Exploring postpartum women’s experiences, perspectives, and expectations in maternal health care at a Chinese maternity care center: a qualitative study | BMC Pregnancy and Childbirth

Participants characteristics

Sixteen participants were selected consecutively, and data collection was terminated after the sixteenth participant when data saturation was reached. Participants had a mean age of 30.6 years. There were seven primipara and nine multiparas. All participants were of Chinese descent. Eleven participants underwent vaginal deliveries and five gave birth via cesarean section. Other general characteristics are presented in Table 1. All participants chose a postpartum recovery period of at least 28 days in the hospital. None of the participants needed further non-routine follow-up from an obstetrician after their delivery.

Data categories

A total of 527 codes were derived from constant comparisons of the statements. Codes were categorized into seven sub-categories and grouped into three main categories. The main categories comprised “co-created health management”, “shared knowledge and growth”, and “interpersonal connections and support” (Table 2).

We identified three main themes that emerged as significant needs and perspectives from the participants, potentially influencing their experiences during their hospital stay. These themes were derived from the participants’ expressions during the interviews. Each theme was then thoroughly analyzed through more detailed subcategories for a comprehensive understanding.

Findings

This study identified three main categories in postpartum care: Co-created health management, shared knowledge and growth, and interpersonal connections and support. These categories are informed and shaped by the interplay between modern western medical practices and traditional Chinese customs, illustrating the complex backdrop against which postpartum care is provided and experienced (Fig. 1).

The figure visualizes the interplay of three main themes in postpartum care: co-created health management, shared knowledge and growth, and interpersonal connections and support, each influenced by the mix of traditional Chinese customs and modern healthcare. These themes collectively shape new mothers’ postpartum experiences, blending time-honored practices with current medical standards to meet their health needs and expectations

Main category 1: co-created health management

When exploring positive experiences, participants underscored that efficacious postpartum care embodies an interactive and dynamic process. Within this context, healthcare professionals and new mothers engage in a collaborative partnership, jointly shaping the postpartum experience. This cooperative approach caters to the contemporary needs and expectations of new mothers, thereby ensuring that the care provided is not only effective and gratifying but also deeply respectful of the mother’s pivotal role in fostering value throughout this critical period.

The concept of co-created health management was dissected into three sub-categories, as illustrated in Table 2. These three sub-categories encompassed: (1) Physical and emotional well-being; (2) Professional medical care and specialized services; and (3) Hospital policies and value considerations.

Sub-category: physical and emotional well-being

Participants stressed how important it is to have professional medical care and advice to help with their physical discomfort like pain, fatigue, and insomnia, etc. They pointed out that it was valuable when healthcare providers and patients work together. This collaboration is particularly crucial in the context of maternal and infant health, necessitating access to experienced doctors, nurses and other postpartum caregivers. Furthermore, they also repeatedly said how important it is to have medical care that is specially designed for each mom and baby.

“I feel that in the hospital, in terms of medical care, the nurses’ skills are insufficient, and the ward rounds are quite formalized. There are just fixed rounds every day, but they don’t address my personal issues.” (participant 1, 33 years old).

Healthcare professionals and caregivers play a vital role in offering emotional support and reducing anxiety. Many participants express a desire for a supportive environment that respects privacy, personal preferences, and includes personalized emotional wellness follow-ups by doctors.

“Confinement during the postpartum period is quite boring for me, and I don’t feel disturbed by the ward rounds. Since I’m having trouble with breastfeeding, coupled with physical pain and conflicts with my family, I feel a sense of loneliness.” (participant 4, 26 years old).

Sub-category: Professional medical care and specialized services

Participants highly value the presence of professional medical staff, including doctors and nurses, especially when addressing specific health concerns for themselves and their babies. They appreciate personalized medical care, with services such as physiotherapy, lactation consulting, and nutritional advice being particularly beneficial. Educational sessions offered by healthcare experts are also valued for helping them make informed choices. The adaptability of medical staff in responding to patient feedback and changing needs is crucial for effective co-created health management. Additionally, comprehensive care in hospitals, encompassing high-quality medical and non-medical support services like cleaning, entertainment, and wellness treatments, plays a significant role in enhancing the physical and mental well-being of new mothers. Trust in the medical staff’s expertise and the reliability of professional healthcare are key factors in the selection of a postpartum care facility.

“Concerned about the child’s health, we would only choose to spend the postpartum confinement period in a hospital, as the hygiene and professionalism there are more reliable. We trust the pediatricians in the hospital and hope that the hospital employs experienced doctors. As first-time parents with no experience, we hope to receive guidance from professionals during the postpartum period, such as doctors in the hospital, rather than from our family members.” (participant 2, 38 years old).

”If we get tired of the three meals a day in the hospital, it can make the postpartum confinement period quite difficult to endure. Often, the suggestions made by the nutritionist are not well implemented, and the dietary restrictions are not followed. We hope that the food quality can be improved and wish for better implementation of the nutritionist’s advice, focusing not only on nutrition but also on taste.” (participant 11, 29 years old).

Sub-category: Hospital policies and value considerations

The concept of co-created health management in postpartum care aligns with modern expectations, highlighting the critical role of the mother’s active participation in her postpartum journey. This approach is particularly relevant in developing hospital policies and evaluating their value, focusing on individualized care, professional support, and the overall well-being of both the mother and the child. Different maternity centers offer different care programs at varying costs. Therefore, economic factors, such as the cost and perceived value of care, play a pivotal role in shaping patients’ decision-making processes. Consequently, individuals tend to choose the most cost-effective options for their care.

Postpartum centers should be designed to adapt to the unique needs of each mother and child, with services ranging from medical consultations to wellness programs. Policies often prioritize the safety and well-being of both the mother and the newborn. However, participants mentioned the need for flexibility within these policies, which can adapt to their personal needs. Such flexibility enables a more customized approach to postpartum care, ensuring that individual needs are effectively addressed.

“Because I was staying in the hospital, some policies couldn’t be changed, such as the nurses’ rounds at night. I informed them that this was not necessary, but due to hospital policies, the nurses refused my request.” (participant 12, 22 years old).

The economic aspect is a significant factor, with many families weighing the cost against the perceived value of the services. High-quality care often comes at a higher price, making it crucial for hospitals to balance affordability with the level of care provided. The economic considerations extend beyond immediate costs to the long-term health benefits for the mother and child. Investing in quality postpartum care can lead to improved health outcomes, which may reduce future healthcare costs. It’s essential for hospitals to align their services with new mothers’ expectations and needs, offering a mix of medical care at a reasonable price.

“The cost of postpartum care in hospitals can be quite expensive, and I’m torn between the high price and my fear of getting sick. I really like the idea of staying in a hospital for postpartum care, but I also need to consider the cost.” (participant 6, 26 years old).

Main category 2: Shared knowledge and growth

Mothers frequently exchanging information that aids in their own development and the care of their babies. During the postpartum period, they encounter various challenges, learn from both other mothers and professionals, and evolve through these experiences. The concept of shared knowledge and growth can be divided into two sub-categories: (1) Learning journey in motherhood; and (2) Personal development and future planning, which involves mothers thinking about their own experiences and making plans for the future.

Sub-category: learning journey in motherhood

The experience of motherhood and infant care in postnatal care centers represents a blend of challenges and opportunities for learning. Breastfeeding is identified as a particularly intricate aspect that necessitates personalized and empathetic support. The complexities of infant care underscore the necessity for practical skills and emotional strength. Learning and growth are pivotal, underscoring the importance of shared knowledge and community support in fostering confident and informed parenting.

Breastfeeding often involves challenges such as milk supply issues, latching difficulties, and emotional stress from societal expectations. Many mothers struggle with confidence and feel pressured to continue despite difficulties. Support from lactation consultants and hearing other mothers’ experiences can greatly enhance confidence in breastfeeding. However, academic approaches may not always cater to these individual needs, potentially causing feelings of inadequacy or guilt. Mothers value pertinent information and support to make informed decisions for themselves and their babies, without feeling judged.

“I feel that breastfeeding is torture; I can’t sleep at night, and my child doesn’t seem to get enough to eat. Comparing with other mothers, the pressure is even greater.” (participant 8, 32 years old).

New parents frequently grapple with the practicalities of infant care, including managing crying, sleep routines, and feeding. The intense emotions of early parenthood, often exacerbated by lack of sleep and post-childbirth recovery, can be overwhelming. Postpartum care centers offer a structured setting that helps ease the transition into parenthood. The supportive assistance from professionals and peers is vital in overcoming these challenges.

“The nursing approach at the postpartum care center is very evidence-based, and I’ve acquired a wealth of knowledge from the medical staff.” (participant 9, 28 years old).

Mothers greatly appreciate learning from healthcare professionals about infant care and postnatal recovery in postpartum centers. This education encompasses practical skills, medical knowledge, and emergency care techniques. This period also marks considerable personal growth for new mothers, who learn to adapt, make informed decisions, and build resilience amidst challenges.

“Because the older generation lacks experience in childcare, I often have to seek answers to many parenting questions on my own. I am slowly learning and adjusting while taking care of my child. During the postpartum period, the maternity nurse imparts skills, which helps me feel more confident when taking care of my child at home.” (participant 3, 24 years old).

Sub-category 2: personal development and future planning

Motherhood is characterized by personal development, the pursuit of a balance between career and family life, and the need for improved postpartum care services. New mothers undergo substantial personal development as they adjust to the demands of nurturing a newborn. This entails acquiring a range of childcare abilities, encompassing feeding and comforting techniques, as well as gaining insight into the baby’s health requirements. Concurrently, they grapple with physical and emotional transformations, hormonal fluctuations, and the evolving dynamics within their family relationships, particularly when older generations hold divergent childcare beliefs. They progressively realize the significance of maintaining their own health and overall well-being.

“I feel like I don’t need much help from my in-laws or my own parents, as they are getting older, and their sleep patterns are disrupted. If I were to do postpartum confinement in the hospital, my family wouldn’t have to be with me constantly. Having a professional postnatal nanny makes me feel at ease. In fact, my family members have tried to help with taking care of the baby, but their experience and skills are quite limited. It’s better for me to stay in the hospital.” (participant 5, 35 years old).

Many mothers face the challenging, but rewarding task of balancing career goals with motherhood. The desire to return to work or continued education while caring for a newborn presents both challenges and opportunities for personal and professional development. Mothers learn to manage their time efficiently, balancing baby care with personal interests and work commitments. This often involves adapting to a new routine and learning to prioritize tasks. The role of support systems cannot be overstated. Whether it’s postpartum care centers, partners, family, or professional caregivers such as maternity nurses, their contribution is crucial. They provide a nurturing environment that is essential for mothers to successfully balance their professional aspirations with the demands of motherhood.

“After giving birth to my second child, I didn’t want to compromise on my career, so I enrolled my eldest, who is two years old, in daycare. This way, I have more time to focus on my work. I can also allocate more time to pursue my career aspirations. During the day, the postnatal nanny and my mother-in-law assist me in taking care of my second child, allowing me to go to work.” (participant 14, 40 years old).

Main category 3: interpersonal connections and support

The postpartum period is crucial, heavily influenced by interpersonal dynamics and social support. Effective family relationships, particularly with spouses, elders, and extended family, are vital for a new mother’s well-being. The social environment of postpartum care centers, including peer and professional support, significantly impacts their emotional health. Quality interactions, emphasizing effective communication, empathy, and consistent expert care with medical staff, nurses, and postnatal nannies are key in shaping a positive postpartum experience. These elements not only provide crucial emotional and practical assistance but also significantly contribute to a beneficial postpartum journey for new mothers.

Sub-category 1: family and social dynamics

Many mothers expressed difficulties in communicating with older family members, particularly around child-rearing practices and traditional beliefs (e.g., drinking herbal soups). This often leads to tension and arguments, affecting the mother’s mental well-being. Husbands play a significant role in providing emotional support. Their involvement in child-rearing decisions, such as the choice of postpartum care centers and support in breastfeeding decisions, significantly impacts the mother’s experience. Sometimes, the involvement of older family members can intensify stress due to differing views on childcare. New mothers opt for maternity centers to avoid conflicts with in-laws or parents, preferring professional care to traditional family practices [29].

Sharing experiences and tips with other mothers at maternity centers benefits mental health and practical learning. The bond with professional caregivers, including nurses and postnatal nanny, is vital. Group activities and educational sessions are highly valued for socializing and learning, aiding mothers in adjusting to their new roles. Some mothers experience isolation, underlining the significance of social interactions for mental well-being in the postpartum period.

“I trust the hospital’s nursing methods a lot more because they’re based on solid evidence. My parents sometimes suggest traditional Chinese medicine, but those methods can feel a bit old-fashioned to me. Staying in the hospital helps me sidestep any arguments with them about this. Plus, the doctors at the maternal center really know their stuff, and they’re better able to help me out.” (participants 13, 37 years old).

“During the postpartum period, I can meet other new mothers, which I believe is very important. Chatting with other mothers helps me understand that we all face similar issues, which makes me feel more relaxed mentally.” (participant 10, 31 years old).

Sub-category 2: effective communication in healthcare

Mothers in postpartum care centers often encounter a mix of experiences in their interactions with healthcare professionals. These interactions range from appreciative and trust-building to challenging or unsatisfactory. The quality of communication and the expertise of medical staff and postnatal nannies significantly impact the mothers’ postpartum experiences. Positive experiences stem from empathetic, clear communication and professional, responsive care, which significantly reduces anxiety and aids in emotional support during this sensitive period. Expert care, personalized to each mother’s unique needs and inclusive decision-making, profoundly enhances their well-being. Consistency in the healthcare team fosters trust and security, encouraging open communication. In contrast, a lack of empathy, especially in managing emotional fluctuations, and unprofessional behavior can negatively impact the mothers’ experiences, exacerbating anxiety and hindering the development of trust.

“I have great trust in my postnatal nanny, and our communication is very smooth. She has provided me with a lot of experience in caring for my child. This is my second time in the hospital for postpartum care. My previous experience has taught me that good communication with doctors and the postnatal nanny is crucial.” (participant 7, 36 years old).