Evaluation of a nurse-led postpartum self-care program for first-time mothers in Bangladesh

Abstract

Background: Postpartum complications fatigue, depression, and postpartum maternal malfunctioning is a public health problem. Nurse-led postpartum self-care is a new intervention in Bangladesh implemented for first-time mothers. Purpose: This study was aimed to test the effectiveness of nurse-led postpartum self-care intervention in reducing postpartum fatigue, depressive mood, and promoting postpartum maternal functioning. Methods: A non-synchronized design with pretest and post-test. Samples were 68 first-time postpartum mothers 34 in experiment and 34 in control group purposively selected from Dhaka Medical College Hospital, Bangladesh. There was attrition rate 23.5%, in follow-up at 2 weeks and 16.1% at 6 weeks. Measurements of this study were postpartum fatigue, depressive mood, postpartum maternal functioning, postpartum self-efficacy, self-care behavior, and postpartum self-care knowledge. Data were collected by face-to-face interview and mail and maintained confidentiality. Data were analyzed from 68 samples (34 Control & 34 Experimental) using by computer software IBM SPSS program version 21. Demographic data were analyzed by descriptive statistics, using frequency, percentage, mean, and standard deviation. Bivariate statistics- t-test, Chi-square were used to examine homogeneity of variances, and matched pair t- test, and Independent t-test were used to examine differences between groups. Advanced statistics linear mixed model was used to control covariates and test the efficacy of treatment. Results: In this study a high proportion of new mothers had depressive mood (≥ 13). After efficacy testing over time, findings showed that the nurse-led postpartum self-care intervention were statistically significant in decreasing postpartum fatigue (ß = -6.17; SE = 1.81; t = -3.39; p = < .01); and increasing maternal functioning at 6 weeks postpartum in the experimental group (ß = 13.72; SE = 3.67; t = 3.73; p = < .01) compared to control group. However, there were no statistically significant differences for postpartum depressive mood over time. Knowledge was also statistically significant for increased maternal functioning over time (ß = .37; SE = .18; t = 2.03; p =< .05) Conclusion: This study found that a nurse-led postpartum self-care intervention, focusing on strategies for increasing self-efficacy, was feasible and effective in improving fatigue and maternal functioning in new mothers by 6 weeks postpartum. PP care knowledge was effective in improved maternal functioning, and thus supports implementing the NL PPSC for new mothers following delivery. Further studies are needed to expand the NL PPSC in terms of intensity and/or frequency of contact, as well as consider follow up measurement for a longer period. Further exploratory and interventional studies are also needed on postpartum depression, and development of postpartum self-care instruments based on Bangladesh context.