Maternity Care Satisfaction, Birth Mode, and Depression Symptoms: A Mixed Methods Approach

<p dir="ltr"><b>Objectives</b></p><p dir="ltr">The quantitative objectives of the study were to determine whether postnatal care satisfaction ratings predict depression scores following childbirth, as well as to consider whether the relationship varies between different birth modes and outcome. The qualitative objectives sought to hear the lived experiences and perspectives of women, acting as the mechanisms at play behind the survey insights provided. As this is an area of research that has not yet been explored, the findings of this study provide a novel contribution to the evidence base.</p><p dir="ltr"><b>Design</b></p><p dir="ltr">The mixed method study examined care satisfaction and depression in postnatal women with questionnaire responses, as well as explored their voices and perspectives in semi-structured interviews. The quantitative data was then analysed using linear regression, moderator, and mediation analyses, and the qualitative data was analysed using thematic analysis. 103 women were recruited during their stay on a postnatal ward at a local NHS teaching hospital, and completed an anonymous survey, consisting of eligibility questions, the Women’s Views of Birth Postnatal Satisfaction Questionnaire (Smith, 2011), and the Edinburgh Postnatal Depression Scale (Cox et al., 1987). The interview questions were designed around the 13 dimensions of postnatal care that participants were asked about during the survey and a total of 13 interviews were conducted.</p><p dir="ltr"><b>Key Findings</b></p><p dir="ltr">Postnatal care satisfaction ratings were a significant predictor of depression scores. Neither birth type, tear type, or assisted vaginal delivery had a significant moderating effect on the relationship between postnatal care satisfaction ratings and depression scores. Similarly, none of the birth categories had a significant indirect effect on the relationship, which supports an overall conclusion that postnatal care satisfaction ratings predict depression scores, regardless of birth type.</p><p dir="ltr">Qualitative data analysis identified four themes, common across multiple birth type categories, with no themes limited to any one specific birth type. This highlights that the most prevalent issues identified by women did not change based on the type of birth mode or complication. The four themes were:</p><p dir="ltr">1. Unmet Needs and Missed Opportunities</p><p dir="ltr">2. Expectation versus Reality – An Issue of Congruence?</p><p dir="ltr">3. The Construction of a ‘Good’ Mother, Societal Pressures and Expectations –</p><p dir="ltr">4. The Obvious and Less- Obvious Existence of Paternalism, Patriarchy, and Medicalisation</p><p dir="ltr"><b>Conclusions and Implications for Practice</b></p><p dir="ltr">The four themes may be used as a starting point for reshaping the policy that informs practice, as well as identifying some of the prevalent attitudes and cultures that exist within postnatal care, and how women feel that these must change. From the quantitative perspective, it is also worth noting that birth type does not appear to hold as much bearing on women’s evaluations of their postnatal care experiences, compared to the more personable, emotional, and individualised aspects of care and support, which women deemed as lacking. The quantitative findings emphasise the importance of providing women with postnatal care that they are satisfied with, particularly as depression was higher among women with lower care satisfaction ratings.</p>