Totally 28 mothers completed the study who were primiparas aged from 24 to 40 years (30.08 ). Seventeen mothers had a bachelor’s degree or higher. The average age of the babies was approximately five months (5.56 ) Further characteristics of the participants are presented in Table 2. The duration of the interviews ranged from 20 to 86 minutes (mean=32 minutes). Data analysis resulted in three themes and seven sub-themes emerged, which is illustrated in Table 3.
Table 2 Characteristics of the Mothers 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
|
Gender 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
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1. Dissatisfying with current professional services for postpartum mothers
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Disappointment with hospital maternal and child health care service.
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Distrusting services provided by community health centres, private institutes and online platforms.
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2. Likelihood of health care professional help- seeking behaviour
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Seeking help from health care professionals was not the first choice.
|
Hesitating to express their inner discourse to health care professionals.
|
Considering practical factors prohibited mothers from seeking professional help
|
3. Highlighting demands for new health care services
|
Urgent needs for new baby-care-related health care services.
|
Importance of mothers’ self- needs.
|
Dissatisfying with current professional services for postpartum mothers
The vast majority of mothers in this study indicated a low level of acceptance and satisfaction with local maternal and child health care. Their comments regarding health care institutions for maternal and child health care can be categorized into two themes: (a) disappointment with hospital maternal and child health care service and (b) distrusting services provided by community health centres, private institutes and online platforms.
Disappointment with hospital maternal and child health care service
Many mothers mentioned that the services provided in hospital maternity settings during the postpartum period was quite insufficient; they also claimed that health care professionals usually only focused on their current physical health issues, such as prolonged lochia and others. They rarely considered the mothers’ long-term psychological, emotional and informational needs after discharge. Mother 28 emphasized her dissatisfaction with hospital service.
“The service provided in 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 superficial; they don’t take it seriously … what they did for us is not enough.” (Participant 28)
Furthermore, the participants complained that the postpartum hospitalization time was very short and that follow-up checks after discharge were either absent or very simple. If having, health care professionals often made a simple phone call without any home visit. Many mothers felt neglected and uncared for by health care professionals since they felt that they did not receive enough formal support from the hospitals. Both mothers 5 and 27 stressed the importance of follow-up visits by health care professionals. As mother 27 recounted,
“I had not received any service after discharge from the hospital, but I believe that follow-up visits are very important. For example, my brother’s wife had an episiotomy. 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 things that may occur after surgery.” (Participant 27)
Several mothers mentioned that paediatric department in their local big hospitals were very busy. Doctors and nurses in those hospitals were time-constrained who were often impatient. Some mothers indicated that the health care professionals in big hospitals did not even fully listen to their complaints and did not want to talk to them since those health care professionals did not have enough times. The mothers felt that they did not get enough respect when recalled their hospital experiences. One mother felt upset when she took her baby to go to see the paediatrician:
“After all, there are so many patients in big hospitals. When I have a little problem about my child, I really need to consult a family doctor or PG … but there was none, so I had to wait in a long line in the big hospital for a long long time…when I eventually saw the doctor, the length of the conversation was no more than five minutes … I wish that health care professionals could be more patient and spend more time on every baby’s examination.” (Participant 13)
Some mothers also reported that they also felt that they were treated with low levels of humanistic caring and it seemed that in big hospitals efficiency and profit were regarded as the priority rather than patients’ needs.
“My daughter has a red spot on her face, I am very worried … I couldn’t figure out what happened. During the process of her examination, my baby cried fiercely … I was very nervous, but the doctor didn’t care about our emotions at all, he gave no comfort to us, and didn’t explained my daughter’s condition in detail either.” (Participant 23)
Distrusting services provided by community health centres, private institutes and online platforms.
Even though many participants were dissatisfied with health care services in big hospitals, most of them indicated that they still trust the government tertiary hospitals rather than other institutes, because of the high professional skills and well-equipped facilities in those big hospitals. Some mothers expressed their hesitation on seeking helps from health care professionals in community health centres, since they felt that doctors and nurses in those community health centres had lower qualifications, professional titles and level of skills compared with those in the big tertiary hospitals. Furthermore, some mothers also mentioned that the poor-equipped community health care centre couldn’t guarantee the reliability of the examination results. Mother 2 expressed her feelings about the community health centres:
“I think the community health centres are not so good … it’s function is not specific enough. Only when my child need to be vaccinated, I would go there … I am not confident in such settings, because I think health workers there can’t be as professional as in the big hospitals… and the examination equipment there was less reassuring … I felt that 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 private institutes did not have enough qualified health care professionals and were profit-driven. For examples, some private clinics have lactation masseuses who help the mother with lactation by Chinese massage. The mothers indicated that they were skeptical about those professionals’ educational background and professional certificates. In addition, the costs of the services were often too expensive to afford. 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 lactation masseuse in a formal way; those in the private clinics are inexperienced and not well-trained most of time” (Participant 28)
Many participants had mentioned that online services indeed brought much convenience to their life and have advantages over traditional ways. However, some of them suspect the accuracy and reliability of the information provided on lots of profit-driven online platforms, some mothers reported that a plenty of ample educational information tied to goods sales, which may confuse or mislead them. Furthermore, some mothers shown their dislikes towards advertisements and promotions on such platforms. Meanwhile, they also expressed concerns with the qualifications of so-called professionals who provided online services. Therefore, expectations on new online platforms were expressed by many participants that they could easily access to the non-profit and official online platforms operated by government or big tertial hospitals.
“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)
Likelihood of health care professional help-seeking behaviors
Some mothers expressed that their willingness of seeking professional help is not so strong, unless when faced with their own or babies’ acute or critical conditions. Their behaviour of seeking professional help were summarized into three sub-themes: (a) seeking help from health care professionals was not the first choice and (b) hesitating to express their inner discourse to health care professionals and (c) considering practical factors prohibited mothers from seeking professional help.
Seeking help from health care professional was not the first choice
Several participants indicated that they were used to solving common problems by themselves instead of mobilizing support from health care professionals. Some mothers who stressed independent values and thought that it was a sign of independence to deal with most of problems by themselves. One mother mentioned that they felt embarrassed to discuss their private issues, especially emotional and mental issues with any others including health care professionals, because she neither wanted to be a burden to others and nor wanted to show any signs of vulnerability.
“I thought … It was irresponsible to expose my negative feelings to others … which may bring a negative influence on their lives. It's just like throwing my own garbage to someone else … neither I nor anyone else will feel well on that.” (Participant 23)
In addition, most of the participants emphasized that problems occurred constantly in daily life were almost minor ones, so they usually gave priority to the most convenient and economic ways to solve such problems. Most of them had mentioned that they had benefited from online platforms, which were perceived as the most convenient way to obtain informational helps. The accepted forms of such services included apps, videos, online forums, and online counselling. Apps were the most appreciated form of the majority of participants, who preferred and trusted apps and spoke highly of them because of their convenience, many functions, and without any time and space constrains, which allowed mothers to access information anywhere or anytime. Most of the time, they believed that the almost of their problems could be solved in that way.
“For our office staffs, face-to-face services are out of date; the internet platform are faster… 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)
Compared to asking for health care professional helps, many mothers in this study were more likely to discussing current issues with reliable people around them, such as their own parents, significant others or peers. Mother’ s parents, especially their mothers, were mentioned as a trustworthy source for emotional support; the participants noted that their mothers made great efforts for their daughters’ families and often showed understanding and sympathy for their daughters’ 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, but 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)
Hesitating to express their inner discourse to health care professionals
With the influence of face-saving culture in China (face-saving, 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 [i]), mothers mentioned that seeking help from mental health professionals for inconsequential matters in daily life was making a fuss. They were worried about others’ prejudices or stigma towards them if they turned to professionals, which would cause them to lose their or even entire families’ face, even from their entire families. One participant even preferred to discuss matters with a stranger rather than a health care professional:
“When I was upset, I hadn’t considered turning to health care professionals yet … I think it would make more sense and be safer to discuss my story with a stranger.” (Participant 23)
Family conflicts were sensitive topics for almost all mothers in the study, 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 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 health care 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, the fact that we are families … 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 mothers suffered substantially from family conflicts, they 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… I think I could endure that.” (Participant 23)
Some mothers decided to hide their own feeling from others because of their unsuccessful experience of help-seeking. They felt disappointed that even their closest family members could not fully understand them, not to mention others. They also felt frustrated with ineffective communication by the people around them, including health care professionals. They tended to believe that people who had no similar experiences would not understand and had no 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 … I 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 … the doctors didn’t treat my complaints seriously either, and thought my body was alright … they couldn’t understand me at all. It was useless to discuss my feelings with them.” (Participant 5)
Considering practical factors hindered mothers’ professional help-seeking behaviors
Many mothers expressed that they often tried to mobilize support from health care professionals, but almost all of them were not willing to spend money and time on it. In addition, some mothers expressed that they had been overloaded by baby care, they were too tired to go outside most of time. They also felt there was no time to consider their own feelings at all. If they experienced negative emotions, they would put them aside to do household chores or to play with their babies. Mother 6 recounted,
“My life was filled with various household chores… 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 the day finished, I had forgotten my distress, especially when faced with my baby’s smile.” (Participant 6)
In addition, because of the weakened physical condition, many family chores, and baby care during the postpartum period, especially during the first month of confinement “yue zi” (which is a postpartum tradition among Chinese mothers in which new mothers are required to strictly comply with specific regulations within 30 or 40 days postpartum 12), it was inconvenient for mothers to leave the house. As Mother 27 said:
“He (the baby) is too small to go to crowded places, especially hospitals, due to fears that he will get sick… It was also inconvenient for me to go outside with him. I still in the confinement that time (in “yue zi”), I was not allowed to go outside” (Participant 27)
Highlighting demands for new health care services
Twenty-one mothers clearly stated that professional support was urgently needed and had high expectations for new health care services. Their demands could be classified into two aspects: (a) urgent needs for new baby-care-related health care services, (b) importance of mothers’ self- needs.
Urgent needs for new baby-care-related health care services
Baby-care-related professionals, such as professionals in lactation masseuses, nutritionists, paediatricians, and nurses, were mentioned repeatedly for by many mothers to help them with breastfeeding, complementary food supplements, preliminary diagnosis of their babies’ diseases, and trained them in skills for baby 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)
Considering their reliance on the big tertiary hospitals, several mothers indicated their desire for hospital hotlines that would provide round-the-clock counselling in case of their babies’ illness. Besides, some mothers wanted to have regular appointments with experienced doctors or nurses about their babies’ existing problems at a convenient place nearby home. Mother 15 had the following expectations for health care professionals:
“In fact, it is too troublesome to take children to the hospital all the time. The community health centre is much convenient but not reliable, the most important things are the health care professionals who provide service. Rich clinical experience and knowledge, proficient caring skills are the key points for professionals.” (Participant 15)
The majority of mothers also mentioned their requirements for baby-care-related knowledge and information because they believed that acquiring more knowledge in advance would help them have a better understanding of the babies’ needs 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 needs 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 events that may occure 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 highly emphasized by many mothers. 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 health care 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)
Importance of mothers’ self- needs
Several mothers 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 mothers’ requirements. However, some mothers stressed the shortage of the professionals in those area. 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 how to get access to 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, mothers were constrained from leaving the house after giving birth. Therefore, mothers expressed their urgent needs for obstetricians and nurses to help them identify abnormal postpartum symptoms, specifically about lochia and wounds, and teach them interventions 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 health 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 (yue zi) 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 mothers were sensitive regarding that topic. Some participants 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 health professionals like nurse 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.