Abstract
Background: Effective postnatal care can support a safe and confident transition to parenthood, but it is the aspect of maternity care with which women in England are least satisfied. Little is known about first time mothers’ expectations of postnatal care in hospitals, in birth centres and in the community, or how these expectations relate to their subsequent experiences and appraisal of care.Methods: A longitudinal qualitative descriptive study, based on semi-structured, in-depth interviews with first time mothers in England. Each mother took part in two interviews: the first in her third trimester of pregnancy, and the second when her baby was 2-3 months old. Interview transcripts were analysed using trajectory analysis to identify thematic patterns in the relationships between postnatal care expectations, needs, experiences and confidence. Individual cases were chosen to illustrate each trajectory and the variation within trajectories.Results: 32 women took part. Expectations of postnatal care did not shape their appraisal of care as actually experienced. Instead the main influence on satisfaction with care and self-described parental confidence was the extent to which their actual postnatal needs for support were met. Five trajectories were identified: (1) ‘Low needs, low support, confident’, (2) ‘High needs, high support, confident’, (3) ‘High needs, low support, not confident’, (4) ‘High needs, high support, additional risk factors, not confident’, (5) ‘High needs, low support, additional protective factors, confident’.Conclusions: Longitudinal qualitative research using trajectory analysis is a useful and feasible method of exploring expectations and subsequent experiences in the perinatal period. First time mothers’ satisfaction with postnatal care and their confidence as new mothers were primarily influenced not by the extent to which their expectations were met, but the varied extent to which their postnatal needs were met. Rapid and responsive assessment of needs both antenatally and postnatally, and appropriate adjustment of care, is key in supporting women effectively at this time. Providing tailored information on postnatal care, self-care and transition to parenthood during pregnancy may facilitate improvements in women’s experiences of care after birth in the hospital and community.
First-Time Mothers’ Expectations and Experiences of Postnatal Care in England
