and Belgian maternity care systems are compared with regard to the influence of being referred to specialist care during pregnancy or intrapartum while planning for a home birth. We expect that a referral will result in lower satisfaction with childbirth, especially in Belgium., Methods: Two questionnaires were filled out by 605 women, one at 30 weeks of pregnancy and one within the first two weeks after childbirth, either at home or in a hospital. Of these, 563 questionnaires were usable for analysis. Women were invited to participate in the study by independent midwives and obstetricians during antenatal visits in 2004-2005. Satisfaction with childbirth was measured by the Mackey Satisfaction with Childbirth Rating Scale, which takes into account the multidimensional nature of the concept., Results: Belgian women are more satisfied than Dutch women and home births are more satisfying than hospital births. Women who are referred to the hospital while planning for a home birth are less satisfied than women who planned to give birth in hospital and did. A referral has a greater negative impact on satisfaction for Dutch women., Conclusion: There is no reason to believe Dutch women receive hospital care of lesser quality than Belgian women in case of a referral. Belgian and Dutch attach different meaning to being referred, resulting in a different evaluation of childbirth. In the Dutch maternity care system home births lead to higher satisfaction, but once a referral to the hospital is necessary satisfaction drops and ends up lower than satisfaction with hospital births that were planned in advance. We need to understand more about referral processes and how women experience them.

Patient satisfaction is an indicator of quality of care received. Home-visit programs are associated with increased satisfaction and equivalent clinical outcomes but increased cost, compared with clinic visits. We hypothesized that home visits for routine well-child care would also be associated with increased satisfaction and equivalent outcomes. One thousand infants born at Tripler Army Medical Center were identified, and 630 were enrolled. Army and Air Force dependents received 2-week clinic visits. Navy and Marine Corps dependents were offered home visits. At 4 to 6 weeks, families completed a questionnaire. Maternal satisfaction and quality of anticipatory guidance were higher in the home-visit group. Clinical outcomes were equal. Home visits for routine well-child care are valid and are associated with greater maternal satisfaction, better anticipatory guidance, and equivalent clinical outcomes.

The authors used a transcendental phenomenological approach to describe adolescent mothers' satisfactory and unsatisfactory inpatient postpartum nursing care experiences. They analyzed data from 14 in-depth interviews and found that adolescent mothers' satisfaction is dependent on their perceptions of the nurse's ability to place them "at ease." Nursing care qualities that contributed to satisfactory experiences included nurses' sharing information about themselves, being calm, demonstrating confidence in mothers, speaking to adolescent and adult mothers in the same way, and anticipating unstated needs. Nursing care was perceived to be unsatisfactory when it was too serious, limited to the job required, or different from care to adult mothers, or when nurses failed to recognize individual needs. In extreme cases, unsatisfactory experiences hindered development of an effective nurse-client relationship. These findings illustrate the value of qualitative inquiry for understanding patients' satisfaction with care, can be used for self-reflection, and have implications for nursing education programs.

Objective: To examine maternal satisfaction with nipple shield use and maternal and infant physiological outcomes of breastfeeding with and without nipple shields., Design: A descriptive study using a structured telephone survey to examine maternal satisfaction of nipple shield use and a within-subject design to compare maternal and infant physiological outcomes for a subset of mother-infant dyads., Setting: Breastfeeding sessions were conducted in Pacific Northwest hospitals., Participants: 32 lactating women with experience using nipple shields; a subset of 5 maternal-infant dyads participated in the physiological part of the study., Main Outcome Measures: Maternal response to survey explored maternal satisfaction with nipple shield use. To examine maternal and infant physiological outcomes, two measures were used: infant test weighing to evaluate breast milk intake and maternal prolactin and cortisol levels to evaluate breast milk production., Results: Maternal survey response indicated that use of nipple shields may prevent premature breastfeeding termination. Physiological results demonstrated no significant difference in maternal hormonal levels and infant breast milk intake for breastfeeding sessions with and without nipple shields., Conclusion: Use of nipple shields may be considered in face of potential abandonment of breastfeeding.

This paper describes the development and psychometric assessment of a scale to measure satisfaction with intrapartum and postpartum care in hospital: The Care in Obstetrics: A Measure For Testing Satisfaction (COMFORTS) scale. A sample of 415 participants completed the 40-item scale. Cronbach's alpha for the scale was .95. Evaluation of construct validity through principal components factor analysis with varimax rotation yielded six subscales: confidence in newborn care, postpartum nursing care, provision of choice, the physical environment, respect for privacy, and labor/delivery nursing care. The COMFORTS scale was able to discriminate between multiparous versus primiparous women, and between women cared for in single room maternity care versus in separate labor/delivery and postpartum rooms. Pending further validation, the COMFORTS scale has potential to measure women's satisfaction with childbirth care and contribute to an assessment of the quality of care provided., (Copyright 2006 Wiley Periodicals, Inc.)

Background: The aim of this study was to investigate satisfaction with intrapartum and postpartum care, and the risk of not being satisfied in relation to 1) a woman's sociodemographic background, 2) physical and emotional well-being in early pregnancy, 3) labor outcomes, 4) care organization, and 5) a woman's subjective assessment of aspects of care., Methods: All Swedish-speaking women booked for antenatal care during 3 weeks spread over 1 year (1999-2000) were invited to participate in the study, and 2,686 (82% of those who consented to participate and 58% of those who were eligible) completed questionnaires in early pregnancy and 2 months postpartum. Women who were satisfied with overall intrapartum and postpartum care respectively were compared with those who were not regarding possible risk factors, and associations were tested by logistic regression analysis., Results: Ten percent of women were not satisfied with intrapartum care (ip) and 26% with postpartum care (pp). The following risk factors for not being satisfied were found: 1) age <25 years (ip), only elementary school (ip + pp), single status (pp), inconvenient timing of pregnancy (ip), lack of support from partner (ip); 2) suffering from many physical symptoms (ip + pp); 3) newborn transfer to neonatal clinic (ip + pp); 4) length of stay <1 day and > or =5 days (ip + pp), no "debriefing" after birth (ip), large hospital (pp); 5) lack of support by midwife (ip), little involvement in decision making (ip), dissatisfaction with birth environment (ip), insufficient time for breastfeeding support, encouragement and personal questions (pp).

Objective: To investigate the effect of service provision on consumer preferences, in particular, whether women who have access to systems of care which offer particular attributes (such as continuity of carer) value these attributes more highly than women for whom the attributes are not a realistic option., Design: Simple rating scales and a discrete choice experiment were used to assess the importance to women of different aspects of intrapartum care., Sample and Setting: The sample consisted of 301 women at low obstetric risk, identified from three geographical areas, each with a different system of maternity care provision., Methods: Midwives gave an anonymous, self-complete questionnaire to the women at the booking visit. Categorical data from the rating scales were analysed using the chi(2) test. Analysis of the discrete choice experiment was conducted using random effect probit regression. Main outcome measures Women's preference for different attributes of intrapartum care., Results: From the rating scales, it appeared that women in the area with least continuity rated this aspect of care significantly lower than women in other areas (P= 0.007). Although the discrete choice experiment appeared to confirm this, the difference was not statistically significant., Conclusions: The findings from this study suggest that the systems of care on offer do influence women's preferences for aspects of intrapartum care. Women in areas where continuity of carer was a realistic option appeared to value this aspect of care more highly. The tendency for preferences to be influenced not only by previous experience of a service but also by knowledge of its availability has important implications for the inclusion of consumers' values in deciding whether to introduce innovations in care. It has been suggested that greater consumer involvement may be a useful means of challenging the accepted view of what is important in health services and of facilitating change. However, the findings from this study suggest that consumer views may have the opposite effect. If consumers do prefer what they know, then a policy of tailoring health services to local preferences will simply reinforce current provision of services, reinforcing existing inequalities in the provision of care.

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 assess and contrast women's views of antenatal, intrapartum and postnatal care based on data collected in three state-wide surveys of recent mothers conducted in 1989, 1994 and 2000., Methods: Postal surveys were mailed to all women who gave birth in Victoria in one week in 1989, and in two weeks in 1993 and 1999, excluding those who had a stillbirth or neonatal death. Questionnaires were sent to women by hospitals and home birth practitioners 5-8 months after the birth., Results: 58.6% of women participating in the 1989 survey rated their antenatal care as 'very good' compared with 62.4% in 1994 and 66.5% in 2000 (chi 2 for trend = 15.01, p < 0.001). In all three surveys, women enrolled in public models of care were significantly more likely to rate their antenatal care as less than 'very good' than women enrolled in private models of care. More than two-thirds of the women in each survey rated their intrapartum care as 'very good' (1989-67%, 1994-71%, 2000-72%). Over the time period there was an improvement in the proportion of women rating their care as 'very good' among women in private care (chi 2 for trend = 33.1, p < 0.001), but no improvement was seen in public care. Only 52% (1994) and 51% (2000) of women rated their postnatal care as 'very good'., Conclusions: The conduct of three population-based surveys of recent mothers in Victoria over the past 10 years has provided valuable information for charting the impact of organisational changes on women's views and experiences of maternity 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.)

Background: Much postpartum physical and psychological morbidity is not addressed by present care, which tends to focus on routine examinations. We undertook a cluster randomised controlled trial to assess community postnatal care that has been redesigned to identify and manage individual needs., Methods: We randomly allocated 36 general practice clusters from the West Midlands health region of the UK to intervention (n=17) or control (19) care. Midwives from the practices recruited women and provided care. 1087 (53%) of 2064 women were in practices randomly assigned to the intervention group, with 977 (47%) women in practices assigned to the control group. Care was led by midwives, with no routine contact with general practitioners, and was extended to 3 months. Midwives used symptom checklists and the Edinburgh postnatal depression scale (EPDS) to identify health needs and guidelines for the management of these needs. Primary outcomes at 4 months were obtained by postal questionnaire and included the women's short form 36 physical (PCS) and mental (MCS) component summary scores and the EPDS. Secondary outcomes were women's views about care. Multilevel analysis accounted for possible cluster effects., Findings: 801 (77%) of 1087 women in the intervention group and 702 (76%) of 977 controls responded at 4 months. Women's mental health measures were significantly better in the intervention group (MCS, 3.03 [95% CI 1.53-4.52]; EPDS -1.92 [-2.55 to -1.29]; EPDS 13+ odds ratio 0.57 [0.43-0.76]) than in controls, but the physical health score did not differ., Interpretation: Redesign of care so that it is midwife-led, flexible, and tailored to needs, could help to improve women's mental health and reduce probable depression at 4 months' postpartum.

Objective: To describe how maternal-child staff nurses support breastfeeding mothers during the postpartum hospital stay and how these mothers perceive the support received from the nurses., Design: Ethnographic., Setting: Data were collected at a community hospital in southeastern Florida., Participants: Unstructured interviews were conducted with seven maternal-child nurses caring for breastfeeding mothers. The investigator observed 12 nurses' interactions with breastfeeding mothers and newborns. Eight breastfeeding mothers were interviewed, using a semistructured guide, in the hospital before discharge and at 2 and 6 weeks postpartum., Results: Nurses supported breastfeeding mothers by providing information and interpersonal support. Breastfeeding mothers expected the nurses to support their feeding efforts by providing information, encouragement, and interpersonal support., Conclusion: Health care providers can help breastfeeding mothers, but the support offered must be the kind that mothers want.

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.)

This paper examines women's experience of their postnatal care in hospital and at home. It found that over a third of women surveyed had problems caring for themselves and the baby. Breastfeeding mothers were more likely to have problems than bottle-feeding mothers. There was no relationship between having such problems and parity. Women were particularly dissatisfied with postnatal services at home, 45% describing them as inadequate. Satisfaction with services was significantly associated with having sufficient advice from health professionals in hospital and at home. In view of the findings of this paper, it is clear that a strategy is required to identify those most in need of postnatal care and target services accordingly.

Purpose: To explore the relationship between satisfaction with support and functional status after childbirth., Design: Prospective longitudinal survey design., Methods: Two hundred new mothers who had experienced a healthy pregnancy, normal delivery and puerperium, and delivered a healthy infant between 37 and 42 weeks gestation were approached while attending primary healthcare maternal-child health centers and immunization clinics in New South Wales, Australia. Measurement tools included the Inventory of Functional Status After Childbirth and the Support Behavior Inventory, and were administered at 6 weeks, 3 months and 6 months., Results: Significant increases in total mean functional scores, scores for household responsibilities, social activities, and self-care were noted. Although no significant correlation was found between satisfaction with social support and functional status after childbirth, satisfaction with support from one's partner decreased significantly during the 6-month survey period, as did satisfaction with support from others., Clinical Implications: It could be that providers need to assess the social support needs of their clients. A postnatal support plan could be used by mothers to negotiate the long-term involvement of others in household tasks and selected aspects of infant care.

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.

Increased competition in the United States has led to increased interest in women's perceptions of their obstetric experience. Family-centered postpartum care (FCPPC) was originated to improve women's perceptions of care quality. This study examined differences in and the hypothesized relationship between quality and beneficence in a group receiving traditional postpartum care (TPPC) and a group receiving FCPPC in a safety-net hospital in West Tennessee. Both groups had high mean quality and beneficence scores; however, the FCPPC group's scores were significantly higher than those of the TPPC group. There was a relationship between quality and beneficence for the combined sample. The findings suggest that nurses should incorporate FCPPC approaches as a means of improving perceived quality and benefits.