What matters to women postpartum

A study designed to inform a new World Health Organization (WHO) guideline shows that positive motherhood is what matters to postpartum women. Published in PLoS One, the findings show that the period after delivery involves changes in self-identify, redefinition of relationships, opportunities for personal growth, and alterations in sexual behavior for new mothers.

For the meta-synthesis, the authors searched MEDLINE, CINAHL, PsycINFO, POPLINE, Global Index Medicus, EMBASE, LILACS, AJOL and reference lists of eligible studies published from January 2000 to July 2019. Their focus was on qualitative data on women’s beliefs, expectations, and values relating to the postnatal period.

A total of 36 studies from 15 countries, all of which used a validated quality appraisal tool, were included in the analysis. GRADE-CERQual was used to assess confidence in the quality, coherence, relevance, and adequacy of data underpinning the resulting findings. GRADE-CERQual is a transparent way to asses the confidence of evidence from review of qualitative research and conceptually similar to other GRADE tools.

The data from the reports selected represented the views of more than 800 women, all of whom provided first-hand accounts about giving birth, regardless of parity. The women came from a range of ethnic backgrounds and socio-demographic groups.

Five analytical themes emerged when the studies were analyzed: riding the emotional rapids; dancing around the baby-social and relation adaptation; it takes a community to raise a mother; re-forming the birthing body; and putting the mother into postnatal care. The women defined a “positive” postnatal experience as being able to adapt to their new self-identity and develop a sense of confidence an competence as a mother; adjusting to changes in their intimate and family relationships, including their relationship to the baby; navigating ordinary physical and emotional challenges; and experiencing the dynamic achievement of personal growth as they adjusted to the “new normal” of motherhood and parenting in their own cultural context.

“Effective, culturally appropriate family, community and professional support and activities can help women to overcome the exhaustion, and physical, emotional and psychological stress of the early postnatal period,” said the authors. Their review, they believe, “provides evidence that, where this process is positive, it also results in joy, self-confidence, and an enhanced capacity to persevere and to succeed in the new integrated identity of ‘woman and mother’.”