Municipal postnatal healthcare : The perspectives of parents and nurses

Abstract

Background: Postnatal healthcare is a key component of the maternal, newborn and childcare continuum and contributes to improved health outcomes for women, babies and their families in the first six weeks after birth. The length of stay at hospital after giving birth has decreased steadily over the last 70 years, and today discharge within 24 hours after birth is not unusual. The responsibility for care during the initial postnatal period is thereby transferred from the hospital to the municipal postnatal healthcare services, the child’s father (or non-birthing parent) and other family members. Despite an increasing focus on the significance of the father and the family in relation to the mother and baby in the postnatal period, the body of knowledge related to how fathers, parental couples and public health nurses experience and perceive postnatal healthcare is scant. Caring science, with the caritative caring theory, and the theory of being with child and a caring fellowship were chosen as the theoretical perspectives for this thesis. Aims: The overall aim of the thesis was to explore and describe new parents’ experiences and to integrate and synthesise knowledge of nurses’ perspectives on municipal postnatal healthcare in three studies. A synthesis of how fathers, parents and nurses experience and perceive municipal postnatal healthcare was created. The research aims were the following: I) To describe new fathers’ expectations of and experiences with municipal postnatal healthcare services; II) To describe parents’ joint and individual experiences with public health nursing and child and family health centre services in the postnatal period; and III) To integrate and synthesise knowledge of nurses’ perspectives on municipal postnatal healthcare. Methods: This thesis has an explorative, descriptive and synthesising design, and a combination of a phenomenological and hermeneutic approach was used. The data in studies I and II was collected by using semi-structured couple and individual interviews with ten parental couples (ten mothers and ten fathers), while study III was a metaethnography of 13 qualitative studies. The data from the interviews was analysed according to Dahlberg, Dahlberg and Nyström’s reflective lifeworld research approach and the meta-ethnography followed the interpretative process as described by Noblit and Hare. The findings of the studies were synthesised and lifted to a higher level of abstraction to achieve the ambition of the thesis to strengthen the body of knowledge of public health nursing and contribute to the development of postnatal healthcare of the family. Results: Study I describes new fathers’ expectations of and experiences with municipal postnatal healthcare services. The essential meaning structure for the phenomenon is described as Going blindly into the women’s world, followed by four constituents elaborating the essence: Not knowing what to ask for, Feeling excluded, Seeking safety for the family and Longing for care. The fathers experienced a lack of knowledge about postnatal care and a feeling of being excluded by the public health nurse and child and family health centre services dominated, and the child and family health centre were perceived as “a women’s world”. Security was essential for the fathers, who highlighted the home visit as a good experience. The fathers also described a desire to be acknowledged and taken care of in the postnatal period. Study II described parents’ joint and individual experiences with public health nursing and child and family health centre services in the postnatal period. The essential meaning of the phenomenon is characterised by the parents as longing to be seen and confirmed as unique individuals and as a family by the PHN when learning to care for their baby. The meaning of the essence is further elaborated in the following four constituents: Feeling a bit skinless with an increased need for care, Missing a dialogue about parenthood and family, Home visit as a family experience on the parents’ premises and Mother is the messenger. An increased need for both professional and lay care became prominent in the postnatal period. At the same time, a perception of a missing family perspective became evident from the parents’ reflections relating to their encounters with the public health nurse, as the focus appeared to be directed mainly at mother and baby. The home visit was experienced by both parents as concrete care and attention, enabling the establishment of a relationship, which contributed to increased security. The parents experienced how the flow of information and contact solely took place between the mother and the public health nurse. Hence, the mother seemed to take the role as a messenger between the father and public health nurse. Study III integrated and synthesised qualitative studies that illuminated and described nurses’ perspectives on municipal postnatal healthcare. The overarching metaphor of Being a “warrior” to care for the new family was adopted, accompanied by the following three themes: Stretching human boundaries, Stretching system boundaries and Stretching knowledge boundaries. The themes reflect how nurses stretch different boundaries to achieve their goal to provide the best possible care during the postnatal period, while the overarching metaphor offers a deeper understanding of the nurses as “warriors” who were willing to go the extra mile for the new families. A model of the synthesis of the findings across the three studies illustrates postnatal healthcare as it is experienced from the fathers’, couples’, and nurses’ “world”. Conclusion: The findings reveal that becoming a mother or a father is an existential experience and a challenging transition for both parents. In a phase characterised by joy, upheaval and vulnerability, parents long to be cared for as a family, while learning to care for the baby. Even though parenting is seen as a joint project, the child and family health centre appears to be “a women’s world” from which fathers feel excluded, and it is the mother’s role to act as messenger between the father and the public health nurse. Both parents and nurses emphasise the home visit and the significance of the home environment in establishing a caring fellowship in the initial postnatal period. The home appears as “the family’s world” in which professional caring is experienced more on the family’s terms. Notwithstanding challenges linked to a large workload and scarcity of resources, nurses stretch their boundaries to care for the new family. Keywords: Postnatal period, postnatal healthcare, experiences, perspectives, parents, mothers, fathers, public health nursing, nursing, caring science, qualitative method, reflective lifeworld research, metaethnography.