Professional support during the postpartum period: Primiparous women’s views on professional services, their expectations, and barriers to mobilizing professional help

doi:10.21203/rs.2.16975/v1

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Research article

Professional support during the postpartum period: Primiparous women’s views on professional services, their expectations, and barriers to mobilizing professional help

https://doi.org/10.21203/rs.2.16975/v1

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published 11 Jul, 2020

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Background: Mothers of young infants, especially primiparous women who lack experience and knowledge, are usually overwhelmed with a multitude of stressors and challenges. Although support from professionals is needed for new mothers, there is indeed a gap between the necessary high-quality service and the currently provided poor services. This study aimed to explore primiparous women’s views on professional services, identify barriers to mobilizing professional support, and further understand women’s expectations of and preferences for the delivery of professional services.

Method: A descriptive phenomenological study design was utilized in this study, and semi-structured interviews were conducted with 28 primiparous women who were selected from two community health centres and who had given birth within one year before the interview. Each conversation lasted between 20-86 minutes. Colaizzi’s seven-step phenomenological approach was used for data analysis.

Results: Three major themes were identified: (a) dissatisfaction with current professional services for postpartum women, (b) barriers to mobilizing professional support, and (c) primiparous women’s expectations of professional support. Seven related subthemes included primiparous women’s disappointment with clinical services and their low confidence in services provided by communities, social health centres and online platforms; internal personal reasons and external socio-cultural factors that contributed to barriers in obtaining professional help; and primiparas’ new expectations of baby-care-related services, their personal needs for recovery, and their expectations of methods of services delivery. The necessity of professional support in the first month of confinement was emphasized by primiparas. Online methods were perceived by the majority of participants to be the best way to receive services.

Conclusion: The results of this descriptive phenomenological study suggested that the professional services currently provided by medical facilities were insufficient and could not meet the requirements of primiparous women. The identified barriers should be analysed and overcome by enhancing education and eliminating stigma. The results also suggested that providing service focused on women’s requirements may be an effective strategy to enhance primiparous women’s well-being and suggested that women believed that the most acceptable and convenient methods should be considered during the delivery of interventions.

Maternal & Fetal Medicine

primiparous women

professional support

barriers

service delivery

Childbirth and the postpartum experience often generate many physiological and emotional changes for mothers, who have confirmed that they are usually overwhelmed with a multitude of stressors, such as routine baby care, heavy household duties, a lack of sleep, and breastfeeding difficulties [1–3]. This makes the period after childbirth a very challenging time for mothers, especially for primiparous women who lack knowledge and experience [4]. It seems difficult for them to adjust to the new role and shoulder the responsibility of caring for babies [5,6]. They often feel frustrated and unsure due to, for example, being unable to identify any specific reason for their babies’ frequent crying [7]. In this situation, a number of postpartum women have shown their substantial need for guidance and support from professionals to help them with their infants and self-care-related problems [8].

Strong evidence suggests that social support benefits new mothers greatly [9,10].For example, empirical studies have consistently shown that adequate support can reduce stress and the risk of developing depression and can increase parental sensitivity and feelings of self-worth [11,12].Professional support is one of the main sources of social support that can be provided by many professionals in different areas, including midwives, doctors, nurses and so on [4]. The services they provide take different forms and have been indicated to be efficient in many studies. Postnatal care interventions such as home visits by midwives or public health nurses, phone-based support programmes, and online consultation have been shown to help improve maternal confidence, increase successful breastfeeding, and decrease postpartum fatigue and depression [13–16]. Women particularly valued professionals who focused on them and the trusting relationships they developed, including the opportunity to develop new skills in problem solving [17–19].

Although support from professionals is urgently needed for new mothers and has been proven to be quite effective, there is indeed a gap between the necessary high-quality services and the currently provided poor services.

When discussing current views on postnatal care, new mothers expressed great disappointment with the reality of the quality of postnatal care, including insufficient time to ask questions, information provided with little patience and few explanations, and insufficient care [20–21]. Unsatisfied mothers also emphasized that hospital staff were unconcerned and unsympathetic towards their and their infants’ needs. They reported that caregivers were unfriendly, disrespectful, and impersonal [22].In addition, early discharge from the hospital made them feel insecure and worried, and the absence of home visits also magnified these feelings [8]. Negative comments also related to the fact that the services provided did not correspond to their requirements [23,24]. Professionals usually only focused on the physical aspects of baby care but neglected the emotional needs of mothers [25,26]. This situation may be due to a shortage in the quantity of workers and restrained resources [27,28]. However, one of the greatest barriers in providing appropriate care and support is the low level of identification of mothers’ needs [29]. Therefore, it is important to explore new mothers’ views and expectations of professional support. However, the majority of previous studies have focused only on depressed women and separate aspects of problems. Not only have mothers’ general needs and demands not been considered, but there has also been a lack of an overall consideration of problems. Thus, considering the mentioned literature gaps, this study focused on the postpartum period and aimed to explore primiparous women’s views on professional services, identify barriers to mobilizing professional support, and further understand their expectations of and preferences for the delivery of professional services.

Design

A descriptive phenomenological approach was utilized in this study to explore primiparous women’s views on professional services, their expectations, and barriers to obtaining professional help. Such an approach was chosen because it is useful to provide an accurate description of the phenomena [30] Descriptive phenomenology originated from Husserl’s (1960) work, which is commonly used in nursing and midwifery research [31]. Husserl contended that the object of scientific study is the phenomena perceived by the individual’s consciousness. Thus, no assumptions or philosophical or scientific theory, logic procedures, other empirical science or psychological speculations should inform phenomenological inquiry [32]. In Husserl’s descriptive approach, researchers are required to focus on participants’ experiences of a phenomenon and identify the essences of the phenomenon while suspending their own beliefs, attitudes, previous experiences and assumptions [33]. Thus, with the guidance of the methodology above, the researchers aimed to maintain openness, question their pre‐understandings and adopt reflective attitudes during the whole study process, including data collection, data analysis and reporting.

Study site and participants

The study was conducted at two locations in Xi’an City, Shaanxi Province. The areas of Dong Guan and Bai Shu Lin were selected as study sites. In each area, there was a community health centre directed by an experienced doctor who assisted the researchers in delivering the invitation letters to potential participants. A strategy to maximize the variation in the sample was employed when selecting the participants, and the sample size was based on the information saturation principle. A purposive sample of 28 participants who were at least 18 years old, had given birth to their first baby in the first postpartum year, and who expressed interest in participating in the study were recruited.

Ethical considerations

Ethics approval was obtained from the Ethics Board of Xi’an Jiaotong University. All the women provided written informed consent for study participation. They also received oral presentations that included a brief introduction to the study, including the study goals, objectives, procedures, benefits and potential risks of the study. All participants were ensured that they would be given respect and that their information would be kept confidential. The participants were also informed that they could withdraw midway during the interview and that the audio recordings and transcripts would be stored in encrypted databases at the college to guarantee the confidentiality of the information.

Data collection

All interviews were conducted face-to-face in community health care centres, and all interviews were conducted by two researchers, Nan Yiping and Zhang Jingjun. The first researcher was the interviewer, and the second researcher was responsible for recording the interviews, taking notes, making summaries, and supplementing the data as necessary. The questions were obtained and finalized through a literature review and group discussion among the team members. The interview guide was modified by consulting one gynaecologist and one sociologist. Prior to the data collection, a pilot interview was conducted to further modify the interview guide to guarantee the suitability and acceptability of the questions.

Finally, eight open-ended questions were developed. The questions are outlined in Table 1.

Table 1 Interview Guide for the Participants

Further questions were asked flexibly based on the responses of the participants. The prompt questions for each theme were developed to be nonprescriptive and open-ended.

1. What do you think about the current medical facilities, such as hospitals, community health centres or other facilities, in our society?

2. Could you please tell us about your experiences with seeking help from professionals in the health care centres above?

3. Do you like to ask for support from professionals when you are in trouble? Why?

4. Are there any difficulties or barriers when you need professional support? Please give us an example.

5. Based on your experience, what kind of difficulties require assistance from professionals, and what kind of difficulties do not?

6. Please describe what kind of professionals you need most after childbirth and the specific services that you need.

7. Do you have any advice for current professionals, and what are your expectations of new professional services?

8. Please identify what methods of service delivery to receive help from professionals would be suitable for postpartum women?

After the interview, the participants were required to complete a demographic questionnaire to collect information about their demographic characteristics. All of the transcripts were sent back to the participants, and follow-up phone calls were also made with them to check the accuracy of the information.

Data analysis

Colaizzi’s seven-step phenomenological approach was applied to analyse the data [34]. The interviews were transcribed verbatim in Chinese by the two researchers who collected the data. Each audio-recorded interview was transcribed. All transcripts were then cross-checked against the original records by the two researchers above. The seven steps were as follows. 1. Each transcript was read carefully by two researchers, Nan Yiping and Zhang Jingjun, and the fieldnotes taken in the interviews were also combined to obtain a more accurate understanding of the descriptions. 2. The two authors extracted meaningful statements related to the participants’ views, expectations of professional services and the barriers in accessing them, 3. The researchers coded significant statements and participants’ keywords and phrases, and they cross-checked and discussed all codes together. 4. The two researchers repeated and checked the first three steps, and each code was read, compared repeatedly and deliberately, and then clustered together into multidimensional categories. 5. Seven sub-themes were identified, and exhaustive descriptions were also developed. 6. theme was determined based on continuous discussion, comparison, reintegration, and inspection of the sub-themes among all team members. 7. All transcripts were returned to the participants to check their accuracy in capturing the participants’ intended meaning. The coding tree is shown in Figure 1.

The interviewees’ accounts were given priority to help the authors understand their experiences and stories in their own words. The sub-themes and themes were generated from the data and were not informed by a preidentified framework.

The emerging themes were discussed as a team to determine whether to retain them and to ensure the consistency and balance of the main theme.
Figure 1 Coding Tree

All mothers in the study were primiparas whose ages ranged from 24 to 40 years. Seventeen mothers had a bachelor’s degree or higher. The average age of the babies was approximately five months. Further characteristics of the participants are presented in Table 2. In total 28 primiparas participated in the study and completed interviews.The duration of the interviews ranged from 20 to 86 minutes (mean=32 minutes). Through data analysis, three themes and seven sub-themes emerged. Themes and sub-themes are demonstrated in Table 3.

Table 2 Characteristics of the Women Interviewed (n = 28)

Characteristics	n (%)/
Age
(year)	30.08
BMI
<25 kg/m²	23 (82.1%)
≥25 kg/m²	5 (17.9%)
Residence
Urban	24 (85.7%)
Rural	4 (14.3%)
Education level
High school or below	4 (14.3%)
Junior college	7 (25.0%)
Bachelor degree or above	17 (60.7%)
Employment status
Full-time job	14 (50.0%)
Unemployed	14 (50.0%)
The way of delivery
Vaginal delivery	12 (42.9%)
Cesarean delivery	16 (57.1%)
Age of baby at interview
(month)	5.56
Sex of their baby
Boy	15 (53.6%)
Girl	13 (46.4%)
Infant illness within 4 weeks after childbirth
Yes	2 (7.1%)
No	26 (92.9%)
History of depression
Yes	8 (28.6%)
No	20 (71.4%)
Family per capita income
<4000 yuan	12 (43.9%)
≥4000 yuan	16 (57.1%)

Table 3 Themes and Sub-themes Identified in the Interviews

Themes and sub-themes

1. Dissatisfaction with current professional services for postpartum women

Primiparous women’s disappointment with clinical services

Low confidence in services provided by communities, social care centres and online platforms

2. Barriers to mobilizing professional support

Obstacles caused by internal personal reasons

Potential limitations caused by external socio-cultural factors

3. Primiparous women’s expectations of professional support

Urgent demands for new baby-care-related services

Personal needs for recovery that cannot be ignored

Preferences for service delivery methods

Dissatisfaction with current professional services for postpartum women

The vast majority of women in this study indicated a low level of acceptance and satisfaction with maternity care in China. These dissatisfied mothers commented on current professional services provided by professionals in medical facilities. The comments belonged to two categories: (a) primiparous women’s disappointment with clinical services and (b) low confidence in services provided by communities, social care centres and online platforms.

Primiparous women’s disappointment about clinical service

Many mothers mentioned that the service provided in maternity settings during the postpartum period was quite insufficient; they also claimed that they were concerned with the low levels of compassion. Health care workers usually focused on current physical health issues, such as prolonged lochia, instead of considering the mothers’ long-term psychological, emotional and informational needs after discharge. Mother 28 emphasized the defects of hospital service.

“The service provided by hospitals is totally insufficient. I think the postpartum period is very important. We should have received some related education about postpartum problems before we gave birth, but we didn’t. Most of the time, the provided service was just cosmetic, actually; they don’t treat it seriously, and what they did for us is not enough.” (Participant 28)

Additionally, participants complained that the postpartum hospitalization time was very short and that check-ups after discharge were either absent or very simple. Health care workers often simply made a phone call without a home visit. Many women felt uncared for and neglected because of a lack of formal support from the hospital. Both mothers 5 and 27 stressed the importance of following-up. As mother 27 recounted,

“I had not received any service after discharge from the hospital, but I believe being followed up is very important. For example, my brother’s wife had a vaginotomy at that time. Afterwards, the stiches were not taken out completely. But who knew that? The wound was infected with pus eventually. Then, she went to see the doctor by herself. There was no one who reminded her of such matters that may occur after surgery.” (Participant 27)

Several mothers mentioned that paediatric clinics in local hospitals were very busy. Staff were time-constrained, and it seemed that efficiency was regarded as the priority rather than patients’ needs. Mothers similarly felt that staff members were impatient and had little concern for their emotions. The staff did not even fully listen to their complaints and did not want to talk to them very much. When mothers recalled their hospital experiences, they felt they were not treated equally and respectfully. One mother felt upset when she took her baby to go to see the hospital doctor:

“After all, there are so many clients in big hospitals. When I have a little problem about my child, I really need to consult a family doctor, but there was none, so I had to wait in a long line; when I eventually saw the doctor, the length of the conversation was no more than five minutes. I wish health care workers could be more patient and spend more time on every baby’s examination.” (Participant 13)

Low confidence in services provided by communities, social care centres and online platforms

Even though the clinical services provided were very unsatisfactory, mothers demonstrated that they still tended to go to clinical facilities rather than community health centres because of their distrust of the health care professionals and the medical examination equipment there. Mother 2 expressed her feelings about the community health centres:

“I think the community health centres are not so good; the quality of the equipment there is not good enough. To tell the truth, I am not confident in such settings, because I think health workers there can’t be as professional as in the big hospitals. Community health centres should play a role in consulting and being the primary treatment provider. But in fact, I get little help from there.” (Participant 2)

Two mothers mentioned that the staff in postpartum care centres, such as in staff in lactation divisions and local psychologists, were not professional enough; some of them even lacked professional training and formal certificates. In addition, the costs of the services were often too expensive to afford. Furthermore, it was even difficult for mothers to find ways to contact professionals. Mother 28 recalled her experience finding help with her difficulty breastfeeding:

“Low milk supply is a big problem for me; it troubled me a lot. I really needed a professional who could help me at that time. But it’s difficult to find a qualified galactagogue division in a formal way; they are inexperienced most of time.” (Participant 28)

Some professional services, for example, online consultations provided by doctors, could be accessed on various online platforms. However, several substantial defects were reported by mothers, such as ample misleading information on online platforms that confused many mothers. Some mothers disliked the advertisements and promotions on such platforms. Meanwhile, they also expressed concerns with the qualifications of so-called professionals who provided online services.

“I often consulted doctors online on baby health issues. To be honest, I didn’t trust them (doctors) so much, but I had no choice, so I often combined their advice with information from other sources.” (Participant 21)

Barriers to mobilizing professional support

Barriers to asking for professional help were present for many women. The reasons contributing to barriers were summarized and classified into two sub-themes: (a) internal personal reasons and (b) external socio-cultural factors.

Obstacles caused by internal personal reasons

Many participants expressed that they often tried to mobilize support from professionals, but almost all of them were also concerned with the difficult of seeking such support and did not want to spend money and time on it. In addition, some mothers demonstrated that they had been overloaded by baby care, so it was not convenient for them to leave the house. Some mothers also felt there was no time to consider their own feelings at all; if they experienced negative emotions, they were set aside to do household chores or play with their babies. Mother 6 recounted,

“My life was filled with various household chores. In fact, I was too tired to think too much about my distress. I hung out with my baby in the morning, had a nap at noon, and played with my baby in the afternoon. When one day almost finished, I had forgotten my distress, especially when faced with my baby’s smile.” (Participant 6)

Several women were inhibited in mobilizing support from professionals and believed that it was embarrassing to discuss their private issues with others. They indicated that they were not sure whether they needed professional support. Most of the time, they believed that they could solve their problems by using online platforms or discussing current issues with people around them, such as their own parents or peers. Women’s parents, especially mothers, were mentioned as a trustworthy source for emotional support; the participants noted that their mothers made great efforts for their families and often showed understanding and sympathy for their suffering and distress. Some of the participants believed that sharing with peers was also powerful and that peers could be trusted; sharing with peers was described as vivid and providing cognitive empathy about the roles of mothers. Mother 5 showed her appreciation for support from peers:

“I benefited from peer groups a lot, because everyone could obtain limited information by exchanging messages and sharing experiences, and I could view one issue from various perspectives. If I was lucky enough, I could find the information that just matched my requirements.” (Participant 5)

However, several women mentioned that they did not want to be a burden to others and did not want to show signs of vulnerability. Some independent women believed it was irresponsible to expose others to their negative feelings, which could have a negative influence on their lives. Three mothers, Mothers 16, 19, and 23, concealed their feelings and comforted themselves by reading about others’ experiences online:

“When I was unhappy, I just read others sharing on the post bar (on the internet); I selected mothers who had more tragic experiences on purpose to achieve a mental balance.” (Participant 16)

Last, some women felt disappointed about the fact that even their closest family members could not understand them well, and they also felt frustrated about ineffective communication with people around them, including professionals. They eventually decided to hide their own feelings from others because they believed that people who had no similar experiences would not understand and show sympathy for them, let alone professionals who were not familiar with them at all.

“Unlike other young mothers, I was very old when I gave birth. SI suffered a lot from the birth and felt very uncomfortable after that, but when I shared my feelings to peers, they just told me it was a kind of neurosis; they couldn’t understand me at all. It was useless to discuss my feelings with them.” (Participant 5)

Potential limitations caused by external socio-cultural factors

Many mothers pointed out two socio-cultural factors. One factor was that the lack of professionals and the fact that almost all of them worked in large hospitals, which prevented professionals from being able to visit patients’ homes to provide services. In addition, due to the limitations of a weakened physical condition, many chores, and baby care during the postpartum period, especially during the first month of confinement (“yue zi” is a postpartum tradition among Chinese women in which new mothers are required to strictly comply with specific regulations within 30 or 40 days postpartum [7]), it was inconvenient for mothers to leave the house. Even though they overcame the above difficulties to see professionals, their problems were not totally solved due to the impatience of or ineffective communication with professionals. Therefore, the mothers usually preferred more convenient and lower cost methods to address their problems, which were made possible by rapid internet development. Most mothers agreed that the utilization of various electronic devices to search for ways to solve problem was the most convenient way to receive help. As Mother 27 said,

“He (the baby) is too young to go to crowded places, especially hospitals, due to fears that he will get sick, and it was also inconvenient for me to go outside with him. So, I greatly appreciated the consultation with doctors online. They helped me with the common minor diseases of babies.” (Participant 27)

Under the influence of “lian” in China (lian, i.e., saving face, refers to the social confidence in individuals’ moral character in society, and people cannot properly function in society if the integrity of this character is broken [35]), women mentioned that seeking help from mental health professionals for inconsequential matters in daily life was making a fuss. They were worried about others’ prejudices towards them if they turned to professionals, which would cause them to lose face, even from their entire families. One participant even preferred to discuss matters with a stranger but not a professional:

“When I was upset, I hadn’t considered turning to professionals yet. I think it will make more sense and be safer to discuss my story with a stranger.” (Participant 23)

Family conflicts were sensitive topics for almost all mothers, and the conflicts between them and their mothers-in-law were mentioned as the main reason for their distress. However, most mothers believed in the old Chinese adage that domestic shame should not be made public and that no matter what happens, it should be solved within the family. If others knew about the conflicts in their families, it would have made the mothers feel ashamed and would also have demonstrated their incompetence in becoming good mothers. Thus, most of the time when the mothers experienced difficulties, turning to professionals was not their first choice. As Mother 4 said,

“Actually, I just let bad emotions blow over, and I would feel better; after all, it is a fact that cannot be changed that we are family, and no matter how many conflicts happen, they can be settled down eventually. It is not necessary to seriously take them into consideration.” (Participant 4)

Additionally, although some women suffered substantially from family conflicts, they still supposed such conflicts were universal phenomena and followed social norms with little resistance. Mother 23 related her point of view:

“There is an old saying in China, “Judge not upright household chores”. I think maybe that (mother-in-law) is just as well; after all, we are family. I believe conflicts happen in every family, and I think I could endure that.” (Participant 23)

Primiparous women’s expectations of professional support

Twenty-one mothers described their expectations of professional service; they clearly noted that professional support was urgently needed and had high hopes for new services and methods of service delivery. The expectations they had could be classified into three aspects: (a) new baby-care-related services, (b) mothers’ personal needs for recovery, and (c) mothers’ preferences for service delivery methods.

Urgent demands for new baby-care-related services

Baby-care-related professionals, such as professionals in galactagogue divisions, nutritionists, paediatricians, and nurses, were called for by many mothers to help them with breastfeeding, complementary food supplements, preliminary diagnosis of their babies’ diseases, and training in skills for routine care.

“When I added complementary food for my boy, I really didn’t know which kind of food was suitable for him and whether the nutrition was right or reasonable. I always worried, not only about if he had indigestion but also about malnutrition. I really needed some professional advice.” (Participant 26)

The majority of mothers also mentioned their requirements of baby-care-related knowledge and information because they believed that acquiring greater knowledge in advance would give them a better understanding of the needs of babies and be good for the health of their babies. This would also allow greater anticipation of possible risks and the establishment adequate arrangements for that. The need for knowledge could be divided into several aspects: instructions regarding the growth, development and care of babies; methods to promote babies’ growth and development; and possible issues that should be attended to during babies’ growth.

“I’m really confused on her (my daughter’s) mental development. I have little knowledge on the psychological development of children, but I know there must be some meaning in her emotions and actions. I just try to understand her by relying on my intuition. I need professional guidance.” (Participant 22)

The identification of early symptoms of diseases and the management of minor ailments were also emphasized by many mothers. Mother 22 shared her experiences of suffering due to a doctor’s ignorance:

“My daughter was born with a little red spot on her face; the doctor didn’t diagnosis what it was, and it became bigger a month later. I then went to see the doctor, and he told me that it was a haemangioma. I was very angry and asked him why he didn’t tell me that at the beginning.” (Participant 22)

Finally, four mothers emphasized the importance of targeted guidance through the provision of information and knowledge according to the baby’s growth stage. They wished that they could receive reminders and cautionary messages for several key periods during their babies’ growth. As Mother 20 said,

“I wish there were some tips from professionals to regularly remind me of important things, for example, vaccination and examination. What’s more, I would like to receive basic information about growth and development standards that is matched with my baby’s growth stage. For example, at what age can the baby crawl or sit?” (Participant 20)

Personal needs for recovery that cannot be ignored

Several women also reported their personal needs for physical and mental recovery during the postpartum period, including guidance for getting in shape, having a healthy diet, and regulating their emotions. Therefore, related professionals, such as weight managers, nutritionists, and psychologists, were mentioned as necessary to meet women’s requirements. One mother demonstrated her strong expectations for professional help:

“I just want to say that it doesn’t matter if professionals couldn’t offer perfect services; it is also acceptable if there is someone who just provides the information about the ways to contact the professionals above. Most of time when I needed help, my mind went blank; I didn’t know who I should turn to, who could be trusted.” (Participant 28)

The provision of professional support during “yue zi” was stressed by many mothers. Due to the widely accepted social custom, women were constrained from leaving the house after giving birth. Therefore, mothers expressed their urgent needs for obstetricians and nurses to help them identify abnormal symptoms postpartum, specifically about lochia and wounds, and share measures to prevent infection and reduce wound pain.

“I had a vaginal incision while giving birth; there were doctors and nurses who checked and nursed my incision and lochia on time when I was in hospital, but when I left to come home, there was nobody who could help me with that anymore. For example, I was not sure whether the incision was infected or not when I felt unwell, but I couldn’t check it by myself.” (Participant 28)

In addition, some mothers stressed the necessity of receiving education. They hoped to have access to scientific and reliable knowledge to help them achieve a better recovery. The delivery of tips via various methods was also needed to remind them of examinations after delivery.

“I was in a confinement service centre for a month; I indeed received much service in my own recovery, but when I left there, there was no one to guide me anymore. I didn’t know how to go on recovering and needed relevant knowledge at least.” (Participant 10)

Although psychological consultants were mentioned by some individuals, it seemed that most women were sensitive regarding that topic. Some women explained that what they needed was just to find somebody to talk to or to receive mental health guidance from professionals rather than psychologists. Mother 13 felt it was not necessary to go to see a psychologist:

“I think chatting with people like you is enough; I feel much better after I talked with you in so much detail. In fact, those things were unworthy to mention to psychologists; that’s too exaggerated.” (Participant 13)

Finally, support from professionals to improve family relationships was mentioned by three mothers.

Preferences for service delivery methods

Regarding service delivery methods, all but two mothers had preferences. Nineteen participants preferred online services. The accepted forms of such services included apps, videos, post bars, forums, and online counselling. Apps were the most appreciated form among the majority of participants, who preferred and trusted apps and spoke highly of them because of their advantages, including their convenience, many functions, and lack of time and space limitations, which allowed mothers to access information anywhere or anytime.

“For our office workers, face-to-face services are out of date; the internet platforms are faster. For example, I could take advantage of the short time of a bathroom break or other break to read messages and communicate with somebody through apps.” (Participant 13)

However, some mothers reported that current apps still have many defects and need to be improved and updated; mothers expressed the following desires for new features of apps: organized content without advertisements; sound knowledge based on science; targeted guidance according to children’s growth stages; automatic push notifications with tips; more guidance on mothers’ recovery; optimistic group discussion; and most importantly, rapid access to paediatricians when babies are sick. Mother 13 made the following comments about current apps:

“There are so many apps available on the market, but it’s difficult for me to find the information I want most of the time because the mass of disorganized information always confuses me a lot. I think this point should be improved; we need more professional apps.” (Participant 16)

Several mothers also emphasized the importance of face-to-face services and felt such services were irreplaceable due to their characteristics of direct contact and interaction. Some mothers wanted to have regular appointments with professionals about their existing problems. Most of them were less concerned about the place where a consultation would occur; even though they trusted the doctors in hospitals, their priority was convenience. Therefore, community health centres were regarded as the best choice. Mother 15 had the following expectations of professionals:

“In fact, it is too troublesome to take children to the hospital all the time. The community health centre is much better, but the most important things are the people who provide service. Clinical experience, rich professional knowledge, and proficient caring skills are the key points for professionals.” (Participant 15)

Home visits were another face-to-face service mentioned by many mothers who indicated their needs for examinations during confinement. Regarding privacy concerns, some mothers felt uncomfortable with home visits. However, Mother 4 explained why she needed home services:

“I think it is necessary to receive home visit services provided by nurses or doctors. Especially during the confinement period, I can’t go outside; if there were professionals who would come to check my health condition, I would warmly welcome their coming.” (Participant 4)

Knowledge handbooks, telephone follow-up, lectures, and group discussions were also mentioned by some mothers. However, more mothers had noticed the avoidable disadvantages of such services related to their limited times, inconvenience of leaving the house, and less concentration and greater impatience from health care professionals during phone calls. However, several mothers indicated their desire for hospital hotlines that would provide round-the-clock counselling in case of their babies’ illness.

This descriptive phenomenological study aimed to explore primiparous women’s views of current services provided by professionals, their perceived barriers to receiving professional support, and their expectations of professional support. The findings of this study showed primiparous women’s negative attitudes towards current services and professionals. Their disappointment and dissatisfaction were revealed in many areas, including early discharge from the hospital. Subsequent follow-up was very simple or absent, and long-term and potential problems were not considered at all. Participants also believed they were treated unequally and disrespectfully by time-constrained hospital staff who were not patient enough and seemed unconcerned about women’s feelings and needs. These results were highly consistent with the situations in other countries [8,22]. It may be that the lower quantity of qualified health care professionals and the resource constraints in clinics contributed to these conditions, implying that increasing the quantity of health care professionals and investments in medical resources is a precondition for improving the quality of services and the service satisfaction of women [36]. Participants also mentioned that other health care institutions such as community health centres, postpartum rehabilitation centres, and private clinics were not trustworthy enough because of poor equipment, less experienced and less qualified professionals, and high costs. This finding suggested that standardized professional training and financial input should be offered to primary medical facilities to promote service quality and further complement clinical services [37–39].

In addition to the factor of the provision of low quality of service, other barriers to mobilizing professional support, including women’s perceived individual reasons and socio-cultural factors, were also reported by the participants.

Individual reasons included little focus on themselves, inhibition in seeking help from professionals, little trust in professionals, and an unwillingness to show their weaknesses. These reasons may be partially due to their poor knowledge about the problems they faced and the negative influences and consequences of them [40]. Prior studies showed that stigma was also an important factor restricting mothers’ utilization of professional support [41]. This indicated that interventions to improve knowledge levels and eliminate stigma among mothers may trigger further changes to their attitudes and behaviours regarding professional services [42, 43].

Due to the influence of socio-cultural factors in China, almost all of the women needed to undergo the one-month “yue zi” after childbirth. Women had to remain at home and went through the most crucial part of the postpartum period with little professional help [7]. In addition, in this circumstance, home visits and related examinations and care were usually absent and could not be accessed, which is a common phenomenon that has also been observed in other countries, such as America, where women receive little professional guidance within 6 weeks after delivering a baby [44]. Even if services were provided, women’s mental problems were usually neglected. These results are highly consistent with those of other studies that showed that enhancing the training of professionals, especially in mental health areas, is imperative [45]. In addition, more multiple professional services should be provided within the first months postpartum [7].

“Lian” (saving face) is also a typical cultural phenomenon throughout the country [46]. Due to its profound influence, Chinese people may consider family conflicts and related mental health problems to be shameful and assume that they would lead to gossip and the communicate a negative impression of their entire family to others. In fact, stigma towards mental health problems exists all over the world. Eliminating stigma is still a major challenge that deserves further exploration [47–49]. The results indicated that cultural factors, such as “lian” (saving face), should also be considered when conducting interventions in China. By identifying the barriers to mobilizing professional support, researchers and policy makers should have better understandings of the underlying reasons why postpartum women have poor attitudes towards and acceptance of current services. The evidence in this study can help them propose more popular and efficient interventions and policies.

Mothers also expressed their wishes for new professional services and clearly indicated their preferences for methods of service delivery. Most of their needs were the same as women’s needs mentioned in other studies. For example, women demonstrated their urgent needs for knowledge delivery, skills training, access to more kinds of professionals, and more comprehensive service systems [22]. However, a different finding in this study was that women emphasized the time point of service delivery. They hoped to receive enough guidance before giving birth, and they wished that services could be provided at several critical times corresponding to their and their infants’ requirements at that stage. To counteract the current confusion caused by large amounts of disorganized information, they also wanted to be provided with tips to remind them of important points for their own and their babies’ health.

In regard to the method of service delivery, online platforms were considered the most popular and convenient method by a majority of women. Due to the development of technology and network processes, the use of technology in postnatal care has been proven to be efficient and acceptable in many studies [49]. Participants in this study perceived apps and WeChat to be good ways of receiving help and support due to their many functions and greater convenience as well as their low memory footprint. However, the defects of current apps and other online methods were obvious, as reported in other studies, including overly complicated content, a lack of order, too much irrelevant information, and information with little scientific background [50]. Thus, it is important to overcome the disadvantages above and develop more professional, well-organized, integrative, useful and clear apps or other software [51]. Nonetheless, the importance of face-to-face methods cannot be denied. The mothers described such services as irreplaceable for providing love, care, and attention. Many mothers expressed their needs for home visits and consultations. Nicole E. Pugh mentioned in his study that a therapist-assisted internet-delivered intervention had greater advantages in reducing attrition and improving adherence [52]. Therefore, combining online methods and face-to-face methods may be the most comprehensive way to provide service during the postpartum period, which needs to be further verified in future studies.

Limitations:

This study has a few limitations. First, most participants came from cities, with few participants from the countryside; consequently, the results may be subject to selection bias. Further exploration with women of different ethnicities and from different districts would be beneficial to expand the findings of this study. Second, due to the methodology utilized in this study, the qualitative results and conclusion may be subjective or even inaccurate and have less power and should therefore be further verified by quantitative studies.

Despite the limitations of the study design, this research provided insights into primiparous women’s views on current professional support, expectations for new services and the barriers to mobilizing professional support. The results of this study implied that the current services provided by professionals in medical facilities were insufficient and could not meet the needs of primiparous women. The barriers to mobilizing professional support should be analysed and overcome by enhancing education and eliminating stigma. The results also demonstrated that providing services focused on women’s needs may be an effective strategy to enhance primiparous women’s well-being, and they suggested that women believed that the most acceptable and convenient methods should be considered during the delivery of interventions.

Acknowledgements

We thank all mothers who participated in the study, for their contribution to this project.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Competing interests

The authors declare no competing interests.

Ethics approval and consent to participate

The study was approved by the Ethics Committee of Xi’an Jiaotong Univerisity. Written informed consent was obtained from the participants.

Consent for publication

Consent for publication not applicable.

Authors’ contributions:

YN wrote the first draft. WD, RA, XL critically review the article and gave their input. YN and JZ participated in the study design, data collection and analysis. LH, NA, LY, JY coordinated and helped in the carried out the data analysis. All authors read and approved the final manuscript.

Author details

¹²³⁴⁵⁶Department of School of Nursing, Xi’an Jiaotong University, Xi’an, China.

⁷Department of Psychology, Institute of Population and Health Science, Liverpool University, Liverpool, England.

⁸Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK.

⁹Department of School of Nursing, Xi’an Jiaotong University, Xi’an, China.

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Professional support during the postpartum period: Primiparous women’s views on professional services, their expectations, and barriers to mobilizing professional help

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