Exploring the Unmet Needs of Postpartum Mothers: A Qualitative Study

Abstract

This study aimed to identify unmet needs of mothers in the postpartum period. Semi-structured telephone interviews were conducted two weeks postpartum with a convenience sample of 26 mothers who gave birth at an academic medical center. Topics included mothers’ concerns, levels of preparedness, educational needs and preferences during antepartum, labor and birth, and postpartum periods. Data were qualitatively analyzed using NVivo and a combination of open coding and theoretical coding, based on the Perinatal Maternal Health Promotion Model. Three major themes emerged: concerns, expectations, and positive coping strategies, with variations by previous maternal experience. Findings suggest the need for different models of care with more anticipatory, mother-centered care to better meet mothers’ needs and enhance postpartum outcomes and breastfeeding success.

The postpartum period is a critical period as it shapes the long-term health and well-being of both women and their infants. The “4th trimester” refers to the twelve weeks following childbirth because newborns continue to function like fetuses in many ways while mothers provide constant nurturing (Tully et al., 2017; Verbiest et al., 2017). During these weeks, many mothers face major physiological and psychological challenges and concerns, including those related to recovery, infant care, breastfeeding, depression, fatigue, sexuality, and incontinence (Howell, 2010; Kaitz, 2007; Tully et al., 2017; Weiss et al., 2009). Mothers’ postpartum concerns are often intensified with low social support, increased stress, and/or unmet educational needs, which can lead to a lowered sense of well-being (Hannan et al., 2016). Insufficient education on managing these problems can largely influence maternal health outcomes (Logsdon et al., 2018; Weiss et al., 2009). Aside from the standard 6-week postpartum check-up, health care in the United States tends to shift focus in the first year after childbirth from the physical and psychosocial well-being of the mother to the development and growth of the infant (Fowles et al., 2012).

Current models of postpartum care vary. The American College of Obstetricians and Gynecologists (ACOG) recently called for a new paradigm for postpartum care by redefining it as an ongoing and comprehensive process characterized by increased support and follow-up within the first three weeks. Prevailing research also suggests that postpartum care should be adapted to the changing needs and concerns of mothers, however few studies have explored these themes (Almalik, 2017; Cornell et al., 2016). Our aim was to explore maternal concerns and needs for postpartum education, support, and care, to help inform services for women during this critical period.

MATERIALS AND METHODS

Sample and Recruitment

We conducted semi-structured telephone interviews two weeks postpartum with a convenience sample of mothers who gave birth at an academic medical center. All mothers who were in their hospital rooms during the recruitment times and met the inclusion criteria were asked to participate in the study. Women met the inclusion criteria if they were generally healthy, English-speaking, ages 18–45 years-old, and had given birth during the current hospitalization to a single, generally healthy full term baby (defined as 39+ weeks). We defined a generally healthy mother as one without any birth complications, chronic conditions, or known risk of intimate partner violence, mental illness, and/or substance abuse. We defined a generally healthy newborn as one that had a 5 minute Apgar score greater than 6 and was of normal birthweight. Due to the rise in findings indicating that elective births prior to 39 full weeks of gestation can present short- and long-term health risks for the newborn and the close ties between a mother’s postpartum experience and her newborn’s health outcomes, we restricted eligible participants to women who gave birth after 39+ weeks. Mothers were excluded if it was later discovered that they were at risk for intimate partner violence, mental illness, and/or substance abuse, or if their baby was no longer healthy, placed in the NICU, or no longer living at the time of the interview.

Mothers that expressed interest were given a consent form, recruitment flyer with our research team’s contact information, and a children’s book. We followed up with up to three telephone calls one week after obtaining consent to confirm an interview date/time that was most convenient for the mother.

Procedure

The study was approved by the medical center’s Human Subjects Research Institutional Review Board. Interviewers (n = 2) were both female. The semi-structured telephone interviews were conducted between August 2018 and February 2019. Participants gave consent for the interviews to be audio-recorded and were made aware that they could skip any questions they did not feel comfortable answering and could stop the interview at any time. The interviews followed a semi-structured format to allow participants to answer the questions openly and discuss aspects that were not covered in the interview protocol but were important to their individual experiences (Coates et al., 2014). Interview questions were adapted from the Listening to Mothers I-III Surveys and other surveys found in the literature assessing maternal concerns and educational needs (Barnes et al., 2008; Coates et al., 2014; Declercq et al., 2013; Martin et al., 2014; Weiss et al., 2009). Participants were asked about their concerns, information sources, levels of preparedness, and educational needs and preferences during the antepartum, labor and birth, and postpartum periods. We asked follow-up and clarification questions if needed and further encouraged participants to discuss any other issues or aspects they felt were relevant to their experience being pregnant, during labor and birth, or in the first two weeks postpartum. At the end of each interview, we asked participants for demographic and background information. Interviews ranged from 19–55 minutes (Mean = 30.5 minutes).

Data Analysis

We assigned participant numbers to ensure confidentiality. We then de-identified and transcribed the interviews verbatim. The transcripts were qualitatively analyzed using NVivo 11. We developed themes through a combination of open coding and theoretical coding, using the Perinatal Maternal Health Promotion Model (Fahey & Shenassa, 2013). Open coding aims to describe and classify the examined phenomenon, in this case the experiences and concerns of two week postpartum mothers. Theoretical coding uses the tenets of an existing theory to categorize phenomenon data (Saldaña, 2015). By employing both strategies and comparing results, the researchers affirmed their findings’ assertions. During the open coding phase, we read through all of the transcripts to identify comments and experiences that were important to the interviewees and developed codes based on the most common themes that emerged. During the secondary theoretical coding phase to ensure analytical rigor, we considered and integrated the open codes within the framework of the Perinatal Maternal Health Promotion Model (Figure 1), adding codes based on the model as needed. According to this model, physical recovery, maternal role attainment, and care of self, infant, and family are the central maternal tasks of a healthy postpartum period while positive coping, realistic expectations, mobilization of social support, and self-efficacy are the key skills a mother needs to accomplish maternal tasks. The model posits that these key skills are acquired through access to clinical services, support services, information, and material resources (Fahey & Shenassa, 2013).

Figure 1. The perinatal maternal health promotion model (Fahey & Shenassa, 2013).

RESULTS

We approached 72 women 1–2 days postpartum. Twenty-one women declined to participate. Of the 51 women who consented to participate, 22 were lost to follow-up (we were unable to reach them by phone or email after three attempts), 2 formally withdrew, and 1 was excluded due to information revealed during the interview, leaving a total of 26 participants.

Participants were English-speaking women who self-identified as White (n = 21), Black (n = 1), Asian (n = 2), and mixed race (n = 2). Three identified as being of Hispanic, Latino or Spanish origin. The average age was 32 years and ranged from 19–39 years. The distribution of primiparous and multiparous women was equal. A majority of participants were married or living with their partner (92%) and well-educated, with 85% holding undergraduate degrees or higher (see Table 1 for participant demographics).

TABLE 1. Demographic Characteristics of Study Participants.

Characteristic (N = 26)	N (%)
Parity
Primiparous	13 (50.0%)
Multiparous	13 (50.0%)
Age
Under 20	1 (3.9%)
20–29	5 (19.2%)
30–39	20 (76.9%)
40 or Older	0 (0%)
Self-identified Race
White	21 (80.8%)
Black or African American	1 (3.9%)
Asian	2 (7.7%)
American Indian, Alaskan Native, Native	0 (0%)
Hawaiian, or Other Pacific Islander  Other (including multiracial)	2 (7.7%)
Hispanic, Latino or Spanish Origin
Yes	3 (11.5%)
No	0 (0%)
Level of Education
Less than High School	0 (0%)
High School Graduate	2 (7.7%)
Some College	2 (7.7%)
College Graduate	7 (26.9%)
Some Graduate School	0 (0%)
Graduate Degree	15 (57.7%)
Marital Status
Single	2 (7.7%)
Married	22 (84.6%)
Separated	0 (0%)
Widowed	0 (0%)
Living Together	2 (7.7%)
Income Category
$20,000 or less	2 (7.7%)
$20,000–$60,000	5 (19.2%)
$60,000–$100,000	10 (38.5%)
$100,000–$250,000	5 (19.2%)
$250,000 or More	3 (11.5%)
Declined to answer	1 (3.9%)

The combination of open and theoretical coding strategies yielded 20 total codes. The two coding methods were then reconciled and used to identify 3 major themes: Concerns, Expectations and Educational Needs, and Positive Coping Strategies. Examples of direct quotes illustrating each theme and the main sub-themes are provided below and presented in Table 2.

TABLE 2. Direct Quotes from Participants Illustrating Themes and Sub-themes.

Theme	Quote
Concerns
Breastfeeding	“I had concerns about breastfeeding mostly. I didn’t know how to do it. I’ve never used a breast pump. I didn’t know what to expect as far as my milk production, if it was going to be enough for the baby.” “I was overwhelmed because he wasn’t feeding. He had a tongue tie that had to be fixed, and he was kind of having to use a bottle of pumped milk. After giving him the bottle, he was like rejecting breastfeeding at times. After the tongue tie was fixed, he was having to use the bottle of extra milk. He had dropped a lot of weight in the hospital, and so then trying to go back from the bottle to breastfeeding and he was rejecting that and that was frustrating.”
Maternal Health	“It kind of went with the not breastfeeding well part because he was getting up so often and not sleeping for more than an hour at a time for more than a 24-hour period. So that led to my exhaustion and again, hormone changes. Emotionally I was struggling. So, it all kind of went together.” “Just making sure I was taking care of myself, you know instead of only thinking about the baby. So, yeah, I would say that was my biggest concern in the first days.”
Physical and Emotional Recovery	“Umm, first few days leaving the hospital. Um really overwhelmed, I guess really emotionally overwhelmed. Overwhelmed physically too given the lack of sleep and that she was really fussy the first night she was home, wasn’t sleeping, wasn’t eating well. So it was more being worried about her being overwhelmed and then also trying to make sure I was taking care of myself. So, I would say it was a challenging first couple of days.” “I had my mom and my mother-in-law and husband and sister and lots of support throughout the birth process and hospital stays and subsequent weeks after that. So, that helped relieve a lot of the anxiety.”
Expectations & Educational Needs  Breastfeeding	“My struggle breastfeeding was unexpected. It’s not something, you know even though people talked about it, it’s not something I felt like I was prepared for.” “every person had different tips like ‘oh you should do this’ or ‘oh you should do this,’ so it felt kind of like oh my gosh I just need one person to help me like evaluate or assess, like watch me try and get her latched, assess how you think that is, how it went, watch for a little bit while she feeds and give me some tips on how to fix it rather than just dialogue. So when the lactation consultant came in, I told her that like ‘‘this is how I’m feeling and I’m getting a lot of different advice and it feels like everyone has different tips, I just want you to watch and then critique what is going on.’ And so she did that, and that was the most helpful thing that happened was when they would come in and watch what was going on and give you very specific, explicit feedback on what was going on, rather than just like conversation about tips.”
Postpartum and Maternal Health	“I always think that it’s strange that you typically don’t, you have like zero postpartum care from your OB/GYNs. You know, which is…I mean you see the pediatricians and the pediatricians do a little bit of maternal care, but there’s really not any maternal postpartum care before 6 weeks, which is one visit and then you’re done [laughs 26:39-26:40]. So I think that’s kind of weird...I think questions like you’re asking, about those supports and stuff would be really helpful because, and then maybe having some resources for those moms if you are not getting a lot of support maybe suggesting support groups or something. I mean, I think some of the information might be included in like a packet or something, but I think a personal, an actual person talking to you about it might be more responsive.” “I feel like there should be a one week visit, I don’t know or something with an OB for them to check out if the stitches are healing well, if the wound is healing well, and if you’re doing okay. So, I feel like the postpartum care isn’t very good when they just tell you to come back and see them in 6 weeks.”
Caring for the Child/Children	“I mean, never having done it [caring for an infant] before, I could have used more hands-on experience. But I had taken classes and read books. As prepared as you can be with never having done it.” “I think trying to balance the attention that obviously a newborn requires and also trying to give attention to my other children was one of the most difficult things. Obviously, a newborn requires a lot of attention from mom, especially when you’re breastfeeding”
Positive Coping Strategies  Preparation	“Over 9 months, like I educated myself on what was going to happen. I think part of that was self-education, part of that was talking to people I know, part of that was talking to my mom, again she’s an OB nurse, part of that was taking the childbirth class just trying to educate myself. Part of it was really wanting it to happen, like I really wanted to bring my baby into my home, so like emotionally I was really excited to do that, so I think that helped things go well.” “Making sure we have everything we need prior. All the, you know, obviously where she sleeps and all the clothes and changing things and um basically making sure that we’re prepared with all the gear.”
Mobilization of Social Support	“If I was left alone during that period, like if my husband wasn’t off work and if my mom wasn’t available, I don’t know how I would’ve done it. I really don’t. Yeah, so like I got a lot of support that helped with the nighttime feeds and everything because I was completely, I had a difficult time mobilizing and then on top of it, I was just so exhausted.” “Yeah it was just help with stuff around the house, making sure we had food, making sure that um you know we had time to take a shower, take a nap and things like that.”
Information Seeking	“Talking with the nurses and doctors. It was very helpful. I ask a lot of questions, so when different pediatricians or different folks would come in and check on me or my baby I would ask, you know, ‘what are you looking at?’ or like ‘what does that mean?’” “Really a culmination of starting early on gathering supplies, starting early on reading What to expect, trying to get as much rest during pregnancy as I could, and then just books and friends. I have just a really good friend support system of moms who have been through this. So sharing their wisdom.”

Concerns

Infant Care and Breastfeeding

Breastfeeding was identified as the main source of concern and the biggest problem mothers faced in the first two weeks postpartum. Breastfeeding mothers were most concerned with physically feeding the baby and ensuring that the baby was getting enough nutrition and gaining weight. Among the 24 mothers that reported breastfeeding, the health benefits, convenience and prior experience, opportunity for bonding, and affordability of breastfeeding were cited as reasons for choosing that feeding method. Another major concern for mothers was ensuring the overall health of their baby, which included making sure the baby was eating, sleeping, and having bowel movements.

Maternal Health.

Fifteen participants expressed concerns about some aspect of maternal health. The most commonly repeated maternal health concern was sleep deprivation, which was linked to poor infant sleep and feeding. The lack of sleep often contributed to the mothers’ physical and emotional exhaustion in the first two weeks postpartum. Self-care was the next most common maternal health concern expressed by participants as mothers were concerned about having the time and ability to take it easy and focus on their own recovery so that they could care for their new infant appropriately. Multiparous women held the same concerns about self-care but within the context of also having to maintain their household and care for their other children at home.

Physical and Emotional Recovery

The emotional and physical experiences in the first two weeks postpartum elicited many concerns. Concerns related to physical recovery revolved around challenges doing normal things such as walking, using the bathroom, and leaving the house for appointments. When asked to describe how they felt in the first few days upon returning home with their new baby, half of the participants reported feeling overwhelmed. Mothers described feeling overwhelmed as they were faced with new lifestyle demands and changing routines that involved juggling self-care, maintaining the household and caring for their family, preparing meals, hosting visitors, affording a new baby, and getting to know the newborn, all while being physically exhausted from labor and experiencing hormone shifts. However, nine mothers explicitly stated that knowing they had support at home led to less postpartum concerns. Some mothers also stated that having “a good baby” led to less concerns in the first two weeks postpartum. A few mothers also expressed overwhelming feelings of love, happiness, and gratitude in the first two weeks with their new baby at home.

Expectations and Educational Needs

According to the Perinatal Maternal Health Promotion Model, the development of expectations helps one regulate individual behavior and promotes interpersonal interactions. However, whether or not expectations are met in the postpartum period affects a woman’s ability to prepare for and adjust to motherhood and other transitions following childbirth (Fahey & Shenassa, 2013). The findings suggest that whether or not expectations were met was related to the mothers’ existing knowledge about the postpartum period. Differences between mothers’ expectations and lived experiences and their perceived gaps in knowledge highlighted participants’ educational needs.

Breastfeeding

When participants were asked if there was anything they wish they would have known or had more information on before or during the postpartum period, the most commonly cited educational need was to be better informed about and assisted with breastfeeding—half of the participants found it more challenging than expected. Thus, many mothers expressed the need for breastfeeding education prior to childbirth for an easier transition once the baby arrives. Reasons for wanting breastfeeding education during pregnancy included wanting to absorb the information before becoming physically and mentally exhausted from childbirth and wanting an understanding of how to successfully latch, use a breast pump, and pick up on feeding cues before the baby arrives. However, many mothers also acknowledged that successful breastfeeding comes with practice and is attained through a learning curve.

Half of the mothers felt that having an individual present, for the first feed especially, to watch and provide more hands-on, real-time, and problem-solving advice would be most helpful in their ability to breastfeed successfully. Mothers shared positive comments when lactation consultants or nurses played such roles in their breastfeeding, also commenting on the desire for in-home lactation help so that they could learn what works best within the context of their own home environment. Those who had expected breastfeeding to be an easier process expressed the need for more education on the reality of breastfeeding, including the problems and challenges one could face with breastfeeding such as with latching, nipple pain, not producing enough milk, and having to supplement with formula. Some of these mothers expressed feeling pressured to breastfeed by hospital staff and shamed if their bodies were not cooperating, such as by not producing enough milk. These women wanted to be reassured that the feeding method is their choice and that they would receive full support in their decision.

Postpartum and Maternal Health

The second most common category of educational needs is that of managing the postpartum period itself. Participants expressed the desire for more education on what to expect during the postpartum period including more information on pain, possible challenges with physical recovery, how different the emotional experience can be day to day, how to manage having multiple children at home and introducing a new infant, and most commonly, maternal health and self-care. A majority of the mothers highlighted unmet expectations related to maternal care in the postpartum period. In addition to wanting more information on how to care for one’s self and maintain healthy habits (i.e., nutritious diet, exercise, adequate sleep, relaxation, seeking help), many expressed the need for more maternal care. Some participants noted how once their baby was born, the focus has been primarily on the baby, and they would like more attention given to their own physical recovery and emotional well-being.

When asked to assess the postpartum care they received, half of the mothers attributed their positive experiences to having supportive, attentive, and encouraging nurses, having their newborn in the hospital room with them for their stay, and to when their health-care providers clustered care so that there were minimal interruptions to their family time and rest. Improvements to postpartum care suggested by participants included directing more attention to the mother herself. For example, some mothers expressed the need for a check-up before the standard 6-week postpartum check-up so that the mother can engage in a conversation about how she is feeling, how she is recovering and healing physically, mentally and emotionally, and if she has everything needed, including support. One mother in particular mentioned a book that aided in her self-care entitled, The First Forty Days: The Essential Art of Nourishing the New Mother. For this mother, The First Forty Days formed the basis of her education on recovery as it “[contributed] tremendously to [her] mental and physical health” through its emphasis on resting and nourishing one’s self. This mother also noted how she would have liked this information to come from her healthcare providers.

Continuity of care was also an important aspect of nearly all participants’ postpartum care as many described a preference for having a healthcare provider with whom they are familiar follow them through their pregnancy into the postpartum period or follow-up with them in the postpartum period if involved in their birthing experience. Along with these preferences for continuity was the desire for a conversation with a healthcare provider about the postpartum period and maternal health rather than receiving such information in a pamphlet.

Caring for the Child/Children

All multiparous women were prepared for and expected challenges related to the newborn, but the majority noted that the challenge was having multiple children and splitting attention, especially when breastfeeding. Some primiparous women expressed a need for greater hands-on education and practice with infant care skills and assessing infant needs.

Positive Coping Strategies

In the Perinatal Maternal Health Promotion Model, positive coping strategies are defined as efforts to manage and overcome demands or experiences that pose a challenge or a threat of harm, loss, or benefit to a person (Fahey & Shenassa, 2013). Coping can occur in response to or in anticipation of demands or problems, such as the expectations and concerns expressed by mothers during the postpartum period. The most commonly described coping strategies enacted by participants were mobilizing social support, seeking information, participating in prenatal and postnatal classes, and gathering supplies for the new baby.

Preparation

The extent to which participants engaged in positive coping strategies was based on their levels of preparedness. All participants reported feeling prepared to have a new baby at home. Furthermore, all multiparous women felt prepared and equipped with the necessary information and skills in infant care due to prior experience with their other children and four primiparous women expressed similar feelings of preparedness due to experience working with or caring for infants. Most primiparous women, however, expressed feeling unprepared for the physical and emotional experiences in the first two weeks postpartum. Three primiparous women initially felt unprepared for motherhood because they did not know how to be a mother, but said they found that it came naturally.

Mobilization of Social Support

Nearly all participants mentioned the importance of having a support system in the first two weeks postpartum. Social support was mobilized to fulfill various needs such as emotional support and help with basic tasks around the house (i.e., preparing meals, doing laundry, running errands, and giving the mother a break). In addition, multiparous women expressed needs for help with managing their other children while primiparous women needed help managing the new infant and learning how to care for him/her. Not having social support was a main source of concern and frustration for those who felt like they did not have adequate levels of support.

Information Seeking

When asked to identify their sources of information during the postpartum period, the most frequently cited sources were maternity care providers, followed by prenatal classes, close family and friends, the internet or apps, and books.

DISCUSSION

The aim of this study was to identify mothers’ concerns and educational needs in the early postpartum period. The findings suggest that the first two weeks postpartum was a time of heightened concerns for both primiparous and multiparous participants. We found that postpartum maternal health and well-being are related to more than physical recovery and the absence of medical complications as most women in this study raised concerns about issues such as postpartum care, breastfeeding, and support. Previous studies show that higher rates of contact with health-care providers in the postpartum period, such as during a postpartum check-up, is a predictor of maternal needs being met (Almalik, 2017; Kearns et al., 2016). Thus, making time to explore and meet mothers’ needs more often during this time can enhance health-care providers’ abilities to provide appropriate care following childbirth and help reduce postpartum complications (Almalik, 2017).

Unmet expectations may influence a woman’s ability to adjust to transitions following childbirth. Additionally, previous studies show that women who feel unprepared for the postpartum period may be at increased risk for negative postpartum outcomes, such as depressive symptoms and physical limitations, which could impact their ability to provide infant care (Fahey & Shenassa, 2013; Logsdon et al., 2018; Weiss et al., 2009). We found that both primiparous and multiparous participants highlighted unmet expectations related to postpartum care, some wanting greater focus on their physical recovery and emotional well-being. These findings, consistent with other studies, suggest that meeting early maternal needs includes providing more information on maternal health and self-care, which can improve her ability to perform maternal tasks (Almalik, 2017; Gazmararian et al., 2014; Kanotra et al., 2007; Martin et al., 2014; Negron et al., 2013). This may include sharing additional information on postpartum self-care, nutrition, mental and emotional health, and garnering support.

Similar to previous studies, we found that feeding, particularly breastfeeding, is a source of major concern and an unmet educational need (Almalik, 2017; Coates et al., 2014; Gazmararian et al., 2014; Hjälmhult & Lomborg, 2012; Howell, 2010; Kanotra et al., 2007; Negron et al., 2013). Many mothers noted hands-on breastfeeding advice as most helpful and that more breastfeeding education during pregnancy might have enriched their feeding experiences. Lack of support in the early postpartum period is related to early termination of breastfeeding (Wagner et al., 2013).

An important component of maternal role attainment and becoming a mother is self-efficacy, defined as a mother’s belief in her ability to effectively complete maternal tasks (Fahey & Shenassa, 2013; Mercer, 2004; Rubin, 1984). This study confirms findings from past research on the roles of social support and previous experience in enhancing self-efficacy; levels of preparedness for a new infant varied according to parity, prior infant care experience, and level of social support (Fahey & Shenassa, 2013; Negron et al., 2013). Previous postpartum studies identify social support as vital due to its ability to reduce perceived levels of stress (Fahey & Shenassa, 2013; Negron et al., 2013). In this study, social support was associated with fewer concerns and higher levels of preparedness.

This study is not without limitations. The study population consisted mainly of White, well-educated, and higher-income individuals from one medical center, limiting the generalizability of our findings and the ability to discern variations between racial/ethnic groups. Different themes could emerge from a more demographically diverse sample. We were also unable to interview all eligible participants, which may have resulted in selection bias. However, efforts were made to reduce this bias by following up with up to three telephone calls before designating participants as lost to follow-up.

IMPLICATIONS FOR PRACTICE

Our findings indicate that maternal needs and concerns during this period are multifaceted, supporting the need for integration of postpartum education and care based on the Perinatal Maternal Health Promotion Model, described in Fahey and Shenassa, to better meet postpartum maternal needs (Fahey & Shenassa, 2013). This could perhaps be achieved through a more anticipatory, tailored, and mother-centered approach to prenatal education and postpartum care. Mothers often receive more extensive care, assessments, and education about their own health during pregnancy than postpartum, and alternatively, little about newborn care and breastfeeding prior to giving birth compared to the postpartum period. This imbalance, coupled with the challenge of meeting new lifestyle demands, can compromise the health and well-being of mothers and their infants (Lowe, 2018; Tully et al., 2017).

Improving the content, timing, and delivery of prenatal and postpartum education, particularly on navigating self-care, recovery, and breastfeeding can help mothers maintain realistic expectations and better prepare for this period. Past research suggests it may be unrealistic for mothers to retain information concerning infant care in the immediate postpartum period given increasingly shorter periods between childbirth and hospital discharge (Almalik, 2017; Hjälmhult & Lomborg, 2012). Yet, all participants identified maternity care providers as a main source of information during the postpartum period, so health-care providers are in an ideal position to initiate a conversation with mothers during pregnancy and follow-up through the postpartum period to assess individual needs and concerns and tailor education and support.

Despite the physical and emotional challenges mothers face during early postpartum, most women do not see a health-care provider before 6 weeks postpartum (Cornell et al., 2016; Tully et al., 2017; Verbiest et al., 2017). The World Health Organization (WHO) recommends mothers visit a health-care provider 2–3 days after discharge and again 4–6 weeks postpartum (WHO, 2015). Additionally, ACOG recommends women have contact with their obstetric providers within the first three weeks postpartum. Our results support these recommendations. Comprehensive postpartum care and assessing maternal concerns and needs before the standard six week check-up would be valuable for mothers’ overall health and well-being (Almalik, 2017; Fahey & Shenassa, 2013; Lowe, 2018; Tully et al., 2017; Verbiest et al., 2017). Interdisciplinary care and innovative care models such as phone follow-up within the first few days postpartum, telehealth visits, “centering” group visits, home visits, postpartum doulas, and peer support groups could help supplement early postpartum care.

CONCLUSIONS

Our study included both primiparous and multiparous women, unlike most of the previous literature on pregnancy and the postpartum period that has focused on primiparous mothers. Given that every pregnancy and postpartum experience is unique it is important to also explore these themes in multiparous women. Our findings build upon those from previous studies, providing insight into women’s concerns and educational needs in the early postpartum period. We found that these concerns and needs are multifaceted and vary by previous maternal experience. Our findings point to the need for different models of care with more anticipatory, mother-centered care to better meet mothers’ needs and enhance postpartum outcomes and breastfeeding success.

Biographies

CRISTALLE MADRAY earned a Bachelor of Arts Degree in Global Public Health and Bioethics from the University of Virginia and her Masters of Public Health from the University of Virginia School of Medicine. She was an intern with the Improving Pregnancy Outcomes Workgroup of the Virginia Department of Health and is now pursuing a degree in Physician Assistant Studies at Shenandoah University.

Dr. JEANITA W. RICHARDSON is a Professor in the Department of Public Health Sciences (PHS) at the University of Virginia School of Medicine and a Center for Global Health Distinguished Scholar, a Provost award. Dr. Richardson is recognized nation- ally for her expertise in designing effective strategies to enhance the health of children through public health partnerships with schools.

Dr. PAIGE HORNSBY directs Integrative Learning Experience projects in the University of Virginia (UVA) Master of Public Health program and is the primary academic advisor for students in the Global Public Health concentration of the Global Studies major. She is also a Fellow at UVA’s Center for Global Health and a member of the Improving Pregnancy Outcomes Work Group at the Thomas Jefferson Health District. She received her Bachelor of Arts in Human Biology from Stanford University and her PhD in Epidemiology from the University of North Carolina at Chapel Hill, and her primary research is in reproductive epidemiology and maternal and child health.

CASSANDRA GRELLO received her Bachelor of Arts in Human Biology and Spanish at the University of Virginia. She is now pursuing a medical degree at New York University.

EMILY DRAKE is a professor at the University of Virginia School of Nursing. She teaches courses in maternal-child health and has held a clinical position in Labor & Delivery for many years. Her special- ties include high-risk pregnancy, infant development, breastfeeding, and technology.

Dr. ANN KELLAMS a board-certified pediatrician and an internationally board-certified lactation consultant. She has been in general pediatrics since 1995 in both a private group practice setting as well as in academia at the University of Virginia. She serves as the Medical Director of the Newborn Nursery since 2006, and she is involved at the state level as the American Academy of Pediatrics Chapter Breastfeeding Coordinator and prior education chair and as a member of the State Breastfeeding Advisory Committee for the Virginia Department of Health.

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) received no specific grant or financial support for the research, authorship, and/or publication of this article.