Women's postpartum concerns and midwives' reflection on postpartum care : Studies in Dar es Saalam, Tanzania

Abstract: Studies were conducted in Dar es Salaam, Tanzania to explore the postpartum concerns of mothers and midwives' views on their role in postpartum care. In the first study, 50 primiparas and 50 multiparas sorted cards in their homes two weeks after childbirth. The second study involved a cohort of primiparas in their homes one (n=110) and six weeks (n=83) after delivery. Mothers with a minimum of seven years primary education were sub-divided into two groups: interview then sorting cards (n=47) or sorting cards then interview (n=32). Women with less than seven years of primary education (n=31) were interviewed only. Focus group discussions and grounded theory methods were used in the third study on midwives' views. A total of 49 midwives participated. Primiparas categorized significantly more topics as worries than did multiparas for both baby-related topics, and topics about the mother herself. Both primiparas and multiparas expressed a similar number of family-related topics as worrisome. In the primipara's study, general trends of decreasing worry and increasing interest and confidence for factors related to the baby and to the mother herself were observed from one to six weeks. Trends of increasing worry and decreasing confidence among mothers were observed with respect to family relationships. Midwives also identified that first time and younger mothers need more professional as well as family and social support. Postpartum programmes that consider such issues are useful in addressing the specific needs of mothers. Mothers more often expressed worry and interest during the interview when they had sorted cards first. The order of data collection method did not influence the way women sorted cards. Eight categories emerged from the study of midwives' views: a) reflecting, b) getting ready, c) defining abilities, d) networking, e) integrating, f) balancing, g) dealing with reality, and h) caring. The core category was " becoming a good resource and support person for postpartum woman". The mediating factors were: a) structure and approach in maternal and child health services, b) midwives' knowledge, attitude and skills, c) informal sources of knowledge for parents, and d) cultural beliefs and practices. A theoretical framework was developed. Interventions for midwives should focus on the components of the theoretical framework.