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. 2020 Apr 1;29(2):95–102. doi: 10.1891/J-PE-D-18-00044

The Effect of Client Needs Counseling on the Postpartum Quality of Life of Women

Mina Esmkhani, Leila Ahmadi, Azam Maleki
PMCID: PMC7159795  PMID: 32308359

Abstract

In a randomized clinical trial study, the effect of client needs counseling on the postpartum quality of life of 84 women were investigated. The data were collected using the Postpartum Quality of Life Questionnaire. The post-test mean total score of quality of life had a statistically significant difference between two groups (p = .001). There were significant differences between two groups in the post-test mean of mother's feelings toward herself, her husband and others, physical changes, satisfaction with birth method, and selection of the next method of birth areas (p < .05). Our findings indicated that providing two additional counseling sessions based on the client's needs can be effective in promoting the quality of life of low-risk women.

Keywords: quality of life after birth, counseling, client needs, clinical trial, women health

INTRODUCTION

The postpartum period, one of the most critical periods of the life of mother and child, begins immediately after giving birth and continues until 42 days after birth. It is expected that during the postpartum period the physiological changes related to pregnancy gradually return to their original state, however, some physical and psychological complications (for example, postpartum hemorrhage, backaches, headaches, pelvic pain, incontinency, and depression) occur during this period that affects their health (Callaghan, Creanga, & Kuklina, 2012; Wadsworth & Bhatia, 2015).

It is important that postpartum care is integrated into primary health care. The coverage of care, the timing, and content of routine care for mothers and infants in this setting varied both between and within countries (Wiegers, 2006). Some guidelines have provided comprehensive recommendations for the care of postpartum women and their infants. However, further research is needed to provide specific guidelines with consideration given to the needs of each region (Haran, Van Driel, Mitchell, & Brodribb, 2014). In Iranian context the viewpoints of the mothers indicated that they had not received adequate information about the present or the future status of their postpartum lives (Mohseni, Bahadoran, & Abdi, 2009).

Level of access to social support and health-care providers' attention to the content or using method of consultation are important factors in adapting to this period (Gazmararian et al., 2014). In some countries, despite the importance of postpartum care, mothers are still not well prepared to face the physical and mental changes of this period (Howell, 2010; Martin, Horowitz, Balbierz, & Howell, 2014) and lack of adequate motivation among the mothers, lack of appropriate facilities, short duration of hospitalization, lack of time, and a variation of educational needs contribute to this issue (Heaman et al., 2015).

Poor adaptation to these changes can affect the quality of life (QOL) and the health of women (Hammoudeh, Mataria, Wick, & Giacaman, 2009). QOL is a feeling of well-being and its status results from satisfaction or dissatisfaction with various aspects of life including physical and mental health, level of independence, social relationships, environmental position, and spiritual dimensions (Roop, Payne, & Vallerand, 2011). It is also one of the important indicators of health and an indirect sign of the quality of health care and services. Therefore, measuring QOL is very important in social, medical, and clinical decisions (Hamming & De Vries, 2007). A variety of medical, psychological, social, and obstetric factors might affect QOL after birth (Jansen, Essink-Bot, Duvekot, & van Rhenen, 2007).

Several studies indicated that supportive counseling can have a positive effect on improving QOL, self-efficacy, and promoting the health of women who have newly given birth (Bahrami, Simbar, & Bahrami, 2013; Gao, Sun, & Chan, 2014; Ghiasvand, Riazi, Hajian, Kazemi, & Firoozi, 2017). In another study, purposive educational had a positive effect on increasing of knowledge or improving the specific problems of mothers (Kamali et al., 2016).

Improving information may be challenging because the educational needs of each woman varies according to age, background, experiences, and expectations. Additionally, clinicians might under estimate patients' needs (Mohseni, Loripoor, & Nekuei, 2017). Conducting a patient needs assessment before any intervention is an important factor in guiding treatment and determining the priority of educational needs (Golyan, Rahimi, Neisani, Ebrahimi, & Karimi, 2017). In client needs counseling, the patient directly participates and is involved in medical treatment and nursing care (Thompson, 2007). The main distinguishing feature between patient involvement and patient participation concerns the degree to which patients take part in the decision-making process, indicating a degree of transfer of power from the professional to the patient in the form of increased knowledge, control, and responsibility (Thompson, 2007).

According to evidence, intervention based on clients' needs is an effective way to improve the QOL of chronic patients (Cruickshank, 2014; Momino et al., 2017). There is a lack of information on the effectiveness of it on QOL of women in the postpartum period in Iran. Therefore, suitable interventions must be designed and implemented in this area (Mohseni et al., 2017). The provision of appropriate care in the right time at the right place is cost-effective health care (Macinko, Starfield, & Shi, 2003). Individual counseling is more personalized and the practitioner is allowed to focus on the client's specific problems. As a result, the professional can develop a set of recommendations, strategies, and treatments tailor-fit to the patient's situation. Furthermore, individual counseling can help one develop fresh perspectives about life and new skills, improve relationships, regain sense of self-empowerment, and find ways to relate and deal with emotional suffering (Capuzzi & Stauffer, 2016). Therefore, the present study was carried out with the aim to determine the effect of counseling based on the needs of the client on women's QOL level in the postpartum period.

MATERIALS AND METHODS

Study Design and Setting

This study was a randomized controlled trial. The setting of study was Ayatollah Mousavi Hospital in Zanjan, Iran.

Participants

The study population consisted of women who had a normal pregnancy and birthed at Ayatollah Mousavi Hospital in Zanjan, Iran. Sample size was calculated to be 84 (n = 42 individuals in each group) through a pilot study with 95% confidence level, power 80%, and a 10% attrition rate. The study inclusion criteria included an age range of 18 to 35 years, lack of underlying mental and physical illnesses (according to self-reports), lack of use of assisted reproductive technology (ART) in the recent pregnancy, wanted pregnancy and birth without complications, without depression symptoms based on the Depression Anxiety Stress Scale (DASS-21), literacy (reading and writing), and the birth of a healthy baby. The exclusion criteria included lack of participation in counseling sessions, the loss of any of the inclusion criteria, simultaneous participation in other training classes, and unwillingness to continue cooperation during the study.

Sampling Method

First, subjects who met the inclusion criteria were selected using a convenience sampling method, and then they were randomly divided into intervention and control groups. The intervention group received counseling based on the needs of the clients, and the control group received routine care (control of vital signs, breastfeeding, control of bleeding, personal hygiene) respectively.

Intervention

An intervention was developed to increase patient involvement in care. Postpartum care could be tailored flexibly to individual needs. A number of pressures and policy shifts were identified: preventive and supportive care that works to strengthen women's capabilities in the context of respectful relationships, is tailored to their needs, focuses on promotion of normal reproductive processes, and in which first-line management of complications and accessible emergency treatment are provided when needed (Renfrew et al., 2014; Thompson, 2007).

In our study, participation was broadly involved in discussions about their condition, providing them with relevant information, asking for their opinion on possible treatments, and involving them in the decision-making process, should they so wish. The main counseling topics included personal hygiene, breastfeeding, immunization, use of vitamins, examinations related to postpartum hemorrhage or infections, baby care, family planning, sexual health, mental health, breast exams, physical activity, nutrition, life style, and strengthening relationships with the spouse.

Routine care included three visits in 3, 15, 40 days after birth. The intervention group received two additional visits in 24 hours and 7 days after birth. The care plans were made in two individual counseling sessions, tailoring care to individual needs rather than based on a predetermined schedule. The first session of intervention was held within the first day after birth and the next session was on the seventh day after birth and was based on the priorities requested by the client. Participants were followed up six weeks after completing the consultation.

Data Collection Instrument

In the study, three questionnaires were used to collect data.

Sociodemographic

The first questionnaire consisted of questions on sociodemographic characteristics including the client's occupation, housing status, type of birth, gender of the baby, parity, age, and husband's occupation.

DASS-21

The second questionnaire was the Persian form of the standard DASS-21 (Asghari, Saed, & Dibajnia, 2008). It was used for entering the participant into the study. Based on this questionnaire, subjects with scores of less than or equal to 8 were included.

Postpartum QOL

The Postpartum QOL Questionnaire as the index of mother's productivity was designed by Symon and McKay (Symon, MacDonald, & Ruta, 2002) and translated and revised by Turkan et al. (Torkan, Parsay, Lamyian, Kazemnejad, & Montazeri, 2009). This tool contains 30 questions in eight dimensions related to birth and delivery including the mother's feelings toward herself, mother's feelings toward the child, mother's feelings toward her spouse and others, mother's feelings about sexual relationships, physical health, relationship between birth and economic status, mother's satisfaction with the birth method, and the selection of the next birth method. The questions were scored based on a four-point Likert scale ranging from 0 to 4. Therefore, the QOL score was in the range of 0 to 120. A high score reflects a better QOL. The reliability coefficient of this questionnaire was 83% in the present study.

Data Analysis

Data were analyzed using the independent t-test and chi-square test at a significance level of 0.050.

RESULTS

Demographic Characteristics

The comparison of the demographic characteristics of the intervention and control groups showed that there was no significant difference between the two groups in terms of occupational status, housing, type of birth, gender, age, number of children, and husband's occupation (p ≤ .050). Therefore, the two groups were homogeneous (Table 1).

TABLE 1. The Comparison of the Participant's Demographic Characteristics Distribution in Two Groups.

Variable Control Intervention p Value
Frequency Percent Frequency Percent
Spouse occupationa Government employee  8 19.5 11 26.8 .427
Self-employment  9 22 14 26.8
Unemployed  9 22  4 34.1
Farmer  8 19.5  6 14.6
Others  7 17.1  6 14.6
Client's occupationa Employee  3 7.1  7 16.7 .156
Housewife 39 92.9 35 83.3
Housing statusa Private house 24 58.5 28 66.7 .607
Rental house 12 29.3  9 21.4
With your family  4 9.8  5 9.11
With spouse family  1 2.4  0    0
Type of birtha Normal birth 17 40.5 25 5.59 .063
Cesarean surgery 25 5.59 17 5.40
Gender of the babya Female 18 4.47 21 2.51 .454
Male 20 6.52 20 48.8
Paritya 1 25 59.5 27 64.3 .41
Equal/More than 2 17 40.5 15 35.7
Age/yearsa 18–24 17 40.5 17 40.5 .96
25–29 14 33.3 15 35.7
30–35 11 26.2 10 40.5
Location of residencea City 18 42.9 26 35.7 .044
The village 24 57.1 14 23.8
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a

The sum of the difference is due to the missing data.

Postpartum Quality of Life

The mean of the total QOL score in the control group and intervention group was 52.30 ± 8.87 and 54.73 ± 9.46 respectively. After the intervention, this value reached 88.42 ± 15.42 and 98.30 ± 10.79 in the control and intervention groups, respectively. The comparison of the mean total QOL score before the intervention showed no significant differences between the two groups (p = .220). However, differ-ences were significant after the intervention (p = .001). There was a statistically significant difference between the two groups before the intervention in terms of satisfaction with the birth method and feelings toward the child, however, in other areas differences were not significant. After adjusting the confounding variables using univariate covariance test, the differences between the two groups in terms of feelings toward the child was not statistically significant (Table 2).

TABLE 2. The Adjusted the Confounding Variables Using Univariate Covariance.

Adjusted Variables F p Value
Satisfaction with the birth methoda 0.04 .84
Feelings toward the childa 2.72 .10
Group 6.006 .001
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a

No significant between two groups.

The comparison of QOL scores after the intervention in terms of QOL areas indicated that the mean of mother's feelings toward herself (p = .004), toward her husband and others (p = .010), economic status (p ≤ .001), physical status (p = .020), satisfaction with the birth (p = .002), and selection of the next birth method (p = .002) were significantly different between the two groups. In terms of the mother's feelings toward her child (p = .580) and the sexual relationships (p = .800) there was not a statistically significant difference between the two groups (Table 3).

TABLE 3. The Comparison of Means Scores of Quality of Life and its Domains Between Two Groupsa.

Variable Control Mean ± SD Intervention Mean ± SD p Value
Feelings toward herself Pretest 11.07 ± 4.19 12.59 ± 4.04 .094
After 6 weeks 16.11 ± 3.35 17.97 ± 2.20 .004
Feelings toward the child Pretest 3.71 ± 1.19 4.40 ± 1.38 .016
After 6 weeks 10.14 ± 2.03 10.35 ± 1.52 .586
Feelings toward her spouse and others Pretest 11.92 ± 4.53 12.52 ± 3.94 .523
After 6 weeks 24.66 ± 5.88 27.83 ± 5.10 .010
Physical health Pretest 11.47 ± 4.81 12.92 ± 5.17 .187
After 6 weeks 23.28 ± 4.74 25.59 ± 4.33 .022
Sexual relationships Pretest 4.07 ± 1.47 4.47 ± 1.36 .195
After 6 weeks 6.57 ± 2.43 6.71 ± 2.90 .808
Economic status Pretest 1.42 ± 0.70 1.30 ± 0.68 .433
After 6 weeks 2.57 ± 0.91 3.38 ± 0.93 .0001
Satisfaction with the birth method Pretest 2.04 ± 0.98 1.59 ± 0.76 .021
After 6 weeks 2.59 ± 0.93 3.26 ± 0.96 .002
Selection of the next birth method Pretest 2.09 ± 1.18 1.06 ± 0.98 .075
After 6 weeks 2.47 ± 0.99 3.19 ± 1.01 .002
Total QOL scores Pretest 52.30 ± 8.86 54.73 ± 9.46 .229
After 6 weeks 88.42 ± 15.42 98.30 ± 10.79 .0001
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Note. SD = standard deviation.

a

A high score reflects a better QOL.

DISCUSSION

The findings of the present study showed that routine care is inadequate, that two additional counseling sessions based on the client's needs are necessary, and that there is an effective intervention in the improvement of QOL. The results of our study were in agreement with the findings of a supportive education based on health promoting behaviors in terms of the overall score of QOL and areas of the mother's feelings toward herself, toward her husband and others, and their physical condition. However, these two studies were not in agreement in the areas of economic status, satisfaction with birth method, selection of the next birth method, and mother's feelings toward her child (Ghodsbin, Yazdani, Jahanbin, & Keshavarzi, 2012). The differences in results may be due to the inconsistency in implementation. This suggests that paying attention to the primary knowledge and active participation of the client in meeting their needs can increase the rate of satisfaction with the method of birth and the selection of the next birth method. This finding is very valuable. In addition, this approach can be used to reduce the rate of cesarean surgeries as a social problem.

According to a study by Ghiasvand et al. (2017), among primiparous women the teach back self-care method was effective in improving the total score of QOL in the postpartum period, the mother's physical condition, the mother's feelings toward herself, toward her child, and toward her husband. However, in the areas of gender, economic status, satisfaction with birth method, and selection of the next birth method, the method was not significant. It was consistent with our study in terms of gender, however, it was not in agreement in the areas of economic status, feeling toward the child, satisfaction with birth method, and selection of the next method of birth (Ghiasvand et al., 2017) The differences of study population and the content of education may have caused the inconsistency. In Ghiyasvand et al.'s study, the intervention was performed only among primiparous women and the teaching content was provided through the teach-back method.

In an inconsistent study, home-based protective care did not have a significant effect on the QOL of low risk women (Mirmolaei, Amel Valizdeh, Mahmoodi, & Tavakkol, 2011). The reason for this inconsistency may be differences in timing, and content of counseling. This contradictory finding has been emphasized in the results of a review article by Shaw, Levitt, Wong, Kaczorowski, and McMaster University Postpartum Research Group (2006). QOL is a multi-dimensional concept which is affected by individuals' perception, expectations, communications, needs, and beliefs. It is also influenced by various factors including age, education, income rate, and number of children (Akýn, Ege, Koçoðlu, Demirören, & Yýlmaz, 2009). Therefore, attention to individual differences, primary knowledge, and direct involvement of the client in self-care are greatly important in the effectiveness of interventions related to QOL, and should be addressed by the health staff. Although home care seems to be beneficial for mothers in the above studies, it is not feasible due to limited staffing in some communities and may be cost-effective for mothers with low risk levels. Nevertheless, the results of this study indicate that intervention based on the client's needs is an efficient and cost-effective solution to improving the QOL of low risk women and can be used for planning in the field of mother and childcare.

LIMITATION

Regarding the study population which consisted of low-risk women aged 18 to 35 years, the ability to generalize the findings to other age groups or to high-risk pregnancies is limited. Therefore, it is suggested that future studies be conducted on the effectiveness of the intervention based on the client's needs using other counseling approaches, a larger sample size, and different follow-up periods among women with different age groups or high risk pregnancies.

Additionally, at the start of the study non-homogeneous findings were presented for the treatment and the control groups which can influence postpartum QOL. To improve the validity of the results, we adjusted the non-homogeneous variables.

CONCLUSION

Our findings indicated that providing two additional counseling sessions based on the client's needs can be effective in promoting the QOL of low-risk women compared to the control group. Furthermore, its effect is highly important in improving mothers' satisfaction with the birth method and selection of the next method of birth, which can be considered by planners in the field of maternal–child health. In addition, the development of postpartum care packages based on the needs of the client and their implementation using various approaches of counseling and health education seem necessary.

ACKNOWLEDGMENT

This article is part of a student project supported by Zanjan University of Medical Sciences. We would like to thank the University's vice-chancellor of education and vice-chancellor of research for their financial support to carry out the study.

Biographies

MINA ESMKHANI is an Msc student in Counselling in Midwifery, School of Nursing and Midwifery, Zanjan University of Medical Sciences, Iran.

LEILA AHMADI is an Msc student in Counselling in Midwifery, School of Nursing and Midwifery, Zanjan University of Medical Sciences, Iran.

AZAM MALEKI holds a PhD in Maternal and Child Health, Social Determinants of Health Research Center, Zanjan University of Medical Sciences, Zanjan, Iran.

DISCLOSURE

The authors have no relevant financial interest or affiliations with any commercial interests related to the subjects discussed within this article.

FUNDING

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the Zanjan University of Medical Sciences, awarded to Dr. Azam Maleki.

REFERENCES

  1. Akýn, B., Ege, E., Koçoðlu, D., Demirören, N., & Yýlmaz, S. (2009). Quality of life and related factors in women, aged 15–49 in the 12-month post-partum period in Turkey. Journal of Obstetrics and Gynaecology Research, 35(1), 86–93. 10.1111/j.1447-0756.2008.00870.x [DOI] [PubMed] [Google Scholar]
  2. Asghari, A., Saed, F., & Dibajnia, P. (2008). Psychometric properties of the Depression Anxiety Stress Scales-21 (DASS-21) in a non-clinical Iranian sample. International Journal of Psychology, 2(2), 82–102. [Google Scholar]
  3. Bahrami, N., Simbar, M., & Bahrami, S. (2013). The effect of prenatal education on mother's quality of life during first year postpartum among Iranian women: A randomized controlled trial. International Journal of Fertility & Sterility, 7(3), 169. [PMC free article] [PubMed] [Google Scholar]
  4. Callaghan, W. M., Creanga, A. A., & Kuklina, E. V. (2012). Severe maternal morbidity among delivery and postpartum hospitalizations in the United States. Obstetrics & Gynecology, 120(5), 1029–1036. 10.1097/AOG.0b013e31826d60c5 [DOI] [PubMed] [Google Scholar]
  5. Capuzzi, D., & Stauffer, M. D. (2016). Counseling and psychotherapy: Theories and interventions. Hoboken, NJ: John Wiley & Sons. [Google Scholar]
  6. Cruickshank, S. (2014). The effectiveness of an intervention by specialist breast care nurses to address the perceived needs and enhance the quality of life of women with breast cancer receiving follow-up care: A randomised controlled trial. Doctoral dissertation, Edinburgh Napier University, Edinburgh, Scotland. [Google Scholar]
  7. Gao, L.-l., Sun, K., & Chan, S. W.-c. (2014). Social support and parenting self-efficacy among Chinese women in the perinatal period. Midwifery, 30(5), 532–538. 10.1016/j.midw.2013.06.007 [DOI] [PubMed] [Google Scholar]
  8. Gazmararian, J. A., Dalmida, S. G., Merino, Y., Blake, S., Thompson, W., & Gaydos, L. (2014). What new mothers need to know: Perspectives from women and providers in Georgia. Maternal and Child Health Journal, 18(4), 839–851. 10.1007/s10995-013-1308-8 [DOI] [PubMed] [Google Scholar]
  9. Ghiasvand, F., Riazi, H., Hajian, S., Kazemi, E., & Firoozi, A. (2017). The effect of a self-care program based on the teach back method on the postpartum quality of life. Electronic Physician, 9(4), 4180 10.19082/4180 [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Ghodsbin, F., Yazdani, K., Jahanbin, I., & Keshavarzi, S. (2012). The effect of education on health-promoting behaviors at the first six weeks post-delivery on the quality of life of primiparous women. Armaghane Danesh, 17(4), 279–288. [Google Scholar]
  11. Golyan, T. S., Rahimi, F. A., Neisani, S. L., Ebrahimi, M., & Karimi, N. (2017). Evaluation of effect of postpartum care education based on maternal educational needs on knowjedge of postpartum care. The Journal of Urmia Nursing and Midwifery Faculty, 15(2), 76–85. [Google Scholar]
  12. Hamming, J., & De Vries, J. (2007). Measuring quality of life. British Journal of Surgery: Incorporating European Journal of Surgery and Swiss Surgery, 94(8), 923–924. 10.1002/bjs.5948 [DOI] [PubMed] [Google Scholar]
  13. Hammoudeh, W., Mataria, A., Wick, L., & Giacaman, R. (2009). In search of health: Quality of life among postpartum Palestinian women. Expert Review of Pharmacoeconomics & Outcomes Research, 9(2), 123–132. 10.1586/erp.09.8 [DOI] [PubMed] [Google Scholar]
  14. Haran, C., Van Driel, M., Mitchell, B. L., & Brodribb, W. E. (2014). Clinical guidelines for postpartum women and infants in primary care–A systematic review. BMC Pregnancy and Childbirth, 14(1), 51 10.1186/1471-2393-14-51 [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Heaman, M. I., Sword, W., Elliott, L., Moffatt, M., Helewa, M. E., Morris, H., … Cook, C. (2015). Barriers and facilitators related to use of prenatal care by inner-city women: Perceptions of health care providers. BMC Pregnancy and Childbirth, 15(1), 2 10.1186/s12884-015-0431-5 [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Howell, E. A. (2010). Lack of patient preparation for the postpartum period and patients' satisfaction with their obstetric clinicians. Obstetrics & Gynecology, 115(2), 284–289. 10.1097/AOG.0b013e3181c8b39b [DOI] [PubMed] [Google Scholar]
  17. Jansen, A. G., Essink-Bot, M.-L., Duvekot, J. J., & van Rhenen, D. J. (2007). Psychometric evaluation of health-related quality of life measures in women after different types of delivery. Journal of Psychosomatic Research, 63(3), 275–281. 10.1016/j.jpsychores.2007.06.003 [DOI] [PubMed] [Google Scholar]
  18. Kamali, M., Mirghafourvand, M., Mohammad, S., Khodabandeh, F., JafarAbadi, M. A., & Mansoori, A. (2016). Effect of lifestyle educational package on prevention of postpartum health problems in nulliparous mothers: A randomized clinical trial. Journal of Mazandaran University of Medical Sciences, 25(132), 33–48. [Google Scholar]
  19. Macinko, J., Starfield, B., & Shi, L. (2003). The contribution of primary care systems to health outcomes within Organization for Economic Cooperation and Development (OECD) countries, 1970–1998. Health Services Research, 38(3), 831–865. 10.1111/1475-6773.00149 [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Martin, A., Horowitz, C., Balbierz, A., & Howell, E. A. (2014). Views of women and clinicians on postpartum preparation and recovery. Maternal and Child Health Journal, 18(3), 707–713. 10.1007/s10995-013-1297-7 [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Mirmolaei, T., Amel Valizadeh, M., Mahmoodi, M., & Tavakkol, Z. (2011). The effect of postpartum care at home on maternal received care and satisfaction. Evidence Based Care, 1(1), 35–50. [Google Scholar]
  22. Mohseni, M., Bahadoran, P., & Abdi, H. A. (2009). The quality of postpartum care from mothers' viewpoint. Hakim Research Journal, 12, 27–34. [Google Scholar]
  23. Mohseni, M., Loripoor, M., & Nekuei, N. (2017). Educational needs of postpartum period in women referring to health care centers of Rafsanjan in 2008. Community Health Journal, 7(1), 18–27. [Google Scholar]
  24. Momino, K., Mitsunori, M., Yamashita, H., Toyama, T., Sugiura, H., Yoshimoto, N., … Akechi, T. (2017). Collaborative care intervention for the perceived care needs of women with breast cancer undergoing adjuvant therapy after surgery: A feasibility study. Japanese Journal of Clinical Oncology, 47(3), 213–220. 10.1093/jjco/hyw189 [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Renfrew, M. J., McFadden, A., Bastos, M. H., Campbell, J., Channon, A. A., Cheung, N. F., … Declercq, E. (2014). Midwifery and quality care: findings from a new evidence-informed framework for maternal and newborn care. The Lancet, 384(9948), 1129–1145. 10.1016/S0140-6736(14)60789-3 [DOI] [PubMed] [Google Scholar]
  26. Roop, J. C., Payne, J. K., & Vallerand, A. H. (2011). Theories and conceptual models to guide quality of life research In King C. R. & Hinds P. S. (Eds.), Quality of life: from nursing and patient perspectives: theory, research, practice, (pp. 45–51). Sudbury, MA: Jones & Bartlett Learning. [Google Scholar]
  27. Shaw, E., Levitt, C., Wong, S., Kaczorowski, J., & McMaster University Postpartum Research Group. (2006). Systematic review of the literature on postpartum care: effectiveness of postpartum support to improve maternal parenting, mental health, quality of life, and physical health. Birth, 33(3), 210–220. 10.1111/j.1523-536X.2006.00106.x [DOI] [PubMed] [Google Scholar]
  28. Symon, A., MacDonald, A., & Ruta, D. (2002). Postnatal quality of life assessment: Introducing the mother-generated index. Birth, 29(1), 40–46. 10.1046/j.1523-536X.2002.00154.x [DOI] [PubMed] [Google Scholar]
  29. Thompson, A. G. (2007). The meaning of patient involvement and participation in health care consultations: A taxonomy. Social Science & Medicine, 64(6), 1297–1310. 10.1016/j.socscimed.2006.11.002 [DOI] [PubMed] [Google Scholar]
  30. Torkan, B., Parsay, S., Lamyian, M., Kazemnejad, A., & Montazeri, A. (2009). Postnatal quality of life in women after normal vaginal delivery and caesarean section. BMC Pregnancy and Childbirth, 9(1), 4 10.1186/1471-2393-9-4 [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Wadsworth, R., & Bhatia, K. (2015). Core topics in obstetric anaesthesia (pp. 201–210). New York: Cambridge University Press. [Google Scholar]
  32. Wiegers, T. A. (2006). Adjusting to motherhood: Maternity care assistance during the postpartum period: How to help new mothers cope. Journal of Neonatal Nursing, 12(5), 163–171. 10.1016/j.jnn.2006.07.003 [DOI] [Google Scholar]

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