Elsevier

Midwifery

Volume 19, Issue 4, December 2003, Pages 267-276
Midwifery

Postpartum care should provide alternatives to meet parents’ need for safety, active participation, and ‘bonding’

https://doi.org/10.1016/S0266-6138(03)00030-5Get rights and content

Abstract

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.

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.

References (0)

Cited by (40)

  • Early discharge from hospital after birth: How Norwegian parents experience postnatal home visits by midwives – A qualitative study

    2021, Sexual and Reproductive Healthcare
    Citation Excerpt :

    In order to de-medicalize perinatal care, WHO has developed some principles, one of which is that the care offered ought to be family-focused [6]. Earlier research indicates that the desire to be together with her closest family is the main reason why women tend to prefer an early discharge from hospital [7–9]. The follow-up after birth and the length of the postnatal stay should be agreed upon between the individual woman and health care professionals, taking into consideration the health of the woman and baby as well as the expected social support following discharge [3,10].

  • Effect of the Postpartum Hospital Environment on the Attainment of Mothers’ and Fathers’ Goals

    2017, JOGNN - Journal of Obstetric, Gynecologic, and Neonatal Nursing
  • Parental experiences of early postnatal discharge: A meta-synthesis

    2015, Midwifery
    Citation Excerpt :

    Some parents underlined that domestic surroundings gave them a positive feeling that childbirth is natural. The feeling appeared as soon as they took a step away from the hospital: ‘It felt healthy in some way…and somehow it is when you take the step from the hospital to something else’ (mother) (Fredriksson et al., 2003). In particular, several fathers experienced it as easier to rest at home in their own surroundings, they felt calmer and slept better (Fredriksson et al., 2003; Johansson et al., 2010).

  • Do families after early postnatal discharge need new ways to communicate with the hospital? A feasibilility study

    2014, Midwifery
    Citation Excerpt :

    The definition of early discharge differed between local standard practices in the different studies, with early discharge varying from 12 hours to just under 72 hours. Some studies show that new parents experience feelings of insecurity during the postnatal period (Persson and Dykes, 2002; Frederiksson et al., 2003; Persson et al., 2011). A Danish questionnaire study (N=1507 women) identified that a proportion of the women who were discharged early postnatal (within 24 hours) experienced lacking follow-up support, i.e. 44.3% did not receive the support needed to care for the newborn; 37.5% did not receive support for postnatal self-care; and 46.1% did not receive support in breast feeding (Unit of patient perceived quality, 2010).

View all citing articles on Scopus
View full text