‘I couldn't change his nappy’: New mothers' experiences of De Quervain's tendinosis and its impact on occupational performance

Abstract

Introduction

De Quervain's stenosing tendinosis (DQST) is common in new mothers because of awkward wrist postures during repetitive mothering occupations such as nursing and lifting their baby. However, little is known about how DQST affects occupations of first‐time mothers. This study aimed to explore the experiences of first‐time mothers living with DQST and how it affects performance of their motherhood occupations.

Methods

A descriptive phenomenological study design was used. Participants were 15 first‐time mothers of a child aged ≤24 months, with a current or previous diagnosis of DQST, and/or non‐trauma‐related symptoms of pain, tenderness, and/or swelling near the base of the thumb or wrist. Participants completed the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire and participated in semi‐structured interviews.

Consumer and Community Involvement

No consumer and community involvement.

Findings

Five themes developed from interview data: (1) My everyday life is affected; (2) not being prepared and not knowing what to do; (3) learning to modify, adapt, and carry on; (4) perceived practicality of management options; and (5) the importance of education and early intervention. DASH disability scores ranged from 50 to 80 for participants with active symptoms.

Conclusion

DQST disrupted first‐time mothers' occupational performance. Participants felt that until they developed DQST, they received insufficient information about it from health professionals during pregnancy and the first‐year post‐birth. Pain management options were often not practical when performing motherhood occupations. New mothers would benefit from preventative perinatal education about DQST and treatment options that consider their mothering occupations.

PLAIN LANGUAGE SUMMARY

New mothers can develop a common upper limb condition called De Quervain's Stenosing Tendinosis (DQST), also known as ‘mummy's thumb’, which can make daily occupations difficult. This includes bathing, dressing, and helping their babies sleep. Fifteen first‐time mothers with babies under 2 years old and DQST were interviewed and filled out a functional questionnaire. The results showed that DQST affected their daily occupations, such as caring for their babies, doing housework, self‐care, leisure occupations, sleep, social interactions, and self‐esteem. Many mothers said they did not receive any information about DQST before they developed it during pregnancy or in their baby's first year. Some were given treatment options like using a splint to rest their hand, but these were not always comfortable or practical due to their caregiving duties. The study highlighted that educating mothers on how to adjust their occupations during pregnancy and after birth could help prevent DQST. Treatment options should also consider their role as caregivers. This was the first study to look at how a common hand condition affects mothers' daily occupations. A limitation was that the study did not ask mothers for details about their marital status, culture, or economic background, which could have added to the understanding of the group's diversity.

Key points for occupational therapy.

• Occupational therapists could be more actively involved in the perinatal period to support mothers with DQST.

• Occupational therapists should develop perinatal educational resources to prevent DQST in mothers.

• Occupational therapy interventions can support mothers with DQST through adaptation and modification of mothering occupations and environments.

1. INTRODUCTION

De Quervain's stenosing tendinosis (DQST) is a common diagnosis for new mothers that results in significant pain and distress, and can impact quality of life (Avci et al., 2002; Fernandes, 2018). DQST is a musculoskeletal disorder of the upper limb, affecting the abductor pollicis longus and extensor pollicis brevis muscles (Cooper, 2014). Symptoms of DQST include pain and swelling to the radial aspect of the thumb and wrist, numbness, stiffness, and reduced strength and active range of motion, which may affect a person's ability to complete their daily occupations (Andreu et al., 2011; Da Silva & Batigália, 2013). Over time, DQST leads to stenosis, irritation, and impaired tendon gliding, which limits functional movement of the thumb and wrist (Borg‐Stein & Dugan, 2007; Da Silva & Batigália, 2013).

The incidence of De Quervain's tenosynovitis varies based on the population studied. In the general population, women have a significantly higher rate of DQST than men (Le Manac'h et al., 2011; Walker‐Bone et al., 2004; Wolf et al., 2009). In addition to biomechanical considerations, hormonal and immunological factors also play a significant role (Balık et al., 2014; Daglan et al., 2024). Hormonal changes, particularly during pregnancy and postpartum periods, have been associated with an increased incidence of DQST, potentially due to fluid retention and connective tissue remodelling (Balık et al., 2014). The prevalence of DQST in women increases in the perinatal period, that is, during pregnancy and up to 12 months postpartum with symptoms often occurring during the late stages of pregnancy and more frequently in the postpartum period (Balık et al., 2014; Borg‐Stein & Dugan, 2007). Among 383 pregnant women in a cross‐sectional study, 20.9% had DQST (Balık et al., 2014), and in another cross‐sectional study of 259 postpartum women, 59.3% reported pain on the thumb side of the wrist (Sit et al., 2017).

Repetitive wrist and thumb motions, such as lifting and holding an infant, are significant contributors to postpartum DQST (Borg‐Stein & Dugan, 2007). There is an increased risk of developing DQST postpartum among women who are first‐time mothers, had a longer pregnancy (>40 weeks), and higher maternal weight (Daglan et al., 2024). The way mothers perform caregiving occupations may contribute to the development of DQST as they require awkward postures of the wrist and thumb when caring for their child (Daglan et al., 2024; Fernandes, 2018). For example, repetitive use of the wrist and thumb during nursing (breast and bottle feeding), frequent lifting and holding of the baby, and bathing or supporting the baby in sleep are all involve ulnar deviation at the wrist and thumb abduction (Borg‐Stein & Dugan, 2007).

Given that new mothers may be at a higher risk of developing DQST, evidence indicates this group would benefit from wellness programs aimed at preventing the onset of DQST (Roberts, 2011; Sanders & Morse, 2005). For the purposes of this study, new mothers are defined as pregnant women and women with young children. Prevention of DQST could be supported through education of women in the perinatal period about ergonomic techniques to perform everyday occupations that involve the wrist and hand (Griffin & Price, 2000; Vincent & Hocking, 2013). Once symptoms of DQST develop, the recommended management strategies include conservative and non‐conservative techniques (Goel & Abzug, 2015). Conservative techniques include the use of non‐steroidal anti‐inflammatory drugs, rest, immobilisation with a splint, and local steroid injection (Fedorczyk, 2012). However, conservative strategies such as splinting, resting, and limiting occupations involving ulnar deviation of the wrist can be restrictive and impractical for mothers to use (Roberts, 2011). Education about the risk factors for DQST, coupled with recommendations for activity modification and posture training, is critical in early resolution of symptoms (Borg‐Stein & Dugan, 2007; Thabah & Ravindran, 2015). The last treatment option is surgery to release the first dorsal compartment (Goel & Abzug, 2015).

Occupational therapists have a unique role in supporting new mothers with DQST by leveraging their expertise in occupational and environmental modifications to aid in both the prevention and management of the condition (Fernandes, 2018). Notably, research has found that the weight of the baby or having twins is not associated with an increased risk of developing DQST postpartum, likely because repetitive motion and positioning are more significant contributors than load (Daglan et al., 2024). These findings underscore the importance of modifying and adapting how first‐time mothers perform daily occupations to prevent or manage DQST effectively. New motherhood is often accompanied by occupational shifts, with increased focus on caregiving and productivity‐related occupations, while self‐care and leisure occupations may become more difficult to prioritise (Horne et al., 2005). Occupational therapists can play a critical role in helping mothers navigate these changes, promoting strategies that enhance overall health and wellbeing. More research and advocacy are needed to strengthen and expand on the role of occupational therapy in addressing the unique challenges faced by this population (Slootjes et al., 2016). Given the importance of the transaction between person, environment, and occupation factors to the prevention and treatment DQST in mothers, the Person–Environment–Occupation Performance (PEOP) model (Baum et al., 2015) has been selected for use in this research. The PEOP model focusses on how the environment impacts on a person's occupational performance and emphasises that a dynamic interaction between the person and the environment, which present as barriers and/or enabling factors to influence the person's performance in their chosen occupations (Bass et al., 2024; Baum et al., 2015).

Currently, there are no known studies that have explored first‐time mother's experiences of DQST and its impact on performance of their occupations. Previous studies have focussed more on prevalence (Balık et al., 2014), risk factors (Daglan et al., 2024), and treatment (Avci et al., 2002). Understanding the experience of DQST from the perspectives of first‐time mothers and its impact on their daily occupations would help inform the development of targeted educative resources to support mothers to prevent and manage DQST.

Therefore, the purpose of this study was to explore the experiences of first‐time mothers living with DQST. The aims were to (i) determine the impact of DQST on daily occupations of first‐time mothers; (ii) determine new mothers' understanding of the risk factors for DQST; (iii) determine new mothers' current understanding and application of management strategies; and (iv) identify the desired delivery characteristics for future DQST prevention education from the perspectives of first‐time mothers.

2. METHODOLOGY AND METHODS

2.1. Study design

A descriptive phenomenological design was used to explore and describe first‐time mothers' lived experiences and knowledge of DQST, because it is useful for exploring individuals' subjective lived experiences (Christensen et al., 2017; Reiners, 2012), and appropriate for the current study, given there is little known currently about the impact of DQST on first‐time mothers' daily occupations (Christensen et al., 2017). A self‐report questionnaire was used to quantify any difficulties in the participants' performance completing certain upper limb occupations; the impact of which was then explored through semi‐structured interviews.

2.2. Recruitment

Ethics approval was obtained from the Curtin Human Research Ethics Committee (HRE2017—0838). Convenience sampling was used to recruit participants via electronic flyers distributed to the researchers' professional and social networks and by word of mouth. Inclusion criteria for participation were having a child aged 24 months or younger, and a current or previous formal diagnosis of DQST via diagnostic imaging, or self‐reported DQST symptoms, including non‐trauma‐related pain, tenderness, or swelling near the base of the thumb or wrist. The primary researcher answered any questions prospective participants had to ensure they fully understood the requirements of the study. Informed, written consent was obtained from each participant prior to data collection.

2.3. Data collection

Data collection was completed between February and June 2018. Participants completed a demographics questionnaire and the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire online (Hudak et al., 1996; SooHoo et al., 2002) and then participated in one semi‐structured interview. A small number of participants were known to some members of the research team. To manage this, the interviews were conducted by the primary researcher who had no social or professional connections to any of the participants.

2.3.1. DASH questionnaire

The DASH questionnaire measured participants' perceived level of disability in performing activities at a point in time (Beaton et al., 2001). The DASH is a 30‐item self‐report questionnaire designed to measure the severity of symptoms and degree of difficulty in completing physical activities due to upper limb disorders (Hudak et al., 1996; SooHoo et al., 2002). The DASH questionnaire is scored is out of 100. Higher scores indicate greater disability and severity of symptoms and are indicative of participants who had unresolved symptoms at the time of data collection (Beaton et al., 2001). The DASH has confirmed discriminative and convergent construct validity with other measures of upper limb function and excellent test‐retest reliability (ICC = 0.96) (Beaton et al., 2001) and is recommended for use in clinical and research settings (Hunsaker et al., 2002). Quantification by the first‐time mothers of the perceived level of disability associated with DQST helped to minimise the researcher's assumptions about impact of the impact on the new mothers' daily occupations while providing preliminary information that could be explored during the semi‐structured interviews.

2.3.2. Semi‐structured interviews

A total of 15 semi‐structured interviews were conducted by the primary researcher (CK) using an interview guide (see Appendix A), which aligned the interview questions to the aim of the study (Lune & Berg, 2017). Open‐ended questions were used to encourage detailed responses from participants and probing was used to draw out more information and to achieve clarity when necessary. The interviewer maintained the methodological principles of descriptive phenomenology by demonstrating openness with sensitivity to the experiences described by the participants and questioning pre‐understanding by setting aside any preconceptions and assumptions they may have held about the experiences of the participants. These interrelated actions led to a reflective approach, which allowed the researcher to understand how meaning was experienced (Sundler et al., 2019). The interviews lasted 45–60 minutes and took place at the participants' locations of choice, including their homes, workplaces, and at cafes. One interview was conducted via telephone as the participant lived in a rural location. Interview data were recorded using a Dictaphone and the audio recordings uploaded to a secure digital folder for later transcription.

2.4. Data analysis

All data were de‐identified before analysis to minimise any biases. The DASH questionnaire data were scored to provide an overall score indicating the level of disability. Interview recordings were transcribed verbatim by CK and then analysed by the primary researcher (CK) following the six steps of thematic analysis as recommended by Braun and Clarke (2006). Step one, familiarisation with data, occurred while the primary researcher conducted all the interviews, listened to all the audio‐recorded interviews during the transcription process, and read all interview transcripts at least twice. In step two, generate initial codes, the data were organised into meaningful groups and assigned initial codes by working through the data and identifying patterns. In step three, searching for themes, coded and collated data were organised into broad themes. In step four, reviewing themes, data within themes were reviewed for coherence to a meaningful pattern. Step five, defining and naming themes, the developed thematic map of the data were defined and redefined into definite themes and the essence of each theme identified; and for step six, producing the report, a final analysis and report were produced. Thematic analysis is appropriate for a descriptive phenomenological approach; it supports identification of patterns and themes from the interview data (Sundler et al., 2019).

To enhance the confirmability of the study findings, CK used a reflective journal to document her thoughts, experiences, and values, as well as her potential influence on her interpretations and interactions with participants prior to each interview. This reflective journaling process also supported the data analysis phase by helping to separate her perspectives from the participants' data (Liamputtong, 2020). Throughout the analysis, all authors consciously set aside their preconceived notions about the phenomenon of DQST in new mothers, relying solely on participants' statements to assign meaning to the phenomenon (Nowell et al., 2017). Credibility was strengthened through member checking, where participants were emailed their individual interview transcripts for validation, and through researcher triangulation, as the developing themes underwent independent peer review by three researchers: one (MC) with expertise in qualitative analysis, and two (TT and JB) with extensive knowledge of hand tendinopathies and clinical experience in hand therapy. Dependability was ensured by maintaining an audit trail of all decisions made during data analysis, with CK documenting the various iterations of themes and sharing detailed summaries of team discussions after each meeting. Transferability was enhanced by providing rich, detailed descriptions of the study's context and participants, ensuring that findings can be meaningfully understood and applied in similar contexts.

3. POSITIONAL STATEMENT

Caroline Khama was an occupational therapy honours student with an interest in hand and upper limb therapy at the time of completing this study. Thuy Tran and Julie Brayshaw both have extensive clinical and academic experience as occupational therapists in hand and upper limb rehabilitation. Marina Ciccarelli and Megan Hatfield are occupational therapy academics with experience conducting qualitative research. Megan has a background in paediatrics and experience conducting research related to occupational therapy and motherhood.

4. RESULTS

4.1. Participant characteristics

A total of 15 new mothers were recruited into the study. All participants were first‐time mothers who were aged 26–41 years (Mean ± SD = 31.67 ± 3.94 years). The participants' children were aged 1.5–24 months (Mean ± SD = 10.60 ± 7.71 months). Eight participants were on maternity leave and seven participants were back at work (See Table 1). Seven participants experienced bilateral symptoms and eight had unilateral symptoms. Of the 15 participants, 12 sought assistance from a health professional and received a formal diagnosis; two did not have a formal diagnosis and did not seek help; and one received advice through a hand therapist colleague. The participants with formal diagnoses of DQST reported that they received conservative interventions to manage their condition, which included the use of orthotics, and a mixture of, ultrasound, taping, massage, resting and icing, corticosteroid injection, and education on better handling techniques.

TABLE 1.

Patient characteristics.

Participant number	Age (years)	Age of child (months)	Work status (occupation)
01	28	6	Maternity leave
02	30	3	Maternity leave
03	30	17	Maternity leave
04	34	24	Maternity leave
05	28	9.5	Maternity leave
06	28	1.5	Working (therapist)
07	28	12	Maternity leave
08	36	5.5	Maternity leave
09	32	24	Working (administrative work)
10	36	10	Working (pharmacist)
11	32	3.3	Working (health and safety specialist)
12	26	1.8	Maternity leave
13	35	11.5	Working (fitness instructor)
14	31	23	Working (office‐based)
15	41	7	Working (accountant)

4.2. Perceived levels of disability—DASH results

Perceived levels of disability were measured using the DASH (see Table 2). The mean score was 49.7 and ranged from 25 to 80. Nine of the 15 participants did not have active symptoms. Six of the 15 participants had active symptoms with individual disability scores that ranged from 50 to 80. Of these, six participants agreed or strongly agreed with item 30 on the DASH questionnaire: I feel less capable, less confident, or less useful because of my arm, shoulder, or hand problem due to their DQST symptoms. Eight participants reported that their injury slightly to extremely impacted on their social activities with their family, friends, neighbours, and groups (DASH Item 22). Ten participants reported that their injury limited their participation in their work and daily activities (DASH Item 23) and impacted on their sleep routine (DASH item 29). The results for items 22, 23, 29, and 30 of the DASH are shown in Table 2.

TABLE 2.

Disability scores of participants from the disabilities of the arm, shoulder, and hand (DASH); (N = 15).

Participant number	DASH disability score	DASH item 22 b	DASH item 23 c	DASH item 29 d	DASH item 30 e
01	50 a	Slightly	Slightly limited	Mild difficulty	Disagree
02	49.2	Slightly	Slightly limited	Mild difficultly	Disagree
03	42.5	Not at all	Slightly limited	No difficulty	Neither agree or disagree
04	75 a	Extremely	Very limited	Severe difficulty	Agree
05	31.7	Not at all	Not limited at all	No difficulty	Strongly disagree
06	63.3 a	Slightly	Slightly limited	Mild difficulty	Agree
07	66 a	Moderately	Slightly limited	Mild difficulty	Neither agree or disagree
08	25	Not at all	Not limited at all	No difficulty	Disagree
09	27.5	Not at all	Not limited at all	Mild difficulty	Disagree
10	60.8	Slightly	Slightly limited	Mild difficulty	Agree
11	28	Not at all	Not limited at all	Mild difficulty	Disagree
12	41.7	Not at all	Slightly limited	Mild difficulty	Agree
13	80 a	Moderately	Moderately	Moderate difficulty	Strongly agree
14	35	Not at all	Not limited at all	No difficulty	Disagree
15	70 a	Moderately	Moderately limited	No difficulty	Agree

Note: DASH disability scores range from 0 (no disability) to 100 (most severe disability).

^a Participants with active symptoms at time of interview.

^b DASH item 22: During the past week, to what extent has your arm, shoulder, or hand problem interfered with your normal social activities with family, friends, neighbours, or groups.

^c DASH item 23: During the past week, were you limited in your work or other regular daily activities as a result of your arm, shoulder or hand problem?

^d DASH item 29: During the past week, how much difficulty have you had sleeping because of the pain in your arm, shoulder, or hand?

^e DASH item 30: Statement: I feel less capable, less confident, or less useful because of my arm, shoulder, or hand problem.

4.3. Interview themes

Thematic analysis of the interview transcripts revealed five themes: (1) My everyday life is affected; (2) not being prepared and not knowing what to do; (3) learning to modify, adapt, and carry on; (4) perceived practicality of management options; and (5) the importance of education and early intervention.

4.3.1. Theme 1: My everyday life is affected

Overall, participants described either gradual or sudden onset of symptoms, reporting sharp pain on the affected upper limb that was constant and worse on exertion. Some participants also reported altered sensation along the radial area of their affected thumb and wrist. Symptoms were reportedly worse in the mornings: ‘It got worse and worse, especially in the morning after you sleep, it is really bad in the morning’ (P8). Participants described how their ability to engage in their daily occupations was affected by their DQST symptoms: ‘It just constantly hurts and now it is interfering with my day‐to‐day life’ (P1). Problematic occupations related to (1) caring for the baby; (2) home management; (3) leisure occupations; and (4) self‐care.

Caring for the baby

All the new mothers reported difficulty picking up and lifting their baby due to their DQST symptoms. The most commonly reported activities that were difficult involved lifting the baby in and out of the car seat or cot‐bed and picking up the baby for a feed, ‘I found it probably just mostly hard picking up my baby and putting him on the change table and just doing everyday things with him’ (P3). Due to the intensity of pain on exertion, three participants described feeling ‘scared’ and ‘nervous’ to pick up their baby: ‘That was probably the biggest thing that I found that impacted. Being nervous to pick him up because I'd get pain and worry I would drop him’ (P5).

Completing other mothering occupations such as changing nappies, expressing breast milk, and bathing and dressing the baby were also affected: ‘When I first got it [DQST], I couldn't change his nappy, the first nappy in the morning. I couldn't do it; I had no strength in my hands’ (P1). Participants also reported pain and discomfort when reaching for and handling items required to care for their baby. Three participants reported having trouble with lifting, holding, and pushing the pram.

Home management

The new mothers described how DQST affected their occupational performance during home management occupations, including household chores such as wiping counters, vacuuming floors, mopping floors, and washing dishes: ‘The repetitive kind of moves are a bit harder, so like mopping and vacuuming and that, are probably a bit harder’ (P12). Participants also experienced decreased ability when opening jars, cutting food, baking, and cooking: ‘I lost a lot of strength and when it came to gripping things, I wouldn't do that; jars et cetera and things like that’ (P4).

Leisure occupations

Leisure occupations that became challenging to engage in due to the symptoms of DQST included crafts requiring fine motor manipulation such as crocheting and gross motor exercise routines such as yoga, lifting weights, planking, doing chin‐ups, swimming, playing basketball, cycling, and boxing:I found it difficult to do a lot of the usual exercises that I normally do; so, like holding weights and barbells and things like that; I couldn't do that, and push‐ups and things like that were more difficult. So, I was quite limited at that time to what exercise I could do (P3).

Self‐care

Five participants described having trouble completing self‐care occupations related to grooming, showering, and dressing. Problematic activities included fastening bras, and washing, blow drying, and tying hair: ‘Yeah, hair. I usually blow dry and straighten it every week, when it [DQST] first came on, I had to stop doing that and brushing. It just makes it so much harder’ (P12).

4.3.2. Theme 2: Not being prepared and not knowing what to do

Nearly, all participants (n = 11) had no prior knowledge of DQST before acquiring it, and all participants reported a lack of information from health‐care providers about the condition. Participants reported that when they developed the symptoms, they could not comprehend what could possibly be happening. Most participants thought it would go away and delayed seeking help until it became debilitating, ‘I thought it was just normal, a bit of funny movement or something, so I never paid attention to it until it got really bad’ (P8). The new mothers reported that they would have liked information provided to them about DQST at antenatal and postnatal classes:

But I never received anything at the hospital, not at the child health nurse, I got it [information] from me proactively seeing a physiotherapist and then seeing the occupational therapist and then seeing my doctor. Unless you do those things, you are not going to know about it, because it is not available as such, well not up in your face (P9).

Participants reported that most education provided was about the baby and no real emphasis was placed on the mother's wellbeing: ‘At antenatal classes, you learn about looking after the baby but not so much caring about yourself. And if it is such a common thing, it is probably something worth giving some literature or information about’. (P4). Due to a lack of information about DQST, three participants described feeling misunderstood by others, including their partners; some of whom did not quite know how best to provide support:

But, it's not probably something that people really talk about, because it's just, oh yeah, it's just my wrist, it'll go away and oh you'll be fine. My husband's like, ‘oh do you want a drink of water?’ I'm like ‘oh yeah, that's really going to help’. That was his way of offering support – ‘do you want a drink of water?’ (P13).

4.3.3. Theme 3: Learning to modify, adapt, and carry on

Participants described how caring for their baby and completing home chores were of paramount importance to them. They reported they continued doing what needed to be done, despite the challenges they faced:

Obviously, I still do it [home chores], I mean it's not like if you broke your toe, you know to rest it and to put it up and you kind of limp. You can't limp with your hands. You just got to do it, even in pain (P1).

The new mothers described how they learned to adapt and modify their occupations to carry on. The most reported adaptive technique was scooping the baby or lifting the baby from under their bottom using one hand (with the thumb tucked in and palm up) and the other hand supporting the baby's head. This technique was instead of lifting the baby under their arms with the thumb open. Other adaptive techniques included the mothers laying down to breastfeed their babies, taking extra time to complete activities, and using their non‐affected hand for support: ‘And with feeding her, I ended up trying a lot of different ways of feeding her. Even lying down, so I didn't have to hold her’ (P10). Mothers also described that it was important to be aware that the nature and frequency of their daily occupations had changed after having a baby: ‘I suppose maybe just being aware of how you are lifting and carrying the baby, it is a completely different thing that you are doing in a hundred times a day’ (P3). One participant reported that she had to stop and think about her body positioning before performing home chores to avoid getting pain: ‘If I was doing chores around the house, I had to really pause and think about how I was going to move my body, so it didn't hurt’ (P10). New mothers also sought help from their partners and family, for example, asking their partner to lift and position the baby for breastfeeding. They described support provided by partners and family members as beneficial in helping them take care of their baby: ‘It is awkward for me getting the baby in and out of the bath, but my husband does that. That's like his little job.’ (P2). Regarding exercise, participants either stopped exercises until symptoms resolved or did modified exercises, ‘I had to change all the exercises and things that I was normally doing until I didn't have that pain anymore’ (P3).

4.3.4. Theme 4: Perceived practicality of management options

Participants described how the symptom management options provided to them by their health‐care providers were often not practical or tailored to the occupations of motherhood. All participants had been recommended the conservative intervention of resting the affected hand, but described how this was impractical given the myriad of activities involved in looking after a baby: ‘… as much as I tried to rest it [the affected hand], having a newborn, you just can't’ (P11).

Of the 13 participants who were prescribed a splint, 12 reported that wearing the splint was impractical and impeded occupational performance. Due to the hook and loop fastening straps on the splint and rigid splint material, participants also worried about scratching the baby's skin and the comfort of the baby, ‘I sort of scratched her a few times with it [the splint]. And she seemed quite uncomfortable with me holding her with it [on]’ (P10). Consequently, the first‐time mothers reported poor adherence to the prescribed wearing schedule and either limited wearing the splint to mainly at night or stopped wearing it altogether: ‘She [an occupational therapist] gave me a splint, which I hardly ever wear. It is good at night, I put it on but it's so hard with her [the baby], like everyday life, it is just not possible’ (P8). Three participants reported wearing their orthosis consistently due to severe symptoms, for at least a month, and thereafter to night‐time wearing only.

4.3.5. Theme 5: Importance of education and early intervention

Participants stated that getting early information and education about DQST from health‐care providers would have been beneficial. They wanted to know how to identify symptoms early, what movements to avoid, correct handling techniques, and as one new mother put it:

It would have been good to have information before that would tell me how I could go about preventing something like that, particularly around feeding position. And I think that would have had a big difference, particularly if I knew the right position to use to prevent it [DQST] from happening (P5).

All participants identified education about prevention of DQST and early intervention once symptoms developed as key to managing the condition. When asked what advice they might have for other new mothers, one participant said, ‘seek help early, don't ignore it, it can actually get quite debilitating; fix it early; do the exercises early if it is an issue’ (P4). Other common advice given were to wear the splint as much as possible; get people to help with activities; be mindful of how to lift and hold the baby; try and get into a good feeding position by using a feeding pillow, keep the wrist neutral; and try to ‘scoop’ by keeping the thumbs in so that it is not repetitively over extended. One of the mothers advised: ‘From an education point of view, I don't know how many mothers are struggling with it, who could use the scoop—you know! Maybe put a big flyer on Facebook to say Scoop, scoop! You have a baby, scoop!’ (P7).

Thirteen of the new mothers reported that it would be good to receive information about DQST from health‐care professionals either at antenatal or postnatal classes, in hospital from midwives and other health personnel, and at parenting groups and/or parenting classes. Other commonly identified education delivery options included online on social media and/or a pamphlet or brochure in the hospital information bag: ‘Probably more social media because it's a bit more accessible, realistically everyone is on a smartphone’ (P6).

5. DISCUSSION

This study describes the experience of DQST from the perspectives of first‐time mothers using a descriptive phenomenological approach. The findings suggest that DQST had a major impact on the daily occupations of first‐time mothers who experienced painful and disabling symptoms. Reduced occupational performance is confirmed by the quantitative and qualitative data provided by the participants. The DASH data revealed that participants with active symptoms of DQST had scores of up to 80, indicating a severe level of disability when performing daily occupations (Beaton et al., 2001). A third of participants reported in the DASH experiencing reduced confidence and capability in fulfilling their occupational roles. Interview data confirmed that DQST impacted on new mothers' abilities to complete mothering occupations, household chores, and self‐care occupations and to engage in exercise and sports leisure occupations. Difficulties with occupational performance in caring for their children and household can adversely affect new mothers' health and life satisfaction (Bar & Jarus, 2015). Conversely, improved occupational performance has a positive effect on mothers' life satisfaction and enhances their mental health (Bar & Jarus, 2015). Mothers have reported good mental health to be a factor that enables them to carry on with their role as caregiver to their children and be good mothers (Lewis & Ridge, 2005). It is therefore to support new mothers' engagement in mothering occupations to enhance their health and wellbeing.

All participants in this study were primiparas. Primiparity is a risk factor for developing wrist pain and other physical conditions following childbirth (Cooklin et al., 2015; Daglan et al., 2024; Iwata et al., 2018; Schytt et al., 2005; Sit et al., 2017). Only six of the mothers reported active symptoms of DQST, which allowed the researchers to capture the perspectives of women at different stages of their experiences with DQST.

This study's findings support the need for preventative education about DQST in pregnancy and postpartum. The first‐time mothers in this study reported they were not educated about DQST by health‐care providers before developing the condition, and that they felt unprepared when they developed symptoms of DQST. First‐time mothers stated that if they had received information and education about DQST before the birth of their babies, they would have known preventative strategies to avoid the development of DQST. Previous studies have also reported the importance and need for educational programs that educate mothers on the importance of joint protection and correct handling techniques through preventative ergonomic education (Griffin & Price, 2000; Thabah & Ravindran, 2015; Vincent & Hocking, 2013). Education and prompt diagnosis of DQST are vital in the early resolution of symptoms (Borg‐Stein & Dugan, 2007). The mothers in the current study reported that if they had known about DQST they would have sought help soon after developing symptoms instead of waiting until the symptoms worsened; the latter leading to prolonged recovery time. New mothers often use the Internet to access information and discussion forums related to parenting (Moon et al., 2019), and the participants in the current study recommended social media to disseminate education about DQST due to its convenience.

While occupational therapy interventions such as splinting and rest are valuable for managing symptoms of DQST, the study findings suggest that they may hinder mothers' occupational performance and engagement. Participants in this study described splints as restrictive and found recommended wearing schedules unrealistic given the continuous demands of caregiving, such as feeding, changing nappies, and holding their babies. Similarly, advice to rest or modify activities often conflicted with the essential occupations of mothering, creating frustration, and a sense of inadequacy. These findings highlight the need for occupational therapists to critically evaluate the feasibility of interventions within the unique context of new motherhood. Person‐centred approaches are vital, focussing on collaborative goal setting and adaptive strategies that respect mothers' roles and responsibilities, especially as research has indicated that caregiving occupations play a role in developing DQST (Ferraro et al., 2023). For example, occupational therapists might explore flexible splint‐wearing schedules, educate mothers on activity pacing, and suggest alternative ways to protect hand function without compromising caregiving occupations (Goel & Abzug, 2015). By balancing therapeutic goals with the realities of mothering occupations, occupational therapy interventions can better support this population's engagement and performance (Walker et al., 2019). Consideration of motherhood occupations can inform development of interventions; for example, if neoprene splints affect daily activities like changing nappies or feeding, the occupational therapist may recommend that a splint be worn at night to rest the affected upper limb or limbs and prevent awkward postures. Educating new mothers on massage techniques and strengthening exercises that can be done at home may be beneficial, but therapists must also coach new mothers about how this might fit into their new routine, given new mothers find fitting in self‐care occupations often challenging (Baker et al., 2024). Future research should focus on developing resources that support occupational therapists to consider motherhood occupations in the assessment and treatment of first‐time mothers with DQST.

The findings of this study confirm the important role that occupational therapists can have to improve occupational performance in mothering and other occupations among women in the perinatal period (Acharya, 2014; Fernandes, 2018; Slootjes et al., 2016). Occupational therapists are well positioned to support the occupational performance of mothers because not only are they involved in the conservative management of DQST but they also possess expert skills in activity analysis and ergonomics evaluations (Quinnelly & Schroeder, 2013). Occupational therapists can expand their roles with mothers with DQST by providing preventative education about risk factors and early warning signs of DQST, and correct posture, positioning, and activity adaptation to reduce risk and/or minimise symptoms (Allbrook, 2019). This education may help reduce the occurrence of DQST among new mothers and promote their early help‐seeking behaviour if symptoms develop. Wellness education about DQST should be provided to women in the perinatal period—during pregnancy and soon after childbirth—as this is the greatest risk period for developing DQST among new mothers (Borg‐Stein & Dugan, 2007). Participants in the study recommended that education can be delivered at antenatal classes, in hospital after childbirth, at postnatal classes, and online through social media in all stages. Developing online educational programs, hosting talks, and workshops at antenatal and postnatal classes, as well as other mothers' groups, are opportunities to expand occupational therapy reach and involvement with the new mothers.

6. LIMITATIONS

There are some limitations to consider when reviewing this paper. Firstly, contextual factors such as the participants' duration of symptoms, comorbidity, marital status, and cultural or socio‐economic backgrounds were not collected, which may have allowed a better description and understanding of the diversity of participants. Future research should use a sampling framework to include women with diverse contextual factors to determine any associations between these factors and the prevalence of DQST and how it may affect occupational performance in mothering and other occupations. Secondly, some participants did not have active symptoms at the time of the interviews; therefore, this may have affected the recall of their experiences. Finally, the use of convenience sampling to identify new mothers who had experienced DQST presented a potential bias as some of the participants were from the social and/or professional networks of the research team. To minimise this potential bias, all interviews were conducted by one researcher (CK) who was not known to the participants prior to the study.

7. CONCLUSION

This study described how new mothers experience difficulties with their occupational performance because of symptoms related to DQST. Participants reported they received insufficient preventative education about DQST from health‐care providers during the perinatal period. Occupational therapists have a valuable role in supporting mothers with DQST by facilitating occupational adaptation and providing holistic and client‐centred support. Future research should aim to develop educational resources and programs that consider motherhood occupations that can assist in the prevention and prompt treatment of DQST during the perinatal period.

AUTHOR CONTRIBUTIONS

The authors of the research project contributed to the study design, data collection, analysis of the findings, and drafting and editing of the research manuscript. All researchers approved the final version of the research manuscript, prior to submission.

CONFLICT OF INTEREST STATEMENT

The authors have no conflicts of interests to declare.

Appendix A: Semi‐Structured Interview Guide A.

• 1
  Tell me about your experience of DQST.

  Probing Questions:

  When did your symptoms start? When did you seek help and where? What information was provided to you? What impact did it have on your daily routine and in the role of new mother? What was he most challenging part? What helped you overcome it? What did you find helpful? What support was available to you? What did you find unhelpful? What were your symptoms and how long did they last? What were the barriers and facilitators to receiving help and resolving the symptoms?

• 2How do you define DQST?

Probing Questions:

What are the risk factors? How can women reduce the risk?

• 3What management strategies for DQST are you aware of?

Probing Questions:

How do you apply them? Of all the management strategies, you have mentioned, which were the most helpful to you? Why?

• 4What is your awareness of preventative education resources for DQST?

Probing Questions:

Have you accessed such resources before? How helpful were they? If an education resource was developed for the future, how would you like to have it delivered?

• 5Do you have any other thoughts you would like to add to your experience of DQST and what can be done to reduce the risk of the condition among new mothers?

*Note: Additional follow‐up questions maybe asked, as appropriate, with each participant and they may be more specific based on the results of the DASH questionnaire.

Khama, C. , Ciccarelli, M. , Brayshaw, J. , Hatfield, M. , & Tran, T. (2025). ‘I couldn't change his nappy’: New mothers' experiences of De Quervain's tendinosis and its impact on occupational performance. Australian Occupational Therapy Journal, 72(2), 1–14. 10.1111/1440-1630.70014

DATA AVAILABILITY STATEMENT

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.