Postpartum care should provide alternatives to meet parents’ need for safety, active participation, and ‘bonding’
Introduction
The period immediately after the birth of a baby is both a meaningful and an overwhelming time for the new mother and father. Becoming a mother is a transition that brings with it contrasting feelings (Sethi 1995, Barclay et al. 1997) and many first-time mothers are overwhelmed by the demands of motherhood (McVeigh 1997). First-time fathers likewise experience great change (Henderson & Brouse 1991) and an ‘awakening’ as they become aware of the baby's enormous needs for care (Hall 1995). The new mother and father need to be given information and practical support while they grow into their new role of parents (Moran et al. 1997, Barclay & Lupton 1999, Nyberg & Bernerman Sternhufvud 2000, Lugina et al. 2001). The mother may also feel the need to recover, and obtain advice and assistance with physical and emotional health problems (Ruchala & Halstead 1994, Brown & Lumley 1998).
Since the birth of a baby is a sensitive time for the new mother and affects the whole family, the care environment and opportunity for privacy become an essential factor in babybirth and postnatal care (Burden 1998, Janssen et al. 2000). Most mothers of newborn babies need to be left in peace to take care of themselves, to rest and be with the family, and at the same time have the carers close at hand should the need for information and support arise. Parents in a previous study who opted for early discharge (ED) postpartum described the home setting as important in providing a feeling of freedom, peace and privacy, and considered the maternity ward (MW) unable to provide them with this (Paavilainen & Åstedt-Kurki 1997). Several studies show that among parents choosing an ED, being in control is important (Hall & Carty 1993, Persson & Dykes 2002). By ‘control’ a feeling of competence and confidence is meant, and the ability to decide for oneself and take responsibility for the new baby. In a study of pregnant and postnatal women Proctor (1998) found that ‘control’ involved the feeling of being confident enough to ask for help or advice when there is a need for support. Feelings of control have also been shown among fathers during the delivery when they take an active part and have a task (Wikander & Theorell 1997).
For staff providing postnatal care it is important to understand the concerns and needs of new parents. The experience of women of care during the postpartum period has in one work been described as ‘confirmatory moments of communion’ (Bondas-Salonen 1998). The new mother feels she is receiving care when the midwife takes part in different ways in her (the mother's) new situation, when she learns through the midwife's teaching and even indirectly, when she is allowed undisturbed time together with her baby and family. In a UK study Proctor (1998) found that midwives underestimated women's concerns about issues, such as the importance of postnatal information, the need for control and confidence in adjusting to the role of mother, and involving the woman's partner in the delivery of care. Tarkka and Paunonen (1996) found that the support and help that new mothers received from the staff at the MW primarily had to do with concrete help while confirmation and emotional support were given less frequently. There was a desire among both primiparae and multiparae for more individual guidance/postnatal counselling. Other studies have shown that the role of the father-to-be is rarely discussed during the pregnancy (Olsson 2000) and that there is not sufficient preparation for parenthood to meet the needs of the man (Donovan 1995).
In Sweden, as in many other Western countries, the length of hospitalisation following babybirth has been steadily shortened. Studies indicate that an ED after childbirth is safe for carefully selected mothers and babies (Gagnon et al. 1997, Grullon & Grimes 1997, Odelram et al. 1998) and does not jeopardise breast feeding (Kvist et al. 1996). Among parents the experiences of an ED and early home-coming appear to be predominantly good, although for this to be successful a well-organised care system is required, as well as preparation of the parents during pregnancy (Winbladh et al. 1994, Darj & Stålnacke 2000). An alternative to traditional maternity care or the ED, as described in Norway, Sweden, and the United States (Parsons et al. 1999, Lindgren 2000), is what we refer to here as the ‘family suite (FS)’. This care option features a more relaxing and home-like environment located near the hospital in which parents are offered information, help and support during the first few days following childbirth.
Northern Sweden (Umeå) has had FS hotel settings since 1994. Family suite hotels are located next to the hospital area and provide facilities and care for families where the woman has had a normal pregnancy and delivery. In 1998 a system for an ED postpartum was started as an alternative following a normal pregnancy and delivery. If complications develop during the pregnancy or delivery, care is provided at the hospital's MW.
The MW is staffed 24 hours per day. Most women at the MW share a room with another new mother. At the MW the father and siblings can visit the mother and the newborn baby during the day but are not able to stay overnight.
At the FS, the family is given a room for the first 3 days postpartum. Midwives work at the FS during daytime hours but during the study period FSs were not staffed during night hours. The FS had 24-hour staff 1994–1997, and again since 1999. Parents in need of advice or support at night could contact the staff at the hospital's MW by telephone. The FS is closed for a few weeks in the summer and during this period families who do not opt for an ED receive care at the hospital's MW or in a double room at the delivery ward.
‘Early discharge’ means discharge from the hospital/FS for both the mother and the baby at 6–72 hours following the birth. Both mother and baby were to be healthy, the pregnancy and delivery normal, and the baby had to be examined by a paediatrician before discharge. Families discharged within 24 hours after delivery are paid a home visit during the first day at home. All couples making use of this discharge option are contacted daily by telephone by a midwife, and have access to a midwife by telephone 24 hours a day. At 3–5 days post-delivery the mother is given a final check-up and consultation, and the baby is given a physical examination and phenylketonuria (PKU) screening.
Care after childbirth has undergone great changes in the last decades and there are now a number of different care forms available. The changes have chiefly been studied from the perspective of the safety of the mother and baby, with few studies focusing on the new mother's experiences and even fewer on the father's perspective. The aim of this study was to describe the choice of new parents with regard to type of maternity care, an ED or a FS, and to gain a better understanding of parents’ experiences in different care alternatives.
Section snippets
Methods
The design was a qualitative study using semi-structured interviews.
Findings
Eight first-time parents participated, five women and three men. Fifteen parents, seven women and eight men, had older children. The age of the parents ranged from 22 to 44 years. The decision to opt for an ED was taken within one hour of the birth for all couples except one who took the final decision 10 hours after childbirth. For the couples who decided to stay at the FS the decision to do so was taken within two hours of the birth.
Regardless of whether the choice was ED or the FS some
Discussion
According to the parents’ description of the postpartum period, this is a time of many questions. The parents made a decision based on the risks and benefits of the different care alternatives when they made their choice. Their freedom to choose was, however, limited by a number of circumstances over which the parents did not feel they had control. Important factors in the postpartum period were the opportunity the family had for privacy, and the physical setting. A third important factor
Acknowledgements
We would like to thank all the parents who took part in this study by sharing their experiences. The study was made possible by research and development grants from the County Council of Västerbotten, Västerbotten, Sweden.
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