Social Support Received by Postpartum Mothers in Indonesia:

A Descriptive Phenomenological Study

Maidaliza

Asniar

and Suryane Sulistiana Susanti



Master Program of Nursing Science Faculty of Nursing, Syiah Kuala University, Banda Aceh, Indonesia

Department of Community Health Nursing, Faculty of Nursing, Syiah Kuala University Banda Aceh, Indonesia

Department of Family Health Nursing, Syiah Kuala University Banda Aceh, Indonesia

Keywords: Phenomenology, Postpartum Mother, Social Support, Indonesia.

Abstract: Postpartum is a critical period for both mothers and their newborn babies, particularly during the first week

after birth. This situation relates to the changes they experienced, such as physical and psychological

changes, as well as their previous experience of pregnancy and childbirth. Therefore, mothers need social

support from their husbands, families and significant others during this period. This study explored the

experiences of postpartum mothers in receiving social support during their postpartum period. This

qualitative study employed descriptive phenomenological design and involved eight postpartum mothers

living in Bukittinggi as key participants. In-depth interviews and field notes were applied as data collection

methods. Data analysis was conducted using Colaizzi technique. This study emerged three themes: (1)

information support as new experience and knowledge, (2) emotional support giving comfort and affection,

and (3) self-reinforcement obtained with instrumental support. The findings show the type of social support

received by the postpartum mothers which might reduce their physical and psychological burden during

their postpartum period. The findings emphasise the need of social support among postpartum mothers,

which its fulfillment should be facilitated by the health care providers during this critical period of

postpartum.

1 INTRODUCTION

The postpartum period begins immediately after the

baby is born until the reproductive organs return to a

non-pregnant state within six weeks (Bobak,

Lowdermilk, & Jensen, 2005). Most mothers are

usually experienced fatigue during this period,

which affects daily functioning, mental health, and

childcare practices (Dunning, Seymour, Cooklin, &

Giallo, 2013). The birth of a child causes a

fundamental challenge to the interaction of the

family that has been formed. The observations of

how families perform routine daily activities

indicate how well families can accept their changes

(Reeder et al, 2014). Within this condition social

support is needed for the mothers, since it is very

important in supporting mothers to care for and

integrating babies in the family (Ricci, 2013).

According to Dzubaty (2016) family-centered

care includes the involvement of all family members

who participate in caring for mothers and their

newborns. Previous research indicated that parents

need practical support, monitoring and care which

important for the health and well-being of mothers

and children. Integrated care services including

professional home visits can help meeting the needs

of the family (Kurth et al., 2016). This study aims to

investigate social support for mothers during the

postpartum period.

2 METHODS

This study uses a descriptive phenomenological

design. Descriptive phenomenology stimulates

researchers' perceptions of life experiences while

emphasizing the breadth and depth that aim for

maximum intuitive presentation (Streubert &

Carpenter, 1999).

The study was conducted in Bukittinggi district

of West Sumatera, Indonesia from December 2017

to May 2018. The research ethics obtained from

Andalas University, Padang, West Sumatera. It was

conducted by observing ethical principles in

Maidaliza, ., Asniar, . and Susanti, S.

Social Support Received by Postpartum Mothers in Indonesia: A Descriptive Phenomenological Study.

DOI: 10.5220/0008396500002442

In Proceedings of the Aceh International Nursing Conference (AINC 2018), pages 205-210

ISBN: 978-989-758-413-8

205

research. The researchers refer to the five principles

of Human Rights That Require Protection in

Research issued by the American Nurses

Association (ANA, 1985 in Burns & Grove, 2005)

as a form of ethical consideration

Participants in this study were postpartum

mothers who had been given postpartum visits by

the health workers in Bukittinggi Health Centre. The

participants were selected by purposive sampling

technique, based on the criteria that are considered

representing the research sample (Burns, 2005). The

recruitment of participants was carried out by

identifying prospective participants through the

responsible person for the Maternal and Child

Health program in Bukittinggi health center. The

researcher contacted prospective participants,

explained the purpose of the study, and asked the

agreed participants to sign the informed consent,

prior carrying out the in-depth interviews with each

participant. The interviews were transcribed,

encoded and analyzed by using Colaizzi technique.

Furthermore, the researcher had discussions in order

to confirm the research themes.

The interviews were conducted by utilizing a

voice recorder (MP4), interview guidelines and

notebook to record things observed during the

interview process. In addition, the researcher also

used the respondent's demographic form in order to

get participants' basic data. Data analysis in this

study uses techniques from Colaizzi (1978 in

Streubert & Carpenter, 1999). The interview

transcribed in verbatim from and grouped the

keywords in the form of coding. All the codes then

formed into sub-themes and grouped into themes

and produced categories. The study obtained three

themes, namely information support, emotional

support, and instrumental support.

3 FINDINGS

There were three themes emerged from the study.

The first theme is information support as new

experience and knowledge, second theme is

emotional support giving comfort and affection and

the last theme is self-reinforcement obtained with

instrumental supports.

3.1 Information Support as New

Experience and Knowledge

Information support is an explanation to overcome

problems that are being experienced, Information

support was obtained by participants from the health

workers and community health workers (cadres).

Information support is very beneficial for

participants, since it enables them having new

experiences, knowledge, insights and skills. The

information obtained by the participants mostly

about, maternal nutrition, breastfeeding, and caring

for the baby.

The counseling always delivers the same

information... like what to eat during this

period...about nutrition… Don't reduce our

food intake, how to breastfeed and its

knowledge (breast milk) (P4)

In addition to nutrition, other participants also

obtained information about breastfeeding techniques

and the care of the baby.

She (the health worker) explained about how

to breastfeed the baby. Even though it’s the

same information she has been delivered, she

still explained it. She said ‘If you want to

breastfeed your baby, clean the nipple first’

she said ... Just the information about the

breastfeeding really... Oh…She also

explained about how to bath the baby... (P5)

The nipple must be clean before breast-

feeding the baby, first clean it she said...

When breastfeeding the baby, (make sure) the

nipple is clean, then (make sure) all of them

(the area of nipple) covered by the baby’s

mouth... (When breastfeed the baby) make

sure his (the baby) body is straight…She (the

health worker) explained: ‘the baby’s body

should be straight... not in bending posistion,

if he (the baby) bend, the baby is not feeling

comfortable, lean him against the shoulder,

pat him on the back until he is belching’. (P6)

The same thing also expressed by participants

two, three and five, where the information conveyed

related to maternal hygiene.

Mmm…She (health worker) explained about

ASI (breastmilk) as supporting food... what

else (eyes glance over right), mmm… (she

also explained) about personal hygiene

(While pointing to the body), for example I

should often replace the maternal pads...

Ensure the cleanliness; it’s all about personal

hygiene.... (P2).

I usually replace the bandages at seven

o'clock and change it frequently (P3)

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She (the health worker) said we must be

clean before carrying the baby…we must

wash our hands first, when holding the the

baby make sure ourselves are clean, we

should wash our hands first (P5)

Information support is also obtained from the

health cadres (community health workers).

Cadres reminded us to eat lots of vegetables

to swift the milk production. Drinking plenty

of warm water, so that breast milk is not

cold.... Do not work too hard, reduce the

activities outside the house, because we have

just given birth. (P6)

Only at that time she (cadres) suggested to

drink the warm water…. Eat lots of

vegetables and to drink lots of water (P7)

3.2 Emotional Support Providing

Comfort and Affection

Emotional support is an attitude by giving attention,

listening, understanding and believing on the feeling

of others. Emotional support obtained during the

postpartum period is very beneficial for the mothers.

Participants would be very pleased and feel cared for

by their families. Husbands and families expressed

their care for the mothers by providing attention and

fulfil the mothers’ need of relaxation.

The most frequent one is the health staff told

me to have enough rest…to have enough

sleep also to eat more fruits. (P2)

At the beginning he (husband) was there to

observe me bathing the baby... since then he

had been bathing our baby at least once in a

week. (P3)

Yesterday my husband said to me not to think

about the problem too much....I could get

sick. (P7).

3.3 Self-reinforcement Obtained with

Instrumental Supports

Instrumental support is direct assistance in the form

of facilities and materials provided by the husbands,

parents and close relatives. Participants received

immediate assistance from their families in meeting

their needs, self-care, baby care and even temporary

role taking. The results of this study revealed that

during the postpartum period many participants

received support from the surrounding people, such

as husbands, parents and other family members.

Their support is provided in order to meeting the

needs of mothers, supporting the care and other

domestic works. Family involvement in providing

support to participants becomes a physical and

mental strengthening for participants in undergoing

the postpartum period. Participants would not be

feeling only contented and cared for, but also

allowing them to enjoy their time. Participants

mentioned that support was obtained from husbands,

parents, children and other family members during

the postpartum period.

I’ve got enough support ... from my mother

also from my husband... (P1)

In terms of support, I’ve got help from my

mother, grandmother and my brother as well

who are caring for us... and sometimes my

husband (P2)

I’ve got so much support from my father…he

always ensure I am doing fine (P6)

I’ve got help... from my mother in law ... she

helps me doing household and care for the

baby (P8)

Assistance and support are varies among the

participants. Most of them said that the husband and

family members help them in caring for the baby,

meeting the needs of the mothers and housework.

If the baby urinates at night my mother helps

me to replace her (the baby) diaper, I was

awakened just to breastfeed the baby. It is

nice to have support especialy from the

family members. (P7)

(The family members) helps me to bath him

(the baby), replace his diapers, and swap the

powder (P4)

Other participants also mentioned about

receiving supports. They delivered assistance in the

form of fulfilling maternal needs and care during the

postpartum period.

They (family members)... helped me to bath

the baby, prepare the meals for

us…sometimes twice a week the

grandmother helps me to cook the meal at

home, (and helping) in bathing the baby...

also one or twice a week my husband

Social Support Received by Postpartum Mothers in Indonesia: A Descriptive Phenomenological Study

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shopped (groceries)... ...(buy some) fruits,

buying the milk, honey and other groceries.

(P2)

At the beginning he (husband) still observed

me (bathing the baby), since then he had been

helping me to bath the baby every twice or

three times a week (P3)

All participants also said that during the

postpartum period the assistance obtained was not

only a matter of caring for the baby and herself

(mother), but the family also helped them in their

domestic work.

The household all handled by my family...

such as cleaning the house, washing, ironing,

all the homework…except cooking, I still

prepare the meal. (P3)

Yes... he (husbands) helps me in doing any

household that he can do... for example doing

the laundry and washing the dishes. (P5)

My husband helps me in washing the dishes,

and cooking... Sometimes he also helps me in

bathing the other kids and doing the laundry.

(P6)

4 DISCUSSION

The results of the study have identified three themes

firstly the information support as new experiences

and knowledge. Secondly, emotional support

providing a sense of comfort and affection. Thirdly,

self-reinforcement obtained with instrumental

support.

The study identified that all participants obtained

support information from health workers both in the

clinic and during postpartum visits at home.

According to Bobak et al., (2005) postpartum health

information is provided from the moment the mother

is hospitalized and shortly before the mother is

discharged from the hospital. The information

provided includes comfort, rest, ambulation,

physical exercise, breastfeeding and defecation. The

support information obtained by the participants

involved the needs of nutrition, fluids, caring of the

baby, also rest and activity. In accordance with the

research findings of Hetherington, McDonald,

Williamson, Patten, and Tough (2018) mentioned

that information and emotional supports is the most

important type of support for postpartum anxiety

problems.

Participants also revealed that the information

provided positive impact for the mother, where they

gained knowledge on maternal health care and

experiences. Nurses and midwives need to be aware

and acknowledge the significant contribution of

social support especially from family and friends in

order to positively affect maternal health during the

postpartum period (Leahy, McCarthy, & Corcoran,

2011). Mangwi et al., (2015) mentioned the

information that was obtained during postpartum

period reducing the cost of access of the treatment

and referral procedure. Whereas Arifeen et al.

(2010) indicated that providing consoling during

visits could significantly reduce the prevalence of

breastfeeding and bonding problems. In line with

Clark's (2016) research where emotional support is

considered as effective support for early initiation

and duration of breastfeeding. In contrast with the

study of Barimani, Oxelmark, Johansson, and

Hylander (2015) states that mothers feel lack of

information about the difficulties that occurred

during postpartum.

This study indicated that the information

provided during postpartum period can improve the

knowledge and skills of the mothers, thus they have

more confident during the treatment and undertaking

action when the problems occurred during the

postpartum period. Therefore, the risks and

challenges during this period can be minimized. The

results also revealed that the information obtained by

the participants mainly related to nutrition. In

accordance with the research of Falciglia, Piazza,

Ritcher, Reinerman, and Lee (2014) states that the

period after giving birth is a perfect time for dietary

measures where nutritional education is considered

very important as additional intervention after the

childbirth. Extensive information coverage of

postpartum maternal diet education must be

improved through mass media and nutritional

information needs can be met through appropriate

counselling (Mahmoud et al., 2014).

According to Peate and Hamilton (2008) being

emotional is the main vulnerable stage in women's

lives. In this study participants received emotional

support from their husbands and families in the form

of assistance in solving problems experienced during

the postpartum period. Coates, Ayers, and Visser

(2014) in their study stated that there was an

increasing needs in women for the emotional support

and practice from their spouses and close relatives

and had desire to share experiences with others who

had the same conditions.

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Gao, Sun, and Chan (2013) in his research stated

that social support obtained positively collaborated

with parenting self-efficacy and emotional support

mostly influent in reducing the risk of postpartum

depression (Koblinsky, 2005). Leahy et.al (2011)

also explained that nurses and midwives need to be

aware and recognize the significant contributions

from social support, especially family and friends,

whom positively affect postpartum maternal health

and mental well-being.

Zhang and Jin (2016) stated that postpartum

expression not only affects the mother’s health

condition but also causes barriers between the

relationships among mothers and have a negative

impact on the mental development of infants.

Therefore, social support is needed to prevent the

occurrence of postpartum depression.

The study concluded that the emotional support

provided by the significant others have a positive

impact on the psychological health of the mothers.

The mothers would not feeling alone and have a

place to share in addressing the problems that occur

during the postpartum period. As a health worker, it

is important to understand the emotional support and

the needs of the mother in order to provide effective

emotional support. This support will provide caring

and increase the mothers’ self-confidences in the

care of them-selves and their babies. The health

worker needs to consider the mother's emotional

state and whether the family provides support during

the postpartum period.

According to Howell, et al. (2014) instrumental

support plays important role in meeting the basic

needs of mothers during the postpartum period. In

this study, various participants obtained mental

support from their husbands and family members, in

terms of supporting care and meeting the needs of

the mother, the care and household during

postpartum period.

Peate and Hamilton (2008) mentioned that every

mother feels tired at the beginning after giving birth,

making her very dependent and unable to carry out

the role. In this situation assistance or support by a

partner is very meaningful, ranging from clothing

preparation to the cleanliness of the home

environment. Mbekenga, Pembe, Christensson, Darj,

and Olsson (2011) stated that, after giving birth the

first thing the mother needed was support both in the

care of the baby, selfcare and some domestic works.

The study concluded that the initial needs of

postpartum mothers are instrumental support, where

such support can be provided by their husbands,

family members, relatives and their next of kin. The

expected support starts from the mother’s self-care

also, meeting the baby's needs and care. With this

support, the mother can recover from the physical

and, psychological conditions that she experienced

during the postpartum period, thus the mother could

provide the total care for her baby. The health

worker must understand and provide explanation to

the family about the dependence of the mother on

instrumental support during the postpartum period.

By understanding these conditions both health

workers and families can provide maximum support

during the postpartum period.

5 CONCLUSIONS

This study identifies social support received by the

participants during the postpartum period. This

support provided from, both their husbands, family

members and the health workers. The support

obtained during postpartum period is information,

emotional and instrumental support. These supports

have a positive impact on the mothers, where they

feel cared for, loved and could increase the quality

of the breastfeeding process. For the health workers

who conduct postpartum visits should certainly

understand the need of social support during that

period, also providing education and explanation to

husband and family members in order to meet the

need to improve maternal and infant health during

the postpartum period. For the researchers, the

results of this study could inform and increase the

knowledge about social support obtained by the

mothers during the postpartum period. Social

support for husbands and, children with the new

family presence could be explored for further

research

ACKNOWLEDGEMENT

The researchers would like to thank the ethics

committee of Postgraduate Nursing Program, Andalas

University West Sumatera, Bukittinggi City and

Political and Unity Office (KESBANGPOL),

Bukittinggi City Health Office and Health Centre for

the support given during the data collection. The

researchers also expressed their gratitude to all

participants, especially postpartum mothers and their

family members who had been willing to take part in

the study. Lastly to STIKes Perintis Padang for the

support in order to complete this study.

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