Postpartum: Experiences paving way to better Metamorphoses
Introduction
Women undergo many physiological changes in their life which includes menarche, pregnancy (Antepartum, Intrapartum and Postpartum), breastfeeding time, and menopause. Each transition period is delicate and should be handled with utmost care. Postpartum is a period of renewal for the women and newer adaptive methods are required to regain and accept the changed roles as a mother.
Objectives
The objective of this study is to describe on the postpartum experiences of women in a rural area.
Method
It is a qualitative study done as a part of a larger study which analyzed quantitatively the postpartum morbidities and tool based postpartum quality of life.
Information was sought from 343 postpartum women in a rural area of Kerala. In addition to the morbidities collected objectively, they were encouraged to describe about their experiences during postpartum with an open ended question. Narratives received in regional language from 137 women were translated and analyzed. The content was coded inductively and organized into themes. Peer debriefing and negative case analysis was used for validation.
Results
Codes were organized into eight themes. Accordingly the inferences include: the physical and psychological concerns during postpartum evident and hidden components. Postpartum is considered a window of opportunity to redefine the women’s identity where the emotions head the preparations of physique and psyche to adapt to the new role. Societal role in women’s adaptation to make them inclusive needs to be re-examined. The experience of roving population of women reveals an emerging concern. There is a subset of mothers whose opinion differ from the emerging themes and was considered for validation.
Discussion
The eight themes are following and explained
Arrayed Morbidites
The common and evident morbidities during postpartum explained by the women received attention and management. There were many issues during pregnancy and postpartum which were considered as a concern to be looked after both by the mother and the doctor. For these concerns the mothers did seek doctor’s consultation and received the required attention.
Neglected Concerns of the mothers
In the postpartum, many concerns remain with the mothers such that they bear the suffering. Usually they neglect these problems unless they are probed. They may represent the tips of the icebergs for example constipation may point towards infected episiotomy wound or hypothyroidism, recurrent miscarriage may indicate hypothyroidism, impending Diabetes or an underlying ovarian/uterine/hormonal diseases.
There were many emotional aspects such as feeling of distancing from oneself and others which the mothers are not able to express themselves for which solutions are not readily available which is comparable to another study. (4)
Another study explained how some of the aspects like pain, wound complications and less mobility hindered physical recovery.(6) So these are some of the concerns which should be probed into and managed accordingly for helping the mothers get better adapted to the postpartum.(6)
Fighting all odds to regain the identity
The women, in spite of many problems they encountered, maintained their confidence to cope with the new identity and roles they have to perform. Even though the mothers are surrounded by numerous problems, they still take effort to adapt to the motherhood, resume their studies/work as well as regain their normal physiological functions.
One of the study explained that separating the newborn from the mother caused hindrance to the postpartum care (2), a situation explained in this study also, where the neonates are separated from the mothers for various reasons (jaundice, low birth weight, separation after Caesarean section).
Another comparable study explains how the mothers are submerged in distress caused by traumatic experiences during pregnancy and postpartum and has difficulty in overcoming it without support.(3)
It also explains the lactation difficulties the mothers face for which a complete solution is not available. But the mothers still want to work on the bonding as well as satisfy the nutritional needs of the baby.(3)
Disappearing Societal intervention
Diagnostic, treatment and procedural interventions are outrunning the conservative methods. The interventions are trying to resolve some of the problems encountered by the mothers but at the cost of neglecting simple, conservative management.
In addition, a mutually supportive scenario is slowly dissolving. The change from extended family system to nuclear family system and a lack of cohesive neighborhood is taking much toll on the speedy recovery of mothers both physically and mentally. Even the role of community networks in supporting and providing messages to the mothers is diminishing (1).
One of the study conducted in a developed country explains how the well-being of the mothers is compromised after child birth and there is a state of social isolation and disengagement with family which is comparable to the experiences of the mothers in this study.(4)
Motherhood for the Rovers
The experiences of the travelling and migrating mothers opened up a new set of problems for which the solutions have to be specific for them.
They are already in a state of lost identity. An understanding, supportive environment is required for them to receive even the basic amenities.
In the context of developed countries the expectations of the resident mothers regarding the postpartum service provided by the facilities are not met satisfactorily (4). An exaggerated situation of this scenario was existent for the migratory mothers.
Conclusion
An active awareness creation among the mothers regarding the common morbidities during postpartum which the mother is reluctant to reveal should be mandatory. Conservative management should be advised along with medical management. An integrated approach with other systems of medicine will help in smooth recovery. Discussions and experience-sharing among community networks and motherhood groups will help in better understanding of the possible forthcoming issues, help in preparedness to handle them and provide less hindrance to overcome the problems. A technology-based peer support group would be conducive in this period of social distancing (5)
Pre-pregnancy screening tests for common diseases and management of them (if any) will avoid pregnancy and post pregnancy morbidities.Nowadays, migration being a common phenomenon, there should be a system where the migratory mothers should be able to receive the adequate and inclusive pregnancy care.
Women are taking effort to regain themselves even in the midst of chaos. Unearthing conservative supports aids women and babies’ attempt to be included in the society. Societal role in supporting women in their endeavor has to be explored further.
References
1. NP K. Community Participation and Mobilization in Community-Based Maternal, Newborn and Child Health Programmes in Nepal. Journal of Nepal Health Resource Council. 2011;9(2):101-106.
2. Beake S. A qualitative study of the experiences and expectations of women receiving in-patient postnatal care in one English maternity unit. BioMed Central Pregnancy and Childbirth. 2010;10(70):1-9. Available from: http://www.biomedcentral.com/1471-2393/10/70/prepub
3. Coates R. Women’s experiences of postnatal distress: a qualitative study. BioMed Central Pregnancy and Childbirth. 2014 ;14:1-14. Available from: http://www.biomedcentral.com/1471-2393/14/359
4. Alderdice F. Exploring subjective wellbeing after birth: A qualitative deductive descriptive study. European Journal of Midwifery . 2019;5:1-8. Available from: https://doi.org/10.18332/ejm/104679
5. Shorey S. Evaluation of a Technology-Based Peer-Support Intervention Program for Preventing Postnatal Depression (Part 2): Qualitative Study. Journal of Medical Internet Search [Internet]. 2019 [cited 3 December 2020];21(8). Available from: http://www.jmir.org/2019/8/e12915/
6. L B. Recovery after childbirth: A qualitative study of postpartum women. Clinical Obstetrics, Gynecology and Reproductive Medicine. 2018;4(1):1-5.
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