ReviewNew parents’ experience of information and sense of security related to postnatal care: A systematic review
Introduction
Becoming a parent is described as one of the most challenging transitions that human beings experience in life. Many couples are under great strain when a child enters the family. The transition is revolutionary mentally, physically and emotionally, and a natural consequence is relationship change. The partnership can change for the better however it can also lead to separation and divorce [1]. Swedish researchers have found that postnatal care does not always meet the parent’s need of information and support [2]. Care during childbirth involves major challenges. In many families there is no proximity to grandparents and close relatives who could be of support for new parents. Urbanization, where many young people move from their hometown, as well as migration from other cultures and displacement due to war, place additional demands on postnatal care, further increasing the need for individualized care, information and support [3]. Approximately 85% of all new-born children in Sweden receive their postnatal care at a hospital unit. The average hospital stay after birth is at the moment less than two days for a mother with a healthy baby [4].
The purpose of postnatal care according to the World Health Organisation (WHO) is to provide “the highest possible quality of care and medical treatment with the least possible intervention to optimize the health and well-being of the new family” [5]. The goal of care after normal childbirth with a healthy child is to give the parents of the new-born, support in their role, to introduce breastfeeding and to help first-time parents to interpret the child's signals [5]. Postnatal care should focus on the needs of the whole family, not just the new-born child and the mother [4].
In a study aimed to evaluate dimensions of parent’s sense of security the first week after childbirth, it was found that a sense of security among mothers’ was related to midwives/nurses empowering behaviour and a sense of general well-being. Among fathers a sense of personal well-being, a sense of mother’s well-being as well as midwives/nurses empowering behaviour was important [6].
It is well known that it is important to see parents and children as a whole unit and that both parents' ability to exercise parenthood is assured [7]. During the first period after birth, parents need information and counselling around breastfeeding and care of the new-born child, information on physical changes including signs of illness or health issues, self-care including hygiene and healing processes, sex life, contraception and nutrition [5].
In order to respond to the needs of parents and to ensure that parents feel secure in the parenting role, healthcare professionals need to understand factors leading to increased or decreased self-reliance and sense of security. There is also a need for more knowledge of how parents perception of the information given regarding the new-born child, so that healthcare professionals can gain a better understanding of the parents' experiences.
Our definition of sense of security includes confidence and adjustment, which is used by Persson et al in their studies [6]. Sense of security is found to be an internal sense – an intrinsic state based on faith and trust in oneself and others. External factors that strengthened Sense of security are to be part of a community, to recognize and be familiar with things and situations and to use various kinds of aids [8].
The aim of our study was to provide a contextualised understanding of how parents experience postnatal care in relation to information and sense of security”.
Section snippets
Literature search
A systematic search of PubMed and CINAHL database for literature published between January 2002 and August 2017 in English was conducted. We searched for original peer-reviewed quantitative, qualitative, and mixed methods studies of postnatal care and new parent’s experience of information and sense of security. The literature search began with the keywords; information, new parents; maternity hospital; early parenthood, sense of security; post-natal care (Mesh term); postpartum period (Mesh
Results
This review is based on studies utilizing both qualitative and quantitative design. After the initial review of 68 abstract and 28 papers, ten articles with suitable content remained for our study. Six of the ten included studies were conducted in Sweden; one in Norway, one in the UK and two in Australia. Eight articles were conducted with qualitative design and two with quantitative design. Participants in the included studies varied between 9 and 2699. The articles are presented in Table 1.
Discussion
Qualitative studies can provide a rich, contextualized understanding of some aspect of human experience in care. In healthcare where evidence for improving practice is very important, generalization in relation to knowledge claims careful attention by both qualitative and quantitative researchers. It is difficult to generalize qualitative studies, but insights from qualitative inquiry can be a very important source of evidence for practice [22]. Integration of qualitative and quantitative
Conclusion
Continuity of care, parent participation, individually adapted and consistent information, as well as preparation for parenting appear to be important factors related to parents' sense of security postnatal according to the studies included in our literature review. These factors are in line with the objectives of person-centered care which has revealed better outcomes for patients in various sectors in health care.
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Cited by (28)
Fathers’ negative experience of childbirth is associated with an increased risk of paternal postpartum depression
2023, Gynecologie Obstetrique Fertilite et SenologieMaternity care during a pandemic: Can a hybrid telehealth model comprising group interdisciplinary education support maternal psychological health?
2023, Women and BirthCitation Excerpt :Mental health and maternity services are interconnected [26]. While the provision of effective maternity care continues to be a global health policy goal [11,43], unmet needs across episodes of maternity care remain [40,73,84]. For example, in high-income countries, antenatal care usually involves appointments with health care professionals (e.g., hospital midwives and obstetricians) with childbirth education classes referred as an adjunct, on an opt-in basis [52].
Postnatal mental health during the COVID-19 pandemic: Impact on mothers’ postnatal sense of security and on mother-to-infant bonding
2023, MidwiferyCitation Excerpt :These authors defined it as “a sense of empowerment and self-efficacy, affinity within the family, autonomy and control and well-being - including finding breastfeeding manageable” (Persson et al., 2007). In a systematic review, Werner-Bierwish et al. (2018) described factors that can impact mothers’ emotional security, namely: the woman's emotional state, knowledge, and previous experiences of maternity, the physical health of the mother and child, the mother's personal life situation, perinatal health support, maternity care settings and options, partners’ active involvement during the pregnancy and postpartum process, support from relatives, a planned follow-up after birth (Persson et al., 2011), preparation for childbirth and parenting, and consistent information provided by healthcare professionals (Wicklund et al., 2018). Midwives and healthcare professionals play a key role in fostering a sense of security for mothers (Werner-Bierwish et al., 2018).
Family life starts at home: Fathers’ experiences of a newly implemented Swedish home-based postnatal care model – an interview study
2022, MidwiferyCitation Excerpt :Literature reviews state that the length of the hospital stay following birth has decreased over time (Malouf et al., 2019), including in Sweden, where the average time spent in hospital-based postnatal care is two days for vaginal deliveries and three days for cesarean deliveries (The Swedish Association of Midwives, Swedish Society of Obstetrics and Gynecology, and Swedish Neonatal Society, 2013). By only spending two to three days in postnatal care, many families do not feel prepared to be completely on their own in their home, and believe that receiving care over a longer time period would be beneficial (Danbjørg et al., 2014; Wiklund et al., 2018) Midwives play an important role in empowering fathers in the postnatal period of their infant's lives.
“Reassurance that you're doing okay, or guidance if you're not”: A qualitative descriptive study of pregnant first time mothers’ expectations and information needs about postnatal care in England
2020, MidwiferyCitation Excerpt :This was true for mothers of all backgrounds and all ages, including older mothers worried about losing status and role identity and younger mothers worried about age discrimination and child protection proceedings. The prominence of this desire closely reflects empirical findings that the manner in which postnatal information and advice are given are experienced as equally important as the content, and new mothers are highly sensitive to feeling judged (Aston et al., 2018; Henshaw et al., 2018; Lagan et al., 2014; Leahy Warren, 2005; Roche et al., 2005; Schmied et al., 2011; Wiklund et al., 2018). This is the first qualitative research to explore in depth first time mothers’ expectations and information needs about postnatal care prospectively, distinguishing real and ideal expectations.
Parents' experiences of early discharge after a planned caesarean section: A qualitative interpretive study
2020, MidwiferyCitation Excerpt :For a few women in this study, prior problems with breastfeeding affected their attitude toward early discharge because they needed experiences of successful breastfeeding before feeling ready to go home. This corresponds with other studies (Nilsson et al., 2015; Wiklund et al., 2018) showing that successful breastfeeding promotes a sense of security. Other studies have implied that CS increases the risk of early cessation of breastfeeding (Zanardo et al., 2010; Prior et al., 2012) and that postoperative pain hampers in women's ability to breastfeed (Sell et al., 2012) therefore, these are important aspects to address in planning the length of hospital stay.