Which behavior would post partum woman demonstrate during taking in phase?

Demographic information of the participants

A total of 22 participants were recruited and interviewed. The women were between 22 to 43 years of age (mean = 31.75 ± 4.35 years old). Among them, 14 were first-time mothers and 8 were second-time mothers. They had lived in Shenzhen for 1 to 29 years (mean = 11.65 ± 6.68 years). More than half of the women (n = 12, 54.5%) reported having a monthly household income of between 10,001 to 30,000 RMB (US$1455 - $4366).

Thirteen out of the 22 (59.1%) women had a vaginal delivery. The women were taking an average of 183.33 ± 27.49 days of maternity leave. All of the women continued to breastfeed, with 9 (40.9%) breastfeeding exclusively and 13 (59.1%) breastfeeding partially at the 42nd day after giving birth. During the “doing the month” early postpartum period, which is a Chinese tradition, 4 (18.2%) were cared for by both their mother and their mother in-law, 10 (45.5%) by their mother-in-law with or without the aid of a “doing the month maid,” and 6 (27.3%) by their mother together with a “doing the month maid.” One woman hired a “doing the month maid” and one was cared for mainly by her husband. Of the mothers / mothers-in-law, 12 (54.5%) came from suburban areas of China, and 10 (45.5%) from urban areas (Tables 1).

Six main themes emerged from the analysis of the interview transcriptions. They were: “the self-care needs of women,” “proficiency in infant care,” “involvement of family in postpartum and infant care,” “family conflicts over postpartum and infant care,” “preparing for the transition to parenthood / grandparenthood,” and “the need for comprehensive postpartum home visit services” (Table 2).

Table 2 Summary of themes and categories from the findings

Full size table

The self-care needs of women

The women who were interviewed were concerned about their physical discomfort and recovery, and about the need to take nutritional supplements in the early postpartum period. While the first-time mothers were concerned about changes in their body, the second-time mothers believed that their physical health was worse than it had been after their first delivery.

Physical discomfort and recovery

In this early postpartum period, most women were concerned about the various forms of physical discomfort that they were experiencing after childbirth. These involved pain from wounds from a cesarean section / perineal tears, nipple soreness from breastfeeding, and injuries to their waist and wrists. Women were also concerned about the loss of elasticity in their pelvic floor muscles.

Due to perineal tears during delivery, women experienced indescribable feelings and pain. They wanted to know if their vaginal area was healing properly, and how to determine whether their lochia was normal. They were embarrassed to ask, but anxious about the physical changes that they were experiencing and about the healing process. They wished that someone would tell them how they were doing.

I am curious about my body, particularly my perineal healing and lochia discharges. I learned that it is normal for it to take as long as 30–40 days, but I am still nervous about some bloody lochia that I have discharged. (P19 – first-time mother).

They complained about the discomforts caused by childbirth, with pain coming from a cesarean wound or a perineal tear from a vaginal delivery.

I have discomfort from the cesarean wound on my tummy. When I bend over to wash my baby, it causes pain. I feel that I cannot stand straight at the waist / tummy after I had the cesarean section. (P6 – second-time mother).

While women enjoyed breastfeeding their baby, which gave them a wonderful feeling of motherhood, they also complained of sore nipples. Some women had cracked nipples and felt pain when breastfeeding, but felt too guilty to stop breastfeeding their baby. Women wanted to learn more about caring for their nipples.

Somehow, each time I feed the baby, she could not snatch on the nipples very well, and I felt pain. The skin on my nipples is breaking and bleeding. I am scared every time the baby sucks on my nipples. (P17 – first-time mother).

My baby boy is strong. He sucks intensely and powerfully, and both of my nipples are sore …. (P3 – first-time mother).

I had galactostasis, then acute mastitis. My inflamed breasts are painful … it’s torture. I will have to stop breastfeeding. (P21 – first-time mother).

Caring for and holding the baby also caused injuries to the waist and wrists of the new mothers. Women reported having waist and wrist pain from bending over and holding the baby when changing diapers or breastfeeding. As the baby got heavier, the pain worsened.

I have pain in my wrists. It is stiff and painful when I turn my hands. It is worse when I have to hold the baby in my arms, and hold my breast for feeding. (P3 – first-time mother).

She cries a lot, so I have to hold her in my arms. My waist is sore, and I hope I can get some rest if somebody else can hold her for a while. (P6 – second-time mother).

Some women worried about a loss of elasticity in their pelvic floor muscles, leading to urination incontinence. They had embarrassing moments when they felt an urgent need to urinate or experienced leakages when they sneezed. They heard stories about how pelvic floor muscles can be damaged during a vaginal birth, and now their urinary incontinence worried them. They wanted more information on whether their muscles would recover elasticity.

My pelvic floor muscles have not regained strength after delivery. I experience urgency and frequency of urination. I also experience leaks when I laugh. I am not sure if the muscles need to be repaired. My friend told me that she has been incontinent since giving birth a few years ago. I want to know if the injury to my pelvic floor is serious …. (P4 – first-time mother).

Besides the issues of physical discomfort and recovery, the women also described themselves as being “weak” from sweating. In Chinese, “sweat” is “xu,” which is similar to the English term for “weak.” The women believed that the process of giving birth made them weak in that they lost energy (“qi” in Chinese) in their body. They lost bodily strength from the exhausting process of going into labor, and also lost body fluids, experienced bleeding, wounds (breaks in their skin, which allows “qi” to escape), and pain. So they needed to recuperate to regain their strength, to meet the demands of caring for a baby.

I need to have a longer postpartum “doing-the-month” period to have a good rest. I need to recover and regain my strength so I can have the energy to take care of my baby …. (P11 – second-time mother).

Need for nutritional supplements

According to the Chinese culture, nutritional supplements are important in the postpartum recovery process. Women are considered “xu” (weak) after giving birth and are thought to require nutritional supplements to regain their strength, in order to balance the “ins” and “outs.” The belief is that if the “outs” from childbirth are not supplemented with appropriate and sufficient “ins” after delivery, women will not recover their pre-pregnancy state. The women expressed a need for nutritional supplements for a better recovery.

I did not like the food prepared by my mother. If economic conditions had permitted, I would have wanted to hire a “doing the month maid” to assist me by preparing nutritious and tasty “postpartum meals.” A “doing the month maid” will be more professional than my mother in cooking “postpartum meals” that will bring about a faster recovery. (P6 – second-time mother).

Apart from their need for nutrients to achieve a better recovery, the women believed that their physical health would affect the development of their baby.

I would like to eat more nutritious foods to produce better-quality breast milk for my baby. (P5 – first-time mother).

I want to have tonic foods to regain energy and avoid any comorbidities. Otherwise, I would not be able to take good care of my baby and provide her with nutritious breast milk. (P11 – second-time mother).

Proficiency in infant care

Surprisingly, not only the first-time mothers, but also the second-time mothers were concerned about their proficiency in caring for their infant. They were concerned about the baby’s feeding, elimination, skin rashes, and crying. The mothers were anxious about everything related to caring for their newborn baby.

Baby’s feeding

Mothers were concerned that they were not producing enough breast milk for their baby. Some would supplement their feeding with baby formula. In not knowing how to assess whether the baby was consuming enough, many used the baby’s weight gain as a reference.

My baby weighed 3.45 kg at birth, and she weighed only 100 g more on the 15th day. My sister-in-law suspects that I do not produce enough milk and said that I should feed my baby with formula. So I added formula to my feeding. (P4 – first-time mother).

Baby’s elimination

Besides feeding, the mothers also scrutinized their baby’s stool to determine the baby’s well-being. The women usually did not know what to look for, and were frightened at the appearance of the baby’s stool.

At the first few days after birth, I thought the baby was having diarrhea. I then became nervous. Then, there were times when, with his red face, he looked like he was straining to eliminate stool; I would get anxious again. (P12 – first-time mother).

Baby’s skin rashes

It was a nightmare for mothers to see skin rashes on a fragile baby. Women were frustrated with rashes that did not heal.

My baby has skin rashes that do not heal, and I was told he has eczema. I don’t know how to deal with it, but was told not to put ointment. It must be painful, and it hurt me to see the rashes. There are times when it gets a bit better, but I worry about recurrences. (P11 – second-time mother).

Baby’s crying

Babies cry when they are hungry, if their diaper is wet, or if they do not feel well. The women were confused about the crying, and became frustrated when they could not comfort the baby. When there was no way to stop the baby from crying, they would calm the baby by holding the baby in their arms.

I am very nervous when my baby cries; I don’t know what is really wrong with him. Then I begin to worry and feel like a fool. (P12 – first-time mother).

I would read books or surf the internet to find information on a baby’s cries. I wanted to know how to differentiate between the cries. (P20 – first-time mother).

I stayed up for three days …; she would fall asleep when she was sucking, then if I put her to bed she would start crying again. I would pick her up and hold her in my arms until she fell sleep again. I kept doing this all the time, until daylight. (P14 – second-time mother).

Involvement of the family in postpartum and infant care

Women were desperate to receive support from their husband and extended family members in postpartum and infant care. It was notable that first-time mothers made more requests to family members for support. Such support meant a lot to the mothers. They hoped that family members would help them care for their child, rather than be a burden on them.

Father’s support in child care

A few mothers complained that the baby’s father was not assuming any responsibility for caring for the baby. For the fathers, the baby was just like a doll to play with.

My husband will play with the baby, but as soon as the baby cries, he will quickly hand the child over to me. I hope he realizes his role as a father and provides me with childcare support. (P3 – first-time mother).

It was obvious that mothers were more satisfied if their husband shared the responsibility of caring for the baby. The attention and readiness of fathers to help meant a lot to the women. With their husband’s support, the women felt loved, supported, and protected.

My husband is great. He takes care of the baby after he returns from work. Our baby laughs when he plays with him, which he does not do with me. When the baby is hungry at night, he will get up and heat up milk from the refrigerator. He is good at helping and I am grateful. (P10 – first-time mother).

Support from grandmothers in child care

In Chinese traditional culture, parents, as extended family members, are involved in caring for their grandchild. The mother / mother-in-law of the women are eager to provide help in caring for the new mother and baby. The women usually felt more comfortable with their own mother, who understood them and whom they found easier to talk to.

Actually, I wanted to go to a “doing the month” maternity hotel, but my mother-in-law insisted that she would take care of me. Due to her traditional beliefs, she feels that she should help, since my husband is her only son. I would love to return to my parents’ home for postpartum support. It would be easier to talk to my own mother about my needs. My mother would be able to comfort me and provide me with psychological support. (P10 – first-time mother).

Some women considered themselves lucky to have both mothers work in harmony when helping them. Each of the mothers took up different responsibilities to provide the needed postpartum and infant care.

Both my mother and mother-in-law came to Shenzhen from their hometown after I gave birth to support me in “doing the month.” My mother cooks the nutritious food that I am used to. My mother-in-law does the cleaning or other necessary household chores, while I focus on caring for the baby. (P14 – second-time mother).

Family conflicts over postpartum and infant care

While some women appreciated the support that they received from their husband and mother / mother-in-law, not all could work together in harmony due to different postnatal care beliefs and childcare practices in different provinces in China. Both the first-time mothers and second-time mothers were concerned about the “old ways” of their mother / mother-in-law in infant care. Some families had disputes arising from different expectations.

Disagreements over nutritional supplements for postpartum women

Determining what a woman should eat that is good for recovery, lactation, and producing quality breast milk can be a hassle to families because rituals and food preferences differ in different provinces of China. What women should or should not eat can cause conflicts.

My mother-in-law from Hunan would not cook “postpartum pig-feet soup” for me. But where I came from, this dish is considered most beneficial for postpartum women. “Pig-feet, egg, and ginger soup” or “pork bones soup” are to replenish and rebalance the”qi” and rid the body of “wind”. But in Hunan province, postpartum women are forbidden to have soup; they think it is not good for the production of breast milk. She also told me not to eat vegetables or fruits, as she believes that those will cause “wind” and “cold,” which will lead to tummy aches and flatulence for my breastfed baby, or that I will suffer from chronic headaches for years to come. I could not understand their eating style. (P10 – first-time mother).

Conflicts over infant care practices

While the baby is the center of the whole family, each family member has his / her own approach to caring for the baby. Some young mothers secretly wish that the grandparents would not insist on following outdated baby care practices. There can be disagreements between the parents and the grandparents of the child over their respective childcare practices.

Putting too many clothes on the baby can be a problem leading to disagreements between me and my mother-in-law. I told her that she puts too many pieces of clothing on the baby, which could suffocate her, but my mother-in-law insisted. It is not cold here in Shenzhen, and one piece of clothing is enough, but my mother-in-law insists on wrapping up my baby with big blanket. I usually remove the blanket secretly when she is not looking. (P22 – first-time mother).

I do not feel at ease and cannot sleep well when my mother-in-law has the baby with her. I don’t know what she would do for the baby that I don’t agree with. (P14 –second-time mother).

Arguments in multigenerational families

The women appreciate the good intentions of their husband and members of their extended family in trying to help them and the newborn. However, the older generation’s “traditional” ways of caring for the baby may not be what women want. The women therefore sought to achieve mutual understanding of their needs and preferences from their husband and the older generation.

I believe my mother-in-law has good intentions. But her traditional belief of what is best for me is not necessary what I want. It was not easy for me to take at the beginning. I now accept it, although I am not used to it. (P19 – first-time mother).

Both my mother and mother-in-law came to take care of me during the first month. My mother is from the village, but my mother-in-law has lived in the city for a long time. They could not get along. My mother-in-law insisted that I should not eat chicken, but my mother argued that it is best for me and my breast milk. I listened to my mother and ate chicken, then my husband pitched in and said that only rooster is acceptable. The three kept arguing over the issue. I felt exhausted, and finally stopped eating the chicken that my mother had brought from the village. (P6 – second-time mother).

Preparing for the transition to parenthood / grandparenthood

The first-time mothers expressed a need to be better prepared for the newborn, while the second-time mothers had no such concern. The women believed that health professionals could help them to make a better transition to parenthood and achieve better intergenerational family relationships.

Making arrangements before the arrival of the newborn

The new mothers believed that, apart from baby care, the antenatal classes should also have taught her and her husband some parenting skills to prepare them for their new role.

I would have liked to learn more about baby care before the baby’s arrival. Hospitals should provide teaching and learning materials for expectant new parents. It would help new parents to be more assured about their new role. (P5 – first-time mother).

Offer husbands advice on how to support new mothers

The women also hoped that nurses would teach their husband skills on postpartum support and baby care. They feel that teaching their husband how to provide emotional support would be of help to them.

I have worries during pregnancy and in the postpartum period, but my husband is not aware of it. It’s difficult for me to tell him of my feelings and unstable moods. It would be great if the nurses could tell him about my psychological changes, and what he can do to support me. (P18 – second-time mother).

My husband has not even asked me about my childbirth experience as if nothing had happened. He does not see that I really need his support and care. I would say that he does not know my sufferings and the impacts on me. (P16 – first-time mother).

Offer grandparents support in baby care

New mothers wished that nurses could offer grandparents advice on postpartum and baby care knowledge and skills to lessen their tension.

I wish someone would tell my mother that her approach to baby care is outdated. While I don’t want to upset my mother, I wish she would do things that I am comfortable with. I hope the nurses can offer some new baby care skills to my mother. (P3 – first-time mother).

The old generation has their set of beliefs. They said that the newborn’s lanugo should be shaved, which I don’t agree with. They want to shave her eyebrows, too. I was shocked to hear that. My parents-in-law keep chasing after me for what they think is right. I have had to say no. Are there any nurses who would help me to explain this to them? (P10 – first-time mother).

Facilitate intergenerational communication

Many of the women wished that nurses would give advice or training to their mother / mother-in-law on postpartum and baby care. The women stated that their requests were not always understood by their family members and that they were consequently not given the support that they needed. They believed that advice from health professionals would carry some weight with their family members.

My mother-in-law would do things her way and tell me this was in accordance with her experiences. It would be great if nurses would tell my mother-in-law that her approach to baby care is outdated …. I think it is necessary for “a third person,” especially a professional, to talk with the old generation. (P10 – first-time mother).

The need for coordinated and comprehensive postpartum home visit services

While most women welcomed the postpartum home visits, they suggested that it would be better to have a more comprehensive postpartum care program that catered to their needs. There were no differences in expectations regarding home visit services between the first and second-time mothers.

Appreciative of the attention paid by home visit nurses to the psychological well-being of new mothers

The women appreciated the warm and continuous care shown by the home visit nurses, instead of “task-oriented” fragmented care.

I really appreciate the “humanistic care” from home visit nurses. It is good to feel cared for. (P3 – first-time mother).

I think highly of the home visit nurses. They value the feelings of each new mother. For example, after I told them about my concerns when they visited, they sent WeChat messages to check up on me, and asked me if my concerns had been solved. (P17 – first-time mother).

Request for an online support program

While most of the women considered home visits by nurses to be helpful, they wanted to have access to advice whenever they needed it. These women suggested that internet-based or hotline phone support should be offered to allow for the timely receipt of information from health professionals.

Sometimes I have queries about baby care that I need answers to right away. If there is a platform that allowed us to ask questions, I would be able to receive instant answers from a health professional and be reassured. (P18 – second-time mother).

Provide home tests for jaundice

The women also suggested that tests for jaundice be included in the home visits, so that they would not have to bring their baby to the clinic for an examination, because it is a Chinese cultural belief that women and babies should not go outdoors during the first postpartum month.

It would be ideal if jaundice testing could be done at home so that I wouldn’t have to make a trip to the clinic. It is not advisable for me or the baby to go out in the first month. It is not easy for us to go outdoors, and I am afraid that we both will catch germs. (P6 – second-time mother).

Provide support for breastfeeding during home visits

Difficulty in breastfeeding was a common problem for the new mothers. The women requested that a breastfeeding consultant visit them at home. Women had sought breastfeeding consultations, since the service is not available in postpartum home visits.

It would be great if a home visit nurse could offer breastfeeding consultations. I have galactostasis, and wish that the home visit nurse would be able to offer advice and help. (P3 – first-time mother).

I had a breastfeeding consultant visit me as a home visit nurse. She provided me with much knowledge and skills to enhance lactation, and also psychological counseling. (P10 – first-time mother).

One of my major concerns was my insufficient breast milk; I hope that health professionals can give me suggestions [on how to solve this problem]. (P14 – second-time mother).

Which behavior would the postpartum woman demonstrate during the taking in phase?

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