Low income women‟s expectations, needs, and desires for social support in the postpartum period: a feasibility study.

Abstract

The postpartum period represents a significant transition in women's lives. This critical period of adjustment is characterized by physical, emotional and psychological stressors that impact women's experiences, adaptation and health and wellness. Common stressors in the puerperal period include: the transition to motherhood and associated role change and role stress; physical stressors such as hormonal fluctuations, altered sleep, and pain; and, psychological stressors including interpersonal relationship challenges, self esteem and self confidence issues, and postpartum depression (PPD). Social support has been identified as a factor contributing to women's experiences in the postpartum period (Beck, 2001; Dennis, 2003). Lack of social support is also a predictor of functional status problems in the puerperal period (McVeigh, 1997). There is a body of noteworthy literature examining the association between social support interventions provided by health professionals, and negative affect in the new mother (Armstrong, Fraser, Dadds et al., 1999; O'Hara, Stuart, Gorman, & Wenzel, 2000). Critical gaps in maternal support needs have been identified in the literature and indicate that high risk populations of women might benefit from targeted social support services and interventions (Armstrong, Fraser, Dadds et al., 1999; Dennis, 2003; Shaw, Levitt, Wong et al., 2006). The purpose of this feasibility study was to examine and describe low-income postpartum women's perceptions, expectations, and desires for social support and the feasibility and acceptability of a postpartum doula as a vehicle for social support services in the postpartum period. This study utilized focus groups, a social support survey and a socio-demographic survey for data collection. The final sample included a total of 30 participants. First, a pilot test with one participant was conducted to trial the focus group questions and user-friendliness of the social support and demographic surveys. This was followed by three focus groups: Group 1 with nine participants; Group 2 had fifteen participants; and Group 3 had five participants. Recruitment of participants was conducted by a community doula program in the Upper Midwest that has an established priority to serve low-income women.Four categories emerged during the content analysis process identifying types of support that were most important to participants in the postpartum period and areas where they experienced gaps in support: (1) Functional support; (2) Physical support; (3) Educational/Informational support; and, (4) Emotional support/Presence. The findings from the social support survey confirmed this information, as well as identified deficits in the availability of individuals within their support networks to provide much needed support. Participants in this study had experience with birth doulas and expressed interest in postpartum doula care as a desirable method for providing individualized support to meet their needs and to fill deficits in their existing support systems. The findings from both the focus group analysis and the social support survey reiterate the importance of a broader social support network in low-income postpartum women's lives. This study adds to the existing body of research by laying out the foundational pieces for designing an effective intervention targeted to meet postpartum women's expectations, needs, and desires for social support in the postpartum period. Furthermore, the information from this study provides those providing support to new mothers with necessary information to expand current practices in the maternity care model to include targeted postpartum doula support interventions that may ultimately influence maternal outcomes. Additional research is indicated in order to determine the effectiveness of targeted, individualized, in-home social support interventions for women in the postpartum period.