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Concerns of mothers in the first month postpartum Tobert, Sharon R. 1986

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CONCERNS OF MOTHERS IN THE F I R S T MONTH POSTPARTUM  by  SHARON R. TOBERT B.S.N., The U n i v e r s i t y  Of B r i t i s h  Columbia,  1978  A THESIS SUBMITTED IN PARTIAL FULFILMENT OF THE  REQUIREMENTS FOR THE DEGREE OF MASTER OF ARTS in  THE Department  FACULTY OF GRADUATE STUDIES  o f A d m i n i s t r a t i v e , A d u l t And H i g h e r  We a c c e p t to  THE  this  thesis  the r e q u i r e d  as  conforming  standard  UNIVERSITY OF B R I T I S H COLUMBIA October  ©  1986  S h a r o n R. T o b e r t ,  1986  Education  In p r e s e n t i n g  this thesis  in partial  f u l f i l m e n t of the  r e q u i r e m e n t s f o r an a d v a n c e d d e g r e e a t t h e U n i v e r s i t y of  British  Columbia,  it  freely available  I agree that f o r reference  agree t h a t p e r m i s s i o n for  the Library  shall  and study.  I further  f o r extensive copying o f t h i s  thesis  s c h o l a r l y p u r p o s e s may be g r a n t e d by t h e h e a d o f my  d e p a r t m e n t o r by h i s o r h e r r e p r e s e n t a t i v e s . understood that for  make  copying or p u b l i c a t i o n  f i n a n c i a l gain  shall  It is  of this  thesis  n o t be a l l o w e d w i t h o u t my  written  permission.  f\cjrf)ir\ijira-rio(  AdmH  The U n i v e r s i t y o f B r i t i s h 1956 Main Mall V a n c o u v e r , Canada V6T 1Y3  Columbia  Department  Date  E-6  (3/81)  O'Q  of  -/O-jH  )  CMMA  MtjKer-  Edueafiov  ii  ABSTRACT Program planning for postpartum mothers requires knowledge of t h e e f f e c t s o f p a r i t y and t i m e s i n c e d i s c h a r g e on the mothers' p e r c e p t i o n s of t h e i r level of concern regarding self, baby, partner and f a m i l y . I t was f o r t h i s pupose t h a t t h i s d e s c r i p t i v e c o r r e l a t i o n a l s t u d y was c o n d u c t e d . Thirty-one primiparas and thirty-six multiparas c o m p l e t e d a 51 i t e m m a t e r n a l c o n c e r n s q u e s t i o n n a i r e d u r i n g t h e i r first two days a f t e r d i s c h a r g e f r o m h o s p i t a l and a g a i n a t one month after discharge. Nonparametric tests were used to determine any s i g n i f i c a n t d i f f e r e n c e i n i n t e n s i t y and f r e q u e n c y of c o n c e r n between t h e two g r o u p s o f m o t h e r s and between t h e two time measures. The d i f f e r e n c e i n i n t e n s i t y o f c o n c e r n between the g r o u p s was not f o u n d t o be s i g n i f i c a n t f o r t h e t o t a l c o n c e r n s either time period. T h e r e were however, i n d i v i d u a l a r e a s w h i c h one g r o u p had significantly greater concern than other. A significant d i f f e r e n c e was the t o t a l concerns between the two p r i m i p a r a s and m u l t i p a r a s .  two at in the  found i n the i n t e n s i t y of time measures for both  The r e s u l t s d e m o n s t r a t e a need f o r s u p p o r t i v e - e d u c a t i v e p r o g r a m s f o r b o t h p r i m i p a r a s and m u l t i p a r a s i n t h e first month postpartum. They also i d e n t i f y s p e c i f i c a r e a s of concern i n w h i c h t h e f o c u s o f t h e i n t e r v e n t i o n s may d i f f e r for these two groups of mothers.  TABLE OF CONTENTS ABSTRACT i i L I S T OF TABLES v L I S T OF FIGURES v i i ACKNOWLEDGEMENTS viii Chapter 1 : I n t r o d u c t i o n t o Problem 1 Problem 5 D e f i n i t i o n s o f Terms 8 Purpose 9 C h a p t e r 2: Review o f t h e L i t e r a t u r e 10 Introduction 10 C h a r a c t e r i s t i c s and Tasks of t h e Puerperium 11 A s s e s s m e n t o f C l i e n t Needs i n Program P l a n n i n g 21 Concerns of P o s t n a t a l Mothers 25 Research Regarding Concerns of Primiparas 25 S u r v e y s o f C o n c e r n s o f P r i m i p a r a s a n d M u l t i p a r a s . 27 C o n c e r n s o f S p e c i a l G r o u p s o f P o s t p a r t u m M o t h e r s . 29 E f f e c t s o f P a r i t y on P o s t n a t a l C o n c e r n s 34 C h a p t e r 3: M e t h o d o l o g y 38 Introduction .. 38 Sample a n d S e t t i n g 38 Measurement i n s t r u m e n t 40 Data C o l l e c t i o n 41 N u l l Hypotheses 42 C h a p t e r 4: A n a l y s i s o f D a t a 46 Introduction 46 C h a r a c t e r i s t i c s o f t h e Sample 46 Parity 46 Age 47 Gender o f Baby 48 Education 48 E t h n i c i t y of Mothers 49 Type o f I n f a n t F e e d i n g 50 P r e n a t a l C l a s s Attendance 50 R e t u r n t o Work 51 H e l p a t Home a n d Use o f P r o f e s s i o n a l R e s o u r c e s ... 51 Difference Between Concerns of Primiparas and M u l t i p a r a s a t Two Days 52 Self 53 Baby 54 Partner 56 Family 57 T o t a l Items 59 D i f f e r e n c e i n Concerns of Primiparas and Multiparas a t One Month 60 Self 60 Baby 61 Partner 63  i v  Family 64 T o t a l Items 65 Difference i n Concerns o f P r i m i p a r a s i n F i r s t Two Days a n d One Month a f t e r D i s c h a r g e 67 Self 67 Baby 69 Partner 71 Family 72 T o t a l Items 73 D i f f e r e n c e i n Concerns of M u l t i p a r a s i n F i r s t Two... Days a n d One Month 74 Self 74 Baby 75 Partner 77 Family 78 T o t a l Items 79 Summary 80 C h a p t e r 5: F i n d i n g s a n d Recommendations 82 Introduction 82 The Sample 82 Difference i n Concerns of P r i m i p a r a s and M u l t i p a r a s D u r i n g t h e F i r s t Two Days 84 D i f f e r e n c e i n Concerns of P r i m i p a r a s and Multiparas One Month A f t e r D i s c h a r g e 87 D i f f e r e n c e i n C o n c e r n s o f P r i m i p a r a s i n t h e F i r s t Two Days and One Month A f t e r D i s c h a r g e 88 D i f f e r e n c e i n C o n c e r n s o f M u l t i p a r a s i n t h e F i r s t Two Days and One Month A f t e r D i s c h a r g e 90 L i m i t a t i o n s of the Study 93 I m p l i c a t i o n s f o r Program P l a n n i n g 94 Recommendations f o r F u t u r e R e s e a r c h 98 Conclusions 100 References 102 Appendix A 109 Appendix B 112 Appendix C 116 Appendix D 119 APPENDIX E 122 APPENDIX F 127 APPENDIX G 131  V  L I S T OF TABLES Table Table Table Table Table Table Table Table Table Table Table Table Table Table Table Table Table Table Table Table Table Table Table Table Table Table  1: 2: 3: 4:  D i s t r i b u t i o n o f M o t h e r s by Age D i s t r b u t i o n o f M o t h e r s by E d u c a t i o n D i s t r i b u t i o n o f M o t h e r s by E t h n i c B a c k g r o u n d P r i o r i t y ranking of concerns regarding s e l f (1 s t 2 d a y s ) 5: P e r c e n t a g e o f R e s p o n s e s o f 0-4 t o t a l l e d a c r o s s items i n each c a t e g o r y ( 1 s t 2 days) 6: P r i o r i t y r a n k i n g o f c o n c e r n s r e g a r d i n g baby (1 s t 2 d a y s ) 7: P r i o r i t y r a n k i n g of c o n c e r n s regarding partner (1 s t 2 d a y s ) 8: P r i o r i t y r a n k i n g o f c o n c e r n s r e g a r d i n g f a m i l y (1 s t 2 d a y s ) 9: P r i o r i t y R a n k i n g o f H i g h e s t T o t a l C o n c e r n s (1 s t 2 d a y s ) 10: P r i o r i t y r a n k i n g o f C o n c e r n s regarding S e l f ... (1 month) 17: P e r c e n t a g e o f r e s p o n s e s o f 0-4 t o t a l l e d a c r o s s i t e m s i n e a c h c a t e g o r y (1 month) 12: P r i o r i t y r a n k i n g o f C o n c e r n s regarding Baby ...  48 49 50 54 55 56 57 58 59 61 62  13: P r i o r i t y r a n k i n g o f c o n c e r n s r e g a r d i n g p a r t n e r .. (1 month) 14: P r i o r i t y r a n k i n g o f c o n c e r n s r e g a r d i n g f a m i l y .. (1 month) 15: P r i o r i t y R a n k i n g o f H i g h e s t Total C o n c e r n s ... (1 month) 16: P r i o r i t y ranking of concerns of primiparas r e g a r d i n g s e l f ( 1 s t 2 d a y s v s . 1 month) 68 17: P e r c e n t a g e o f R e s p o n s e s o f 0-4 Totalled across Items i n each Category ( P r i m i p a r a s : 1st 2 days v s . 1 month) 69 18: P r i o r i t y ranking of concerns of primiparas r e g a r d i n g baby ( 1 s t 2 d a y s v s . 1 month) 70 19: P r i o r i t y ranking of concerns of primiparas r e g a r d i n g p a r t n e r ( 1 s t 2 d a y s v s . 1 month) 71 20: P r i o r i t y ranking of c o n c e r n s of primiparas r e g a r d i n g f a m i l y ( 1 s t 2 d a y s v s . 1 month) 72 21: P r i o r i t y ranking of h i g h e s t t o t a l concerns of p r i m i p a r a s ( 1 s t 2 d a y s v s . 1 month) 73 22: P r i o r i t y ranking of concerns of multiparas r e g a r d i n g s e l f ( 1 s t 2 d a y s v s . 1 month) 75 23: P e r c e n t a g e o f R e s p o n s e s o f 0-4 T o t a l l e d a c r o s s Items i n e a c h C a t e g o r y ( M u l t i p a r a s : 1st 2 days v s . 1 month) 76 24: P r i o r i t y ranking of concerns of multiparas r e g a r d i n g baby ( 1 s t 2 d a y s v s . 1 month) 77 25: P r i o r i t y ranking of concerns of multiparas r e g a r d i n g p a r t n e r ( 1 s t 2 d a y s v s . 1 month) 78 26: P r i o r i t y ranking of concens of multiparas r e g a r d i n g f a m i l y ( 1 s t 2 d a y s v s . 1 month) 79  Table  27:  P r i o r i t y r a n k i n g of highest total m u l t i p a r a s ( 1 s t 2 d a y s v s . 1 month)  concerns  L I S T OF Figure  1:  Representation  of  FIGURES  research  design  vi i i  ACKNOWLEDGEMENTS I would like t o t h a n k t h e members o f my c o m m i t t e e f o r t h e i r guidance and support as well as t h e i r s t a n d a r d s of academic excellence. I would a l s o l i k e t o thank t h e V a n c o u v e r H e a l t h Department l i a s o n nurses working out of Grace Hospital for their assistance and perseverance in distributing the q u e s t i o n n a i r e s , as well as the prevention community health nurses of the South-East Unit f o r their help i n c o l l e c t i n g the completed q u e s t i o n n a i r e s . F i n a l l y t h e encouragement and s u p p o r t o f my f a m i l y h a s b e e n g r e a t l y a p p r e c i a t e d i n s e e i n g t h i s project to i t s completion.  CHAPTER 1  Introduction  Probably  one o f t h e m o s t  lifetime  is  (Sumner,  1977).  the  that  transition  (Dyer,1963; LeMasters  1957; H o b b s ,  found first  that  worry  experience  for parental  adjustment.  Gruis  must  physical  roles  accomplish  restoration;  infant,  with  the  and  states  that  concerns these  to  each  of these  i n t h e mother.  concerns into  c o n c e r n s about  a  tasks Cibulka  four  t h e baby,  isolation in  the  self,  of a  which the as:  relationship  lifestyle  evoke  about  difficult  f o r a n d meet t h e  and  member.  She  questions  and  (1978)  categorized  broad content areas which about  of  period  family  & Price,  loss  and lack of  the tasks  of  new may  cited  care  alteration  (1963) a n d  t o be a n  postnatal  to  crisis  parenthood  establishment  accommodate  Dyer  (1963),  the  of  that  couples  as f a c t o r s  learning  of a dependent  relationships  of  infant  of  identified  needs  infant  some d e g r e e  social  during  an  demonstrated  majority  Dyer  (1974)  have  i n a woman's  of  1968).  the  over appearance,  periods  delivery  involves  or severe c r i s i s .  preparation  mother  the  researchers  to parenthood  (1957)  extensive sleep,  Several  the  difficult  following  LeMasters,  considered  t o Problem  spouse,  include: and  role  adjustments. There  has  been  some  attempt  in  the  literature  to  2  empirically (Adams, 1974;  describe  1963;  Bull,  these  postpartum  1981;  Cibulka  Harrison & Hicks,  Sumner,  1977).  limited  to e i t h e r  research concern  1983;  Much of  has  care  more r e c e n t r e s e a r c h on has  been  done  demonstrating mother  is  Gruis,  1974;  In  that  Pate,  during  the  United  many  public the  maturational nature  needs a s s e s s m e n t  Harrison  &  descriptive their  Hicks study  sources  on  both  information promotion  obtained  i s necessary  programs  f o r new  and to  maternal the  mothers  after  of the  1978;  agencies n e e d s of  conduct  as  visits  f o r mothers  dispite  the  formal planning, has a  concerns city  have  postpartum  such  However,  evaluation  did  Other  (Cibulka & Price,  to postpartum  was  focus  f o r the purpose  or p o s t n a t a l groups  and  primiparous  a narrow  postpartum  services  i n a Canadian  h e a l t h programs a v a i l a b l e included  of  general  postpartum  of h e l p  1972;  A l s o much of  health  stage.  (1983),  Robinson,  a r e a of  of these programs l i t t l e  including  Gruis,  1977).  universal  h e a l t h nurses  this  widespread  Sumner,  one  States  hospital  1979;  have o f f e r e d  1978;  had  1963).  the concerns  recognized  community  only  some i n t e r v e n t i o n  Canada  m o t h e r s and  to  (Adams,  d i s c h a r g e d from  traditionally  by  in  1979;  concerns  or m u l t i p a r o u s mothers.  limited  infant  & Price,  r e s e a r c h has  primiparous  been  such as  this  Pate,  maternal  been widely  of  done. focused  mothers  w h i c h had mothers.  and  community This  study  m u l t i p a r o u s m o t h e r s and help  mothers.  nurses The  plan  the  health  m o t h e r s were g i v e n  3  a  questionnaire  delivery.  approximately  They  experienced resources  were a s k e d  since that  the  they  findings  were s i m i l a r  (1979),  who  that  also  These  to  birth  used  of  t o those of  results  differed  concerns  during  Robinson,  1972) w h i c h  infant  areas  hypothesis  that  infant  community the  planning  client  that  and  found  return  and  that  of  of  fatigue. looked  about  the self  (1981),  focus of concerns  to  concerns  at  of  and  were  moderate  found  that her  on  self,  and  r e g a r d i n g f a m i l y and  day was  the e f f e c t  not  supported  of the v a r i a b l e both  primiparous  i s important  by  of t i m e and  information for  s u p p o r t i v e - e d u c a t i v e programs  for  group. and H i c k s  (1983), a l s o  68% o f t h e women i n t h e i r  least  one  visit  ranked  last  as a source of h e l p .  question  care  Bull  mothers  and p r i o r i t i z i n g  Pate  infant  concerns  postpartum  Harrison fact  on  and  that  concern.  shift  The  (Bull,1981;  as c o n c e r n  I t seems t h a t  delivery  studies  the  concern.  regarding diet,  t h e y had and  (1974),  demands,  after  two weeks p o s t p a r t u m  the mother's  would  multiparous  this  of  w i t h each  were  by t h e t e n t h p o s t p a r t u m  data.  since  found  infant  retrospectively  those  the f i r s t  b e h a v i o u r as w e l l  major  the  from  weeks  the concerns  Gruis  data  regulating  six  their  to deal  collected  normal,  to  to r e c a l l  the major a r e a s of c o n c e r n  figure  to  four  whether  from  the  found  study  had  a community h e a l t h  postnatal  This  that  received  at  nurse, the nurse  would  visits  d e s p i t e the  lead  one  a r e made a t a  to time  4  when m o t h e r s have a l r e a d y With for  help  the c o n t i n u i n g r e d u c t i o n  assurance  provide  in nursing,  standards  from o t h e r  of  community h e a l t h p r o g r a m s and  quality to  sought  an  sources.  resources  available  i n c r e a s i n g emphasis  some a t t e m p t s a r e  for  nursing  visits  being  on  made  to  postnatal  recently  developed  mothers. The  Vancouver H e a l t h Department  standard  care  postnatal  mothers  these  plans  standards  information involved limited  were  based  developing  resources all  objectives for nursing v i s i t s  (Munroe & W a l k e r ,  from e x p e r t s  in  implement  and  i t may  the  on  prioritization  things  as  opinions current client  the of  standards  not  be  resources  group  w h i c h any the  or  place.  goals  well  that  desirable mothers  They by  of as  individuals  a l l new  achieved  with to and  suggested  examining  and  missions,  f i e l d , , the  literature  for services for this  the a d u l t e d u c a t i o n  emphasizes the  client  be  as  recognized  with  take  content  The  feasible  plans  the  available  field.  to  such  expert and  the  particular  group.  Much o f also  could  The  literature  the  standard  in  the  the  department's  nurses  1984).  in  recommended t h a t p r i o r i t i z a t i o n that  has  adult  importance  in determining  program  i s based.  learner  between what e x i s t s  and and  of  and  including  is  (1981) can more  help  literature  input  prioritizing  Boyle  others what  program p l a n n i n g  the  feels  from  the  needs upon that  identify  desirable.  the  both gap  Knowles  5  (1980), should  also be  purpose  one  that  of t h e c r i t e r i a  has  also  multiparous  reduced  m o t h e r s do  in  Harrison  and  literature  Hicks  (1983),  number  of  they d i d not  a significant  between  these  two  remembered t h a t  this  study  concerns  they  had  eight  that  weeks.  different  It  in  interventions  assumption.  that  t o be  although  major.  i n the  Once a g a i n  mothers  that  a new  over one  to  member  types  of  i t must  be  recall  the past group  to the  two  in their  f o r the  the Also  the  s i x to  had  very  that  similar after several  implications  offered  little  m u l t i p a r a s had  difference  experienced  should  is  t h e e a r l y d a y s a t home but  to having  would have  this  found  consider  asked  possible  the  concerns  t o them  There  support  groups.  g r o u p s were q u i t e  adjusting  information of  is  concerns  needs of both of  services  fact  they  for  significant  more m i n o r c o n c e r n s ,  concerns  find  to in  needs  i n p r a c t i s e t o assume  have as  therefore  the  primiparas expressed  concerns  tendency  not  individuals  f o r a program.  when r e s o u r c e s become s c a r c e .  evidence  same  i n t e r e s t s of t h e  in p r i o r i t i z i n g  been t h e  a s p r i m i p a r o u s m o t h e r s and be  the  of d e v e l o p i n g o b j e c t i v e s  There that  states  the  weeks  family.  Such  t y p e and  timing  different client  groups.  Problem There  is  an  regarding  the  postnatal  period  apparent  concerns  or  deficit needs  of  in empirical mothers  which p r e s e n t s a problem  knowledge  during  f o r those  the  involved  6  in  p l a n n i n g programs or s e r v i c e s  particular variables has  lack of time  l e d to the  1.  Do  first  of  for this client  group.  knowledge c o n c e r n i n g t h e e f f e c t  since delivery  and  parity  of  the  of  the  mother  following questions:  the c o n c e r n s of p r i m i p a r o u s mothers  two  differ  The  days  from  after their  d i s c h a r g e from c o n c e r n s one  the  i n the  hospital  month a f t e r  their  di scharge?  2.  Do  the c o n c e r n s of m u l t i p a r o u s mothers  first  two  days  differ  from t h e i r  after  d i s c h a r g e from t h e  c o n c e r n s one  month  in  the  hospital  after  their  the c o n c e r n s of p r i m i p a r o u s mothers  differ  discharge?  3.  Do  from m u l t i p a r o u s m o t h e r s  in  after  hospital?  4.  d i s c h a r g e from t h e  Do  the  The month the  the  intensity  days  differ  month a f t e r d i s c h a r g e  hospital?  time p e r i o d s of the  after  two  the c o n c e r n s of p r i m i p a r o u s mothers  from m u l t i p a r o u s m o t h e r s one from  first  first  two  d i s c h a r g e were s e l e c t e d and  frequency of  days  a t home and  one  f o r t h e measurement  concerns  because  of  of  their  7  implications In  the  f o r d e l i v e r y of s e r v i c e s to p o s t n a t a l  first  few  mother  i s often  first  time  that  transition  able  to  skills  her  phase.  discharge,  and  i s often  At t h i s many  that  experiencing.  f o r the  f o r concerns  also  often  in  taking-on  t h e mother  and  is  now  h e r new r o l e a n d t h e new the  time  mother  is  Traditionally  weeks  at  whereas  to offer  seek  still  out the  month  the i n f a n t ' s f i f t h  b u t may s t i l l  mother  to One  week o f l i f e , recovery  that  she h a s s o u g h t  sources,  such as f a m i l y  have c o n c e r n s .  i s now a b l e  to leave  community  s e r v i c e s such  as  It i s  still  s e r v i c e s s u c h a s home  nurses are o f f e r e d one  from  t h e home t o  f o r t h e c o n c e r n s she i s  after  after  her  i t i s possible  from community h e a l t h home  needs.  of the t r a d i t i o n a l  the  and  the completion of  visits  drop-ins.  about  she  out a d d i t i o n a l resources  effective  is  mean t h a t  However,  support  or p e d i a t r i t i o n  possible  would  own  help  (1961)  self-directed  i s nearing  childbirth.  seek  be  which  mother  doctor  This  t h e mother Rubin's  acquire.  to  information  from  her  p h y s i c a l l y a n d f a t i q u e h a s an i m p o r t a n t e f f e c t on  ability  help  time  information  she must  from h o s p i t a l t h e  has not y e t sought  between  absorb  recovering  a f t e r discharge  f o r h e r i n f a n t on  During t h i s  taking-hold  the  caring  and l i k e l y  arise.  the  days  mothers.  month  i n the f i r s t  i t may be more  postnatal  classes  or  8  Definitions  o f Terms  P r i m i p a r a : a woman who h a s g i v e n  Multipara:  a  woman  who  has  birth  given  t o her f i r s t  birth  child.  t o two o r more  infants.  Concern: a  question,  problem,  marked p r e - o c c u p a t i o n  related  Intensity:  or value  measured  f r o m no c o n c e r n  Frequency: being  the rating  The  i d e n t i f i e d as a  P u e r p e r i u m : The usually with  number  lasting  a mother a s s i g n s  period  of to  The number o f p a s t of v i a b i l i t y .  of  to a  concern  concern.  repeated  occurances  o f an. i t e m  recovery  following  childbirth  s i x weeks.  Used  interchangeably  p o s t n a t a l and postpartume p e r i o d i n t h i s  Parity:  area  to the post-natal p e r i o d .  t o much  of  or  concern.  period four  misconception  pregnancies that  study.  continued  t o the  9  Purpose The  p u r p o s e of  the  independent  of  the  compared  The  and  This  postnatal addressed in  indepth  the  concerns the  again  chapter  information  used  on  during  hospital  one has  regarding  period. were the  the  current  this  period.  The  the  time  to d e s c r i b e the since delivery and  of p r i m i p a r a s first month  two  intensity and  effect  and  of  parity  of  maternal  multiparas  days a f t e r  were  discharge  from  later.  demonstrated the  the  concerns  specific  The  as  need of  research w e l l as  following  literature  knowledge  was  frequency  presented  study.  look at  study  v a r i a b l e s of  mother  concerns.  this  further  mothers  in  questions  definitions chapter  concerning  regarding  for  the  maternal  the  to of  be  terms  provides  an  puerperium  and  concerns  during  10  CHAPTER 2  Review of  the L i t e r a t u r e  Introduction  A review postdelivery concerns  of was  the  literature  undertaken  experienced  areas  of  literature  three  sections.  The  characteristics  and  will  also  adjustments require  be  of  the  demonstrated expanding  in  of  the  field  needs a s s e s s m e n t  were  literature  that demonstrates  needs  literature mothers'  A  assessment provides  period  in  of  p r o f e s s i o n a l s i n the  services.  review  particular  their field  and  period  represents  for  c o n c e r n s as  current  concerning  in  the is  for c l i e n t  prioritizing  in  this  It  intervention.  focus  need  to  healthy  challenges  prioritization  and  the  during  the  in order  that family  the  into  represents.  the  The  regarding  puerperium,  further rationale  perceptions  divided  of a d u l t e d u c a t i o n  and  clarify  f a m i l y she  literature  process.  the  the  is a critical  planning  the  reviewed  mother and  f o r the  concerns  multiparas.  includes l i t e r a t u r e  tasks  second a r e a  information of  the  and  professional, supportive-educative  The  role  of  primiparas  first  maternal  t o f u r t h e r e l a b o r a t e and  t h a t were  demonstrate that t h i s development  by  regarding  the  program  placed input  process.  on into This  determining w e l l as  developing  those  the of  appropriate  11  The  final  body  characteristics puerperium. nursing,  science citation literature  Much  psychological  regarding  the  that  i n the medical,  and  that  the  educational  a  i n the  comprehensive  concerns  of  mothers  of the Puerperium  literature has  on  Since  that  parenthood their  83% o f f i r s t  parenthood  involves  1968;  essentially  Rossi,  severe c r i s i s  some 1968;  time  following problems  this  studies  time  parents  in adjusting  to their  other  sociologists  degree  LeMaster's  have  crisis 1974).  (1957)  Hobbs  of  degrees of  transition  to  ( D y e r , 1963; Dyer  (1963),  s t u d y and found  experienced  childbirth. accounted  lesser  the  of  Russel,  parents  found  that  that  was done by  and g r a t i f i c a t i o n components  suggest  replicated  53% o f f i r s t  time  maternal  identifying  is a crisis  a n d a l t h o u g h many  results  the  One o f t h e i n i t i a l  e x t e n s i v e or severe c r i s i s  child.  measurement  concerning  focused  He f o u n d t h a t  examined t h e v a r i o u s c r i s i s  that  the  beginning parenthood  (1957).  experienced  Hobbs,  during  r e c e n t a r t i c l e s were c h e c k e d  as a time of c r i s i s .  LeMasters  crisis  mothers  index t o ensure  to parenthood  suggested  early  of  s e a r c h e s were done  and Tasks  of  transition  first  reviewed d e a l s with the  t h i s m a t u r a t i o n a l s t a g e was o b t a i n e d .  Characteristics  period  concerns  Literature  a n d t h e most  review of during  the  sociological,  literature social  of  of l i t e r a t u r e  extensive  (1968),  felt  f o r the v a r i a b i l i t y  or that  i n the  1 2  findings  of  support  the  perceived  the  period  severe  after  felt the  birth  r a t h e r than  also  questioned  child  as a c r i s i s  (1974),  sought  outcomes  of  stressful  and  of a c h i l d  even  identify  first  developmental  were  theory,  primiparas mothers. in  population. that  the  after  delivery  time and  when p h y s i c a l identity  self-conflict  13%  a  slight  t o view  the  which  is  Rossi the  (1968),  birth  crisis.  that as  of a  Russel  as w e l l as  concluded  stressful respondents  only  moderately  rewards. a  to the the  findings  pilot  study  using of  sample  to  crisis  role  assess  theory,  transition  demands and  insecurity.  make  to  a  the  first  crisis.  t a s k s of women  and  sample  caution  must  greater  s u b s t a n t i a t e d the  during  the  size  results  a potential  reformation and  only  ( s i x mothers) s e l f - s e l e c t e d  adjustment  constitutes  normal  a theory  generalizing  maternal  that  labeling  developed  Due  However, t h e  was  s i x weeks f o l l o w i n g c h i l d b i r t h .  and  were t e s t e d u s i n g a s m a l l  taken  of  of p a r e n t h o o d  i n the  child  experience.  conducted  adjustment  first  more a c c u r a t e  a  and  to  experienced  the p o s i t i v e  year  (1981),  questionnaires  be  as  failed  as a t r a n s i t i o n  as a c r i s i s  or  study  found  whereas 87%  w e l l s u p p l i e d with  Sheehan  of  He  i t would be  parenthood  their  postpartum  crisis.  the a d v i s a b i l i t y  to  perceived  Her  that  his  that a d j u s t i n g to a  moderate c r i s i s  He  stressful  s t u d i e s and  hypothesis  as a  experienced crisis.  previous  theory  s i x weeks  It is also  role  a  transition  vulnerable  to  1 3  Melchior study a  (1975), a l s o  to determine  time  of  primiparous  crisis.  different  days  after  sixth  week p o s t p a r t u m .  first  found two  The  small  birth,  sixth  mothers.  occasions,  i n the f i r s t  t h e sample  findings  to  findings  that  other  during  period.  in crisis  clinician,  recognized  a  stressors  which  on  included, of  first,  act  variety  second  stressor  postpartum  body  she  identified  image i n t o  period.  during  a theoretical  of  framework  commonly  postnatal  mothers.  pre-pregnant  The  i s the i n t e g r a t i o n of the  the maternal  perception  expectations  to  result  state.  conflict  back  These  which a r e a  leaking  the  nurse  identified  S t r e t c h marks, p r o t r u d i n g abdomen a n d with  their  of a postpartum  the p h y s i o l o g i c a l s h i f t s  t h e r e t u r n o f t h e body t o t h e  d i d not  i t does support the  a crisis  f o r the r o l e  the  perceived  intervention i s essential  i n developing  theory  mothers  g e n e r a l i z a t i o n of the  However,  t o p a r e n t h o o d and t h a t  grounded  two o r t h r e e  An a d d i t i o n a l mother  to allow  mothers.  (1981),  were  the p o s t n a t a l  some m o t h e r s e x p e r i e n c e  Donaldson  Interviews  a n d one m u l t i p a r a ,  transition this  three  t o be a t i m e o f c r i s i s and  a t any t i m e d u r i n g i s too small  included  i n the f i r s t  Three of the s i x  o f t h e m o t h e r s , one p r i m i p a r a  Again  descriptive  week a t home, a n d d u r i n g t h e  week p o s t p a r t u m  a crisis  small  sample  week t o be a t i m e o f c r i s i s .  the  perceive  a  i f mothers viewed the p o s t n a t a l p e r i o d as  and t h r e e m u l t i p a r o u s  done on t h r e e  the  conducted  normal  of s e l f .  nipples of  may the  1 4  postpartum mother. as  a  major  postnatal  Donaldson  stressor period.  (1981) a l s o  universally Resulting  e x c e s s of  a v a i l a b l e e n e r g y and  important  influence  puerperium. absolute  She  and be  by  In  unanticipated delivery  Based  addition  complicate on  this  interventions cognitive  coping  to  needs  Donaldson  the  usual  framework she strengthen  perception,  on  demonstrates  the  in  effectiveness  situational  supports  timely  identified cesarean which  this the  the  cannot  a  birth,  of  the  mother  problems  defects  stressors  an  and  new  (1981)  or  has  in  commonly  the  and  a pre-term  complications  the  during  as  when t h e  behaviours  s u c h as  fatigue  conflict  acting  state  during  adjustment role  be  fatigue  from a c t i v i t i e s  sleep,  infant's  a crisis  birth  of  identified  stressors  and  part  l o s s of  w h i c h may  usual  experienced  in  process  the  create the  fashion.  further  of  stressors  w h i c h can solved  the  also  nature  experienced  on  identified  may  period.  necessity of  of  maternal  and  coping  behaviours. Gordon in  (1965),  postpartum  about  reorganizing  likelihood  finding  also  intervention  study designed  emotional  responsibilities the  in a  attitudes  and of  r e w a r d s of postpartum  s u p p o r t s the during  adjustment  the  and  to  found  motherhood  emotional  postpartum  that  of  for role  distress.  supportive  period.  factors  instruction  activities  the  necessity  examine  the  reduced This  educative  15  The and the  i n c o n s i s t e n c i e s i n both the  the  definitions  transition  which  For  crisis  as  as  for  t o meet  Rubin most  nuclear is  a period  after.  Rubin  postnatal  need  the  further  the  the  has  described  and  the  f o r the  feels baby  phase,  that this  change  for  i s born  great  everyone  the  she  phases  which  taking-hold  are  the is  s e r v i c e s should  be  stage.  f o r the  the  infant, for  and  myth of lives  is  for  the  motherhood  happily  characteristics  i s multiparas  these  of  postpartum period  the  (1975)  to parenthood  i n t e r m s of c e r t a i n b e h a v i o u r s  the  the  maturational  mother,  be  used  Despite  relationship  that  (1961) d e s c r i b e s  three  must  validation  transition  husband-wife  mother w h e t h e r  taking-in  for  that  period  She  decisive  is unsettled.  needs d u r i n g  period  in  identifying  (1975)  that  their  the  once  or  mothers  family.  that  sharp  (1975) s t a t e s t h a t  of  research  LeMasters  many  vulnerable  continuity  measurement  i n a d e q u a t e , whereas M e l c h i o u r  i t i s apparent  stressful offered  any  are  i n c o n s i s t e n c i e s and findings  in this  example  of c r i s i s  old patterns  defined  crisis  of  t o p a r e n t h o o d as a p o t e n t i a l c r i s i s  acknowledged. definition  of  method  which  of  ever the  appear  or p r i m i p a r a s .  She  designated  the  p h a s e and  the  as  bursting-out  phase. The  t a k i n g - i n phase o c c u r s  p u e r p e r i u m and expended mother  i s the  during  mother's  labour  s e e k s t o meet h e r  and own  i n the  first  response  delivery. needs  to  During  few  days of  excess  energy  t h i s phase  f o r s l e e p and  the  the  nourishment  16  before be  she c a n c o n s i d e r  passive  phase  and a l l o w s  the  mother  experience her  The  an  wants  to give  to  this  at this  She  tends  t o her needs. talk  reality  overwhelming  about  phase t h a t  feeling  In t h i s  her  to the recent  birth  events i n  t h e mother must  (1961) s t a t e s  of  to  that  responsibility  is  time.  taking-hold  approximately  gains  phase d e s c r i b e d  the t h i r d  by R u b i n  p o s t p a r t u m day  (1961)  when  starts  the  mother  more c o n t r o l o f h e r b o d i l y f u n c t i o n s and t h e f o c u s o f  attention crucial  shifts time  infant  care  hospital  from  for and  motherhood.  herself  the a  to  sense  Ironically  beginning  of  with  this  the  or  may  lives.  skills  is  a  related to  the p r a c t i s e of d i s c h a r g e  from  p o s t p a r t u m day many  taking-hold  mothers  p h a s e when t h e y  to acquire support  Follow-up s e r v i c e s  the  go home necessary  and e n c o u r a g e m e n t in  the  community  n o t be a v a i l a b l e d e p e n d i n g on where t h e mother  This  familiar  This  of  receive the necessary  from h o s p i t a l s t a f f .  baby.  responsibilities  t h e r e f o r e do n o t have a c h a n c e and  the  mother t o a c q u i r e  on t h e s e c o n d o r t h i r d  just  skills  may  t o tend  t o g e t t o know h e r i n f a n t a n d R u b i n  experienced  and  also  i n order  frequently  are  others  l i f e . . I t i s also during  begin  on  t h e needs of o t h e r s .  second phase  'baby  physiological  i s a l s o o f t e n c h a r a c t e r i z e d by t h e  blues'  changes  the s h i f t  that  usually  attributed  are occurring.  states  that  of a t t e n t i o n from t h e  infant  a l s o c o n t r i b u t e s t o these  to  Becker mother  the (1980),  to  f e e l i n g s of d e p r e s s i o n .  the  1 7  The passing  third through  weeks a f t e r and  phase in  the  psychologically.  being  the  new r o l e  of in  medical  postpartal  women.  of  decreasing  period,  several  birth,  must  occurs  physically  l e t go o f c e r t a i n  such as  evidence first  on  the  care,  leisure  time  she c a n a d a p t  sought  and  t o her  They  found  the  part  that  that  Rubin's  their  (1984)  but  longstanding  they  concepts  current  with  hospital  attitude  than  of  general  the mothers amounts  stay.  of  However,  insufficent  taking-in  r e p o r t e d by R u b i n  o f t o d a y s women t o a c c e p t  Mitchell  (1961)  increasing  t h i s may i n d i c a t e  few d a y s , d i f f e r i n g  prenatal  during  t h e t a k i n g - h o l d phase seemed t o peak  second day, e a r l i e r  suggested  and  o f t w e n t y m o t h e r s t h e r e was a strong  the  t h e a t t i t u d e s and b e h a v i o u r s o f  during  days and t h a t  They  reexamine  attitudes  c h a n g e was s u p p o r t e d  behaviours sample  to  t o d a y , c o n s i d e r i n g t h e many  social  influence  t o suggest  the  (1984)  amounts o f t a k i n g - i n a n d  their  making  mother  concepts  puerperal  taking-hold  results,  mothers  of a t t e n t i o n before  Rubin's  which  and  The  and M i t c h e l l  education  with  (1961) d e s c r i b e s  as a mother.  validity  notion  postnatal  before  center  Martell  changes  Rubin  d e l i v e r y when t h e woman h a s r e c o v e r e d  advantages enjoyed  a  that  an  being  cautioned  against  unwillingness dependant  from t h a t o f mothers  (1961).  even f o r  i n 1961. M a r t e l l  generalizing  their  encouraged a c o n t i n u a l reexamination whose a c c e p t a n c e  observations  and  on  can  interfere  conclusions  of with  relevant to  18  present  practise.  Gruis of  (1977), has c h a r a c t e r i z e d  the puerperium  t a s k s w h i c h t h e mother must a c c o m p l i s h .  four  major  learning  tasks  relationships  one  puerperium.  or  reduction  must  30%  i n muscle  site.  Blood  i n the f i r s t  and d i a p h o r e s i s . remain  weeks t o become f i r m .  and  restoration i s  accomplish  i n the  The  s i z e , weight volume  l o s s and  decreases  few d a y s due t o b l o o d abdominal  walls  by  loss,  stretched  s o f t and f l a b b y  and take a t l e a s t  Discomfort  the  of  perineum  is  due t o t h e common o b s t e t r i c a l p r o c e d u r e o f e p i s i o t o m y  possible  leaking  perineal  or sore  (Gruis,  such  rapid  would  be  careful  observation  admitted  (1977)  to  and treatment  engorgement a s w e l l a s  be a s o u r c e states  physiological  t o complete  "bundle of j o y " .  Breast  may a l s o  Rubin  reason  home  tears.  nipples  1977).  undergoing  sent  of a  member.  (1961) p h y s i c a l  t h e mother  of the p l a c e n t a l  pregnancy  likely  t h e new f a m i l y  by R u b i n  tasks  by  approximately  six  restoration,  The u t e r u s u n d e r g o e s t h e p r o c e s s o f i n v o l u t i o n ,  characterized  diuresis  physical  and a l t e r i n g h e r l i f e s t y l e  t o accommodate  of the f i r s t  during  the infant  identified  healing  include:  identifies  t o meet t h e needs o f h e r i n f a n t , e s t a b l i s h m e n t  r e l a t i o n s h i p with  As  which  She  i n terms  that  change  hospital  of  discomfort any  f o r any  person other  f o r bed r e s t a n d  whereas t h e new mother  her recovery as well  as care  is  f o r her  19  to  The  second  meet  the  task  identified  needs  of  the  by G r u i s infant.  demonstrated  t h a t m o t h e r s do n o t  for  for  caring  (Adams,1963; Extended  the  infant  Fillmore  &  on  in  the  home.  i n today's  opportunity  The  society results  to experience T h i s then  care  require  s u p p o r t i v e and e d u c a t i v e  Gruis  third  task  (1977),  is  infant.  Jordon,  towards  1973).  to  society the  small  new  nuclear  i n many women n o t h a v i n g o f an i n f a n t  i s a task  until  they  f o r w h i c h many m o t h e r s  a s s i s t a n c e from a g e n c i e s i n  There  t h e mother must a c c o m p l i s h establishing  has  attachment  or bonding process  that  deal  a  and  occurs  learn  1977).  t h e mother needs  development  of  her  interest  and  this  maternal  large controversial  body o f  review.  I t has  but has t o d e v e l o p respond  to learn  been  relationship  to  one  as  normal  does the  another  t o understand  information concerning  infants  with  mother  to  In order  to  between  healthy mother-child  child  of  concerning  which  automatically at birth  (Ludington-Hoe, infant  decade  according  relationship  i s beyond t h e scope of t h i s  established  mother  a  great  A d i s c u s s i o n of t h i s  literature  occur  past  a  in  baby.  the  been  research  and  hospital  community. The  not  prepared  from  provided  trend  parents.  and  s t u d i e s have  adequately  1976;  once  become  the  learning  family i s o f t e n u n a v a i l a b l e i n t h i s mobile  families the  Several  discharge  Taylor,  t o g i v e a s s i s t a n c e and s u p p o r t mother  feel  (1977) i s  her  growth  a n d knowledge o f h e r i n f a n t ' s  20  crying,  sleeping,  feeding  and  other  behaviour  patterns  (Gruis,1977). The her  final  lifestyle  infant. may  task and  t h e mother must a c c o m p l i s h relationships  in  role  conflict  former  lifestyle.  family  1978).  responsibility  structure  for this (1985)  and  The mother  significant  i n her l i f e a l l the  i t i s o f t e n t h e mother who  in  process  examining  p e r c e i v e d support  after  mothers than  parental the b i r t h  t h e women h a d t o c o m p e n s a t e by i n c r e a s i n g  support  terms  the puerperium  of  accomplished,  contact  an a d e q u a t e  behavioural it  is  i s viewed as a c r i s i s phases  apparent  literature  concerning  postnatal  period that  intervention  of  concerning  mothers  during  this  or  tasks  throughout  selected  needs  to maintain  co-workers  network.  Whether in  child  f a t h e r s p e r c e i v e d an  as c o n t a c t with  i n order  1980).  of a  decreased  or r e l a t i v e s  takes  network  need  friends  That  (Becker,  increased  with  f o r support.  persons  o f t h e baby c h a n g e s  integrative  t h a t more p o s t p a r t u m  leisure  may  from  The a d d i t i o n  Cronenwett  occurs  Her own v i e w o f h e r r o l e may d i f f e r  and  her  that  new  and  relationships  of  the  time  of her p a r t n e r or other  (Taggart,  in role  (Gruis,1977).  c h o o s e t o g i v e up h e r j o b , much  found  accommodate  F o r many new m o t h e r s t h e c h a n g e  result  that  to  i sadjusting  period  w h i c h must be  this  review  the c h a r a c t e r i s t i c s i s necessary time.  the n e c e s s i t y of i d e n t i f y i n g  or  of the  t o meet  Selected  of  the  literature  and p r i o r i t i z i n g t h e  21  needs  in order  programs w i l l  Assessment  to  now  plan be  Needs  concerned  of needs assessment  Buskey  and  literature  planning  models r e v i e w e d  a  component  suggests  that  of  step  educational  programs.  most a d u l t e d u c a t o r s matter  out  an  in  learners, learning  used w i t h i n a great  definitions  the deal and  fact  are  literature  of  ninety  needs  program  assessment  process. to  producing  Ellis  program  This be  an  effective  (1971) s u g g e s t  that  regard  of  f o r the  persons  in  learners  as  interests.  includes before  the  They p o i n t  input  from  o b j e c t i v e s of  This  differs  b a s i s of what was  the the from  appropriate  available.  the  concept  of  need  of a d u l t e d u c a t i o n  of c o n f u s i o n uses  of  their  that  the  that  of  considered  determined.  on  or what r e s o u r c e s the  and  identified are  one  the  (Sork,l983).  a n a l y s i s of  preferences  lives  programs  Despite  be  the  experience  regard  t o programs b a s e d p r i m a r i l y upon  approach  needs a r e  prescribing before  Atwood and  p o s i t i o n s without their  an  planning is  process  object  esteem  to address  program  the  or  individuals, that  high  assessment  in  planning  that only  failed  the  needs  administrative  with  revealed  essential  subject  educative  Planning  program  (1982) i n c o n d u c t i n g  planning  as  i n Program  with  process  Sork  supportive  examined.  of C l i e n t  Authors  effective  and the  i s so there  widely seems t o  inconsistency regarding  the  term.  has  Monette  (1977)  22  determined need  the i m p l i c i t  c a n be s o r t e d  felt of  that  and e x p r e s s e d  the term.  major  i n t o four  needs; comparative  needs. the  identified  by  someone  describe  other  need  other  needs;  needs and v a r i a n t out that  variations  and  such as r e a l  need.  Monette  (1977) r e c o g n i z e d  around  t h e term need  application well  levels  uses  t h e two  institutions. educational Peters  Knowles  of  with  identify  needs d e s c r i b i n g  interests  are  of  the  need and  felt  uses  i t s indiscriminate  institutions  three  communities human  t h e gap t h a t  needs,  Boshier  and  needs  and  e x i s t s between  and some d e s i r e d of  and  condition  preference  among  experiences.  from  the adult  and groups  (1980) i d e n t i f i e s  between b a s i c  expressions  Some o f t h e s p e c i a l i z e d u s e s  need o n l y  also  a d i f f e r e n c e between  s t a t e of the learner  alternative  emerged  They  much o f t h e c o n f u s i o n  individuals,  distinguished  are  needs a n d i n t e r e s t s o f i n d i v i d u a l s .  current  whereas  He  (1976) a l s o  interests  that  seems t o be due t o  those  or  needs  owner.  need, e d u c a t i o n a l  individuals.  needs,  the  specialized  t o s o c i e t y , communities,  as  of  prescriptive  than  o f need  a  human  of  needs a r e i d e n t i f i e d by  whereas  concept  of  basic  (1971) p o i n t  Motivational  of  the  definitions  u s e s o f t h e t e r m need r e f e r t o e i t h e r p r e s c r i p t i v e  owner  as  explicit  categories:  Atwood a n d E l l i s  motivational the  and  the debate over learner.  of  the  who c a n b e s t  term assess  Some e d u c a t o r s b e l i e v e  when i t i s r e c o g n i z e d  by t h e  need  that  potential  have  t h e needs a need i s learner  23  as  a  hold  need. that  better  t h e most  recognized  needs w h i c h some  In  i n d i c a t e that which  looking  (1976) s t a t e  unlikely  that  client  will  that  to  some o u t s i d e are  not  the  They  client  feel  will  be m e a n i n g l e s s hand  others  the  unless  states  that  needs.  anticipating learners  that  can  the  future  (1980) a l s o of  the  first  being in  will  real  clients  do  outcomes of t h e  accept  not  a n d make u s e  there  Monette  in  learners  (1977)  of both  on  standards order  to  may a l s o  to  i n t h e end o n l y learnings.  concerning sources.  themselves, a second  source  i n helping  which  recognize  c a n come f r o m s e v e r a l  or people  than  be a s s i s t e d i n  t o l e a r n a n d a c t upon t h e i r information  the  the learner  Persons other  l e a r n i n g needs, but t h a t  field  is  to p a r t i c i p a t e or e l s e  objective  the learners  and  then  specify  that  Boshier  coincide  the needs.  states  determine  i f t h e needs a n d i n t e r e s t o f  identify  clients  the  best  be p l a n n e d ,  the p e r s p e c t i v e s  He f e e l s t h a t  can d e c i d e  needs  experts  be  needs a n d i n t e r e s t s i t  content  refuse  can  the intended  interaction.  can h e l p  learner  Knowles  can  is utilizing  necessarily  i n d i v i d u a l ' s c a n compare t h e m s e l v e s their  observer  o f who  adult's  and t h e program  the  other  Others  T h e s e w o u l d be c o n s i d e r e d  the p o t e n t i a l learner  i t s content.  either  need.  needs a r e t h e ones t h a t  at the question  conform  the  a felt  1977).  program  and  important  needs upon w h i c h p r o g r a m s s h o u l d  Peters  of  w o u l d be c o n s i d e r e d  by o t h e r s .  criteria  (Monette,  the  This  the The being  r o l e s with the  24  l e a r n e r s and a t h i r d Irrespective  source  of  being  what  the l i t e r a t u r e .  point  of  identifying  needs, program p l a n n e r s  of  too  having  resources. Boyle  Therefore  (1981)  setting will  needs  to  priority  states  that  address  political  He s u g g e s t s  feasibility  clientele.  Knowles  appropriate  filters  feasibility  must  critical  and p e r s o n a l  taken  in  the a v a i l a b l e take  step  upon  place.  in priority  which  s e v e r a l sources  (1980)  into a p r i o r i t y  with  setting  the  is  u s u a l l y f a c e t h e dilemma  i s e s t a b l i s h i n g the c r i t e r i a  be made.  needs  many  view  decisions  of input  such as  d e s i r e s a n d needs o f  states  that  s y s t e m needs must  i n o r g a n i z i n g the  be s c r e e n e d  such as the e d u c a t i o n a l  o f m e e t i n g t h e n e e d s and t h e  the  through  philosophy, the  interests  of  the  individuals. In  reviewing  apparent key of  that  role.  the  the  Despite  program clients  that  the  relation making  the confusion  mothers  planners  regarding clients'  place  their  decisions This  perceive  peurperium p r i o r  great  value It  needs  and e x p e r t s  regarding  literature  prioritization  i t h a s been  needs.  perceived  to planning  is  needs  plays  services  a  that  on t h e i n p u t  from  also be  in  the  recognized examined i n field  when  of the program or  concerns or  is  and the l a c k  e x a m i n i n g how or  it  recognized  must  t h e outcomes  supports  their  literature  i n terminology  programmers  t o the l i t e r a t u r e  services.  planning  needs a s s e s s m e n t and  c o n s e n s u s between  many  program  postnatal during  programs  the  i n the  25  community  Concerns  for this  of P o s t n a t a l  As  stated  describing to  in  maternal  either  concern  client  Mothers Chapter  concerns  primiparas  s u c h as  vary depending  Studies and of  had  after  Regarding  & Taylor  describe care  i n t e r v i e w s on  discharge  of  the  changed over mothers infants greatest did  concerns  and  the concerns  The  findings  with  Concerns  of  Considering  find  a  mothers t h e many  limited  studies and  care.  postpartum  month a f t e r  infants She  concern  the  and  found  changes  in  (1963),  one  bathing, crying to determine  the  concerns  those that  throughout  fullterm  concerns  Adams day,  (1967);  week  discharge i n order to  with  significant  Brown,  looked only at  a l s o compared  of  a r e a of  of these  (1963);  regarding feeding,  i n t h e same s t u d y .  not  focus  o f t h e sample,  by Adams,  the second one  She  care  research  of P r i m i p a r a s  (1976) w h i c h  fullterm  infant  the  concerns.  c o r d or c i r c u m c i s i o n time.  of  a narrow  p r i m i p a r o u s mothers r e g a r d i n g i n f a n t  conducted  She  much  the c h a r a c t e r i s t i c s  were c o n d u c t e d  Fillmore  has  care.  method o f d e t e r m i n i n g t h e  Research  One,  o r m u l t i p a r a s o r t o o n l y one  infant on  group.  feeding the  difference and both  of  first  the  i f they of  the  premature was  the  month.  between  premature  or  the  infants.  experience  of  26  childbirth since can  the  be  and  factors  and  Taylor  attendance  m a t e r n a l age  home.  primiparas  of  concern  routine care  and  predict  directions  scores  their  and  an  interests the  concerns. two  and  more  include  the  However, t h e y  do  both  were  questions recent  of m u l t i p a r a s  both  and  only  of  specify The  model  using  an  effective h a l f of  were  in  their  able  to  r e l a t i o n s h i p s between  the  and  worries concept  on  in Moss  concluded  proposed or of  maternal  interest such as  They  a  two  anxieties  and  concern.  Much  concerns  does  i t s definition (1981)  s e p a r a t e l y when l o o k i n g a t  mothers.  not  in  not  variable.  i n t o the  sample  place.  that  that  artifical  researchers  components  the  research  worries  Other  and  of  bathing,elimination,  scheme was  anxiety  of  took  found  independent  results  assistance  a  They  such  amount of with  v a r i a t i o n s in scores,  the  and  and  the  method  interviews  the  to determine  classes,  completed  the  component model c o m b i n i n g  of  prenatal  mothers.  from  large  findings  i n f a n t care  were f e e d i n g , c r y i n g ,  hypotheses d e r i v e d  concern  regarding  model o f c o n c e r n s t h e i r  explaining  these  sought  education  sleeping.  s o c i e t y at  whether  (1976),  were  w h i c h p o s t p a r t u m day  anxiety  f a m i l y and  mothers.  at  and  Interviews  fifty-two  areas  the  day  between c o n c e r n s  as  feeding,  that  of  a p p l i e d to present  correlation  on  role  1960's i t i s q u e s t i o n a b l e  Fillmore  at  the  the  of  measured concerns  27  Robinson  (1972) s o u g h t  perceived  they  information  they wished  learn. two  Data  weeks  had  to determine  been  taught  they  were c o l l e c t e d after  had  what  in  had  hospital  more  physical  and  infant.  in infants,  infant  concerning  common  emotional  changes  mentioned  interest  mothers,  as  that  Surveys  in  arose  (1977)  m u l t i p a r a s and found  postnatal  of  of  and  was a l i m i t e d  that  the  concerning Information feeding  most  and  frequently  twice as  were u n p r e p a r e d  many  f o r the  two weeks.  generalizable  data  I t does,  couples were  82% f e l t  that  to deal with  from  a  in  t o p i c k up c u e s  however,  and as  knowledge support  two  postpartum  sample o f w e l l - e d u c a t e d  the  and  class  the problems that  changes  setting  prenatal  primiparas  arose  m e n t i o n e d by  f e e d i n g and t h e baby's  learning  to  her  The main c o n c e r n s  included  in a university  concerns.  they  whom  period.  interest  grandparents  classes  needs  More t h a n  i n the f i r s t  p a r e n t s were c r y i n g ,  Topics  This  that  surveyed  w o u l d have been h e l p f u l  these  were  of the mothers.  thirty-seven  the  mothers  stated  to  of Concerns of P r i m i p a r a s and M u l t i p a r a s  William  in  mother  ailments  not,  difficulties  class,  both  what  The sample c o n s i s t e d o n l y o f on  of  and  by q u e s t i o n n a i r e  p r i m i p a r o u s m o t h e r s a n d t h e f o c u s was care  mothers  opportunity  retrospectively  discharge.  new  schedule.  family from  life,  t h e baby.  parents attending  such  does  regarding  the fact  that  not  add  maternal this  isa  28  period  i n which p a r e n t s  have them  have  felt  met.  Sumner and F r i t s c h  (1977)  attempted  spontaneous  requests  by m o t h e r s  as  by t h e i r  telephone  evidenced  facility.  A  documenting  t h e volume  asked  descriptive  the  more  percentage They  mothers  multiparous  asking  also  of q u e s t i o n s found  highest  rate  infant's  life.  male  than  mothers  that  alter  infants mothers  of  of  females  concerns  are  facility any  in  importance  to other  asking  at  as a source  information  turned  of  the  one  (1977),  facility  first  sources  of  t h a t 88% o f t h e  was  that  and who  (31%). seems t o with  the  that  mothers  four  weeks infant  infant  at  care few  mothers  c h o s e t o use t h a t study  d i d not g i v e  f o r which the mothers  f o r h e l p or d i d not f e e l  for help at a l l .  the h i g h e s t  i n the f i r s t  looked  The  mothers  regarding  mothers only  25%  t h r e e weeks o f t h e  i n the f i r s t  the concerns  questions  infant  finding  of i n f o r m a t i o n .  regarding  month  parents  suggests to  f o r one  feeding  the  particularly  once a g a i n  Sumner and F r i t s c h  delivered  the  care  multiparas  infant of  had more q u e s t i o n s  T h i s study  who  in  support  health  Once a g a i n  of  the  d i d so a s w e l l a s  the  Another i n t e r e s t i n g  feeding.  weeks.  age  the concerns calls  found  to c a l l  about  the  the  types  They  call.  was  document  done  the  with  per  to  was  calls,  eligible  questions  significantly  of  calls  survey  of  to  f o r i n f o r m a t i o n and  a n d t h e age o f t h e i n f a n t .  primiparous of  l e a r n i n g needs and seek t o  comfortable  I t i s p o s s i b l e that mothers  feel  29  that  i t i s a c c e p t a b l e t o ask  baby  while  at  the  Other of  and Moss  to  of S p e c i a l  groups  Groups of Postpartum  of m o t h e r s .  Cibulka  and  Sater  and  mothers  Price  (1978) s o u g h t  the t h i r d  from h o s p i t a l that The  had  the  postpartum  found t h a t  n o t been d e a l t  in  than p h y s i c a l family  the  terms  care.  sort  interest  61  indicate  frequency. if  days  (1979)  multiparas  at  the  home  and  educational  day,  and  of  multiparous  prior  to discharge  their  their  growth  infants and  development  and  how  the  Moss  (1981) u s e d a method  and The  concerns  very new  concerns  Intensity  infant  change  of  would of  interest  this  following  with  or  based study  be  having  sections  r a n k i n g o f c o n c e r n was findings  rather  concerned  into  of  stay.  b u t were more  also  possible  and w o r r i e s  hospital  were  or w o r r y .  not determined of  and  They  siblings.  mothers  concern, was  by  concerns  to determine  concerns  with during  behaviour  relationships  accepted  few  of  t h e y had many i n t e r e s t s  m o t h e r s were c o n c e r n e d a b o u t  interested  that  mothers.  (1981) i n e x a m i n i n g on  look at the  (1985) l o o k e d a t t h e e x p r e s s e d  needs of a d o l e s c e n t Moss  concerns  Mothers  concerns  c o n c e r n s of p r i m i p a r a s i n t h e f i r s t Stoltz  their  J e n k i n s (1976), Mercer  (1981) l o o k e d o n l y a t t h e  mothers.  for  voice.  s t u d i e s have been done w h i c h  special  caring  same t i m e h a v i n g g r e a t e r  t h e y a r e not w i l l i n g  Concerns  for help in  of  no  worry only do  discharge  in not  from  30 hospital  or w i t h  Jenkins concerns  t h e p a s s a g e of  (1976),  of  a  analyzed  multiparous  conflict  themes w h i c h o c c u r  include  the  children.at as  she  new  mother's the  anticipated  infant,  and  the her  These  f i n d i n g s cannot  only  one  that  mother's  multiparous  pueperium  and  primiparous  the  Sater  medical  older  but  three  have  for  and  child  two  guilt  to  the  children equally.  they  t h e y do  are  based  support  the  idea  during  the  concerns  necessarily  the  same a s  looked at  found  that  the  on  those  of  self-perceived  m o t h e r s between  information  were v e r y  l o v e d and  identified  weeks  t h e p e r i o d of  time  by  how  these  important  to these how  r e s e a r c h e r s was  that  completed  ranged  post  delivery.  It i s very  that  had  delivery.  of  elapsed the  to  a good p a r e n t .  were  perceptions  soon a f t e r  t o be  14 and  concerning  a s p s y c h o s o c i a l needs s u c h as  feel  the  (1985),  needs  thirty-three  needed  of her  the  These  care  of b e t r a y a l  t o l o v e two  also  not  of  identified  physically  feeling  of p r i m i p a r o u s  questionnaires  affected  to  g e n e r a l i z e d as  mothers  They  m o t h e r s as w e l l  limitation  her  experience  needs  y e a r s of age.  baby  and  study  i n the p o s t n a t a l p e r i o d .  ability  they are  and  educational  the  mother  reaction  be  indepth case  mothers.  Stoltz  infant's  one  ability  same t i m e ,  time.  since  18 the  young make  A major the  time  one  to  likely  that  from  giving  i n f o r m a t i o n the  birth mothers  31  Chapman  (1985) l o o k e d a t t h e c o n c e r n s  were b r e a s t f e e d i n g identified  into  c o n c e r n s and  their three  postpartum  from n u r s i n g n o t e s during  the  concerns those  reported  breastfeeding seems r a t h e r  the  control  vague and  the  mothers  regarding infant's  lower of  the  were  of  risk  t o have  were s i m i l a r  to  of  or  to the  to the  state  of  mother  infants  crying,  family.  of mothers a l s o  Not  expressed  f r e q u e n t and f o r the  positive  a  concerns  sleeping,  her  to  of  Once a g a i n  expressed  found a tendancy more  concerns  infants.  problems, and  the  i n comparison  t h e y were l e s s  a  interest  However,  quality  infants  group  They a l s o  the  clarification.  herself  control  mother of  be  examined  intestinal  infant  collected  Most  period.  mothers w i t h normal high  who  concerns  with the  were i m p o r t a n t  (1985)  i n t h e s e a r e a s but  infants  to  the  high risk  appearance,  of a  mothers  perception  of  infant. Cibulka  concerns home  of  intensity.  normal  their  of  feeding,  surprisingly concerns  as  i n need  the  postpartum.  postpartum  Sauve  delivered  group  data  interaction  literature  concern  and  The  months  experiences that  Goodman m o t h e r s who  breast concerns,  i n the t h r e e c a t e g o r i e s  in  of  categories; concerns.  mothers d u r i n g the e a r l y definition  classified  four  identified  mothers  i n f a n t s and  taken of each  first  of  and  Price  (1978),  of p r i m i p a r o u s mothers  but a l s o  the concerns  looked  i n the  of the  not  first  fathers.  only few  Their  at  the  days  at  sample  of  32  twenty  couples  maternity  who  course  completed  had  and  a concerns  home from h o s p i t a l .  of  concern  the  sample,  experiencing  as on  was  a  Variables  such as weight  feeding,  parental  significantly small  age  to determine  as  the  of  They  or  third  of s e v e r a l found  baby,  degree  their  mothers. of  hospital  of  that  fathers  as  method  of  by  with  concern  length  with  group  experienced  of  the  risk  the degree  effect  concerns.  amount  correlated  any  experienced  and  infant  s t a y were  concern.  Their  sample was n o t r e p r e s e n t a t i v e o f t h e t o t a l p o p u l a t i o n  since  t h e y were a l l w e l l  over  the  Therefore  age they  generalized validate  community  (1981),  that  and t h e mothers  and  their  recommended  also  related  on t h e t h i r d  discharge  changed over related  twenty-six  realized  and  concerns  after  of  educated  had  h e l p i n t h e home.  findings  that  were a l l  further  could study  not  be  be done t o  the f i n d i n g s .  Bull of  well  still  uncomplicated  on t h e s e c o n d  conditions  similar  an  f i t into  sought  the  favorable  concern  not  They  expressed variables  despite  did  pleasure scale  day  modifying  experienced  this  to time  to physical  examined t h e f r e q u e n c y and to  self,  infant,  postpartum determine period.  day  and  week  self  increased s i g n i f i c a n t l y  f a m i l y and  again  one  week  i f the focus of the concerns She f o u n d  discomfort decreased  one  husband,  intensity  a t home w h e r e a s t h e c o n c e r n s over  this  that  the  concerns  significantly  after  related  to emotional  time.  Moderate  to  33  much  concern  infant  to  physiological  change a s w e l l a s  b e h a v i o u r p e r s i s t e d a f t e r one week a t home.  regarding little and  related  husband  were  consistently  o r moderate c o n c e r n  concerns  related  to  ranked  as  by more t h a n h a l f family  Concerns being  of  of t h e mothers  presented  little  or  no  c o n c e r n a f t e r one week a t home. This  differs  from  the  findings  o f Moss (1981)  m u l t i p a r o u s m o t h e r s e x p e r i e n c e d much c o n c e r n a b o u t the of  first  week.  the changes  studies  (1981) recommends t h a t  i n concerns  of the concerns  be c o n d u c t e d . shift  Bull  from  community  over  focus  a f t e r one  the  self  to  week  were  not  the  the  i s going through  surprising  that  on  considers mother  family in  further as  comparative  a  maternal  focus  concerns  on f a m i l y a n d  supported.  When,  many p h y s i o l o g i c a l a n d p s y c h o l o g i c a l  that  she  c o n c e r n s and f o c u s  is  on  studies  of p r i m i p a r a s and m u l t i p a r a s s h o u l d  Her h y p o t h e s i s a  time as w e l l  that  during not  new  that  able  ones  week  to  i t  resolve  during  that  one  changes i s not  one s e t o f short  time  period. Walker maternal during  (1986)  role  positive  were about  postpartum  examining  attainment  the peurperium  Mothers  in  shown  demontrated to  themselves  period.  found  become from  stability that  and change i n  maternal  both s t a b i l i t y more  birth  They a l s o t e n d e d  l e s s p o s i t i v e l y a t t h e end o f t h e f i r s t  attitudes and change.  self-confident to  the  t o view six  end their  weeks  of  and the  infants than  at  34  the  beginning.  than is  A l s o , m u l t i p a r a s had  primiparas  not  towards themselves  surprising  t h a t they  felt  more p o s i t i v e and  more  their  attitudes  i n f a n t s and i t  confident  in  infant  care. Mercer role  (1985)  attainment  categories content  of  in over  of  stated  Role  that they  incompetence  demand. well  had  was  different  identified  age  initial  over  f o r a l l age  There  of P a r i t y have  only  the concerns  of  these  conducted  to  of  second  most  identified  find  the  any  during  personal  time  the  first  year  groups d e s p i t e  time. feeling  identified  the  year. amongst  rather  presented  different  as  other  first  difference  m o t h e r s but  most  infant  were the  the  demand  frequently  behaviour  four  from  l e a d i n g to a  a significant  first  The  n i g h t c a r e of  infant  maternal  found similar  levels  of  proficiency.  Effects  Pate,  data.  finding  challenges  groups of  mothering  challenges  year,  not m a s t e r e d  the  (1985) d i d n o t  that  t h a t of  problematic  frequently Mercer  was  S l e e p d e p r i v a t i o n and as  the p r o c e s s  first  the q u a l i t a t i v e  frequently  of  the  at  c h a l l e n g e s or demands w h i c h emerged  analysis  skills  looking  were 1979;  explore  both  Walker, the  on  P o s t n a t a l Concerns  been a few  widely  p r i m i p a r a s and in  1973).  types  the Gruis  focused  m u l t i p a r a s and  United States (1974),  of c o n c e r n s  s t u d i e s on  (Gruis,  conducted  experienced  most  a  i n the  of 1974;  study first  35  month p o s t p a r t u m  and t o determine  any d i f f e r e n c e  concerns  of p r i m i p a r a s and m u l t i p a r a s .  identify  the sources Her  sample  multiparas  who  were The  month p o s t p a r t u m their the  first most  some  consisted under  the concerns  Closely both  expressed  concern  concerns  concern  similarly  of  total  concerns.  g r o u p s were n o t e d  i n that  regarding  behaviour  infant  were c o n c e r n e d  about  during  She f o u n d  that  was r e t u r n o f f i g u r e t o  the  40  i t as being  t o more  mothers  regulating  nearly  of  in their  f o r both  30  also  demands  marriage.  a slightly  These and  higher  i n t h e two  p r i m i p a r a s d i d have more and f e e d i n g w h i l e  of were  primiparous  Some d i f f e r e n c e s  the adjustment  than  three-fourths  m u l t i p a r o u s mothers with p r i m i p a r a s having frequency  a f t e r one  t o t h i s 'were t h e a r e a s o f  sexual r e l a t i o n s  were r a n k e d  infant.  identifying  Of  and  these  private  experienced  had  about  housework, baby a n d f a m i l y about  one  o f w h i c h were o f c o n c e r n  mothers.  concerned  of  they  related  t w o - t h i r d s of the some  care  their  to  17 p r i m i p a r a s a n d 23  to recall  38 o f t h e 40 m o t h e r s  e x e r c i s e and d i e t  sought  were a s k e d  month a t home w i t h  concern.  of  the  mothers  frequently stated  normal w i t h  She a l s o  of h e l p mothers t u r n t o r e g a r d i n g  concerns.  obstetrician.  between t h e  concerns  the multiparas  o f t h e f a m i l y t o t h e new  member. Pate by  Gruis  sample.  (1979) c o n d u c t e d (1974) She f o u n d  a replication  using  a slightly  little  difference  of the  larger in  study  done  a n d more d i v e r s e  the  frequency  of  36  concerns  and  the  two  of  figure  found  studies.  be  concerns self. self  that  most  were  was  to  concerns  exercise  seeking assistance  dispite as  findings Fritsch  the  finding  major  differ  to  c h a n g e were o f p r i m e  still  for concerns seek  concerns  often  to  related  to  than  concerns  significantly  the  Bull  infant  importance  (1981) and  from who  maternal  d u r i n g the  those found  physiological  first  week. Pate  is  that  asked  recall  the  e x p e r i e n c e d over  possible  that  ability  to r e c a l l  the passage  infant  only was  The  the  of  time  results  concerns  she  to  (1979)  Once a g a i n  affected  the  e x p e r i e n c e d one  the i t is  mother's  e x p e r i e n c e d i n the  o f t h e s e s t u d i e s may  A  first  in  month a f t e r  fact the  born.  Harrison  and  Canada u s i n g a  Hicks  random  m u l t i p a r o u s mothers by  were  t h e p a s t month.  the concerns  weeks p o s t p a r t u m . reflect  mothers  of that  (1974) and  concerns  for  related  o f t h e s e s t u d i e s by G r u i s  fact  she  help  limitation the  In  family.  (1972) and  related  were  for concerns  more  return  concerns.  to  that  between  family,  stated  t h e baby t h a n  t o t h e baby o r  Sumner and  and  frequently  of  perceived  These  as d i e t  m o t h e r s were more l i k e l y  related  This  related  the  as w e l l  . patterns  found  of the puerperium  R e g u l a t i n g demands o f t h e  to normal  to  examining also  perceived d i f f i c u l t y  the Winnipeg  (1983), conducted sample  of  f o r whom b i r t h  Department  64  a similar  primiparous  notification  o f H e a l t h and  was  Community  study i n and  94  received Services.  37  The  questionnaires  retrospectively Their Pate  in  their  r a n g i n g from  findings  were  (1979) i n t h a t  concern  about:  figure,  fatigue,  finding  time  study  23  t o 60 d a y s  similar  70  % or  of  demands  emotional  the  two  of  some  time  They  do  changed over It  has  review  r e s e a r c h has days  They a l s o  found  that  both groups  time  there  tended  only indicate  the  how  the  the  that  completing  focus  to  see  been  through  an  of  period  noted  or a f t e r  how  time p e r i o d whether  at the  concerns.  of the  this  attempt  t o measure c o n c e r n s  this  that  and  between  a  concerns  period.  has  during  differences  findings  not  literature  to describe  mothers e x p e r i e n c e d u r i n g the puerperium.  of t h i s  and  t h e r e was  e x p e r i e n c e d t h e s e same  demonstrate  i s known a b o u t  purpose  concerns multiparas  i n the t y p e s of c o n c e r n s  delivery  Little  mothers  of  for personal interests.  been p o s s i b l e  that  return  and  this  that  concerns  few  family,  some  diet  between  not  had  and  exercise,  Once a g a i n t h e s e  questionnaire  (1974)  tension,  difference  groups.  delivery.  women  same f r e q u e n c y o f m a j o r c o n c e r n s and  significant  completed  after  the  a l t h o u g h p r i m i p a r a s e x p r e s s e d more m i n o r had  also  to those of G r u i s  more  regulating  were  either  i n the  t h e p a s s i n g o f one  the focus of  the  the  i n these  time two  The first  month.  concerns  f o r b o t h p r i m i p a r o u s and  shift  multiparous  since  delivery  affects  groups.  It  for  t h e p r e s e n t s t u d y was  conducted.  the  is  the this  38  CHAPTER 3  Methodology  Introduction A descriptive, as  the  methodology  descriptive current of  study  effects parity This  of on  the  the  the d a t a  r e s e a r c h d e s i g n was  this  study.  more  The  which  was  frequency  to  of time and  gathering  used  data  of  about  the  the  and  of maternal  sample and  setting  and  the  the  maternal  concerns.  used  t o measure t h e m a t e r n a l  procedures  purpose  regarding  since delivery  intensity  d i s c u s s e s the  instrument  provide  with  chosen  purpose  information  o f phenomena, i s c o n g r u e n t  the v a r i a b l e s  chapter  study,  for  research, to gain  status  this  correlational  methods  in  this  concerns, of  data  analysis.  Sample and  Setting  This  study  took  Canada where s e r v i c e s priority  of  the  place  city  in  to p o s t n a t a l mothers are at p r e s e n t  a  local  v o l u n t e e r sample o f  thirty-six  multiparas  was  and  used.  residing The  a  community  convenience  hospital  in  hospital  health  thirty-one  delivering w i t h i n one  large  in  one  health  of d e l i v e r y  was  urban  department. primiparas urban  unit's  A and  teaching boundaries  a family-centered  39  maternity  hospital  teaching  and  realistically amount prior  of  philosophy  preparation  there  for  was o f t e n w i d e  teaching  to discharge  variable  whose  provided  from h o s p i t a l .  area  of the c i t y  middle c l a s s  as  homes a s  was a v a r i e t y boundaries  well  of e t h n i c  particularly  in  both  the  absorbed  T h i s was r e c o g n i z e d  served area  unit  variation  parent However,  and t h e i n f o r m a t i o n  was a p r i m a r i l y m i d d l e c l a s s  There  discharge.  t h e i n v e s t i g a t o r was u n a b l e  The  emphasized  as  a  to control.  by t h e c h o s e n h e a l t h with  some  some p o c k e t s subsidized  unit  of upper housing.  g r o u p s who r e s i d e d w i t h i n t h e  of the East  Indian  and O r i e n t a l  cultures. In o r d e r sample  was  to achieve limited  some  to  measure  mothers  of  who  homogeneity  met  the  following  criteria: r  i)  delivered vaginally, a fullterm,  2500 grams, h e a l t h y ii)  were  18  to  greater  than  infant 38  years  o f age a t t h e t i m e o f  from  hospital  delivery iii)  were  infant  discharged  within  five  iv)  resided with  v)  were  language  able  days  with  their  following delivery.  the i n f a n t ' s f a t h e r to  speak  and  read  the  the  English  40  Measurement A  instrument  self-administered  addressed  potential  c a t e g o r i e s of s e l f , Bull  levels  was c h o s e n  in  i t include the  a s t h e measurement  Vancouver  several the  items  infant  getting regarding one  in  H e a l t h Department (Munroe & W a l k e r ,  baby  which  Bull  obtained from  community (1981),  concerns had  nurses,  clarity i t e m s on retained.  score  and  category  there  The r e v i s e d  that  Score .82  concerns  a r e a was n o t  could  readily  more t h a n  50% o f  in this  internal  to  of  as t h i s nurse  found  for  no  area. reliablity  was  was  (1981) a n d r a n g e d  f o r the category of who  more t h a n one y e a r p r i o r a n d  Bull's  content v a l i d i t y  which  particular  A p a n e l of f o u r t e e n mothers  birth  reviewed  In  t h e baby h a d g a i n e d a n d  health  also  regarding family. a  order  Plans f o r  The  for a l l questions  experienced  three  Alpha  in  Standard Care 1984).  on B u l l ' s M a t e r n a l C o n c e r n s  .97  (Appendix  addressed  sample o f m o t h e r s h a d no c o n c e r n s Cronbach's  by G r u i s  i n the area of concerns r e g a r d i n g  immunized.  the  by  or problems  t h e community was e l i m i n a t e d  intervene. her  concerns  s u c h a s , amount o f w e i g h t  the  instrument.  were made i n t h e i n s t r u m e n t  were a d d e d  that  developed  of concerns developed  the p o t e n t i a l  t h e Newborn V i s i t  questionnaire  baby, h u s b a n d a n d f a m i l y ,  & F) Some r e v i s i o n s  that  item  of concern with regards to the  (1981) from a c h e c k l i s t  (1974), E  51  (1981)  prior  at  questionnaire for  t o d a t a c o l l e c t i o n , and  least  80%  agreement  i n s t r u m e n t was r e v i e w e d  were  by a p a n e l o f  41  ten  community  health  m o t h e r s ) who v i s t e d determine c l a r i t y  mothers  data  ages o f p r e v i o u s  were  also  compare  Data  i t t o what  such  in  whom were a l s o  area,  in  order  to  and  order  maternal  assistance  a g e , number  in  the  home  t o d e s c r i b e t h e sample a n d the t o t a l  population.  Collection  study  were c o n t a c t e d  liason The  nurse  were  the  emphasizing  form  or  a  by t h e community  letter  and  with  from  details  to participate  and took  of  health  new m o t h e r s .  the the  researcher study  and  second  day  days The  or  The  one  forms t o t h e i n v e s t i g a t o r and  m a t c h e d numbers  i n order  responses.  signed  the  attached  first  was  completed  on  the  a t home a n d t h e s e c o n d was c o m p l e t e d  liason  questionnaires  she  If  home two c o p i e s o f t h e q u e s t i o n n a i r e  envelopes.  twenty-eight hospital.  given  i n the  t h a t t h e mother c o u l d w i t h d r a w a t any t i m e .  addressed  first  f o r acceptance  i n the h o s p i t a l  purpose  t h e mother a g r e e d consent  criteria  as p a r t of her u s u a l c o n t a c t  mothers  explaining  of  as p a r i t y ,  i s known a b o u t  M o t h e r s who met t h e  in  of  validity.  children  collected  (several  i n the study  and c o n t e n t  Demographic and  nurses  month  nurse  after  returned  at the health  demographic  data  to maintain  discharge the signed unit  from consent  office.  forms were c o d e d  strict  The with  confidentiality  42  Community routinely mothers sealed  i n the to  up  telephone  by  again  questionnaire  completed the  the  as  days  at  nurse  mailed  the  mother  unit  A  to  the  i t i n the  later  have  to the h e a l t h u n i t .  with  access  to  both  Names a n d phone data  collection  her  second  matching  concern.  of  Completed  data  analysis  Null  Hypotheses  numbers  was  were  was c o m p l e t e d was  destroyed  The the  done  only  questionnaire, i n order  the  first  and  second  i f the t o ensure  measure  intensity  completed.  is  i n order  to test  no d i f f e r e n c e  of concern  two d a y s a t  month l a t e r .  of  once t h e  the f o l l o w i n g  hypothesis:  There  as  and matching o f  q u e s t i o n n a i r e s were d e s t r o y e d  D a t a were a n a l y z e d  first  the  q u e s t i o n n a i r e s a n d t h e names a n d phone numbers o f  lost  1.  or  follow-up  f o u r weeks  arrange  up o r m a i l e d  mothers  reminded  to the h e a l t h  and  was t h e o n l y p e r s o n  the  accurate  home,  i f she was t o v i s i t .  s u b j e c t ' s c o d e number a n d name  mother  the  t h e q u e s t i o n n a i r e and p l a c e  picked  subjects.  soon  contacting  was made by t h e i n v e s t i g a t o r  remind  investigator  few  t o be e i t h e r the  call  nurses,  first  complete  envelope,  picked  to  health  i n t h e f r e q u e n c y and  of primiparous  home  and  their  ( F i g u r e 1: A v s .  C)  mothers  i n the  concerns  one  null  43  2.  There  intensity first  is  of concern  two d a y s a t  month l a t e r .  3.  There  multiparous  There  o f m u l t i p a r o u s mothers  home  and  concern  mothers  of  For divided 21  the into  items  items  of  concerning  family. concern,  concern,  3: much c o n c e r n  were d e t e r m i n e d  each  and  f o r the t o t a l  for  level  two d a y s a t home  the  B)  frequency  primiparous  one month a t  and and  home  analysis  the  with  q u e s t i o n n a i r e was  18 i t e m s c o n c e r n i n g  Intensity 1:  little  of concern  self;  was s c o r e d a s  concern,  a n d 4: c r i t i c a l  of i n t e n s i t y concerns.  f o r each  item,  A suitable  f o r items  2:  concern.  on t h e number o f c o n c e r n s  t o the responses  a l l items  and  baby; 6 i t e m s c o n c e r n i n g h u s b a n d a n d 5  0: no  applied  of  four c a t e g o r i e s with  at  one  ( F i g u r e 1: C v s . D ) .  follows:  counts  in  concern  purpose  concerning  primiparous  ( F i g u r e 1: A v s .  m u l t i p a r o u s mothers a f t e r infant.  concerns  i n the frequency and  of  i s no d i f f e r e n c e  i n the  D)  i n the f i r s t  infants.  intensity  their  their  no d i f f e r e n c e  of  with t h e i r  i n the frequency and  ( F i g u r e 1: B v s .  is  intensity  4.  no d i f f e r e n c e  moderate Frequency  mothers had  f o r each  category  chi-square test  w i t h i n each  a c r o s s c a t e g o r i e s t o determine  was  c a t e g o r y and  the s t a t i s t i c a l  44  Primiparas  1st  2  days  1 month  Multiparas  A  B  C  D  Figure 1 Representation  significance A mean items,  of the d i f f e r e n c e intensity  for  items  chosen  r e s p o n s e s may  between  s c o r e was  within  across a l l categories. were  data  not  follow  analysis a  scale.  Mann-Whitney U t e s t  and  direction  between  the  multiparous Signed-Rank the  of two  test  at  may  tests it  f o r a l l items  of was  individual  significance felt  distribution  not q u a l i f y  as an  that  the  and  the  interval  was  used t o t e s t  the  difference  in intensity  of c o n c e r n s  independent  mothers  difference  dependent  the  scale  as  normal  measurement  for  c a t e g o r y and  Nonparametric  for  groups.  calculated  each  underlying The  of R e s e a r c h D e s i g n  groups  both time  of  primiparous  intervals.  was  used to determine the  of  intensity  The  and  significance  multiparas  and  Wilcoxon  of c o n c e r n s i n v o l v i n g  measures of p r i m i p a r a s  degree  the  two  of two days  45  following discharge age,  discharge  respectively.  ethnic  analyzed describing  from  in the  background terms  of  h o s p i t a l and  Demographic and  level  proportions  c h a r a c t e r i s t i c s of  the  data of for  one  month  such  as  education the  sample.  following maternal were  also  purpose  of  46  CHAPTER 4  Analysis  of  Data  Introduction  The  data  determine  any  intensity  of  the  first  self,  the  significant  days a f t e r  The  baby,  the  partner,  reports  sample  and  one  in  data  regarding  of  the  findings will  Characteristics  data by  follow  of  the  data  in chapter  from  into concerns  about  Frequency  calculated.  of This  the c h a r a c t e r i s t i c s relating  D i s c u s s i o n of  in  discharge  characteristics  percentages  to and  multiparas  concerns.  the  regarding  the  study.  total  analyzed  frequency  and  month a f t e r  f a m i l y and  the  followed  hypotheses the  differences  sample were d e t e r m i n e d and  chapter  were  c o n c e r n s were c a t e g o r i z e d  c o u n t s of demographic the  questionnaires  c o n c e r n s between p r i m i p a r a s  two  hospital.  from  the  to  the  of  four  significance  of  five.  Sample  Par i t y The  questionnaires  the c r i t e r i a Over  the  two  of  the  and  were a p p r o a c h e d  were g i v e n  study  one  half  and  out  consented  month p e r i o d  to p a r t i c i p a t e ,  t o 95  73  to  m o t h e r s who  met  participate.  i n which the  mothers r e t u r n e d  mothers the  47  first  q u e s t i o n n a i r e w h i c h was  days  after  complete  discharge.  the  second  discharge  resulting  was  return  a 70%  consisted  of  Six  completed  of these  questionnaire in  a final  rate. 31  t o be  The  primiparas  at  one  36  month  after  in  the  which sample  multiparas.  The  primiparas  made up 46% of t h e sample and t h e m u l t i p a r a s  Thirty-two  multiparas  while her  (86%) were h a v i n g  t h r e e were h a v i n g  fourth c h i l d .  from t h i r t e e n  their  third  their  child  second  54%. child  and one d e l i v e r e d  The ages o f t h e p r e v i o u s  months t o t w e l v e  two  d i d not  o f 67 m o t h e r s  mothers and  to  participants  sample  67  one  children  ranged  years.  Age The years.  ages  of  the  The a g e s were d i v i d e d  below  23, 23 t o 28,  were  chosen  over  30 m o t h e r s category  between  35. (45%).  into  relatively  those  The modal  34.  equal  m o t h e r s who category  was  Twenty - s e v e n m o t h e r s  29 t o 34 y e a r s .  ranged  four  29 t o 34 and above  to provide  to d i s t i n q u i s h those  sample m o t h e r s  (Table 1).  from  19 t o 38  category  groups:  These c a t e g o r i e s age c a t e g o r i e s and  were  30  and  23 t o 28 y e a r s  with  (40%)  over  were  in  the  48  Table Years  1: D i s t r i b u t i o n  Primiparas  18-22 23-28 29-34 35 +  Multiparas  4(13)* 17(55) 8(26) 2(7)  * Percentage of t o t a l  Gender The female  o f M o t h e r s by Age  Total  2(6) 13(36) 19(53) 2(6)  6(9) 30(45) 27(40) 4(6)  in brackets  o f Baby  mothers  in  the  sample  delivered  39 male and 28  infants.  Education The e d u c a t i o n l e v e l from  of the mothers  those having completed  completed school  graduate  whereas  mothers had vocational graduated  23  some school.  i n t h e sample  some h i g h s c h o o l  school.  Seven  completed vocational  t o those having  mothers  high  had  school.  school  and  s c h o o l a n d two c o m p l e t e d  and  two  attended  a graduate degree.  some  Eight  seven  S i x h a d some u n i v e r s i t y  from u n i v e r s i t y  ranged  (Table  of the  completed  whereas some  high  twelve  graduate 2)  49  Table Education  2: D i s t r i b u t i o n  Level  Pr i m i p a r a s  Some h i g h s c h o o l Completed h i g h school Some v o c a t i o n a l / college Completed v o c a t i o n a l / college Some u n i v e r s i t y Completed u n i v e r s i t y Some g r a d u a t e s c h o o l Completed graduate school  Many sample. themselves  as  background.  Other  Canada had  Canada  less  11(36)  12(33)  23(34)  7(23)  1(3)  8(12)  3(10) 3(10) 5(16) 1 (3)  4(11) 3(8) 7(19) 1 (3)  0(0)  2(6)  of  having  the a  groups  German,  of t h e mothers  mothers  Canadian  ethnic  f o r more t h a n  to ten years  7(10)  7(10) 6(9) 12(18) 2(3) 2(3)  e t h n i c g r o u p s were r e p r e s e n t e d  Ismali,  lived  6(17)  of Mothers  Thirty-two  Thirty-four  Total  i n brackets  different  Indian,  Education  Multiparas  1 (3)*  * Percentage of t o t a l  Ethnicity  o f M o t h e r s by  (48%) or  than  five  (10%) o f years.  the  (Table  had  East  Portugese. lived  in  Seventeen of the mothers  i n Canada t e n t o t w e n t y y e a r s , and seven  ethnic  Chinese,  and  (51%) s t a t e d they  twenty y e a r s .  identified  Caucasion  included  Fillipino  in this  nine mothers  sample 3)  had  lived  five in  50  Table  3: D i s t r i b u t i o n  o f M o t h e r s by E t h n i c  Ethnicity  Frequency  Percent  32 1 1 4 5 2 3 3 10  48 1 6 6 8 3 5 5 1 4  Canadian Chinese East Indian Fillipino German Ismali Portugese Other  Type o f I n f a n t At the  Thirteen (12%)  Feeding  the time of c o m p l e t i n g  mothers  (69%)  were  of the mothers  were c o m b i n i n g  Prenatal  Class  prenatal  twenty-nine classes, classes.  five  the f i r s t  questionnaire  breastfeeding  (19%) were f o r m u l a  their  46 o f  infants.  feeding  and e i g h t  t h e two m e t h o d s .  Attendance  Twenty-nine mothers attended  Background  (43%),  classes  with  mothers n i n e t e e n  a l l o f whom were this  attended  primiparas,  pregnancy. the health  the h o s p i t a l c l a s s e s and f i v e  Of  the  department  private  agency  51  Return  At the  the time of c o m p l e t i n g  mothers  Thirty-one to  t o Work  (54%)  were  the f i r s t  planning  questionnaire  to  return  (46%) o f t h e sample had n o t made p l a n s  36 o f  to  work.  to  return  the workplace.  H e l p a t Home and Use o f P r o f e s s i o n a l R e s o u r c e s  At the  the time of c o m p l e t i n g  mothers  helpful that  (81%)  person  their  stated  the f i r s t  that  t o them a t home.  mother  or  their  questionnaire h u s b a n d was  t h e most  Nine of the mothers  s i s t e r was  t h e most  54 o f  stated  helpful  at  this  time. When c o m p l e t i n g after  discharge  from  the  second  hospital  questionnaire the  mothers  during  home.  (90%) h a d had c o n t a c t  community contacts being  ranging  with  pediatrition, contacts being  the  mothers  h e a l t h nurse d u r i n g  1.3.  contact  of  professional  first  the  month  number  f r o m 0 t o 3 and t h e mean number o f  a  physician,  since  The help  from  their  either discharge  family with  did  sought d u r i n g  not this  identify time.  one or  number o f  0 t o 7 and t h e mean number o f  mothers  of  contacts  doctor the  at  with, a  A l l b u t one o f t h e m o t h e r s had had a t l e a s t  ranging  2.2.  t h e month w i t h  month  r e p o r t e d the  number o f p r o f e s s i o n a l c o n t a c t s Sixty  their  one  any  contacts other  52  Difference  Between C o n c e r n s o f P r i m i p a r a s  and M u l t i p a r a s a t  Two Days In  analyzing  completed  during  hospital  the  scale  within  categories  ranked  two  frequencies  of  each  (i.e.,51  of  multiparas.  category  concern  each category  items  four for  and  less  items  across  over a l l  were o b t a i n e d a n d  the  total  was a l s o  and  determined  was u s e d  to  items  the  of  level  frequencies  Therefore  are  o f 0, 1, 2, 3, items  the  in  each  difference  each  category  a n a l y s i s f o r the  only  the chi-square  f o r the t o t a l  reported  in  of i n t e n s i t y of  for  making t h e c h i - s q u a r e  findings  item,  and c h i - s q u a r e a n a l y s i s  f o r each  of responses  f o r each  items.  of responses  significance  of concerns  five  primiparas  multiparas  f o r t h e sum o f  the  t h e mean f r e q u e n c y These  items  between  and  categories questionable.  reported.  totalled  o f any d i f f e r e n c e i n i n t e n s i t y o f  Many o f t h e mean than  point  The Mann-Whitney U t e s t  primiparas  for  frequency  on t h e f i v e  across  and f o r t h e sum o f a l l 51  to determine  from  item,  and  m o t h e r ' s mean f r e q u e n c y  concern. were  each  differed  4, were a l s o c a l c u l a t e d  total  responses  discharge  and a c r o s s a l l c a t e g o r i e s t o determine i f  the s i g n i f i c a n c e  category  after  Spearman's r h o c o r r e l a t i o n  between  The  days  questionnaire  items).  b a s e d on t h e r a n k i n g s . determine  for  the f i r s t  means f o r i n d i v i d u a l  by c a t e g o r y  ranking  from  the f i r s t  Arithmetic  used  data  (0-4) were o b t a i n e d  items  the  the  items  according  is  to the  53  catagories  of  self,  baby,  partner,  family  and  total  concerns.  Self There  was  some  responses  between  primiparas  ranking  from  (  stitches'  difference  the  ' b e i n g a good m o t h e r '  'fatigue'  multiparas  the highest  whereas  the  figure'  t o be o f g r e a t e s t c o n c e r n  4) A c o m p a r i s o n multiparas  difference any  looking  test  the  similar  indicates items  did  between  r h o was  the  not  with  and 'pain of concern 'return  of  (Table  primiparas  .833 (p<.05)  and  f o r the  of s e l f . category  demonstrate  category  the  (U=467;  of a  self,  the  significant  p=.252)  or f o r  items. sum  t h e mean f r e q u e n c y very  at  and  o f mean  i n this category.  i n the category  f o r the ' s e l f  individual For  in  intensity  'fatigue'  Spearmans's  r a n k i n g of the items  Mann-Whitney  found  of r a n k i n g of items  showed  However,  ranking  mothers  having  groups  the of  as  two  in  for  o f t h e 18 i t e m s of concern primiparas  the percentage  for a l l categories.  i n t h i s category  of s e l f  a t each l e v e l of i n t e n s i t y and  of responses  multiparas.  Table  o f 0-4 t o t a l l e d  was 5  across  54 Table  4: P r i o r i t y  Ranking of Concerns Regarding ( f i r s t 2 days)  Primiparas  Self  Multiparas  Item  Mean  B e i n g a good mother Fatigue P a i n from s t i t c h e s Return of f i g u r e Breast soreness Labour & d e l i v e r y exp. Care of b r e a s t s Emotional tension Diet Exercise habits Constipation Lochia Hemorrhoids Unable t o c o n c e n t r a t e B e i n g t i e d down P e r s o n a l time Baby b l u e s Return of p e r i o d  2 .68 2 .38 2 .07 2 .00 1 .93 1 .90 1 .83 1 .81 1 .77 1 .52 1 .52 1 .45 1 .45 1 .41 1 .38 1 .32 1 .23 1 .19  Mean o f r e s p o n s e s on 0-4  Item  1  Mean  Fatigue Return of f i g u r e B e i n g a good mother Labour & d e l i v e r y exp. Breast soreness Emotional tension Care of b r e a s t s Diet P a i n from s t i t c h e s Exercise Lochia P e r s o n a l time Return of p e r i o d B e i n g t i e d down Unable t o c o n c e n t r a t e Constipation Baby b l u e s Hemorrhoids  2 .25 2 .22 2 .03 1 .78 1 .75 1 .69 1 .67 1 .67 1 .58 1 .47 1 .42 1 .33 1 .25 1 .19 1. 1 7 1 .08 1 .06 0 .94  scale  Baby In  examining  Mann-Whitney difference  U  test  between  (U=417.5; p=.0772). which items  the  concerns  did the  not  two  demonstrate  T h e r e were however  the  infant',  'interpreting  illness'  and  significantly multiparas  infant',  greater  at this  time.  with  concern (Table  individual  'comfort  6)  category items  handling  in The the  'crying', 'recognizing  the to  in  the  significant  a t t h e .05 l e v e l .  behaviour',  'travelling  a  baby  groups f o r the t o t a l  t h e d i f f e r e n c e was s i g n i f i c a n t of 'bathing  regarding  infant'  the primiparas  were  of  than the  55  Table  5:  P e r c e n t a g e o f M o t h e r s ' r e s p o n s e s of a c r o s s items i n each c a t e g o r y ( 1 s t two d a y s )  Category  Parity  0-4  L e v e l of 1 2  0  totalled  Concern 3  4  Self 18 i t e m s  Primiparas Multiparas  19 .4 26 . 1  23. 3 23. 8  31 . 1 27 .7  18. 3 16. 1  7. 70 6. 10  Baby 21 items  Primiparas Multiparas  18 .5 28 .0  16. 2 21 . 9  29 .5 26 .6  26. 2 19. 0  9. 50 4. 80  Partner 6 items  Primiparas Multiparas  25 .5 28 .3  25. 5 23. 3  20 .0 26 .9  20. 0 18. 3  8. 50 3. 10  Family 6 items  Primiparas Multiparas  23 .3 20 .0  15. 6 26. 7  33 .3 28 .3  12. 8 21 . 7  5. 80 3. 70  Total 51 items  Primiparas Multiparas  21 .4 26 .3  19. 6 23. 3  29 .4 27 .3  21 . 1 18. 0  8. 05 4. 90  Note:  Primiparas  In t h e was  primipara  identified  followed  by  'feeding'.  n=3l  as  'safety', The  The  ranking  of  significantly  concern  'growth  and  T h e r e was  .783  at  each  of  items  this  illness'  in this  category  'safety',  greatest category  the  two  and  'growth  concerns. was groups  not as  (p<.05)  level  in this  their  between  also l i t t l e  concerns  in  of  development'  also identified  items  different  S p e a r m a n s ' r h o was  'recognizing signs  ' f e e d i n g ' as  the  n=36  greatest  multiparas  d e v e l o p m e n t ' and  21  group the  and  the  Multiparas  of  difference in intensity  category  the  frequency  of c o n c e r n  (Table  5)  f o r the  of sum  56  Table  6: P r i o r i t y  Ranking of Concerns R e g a r d i n g (1st 2 days)  Primiparas  Multiparas  Item  Mean  Recognizing illness Safety G r o w t h and d e v e l o p m e n t F e e d i n g baby Baby's w e i g h t g a i n Baby's B e h a v i o u r Baby's c r y i n g T r a v e l l i n g w i t h baby D r e s s i n g baby Baby's s l e e p i n g B a t h i n g baby Baby's b r e a t h i n g Fussiness Vitamins & F l o r i d e Immunizing baby Comfort i n h a n d l i n g baby Bowel movements Care of c o r d P h y s i c a l appearance Baby's r a s h e s  2 .74 2 .45 2 .35 2 .32 2 .19 2 .19 2 .13 2 .07 2 .03 2 .00 1 .90 1 .87 1 .87 1 .80 1 .74  Care of c i r c u m s i o n  0 .74  1  Baby  1 .74 1 .74 1 .67 1 .58 1 .54  Mean o f r e s p o n s e s on 0-4  Item  1  Mean  Safety Growth a n d D e v e l o p m e n t F e e d i n g baby Recognizing illness Baby's w e i g h t g a i n Baby's s l e e p i n g Immunizing baby D r e s s i n g baby Care of c o r d Baby's B e h a v i o u r Baby's r a s h e s P h y s i c a l appearance Fussiness Baby's c r y i n g T r a v e l l i n g w i t h baby Baby's b r e a t h i n g  2 .08 1 .94 1 .92 1 .91 1 .77 1 .64 1 .64 1 .64 1 .56 1 .47 1 .47 1 .44 1 .44 1 .44 1 .44 1 .39  Bowel movements V i t a m i n s and f l o r i d e B a t h i n g baby Comfort i n h a n d l i n g baby Care of c i r c u m s i o n  1 .39 1 .36 1 .25 1 .06 0 .50  scale  Partner The  Mann-Whitney  significant total  category  individual for  difference  'time  multiparas  (U=491;  items.  test  did  p=.3885)  together'  'birth  not  i n the category or  The p r i m i p a r a s '  alone found  U  control'  demonstrate  of partner,  for  any  of  mean i n t e n s i t y  was  ranked  t o be o f  a  f o rthe the s i x  of concern  highest  greatest  while concern  57  in  this  similarly for  category.  The  between  two  comparison  Table  7:  the  of  ranks  Priority  remaining groups.  was  .657  five  ( T a b l e 7)  Time a l o n e t o g e t h e r Time f o r r e c r e a t i o n Relationship with partner Birth control  1 .87 1.81  Sexual r e l a t i o n s P a r t n e r b e i n g a good father  1 .58  frequency groups.  on  of  0-4  the  Mean  Birth control Time a l o n e t o g e t h e r Time f o r r e c r e a t i o n  1.81 1 .56 1 .47  Relationship with partner Sexual r e l a t i o n s P a r t n e r b e i n g a good father  1 .36  at each l e v e l (Table  rho  Partner  I tern  1  1 .68 1.61  responses  sum  Spearman's  Multiparas Mean  the  ranked  (p<.05).  Primiparas  For  were  R a n k i n g of C o n c e r n s R e g a r d i n g ( f i r s t 2 days)  I tern  Mean o f  items  1 .36 1 .33 1 .33  scale  s i x items of c o n c e r n  in t h i s category  t h e mean  was  for  very  similar  both  5)  Family The the  two  category which  difference  between t h e  g r o u p s o f m o t h e r s was of  family  (U=480; p=  the d i f f e r e n c e  was  intensity also  not  .3254).  s i g n i f i c a n t was  of  concerns  s i g n i f i c a n t for The  only  item  for the in  in 'setting limits  58  on  visitors'  included of  (p=.0325).  in this  'Reaction  calculation  of  siblings'  was  a s i t was n o t o f c o n c e r n  not  t o any  the primiparas. The  inverted  ranking and  groups with be  of  'change this ranks  yielded  a  negative  the multiparas  greatest in  concern  family  category. was -406  Table  o f t h e mean i n t e n s i t y  finding and  lifestyle'  of concern  effect 'reaction  the  2 .04 1 .80 1 .77 1 .64  Mean o f r e s p o n s e s  frequency  similar  of  the  Family  Multiparas  F a m i l y l i f e s t y l e change Limiting visitors Demands o f h o u s e h o l d Finances A v a i l a b i l i t y of resources Reaction of s i b l i n g s  very  identifying  t o be o f g r e a t e s t c o n c e r n i n  Ranking of Concerns Regarding (1st 2 days)  Mean  of  t h e two  of s i b l i n g s ' to  primiparas  Primiparas  sum  was  (p<.05).  8: P r i o r i t y  the  between  ( T a b l e 8) Spearmans's r h o f o r c o m p a r i s o n  Item  The  scores  1  1 .35 0 .00  on 0-4  between  Mean  Reaction of s i b l i n g s Demands o f h o u s e h o l d Finances F a m i l y l i f e s t y l e change A v a i l a b i l i t y of resources Limiting visitors  2 .19 1 .89 1 .58 1 .58 1 .25 1 .22  scale  of responses items  Item  a t each l e v e l  i n the category  of concern f o r  o f f a m i l y was  t h e two g r o u p s o f m o t h e r s .  (Table  again 5)  59  Total  Items  The d i f f e r e n c e primiparas discharge (U=429.5; of  and was  in  multiparas not  p=.1061).  the  'recognizing greatest and  two  in  significant  t h e mean i n t e n s i t y  between  intensity  Table  and  first  for  across  with  items  the  'being a  t o be o f g r e a t e s t  good finding  mother' 'return  concern.  of the t o t a l  items  (p<.05) See A p p e n d i x A f o r t h e r a n k i n g  mean  intensity.  after items  the ranking somewhat  identifying as of  their figure' rho  f o r t h e two g r o u p s  Ranking of H i g h e s t (1st 2 days)  of a l l items  was by  T o t a l Concerns  Mult i p a r a s  I tern  Mean  Recognizing i l l n e s s B e i n g a good mother Safety Fatigue Growth & Development F e e d i n g baby Baby's w e i g h t g a i n Baby's b e h a v i o u r Baby's c r y i n g T r a v e l l i n g w i t h baby P a i n from s t i t c h e s D r e s s i n g baby  2. 74 2. 68 2. 45 2. 38 2. 35 2. 32 2. 19 2. 19 2. 1 3 2. 07 2. 07 2. 03  1  the  Spearmans's  .585  Primiparas  days  a l l 51  primiparas  the .ranking  9: P r i o r i t y  two  varied  for  Table  between  9 demonstrates that  c o n c e r n s and m u l t i p a r a s  'fatigue'  concern  the  s c o r e s of the  groups  illness'  of  Mean o f r e s p o n s e s on 0-4  I tern  1  Fatigue Return of f i g u r e Reaction of s i b l i n g s Safety B e i n g a g o o d mother Growth & development Baby's f e e d i n g Recognizing i l l n e s s Demands o f h o u s e h o l d Birth control Labour & d e l i v e r y exp. Baby's w e i g h t g a i n  scale  Mean 2.25 2.22 2.19 2.08 2.03 1 .94 1 .92 1 .91 1 .89 1.81 1 .78 1 .77  60  The  mean  intensity  frequency  f o r the  significantly =  .73  (df=4)  Difference  sum  of  of  the  different  total  between t h e  (p>.05) ( T a b l e  i n Concerns  responses  at  items two  each was  groups.  level again  of not  Chi-square  5)  o f P r i m i p a r a s and  Multiparas at  One  Month  The items  mothers completed  one  their  month  responses  after  a q u e s t i o n n a i r e w i t h the their  were a n a l y z e d  same  d i s c h a r g e from h o s p i t a l  in  the  same  manner  as  51 and the  f i r s t questionnaire.  Self In between  the the  c a t e g o r y of c o n c e r n s intensity  significant p=.3751). found  using  a  greater  good  mother'  concern  intensity  than  of concern  the  greatest  comparison  of  in  were  which  with  similar  the  the  The  and  (p<.05).  difference  found test  to  be  (U=487.5;  difference stitches'  primiparas  between  ( T a b l e 10) .877  U  the  ' d i s c o m f o r t from  'fatigue'  concerns. r a n k s was  not  multiparas.  was  'being a good mother',  was  Mann-Whitney  items  significant  self  concerns  the  Individual  t o be  'being  of  about  was and  identifying  r a n k i n g o f t h e mean the  'return  two  groups  of  figure'  Spearman's rho  with as  f o r the  61  Table  10: P r i o r i t y  Ranking of C o n c e r n s (one month)  Pr i m i p a r a s Mean  B e i n g a good mother Return of f i g u r e Fatigue Exercise Diet Emotional tension P e r s o n a l time B e i n g t i e d down Lack of c o n c e n t r a t i o n Return of p e r i o d Baby B l u e s Constipation Lochia L a b o u r & d e l i v e r y exp. Care of b r e a s t s P a i n from s t i t c h e s Hemorrhoids Breast soreness  2 .22 2 .20 2 .00 1 .90 1 .81 1 .70 1 .61 1 .48 1 .45 1 .30 1 .10 1 .03 1 .00 1 .00 1 .00 0 .94 0,84 0 .84  Mean o f r e s p o n s e s on  concern  mean  eighteen  items  percentage  of  0-4  I tern  1  2 .06 1 .69 1 .69 1 .60 1 .58 1 .56 1 .47 1 .08 1 .'19 1 .06 1 .06 0 .92 0 .89 0 .86 0 .83 0 .81 0 .78 0 .47  Return of f i g u r e Fat igue P e r s o n a l time B e i n g a good mother Exercise Emotional tension Diet Care of b r e a s t s B e i n g t i e d down Lack of c o n c e n t r a t i o n Return of p e r i o d Breast soreness Baby B l u e s Lochia Constipation L a b o u r & d e l i v e r y exp. Hemorrhoids P a i n from s t i t c h e s  of  responses  significantly in  Mean  scale  frequency  were n o t  Self  Multiparas  I tern  The  Regarding  this  different  category.  responses  of  at  0-4  each  level  f o r t h e sum  Table  11  of  shows  of the the  f o r a l l categories at  one  o f c o n c e r n s between t h e  two  month.  Baby The  difference  groups  was  month  after  difference  not  was  in intensity  significant discharge found  for  (U=  t o be  the 417;  category p=.076l).  significant  for  of  baby  However, the  items  one the of  62  Table  11:  P e r c e n t a g e of M o t h e r s ' R e s p o n s e s of A c r o s s Items i n e a c h C a t e g o r y (one month)  Category  Parity  L e v e l of 1 2  0  0-4  Totalled  Concern 3  4  Self 18 i t e m s  Primiparas Multiparas  28. 9 36. 1  27. 2 25. 6  22 .8 22 .8  1 5.6 12 .2  5 .40 2 .80  Baby 21 items  Primiparas Multiparas  29. 5 37. 6  22. 9 30. 4  20 .0 19 .0  20 .4 1 1.0  7 .10 2 .10  Partner 6 items  Primiparas Multiparas  30. 0 30. 0  15. 8 25. 0  25 .0 25 .0  25 .0 15 .0  5 .30 4 .80  Family 6 items  Primiparas Multiparas  36. 7 26. 7  28. 3 30. 0  18 .3 30 .0  1 2.3 1 1.5  3 .80 3 .70  Total 51 items  Primiparas Multiparas  30. 2 34. 7  24. 3 28. 1  21 .2 22 .4  18 .4 1 1.8  5 .90 2 .70  Note:  Primiparas  'baby's  n=31  breathing',  Multiparas  'bowel  'sleeping',  'interpreting  of  with  the  was  some  illness'  (Table  intensity  of c o n c e r n  rho  being  .863  The  mean  of  the  movements',  behaviour'  primiparas  and  'fussiness'  'recognizing  expressing  greater  and signs  concern.  12)  There  concern  n=36  items  between  the  in two  the  ranking  groups with  of  mean  Spearman's  (p<.05) frequency  were a g a i n 21  variation  not  of  responses  at  significantly different  in this category.  (Table  11)  each for  level the  of sum  63 Table  12: P r i o r i t y  Ranking of Concerns Regarding (one month)  Primiparas  Baby  Multiparas Mean  I tern  Mean  Recognizing illness Fussiness Baby's B e h a v i o u r Safety Growth & Development Baby's s l e e p i n g Baby's f e e d i n g Baby's c r y i n g D r e s s i n g baby T r a v e l l i n g w i t h baby Baby's w e i g h t g a i n Baby's b r e a t h i n g P h y s i c a l appearance Bowel movements Baby's r a s h e s I m m u n i z i n g baby Comfort i n h a n d l i n g Baby B a t h i n g baby V i t a m i n s and f l o r i d e  2.30 2.03 2.00 1 .94 1 .94 1 .90 1 .87 1 .81 1 .74 1 .61 1 .58 1 .52 1 .48 1 .42 1 .42 1 .32  Safety Recognizing illness Growth & Development Fussiness Baby's s l e e p i n g Baby's f e e d i n g Baby's r a s h e s Baby's c r y i n g D r e s s i n g baby I m m u n i z i n g baby Baby's B e h a v i o u r T r a v e l l i n g w i t h baby Baby's weight g a i n P h y s i c a l appearance Bowel movements Baby's B r e a t h i n g  1 .56 1 .50 1 .36 1 .33 1 .33 1 .31 1 .31 1 .31 1 .22 1 .19 1 .14 1 .08 1 .08 1 .06 0 .94 0 .89  1 .07 1 .07 1 .03  0 .81 0 .75  Care of c o r d Care of c i r c u m s i o n  0.65 0.26  Bathing Vitamins Comfort baby Care of Care of  Mean o f r e s p o n s e s on 0-4  I tern  1  baby and f l o r i d e i n handling  . 0.67 0 .61 0 .42  cord circumsion  scale  Partner The  difference  significant after  f o r the t o t a l  delivery  items.  The  differed  in  (U=492;  ranking  both groups i d e n t i f y i n g greater comparison  concern.  category p=  of  significantly  intensity  for 'time  (Table  o f r a n k s was  of  .4020)  the  of  mean  concern partner  or  was one  not month  f o r any o f t h e s i x  intensity  of  concern  t h e two g r o u p s o f m o t h e r s alone 13)  together'  Spearman's  .232 ( p > . 0 5 ) .  to  rho  be  with of  f o r the  64  Table  13: P r i o r i t y R a n k i n g o f C o n c e r n s R e g a r d i n g (1 month a f t e r d i s c h a r g e ) Primiparas  Partner  Multiparas  I tern  Mean  I tern  Time a l o n e t o g e t h e r Sexual r e l a t i o n s R e l a t i o n s h i p with partner Time f o r r e c r e a t i o n  1 .74 1 .68  Birth control Time a l o n e t o g e t h e r Time f o r r e c r e a t i o n  1  1 .68 1 .64  Mean o f r e s p o n s e s  The mean concern the  1 .36 on 0-4  frequency  was  (Table  1 .22 1.19 1 .05  scale  of  responses  again q u i t e s i m i l a r  s i x items.  1 .72 1 .53 1 .50  R e l a t i o n s h i p with partner Sexual r e l a t i o n s P a r t n e r b e i n g a good father  1 .48  Birth Control P a r t n e r b e i n g a good father  Mean  at  each  level  of  between t h e two g r o u p s f o r  11)  Family In a n a l y z i n g t h e d a t a one  month  concern  after  The r a n k i n g o f t h e mean  item  primiparas concern 'reaction 14)  discharge, the d i f f e r e n c e  of  differed finding  in  this  (p>.05).  'household category  of s i b l i n g s '  Spearman's  between  rho  the  two  demands' and  t o be o f for  intensity  of  be  the multiparas greatest  the comparison  (U=525.5;  concern  groups to  family  i n i n t e n s i t y of  between t h e two g r o u p s was n o t s i g n i f i c a n t  p=.68'15). each  regarding the category  with of  on the  highest  identifying  concern. of ranks  (Table was -.086  65  Table  14: P r i o r i t y R a n k i n g (one  Primiparas  I tern  Mean o f r e s p o n s e s  The concern  Family  Multiparas Mean  H o u s e h o l d demands F a m i l y l i f e s t y l e change Finances Limiting v i s i t o r s A v a i l a b i l i t y of resources Reaction of s i b l i n g s 1  of Concerns Regarding month)  I tern  1  1 .68 1 .58 1 .26 1 .23  Reaction of s i b l i n g s 1 .72 Finances 1 .69 H o u s e h o l d demands 1 .65 F a m i l y l i f e s t y l e change 1 .25 A v a i l a b i l i t y of resources 1 .00 0.97 Limiting v i s i t o r s  1. 1 9 0 .00  on 0-4  scale  mean  frequency  of  was  again  similar  very  Mean  responses  for  each  level  f o r t h e two g r o u p s .  of  (Table  11)  Total The not  Items  difference  found  t o be s i g n i f i c a n t  individual  items  difference  between  discharge. the  total  'being  figure',  which  concerns  mother'  there  was  a  intensity  significant  'return  and t h e m u l t i p a r a s  'birth control'  and ' r e a c t i o n  signs of  of  figure'  identifying of other  after  of concern  between t h e two g r o u p s w i t h  'recognizing and  was  (U=448.5; p=.1684) d e s p i t e t h e  o f t h e mean  were v a r i e d  concerns  of the t o t a l  t h e two g r o u p s o f m o t h e r s one month  identifying,  a good  greatest  for  The r a n k i n g items  primiparas  in intensity  of the  illness', as  their  'return of  s i b l i n g s ' as  66  their  greatest concerns.  comparison the  of  ranks  was  r a n k i n g of a l l i t e m s  Table  15:  (Table  Priority  .644  15)  Spearmans r h o  (p<.05).  by mean i n t e n s i t y  R a n k i n g of H i g h e s t (one month)  Primiparas Mean  Recognizing i l l n e s s B e i n g a good mother R e t u r n of F i g u r e Fatigue Baby's b e h a v i o u r Safety Growth & d e v e l o p m e n t Baby's s l e e p i n g exercise Baby's f e e d i n g Baby's c r y i n g Diet  2.30 2.22 2.20 2.00 2.00 1 .94 1 .94 1 .90 1 .90 1 .87 1.81 1 .81  The concern  responses  significantly 5.54  on  0-4  mean f r e q u e n c y for  (df=4)  the  Appendix  of  concern.  Total  B for  Concerns  I tern  1  R e t u r n of f i g u r e Birth control R e a c t i o n of s i b l i n g s Fatigue Personal interests Finances H o u s e h o l d demands B e i n g a good mother Exerc i s e Emotional tension Safety Recognizing i l l n e s s  responses  of  the  f o r t h e two  (Table  Mean 2 .06 1 .72 1 .72 1 .69 1 .69 1 .69 1 .68 1 .60 1 .58 1 .56 1 .56 1 .50  scale  of  sum  different  (p>.05)  See  the  Multiparas  I tern  Mean o f  for  11)  total  for  each  concerns  groups.  level was  Chi-square  of not =  67  Difference  i n Concerns  One Month a f t e r The to  frequency  if  arid  t h e two q u e s t i o n n a i r e s  there  Wilcoxin  determine  and  a  of  s i g n e d rank  test  was a l s o  significant concern  month a f t e r  the s i g n i f i c a n c e  concern. level  was  intensity  mothers over the f i r s t The  Two Days a n d  Discharge  d a t a from  determine  of Primiparas i n F i r s t  analyzed  difference  i n t h e two g r o u p s o f  d i s c h a r g e from  f o r matched p a i r s  of the d i f f e r e n c e  hospital.  was u s e d  Spearman's  o f c o n c e r n on e a c h  correlation  Chi-square  was  used  to  frequencies  of responses  determine  f o r each  i t e m were a g a i n  coefficient any  to  i n i n t e n s i t y of  The mean o f t h e f r e q u e n c i e s o f r e s p o n s e s  of i n t e n s i t y  in  was  ranked  determined.  difference  i n the  f o r the t o t a l concerns.  Self The  difference  primiparas after  the  the f i r s t  intensity  category rank  difference 'diet',  for  concerns  matched  about  pairs  was n o t s i g n i f i c a n t  'return  'tension',  of  of f i g u r e ' ,  concerns  -2.42;  f o r such of  'feelings  'baby b l u e s '  and 'time  for  self.  coefficient  for  ranking  of  .05  level  s e l f using  (Z=  'return  'concentration',  the  of  for  two d a y s a t home a n d one month  d i s c h a r g e was s i g n i f i c a n t a t t h e  total sign  between  in  the W i l c o x i n  P=.0155.)  individual period',  mean  The  items as 'fatigue',  of being t i e d  Spearman's the  f o r the  down',  correlation  i n t e n s i t i e s of  68  concern  was  mother', as  .107  (p>.05).  'fatigue'  the s t r o n g e s t  dropped (Table  and  The  'return  concerns,  t o b e i n g of  less  16: P r i o r i t y (1st 1st  c o n c e r n one  from  good ranked  stitches'  month a f t e r d i s c h a r g e .  One 2,.68 2,.38 2,.07 2,.00 1 .93 , 1 .90 , 1 .83 , 1 .81 . 1 .77 , 1 .52 1 .52 1 .45 1 .45 1 .41 1 .38 1 .32 1 .23 1 .19  Mean o f r e s p o n s e s  The  self.  a  were s t i l l  'pain  2 days  B e i n g a good mother Fatigue P a i n from s t i t c h e s Return of f i g u r e Breast soreness Labour & d e l i v e r y exp. Care of b r e a s t s Emotional tension Diet Exercise Constipation Lochia Hemorrhoids Lack of c o n c e n t r a t i o n B e i n g t i e d down P e r s o n a l time Baby b l u e s Return of p e r i o d  the  'being  Ranking of Concerns of P r i m i p a r a s Regarding Self 2 days v s . 1 month)  Mean  of  figure'  however  Item  each  of  of  16)  Table  at  items  difference level  of  eighteen Table  totalled  on  0-4  Mean  B e i n g a good mother Return of f i g u r e Fatigue Exercise Diet Emotional tension P e r s o n a l time B e i n g t i e d down Lack of c o n c e n t r a t i o n Return of p e r i o d Baby b l u e s Constipation Lochia Labour & d e l i v e r y exp. Care of b r e a s t s P a i n from s t i t c h e s Hemorrhoids Breast soreness  items  2 .22 2 .22 2 .00 1 .90 1 .81 1 .70 . 1.61 1 .48 1 .45 1 .30 1 .10 1 .03 1 .00 1 .00 1 .00 0 .94 0 .84 0 .84  scale  between t h e mean f r e q u e n c y o f  intensity  was in  not  significant  for  concerns the  the c a t e g o r y of c o n c e r n s  17 shows t h e p e r c e n t a g e  a c r o s s items  month  Item  1  of  for a l l categories.  responses  of  sum about 0-4  69  Table  17: P e r c e n t a g e o f P r i m i p a r a s ' R e s p o n s e s o f 0-4 T o t a l l e d a c r o s s Items i n e a c h C a t e g o r y ( f i r s t 2 days v e r s u s 1 month)  Category  Time Measure  Level 1  0  of 2  Concern 3  4  Self 18 i t e m s  1st 2 d a y s 1 month  19.4 28.9  23. 3 27. 2  31 . 1 22. 8  18.3 15.6  7.70 5.40  Baby 21 i t e m s  1st 2 d a y s 1 month  18.5 29.5  16. 2 22. 9  29. 5 20. 0  26.2 20.4  9.50 7.10  Partner 6 items  1st 2 d a y s 1 month  25.5 30.0  25. 5 15. 8  20. 0 25. 0  20.0 25.0  8.50 5.30  Family 6 items  1st 2 d a y s 1 month  23.3 36.7  15. 6 28. 3  33. 3 18. 3  12.8 12.3  5.80 3.80  Total 51 i t e m s  1st 2 d a y s 1 month  21 .4 30.2  19. 6 24. 3  29. 4 21 . 2  21.1 18.4  8.00 5.90  Baby There concern  between  category all  was  items  t h e two  being  not  of  'fussiness', 'interpreting  baby  Spearman's r h o  items  -3.32;  in intensity  p=  'sleeping',  'bowel  remained  movements',  The  similar  f o r the comparison  of  on  on  the  physical 'rashes',  'dressing' ranking the second  r a n k s was  with  difference  'infant's  'crying',  behaviour'.  the  of  total  .0009)  of c o n c e r n  f o r which  included,  'circumsion',  of c o n c e r n  (Z=  l o w e r mean i n t e n s i t y  Individual  infant  difference  measures o f p r i m i p a r a s f o r t h e  significant  appearance',  intensity  significant  of c o n c e r n s about  second measure. was  a  .787  of  and mean  measure. (p<.05).  70  'Recognizing concern  signs  in this  Table  of i l l n e s s '  category.  continued  (Table  t o be t h e h i g h e s t  18)  18: P r i o r i t y R a n k i n g o f C o n c e r n s o f R e g a r d i n g Baby (1st 2 days) 1st  2 days  Item  Primiparas  One Month Mean  Recognizing illness Safety Growth a n d d e v e l o p m e n t F e e d i n g baby Baby's w e i g h t g a i n Baby's B e h a v i o u r Baby's c r y i n g T r a v e l l i n g w i t h baby D r e s s i n g baby Baby's s l e e p i n g B a t h i n g baby Baby's b r e a t h i n g Fussiness Vitamins & F l o r i d e Immunizing baby Comfort i n h a n d l i n g baby Bowel movements  2 .74 2 .45 2 .35 2 .32 2 .19 2 .19 2 . 13 2 .07 2 .03 2 .00 1 .90 1 .87 1 .87 1 .80 1 .74  Care of c o r d P h y s i c a l appearance Baby's r a s h e s Care of c i r c u m s i o n  1 .67 1 .58 1 .54 1 .54  1 .74 1 .74  1  Item  Mean  Recognizing illness Fussiness Baby's B e h a v i o u r Safety Growth & D e v e l o p m e n t Baby's s l e e p i n g Baby's f e e d i n g Baby's c r y i n g D r e s s i n g baby T r a v e l l i n g w i t h baby Baby's w e i g h t g a i n Baby's b r e a t h i n g P h y s i c a l appearance Bowel movements Baby's r a s h e s I m m u n i z i n g baby  2 .30 2 .03 2 .00 1 .94 1 .94 1 .90 1 .87 1 .81 1 .74 1 .61 1 .58 1 .52 1 .48 1 .42 1 .42 1 .32  Comfort Baby Bathing Vitamins Care of Care of  1 .07 1 .07 1 .03 0 .65 0 .26  in handling baby and f l o r i d e cord circumsion  Mean o f r e s p o n s e s on 0-4  scale  The d i f f e r e n c e between t h e mean f r e q u e n c i e s was n o t s i g n i f i c a n t category.  (Table  f o r t h e sum o f  17)  the  21  of concerns  items  in  this  71  Partner  The  difference  i n i n t e n s i t y of concern  m e a s u r e s was n o t s i g n i f i c a n t f o r e i t h e r of  partner  this  The  scores also this  ranking stayed  of  the  somewhat  measures  in  (p<.05).  The i t e m o f  continued  t o be ' f i n d i n g t i m e a l o n e  Table  the  total  category  with  greatest  mean  stable  intensity for  concern  in  this  together . 1  of two .667  category  (Table  19)  19: P r i o r i t y  Ranking of Concerns of P r i m i p a r a s Regarding Partner ( 1 s t 2 d a y s v s . ' 1 month)  1st  2 days  One month Mean  I tern  Time a l o n e t o g e t h e r Time f o r r e c r e a t i o n Relationship with partner Sexual r e l a t i o n s P a r t n e r b e i n g a good father  1 .87 1.81  Time a l o n e t o g e t h e r Sexual r e l a t i o n s R e l a t i o n s h i p with partner Birth control P a r t n e r b e i n g a good father  1  1 .68 1 .58 1 .36  Mean o f r e s p o n s e s on 0-4  Table  17  of concern  similar.  the  Spearman's r h o b e i n g  I tern  level  category  (Z= -.90; p=.3684) o r f o r any o f t h e s i x i t e m s i n  category.  concerns  between t h e two  also for  shows the  Mean 1 .74 1 .68 1 .68 1 .48 1 .36  scale  that six  t h e mean items  responses a t each  also  remained  very  72  Family The concern -2.2;  difference was  p=  between  significant .0279).  the p r i m i p a r a s  f o r the  Items  category  i n c l u d e d , 'household  resources'  and  'household one  after  the comparison  20:  of  of  ranks  Priority  was  .714  Table level family  There  on  0-4  f o r the  for primiparas  was  some  scores  with  in p r i o r i t y  Spearman's r h o  at for  Primiparas  One  17 d e m o n s t r a t e s  of concern  of  (p<.05)  month  Item  1  Mean  1 .68 H o u s e h o l d demands F a m i l y l i f e s t y l e change 1 .58 1 .26 Finances 1 .23 Limiting visitors A v a i l a b i l i t y of 1 .19 resources R e a c t i o n of s i b l i n g s 0 .00  F a m i l y l i f e s t y l e c h a n g e 2 .00 1 .80 Limiting visitors 1 .77 H o u s e h o l d demands 1 .64 Finances A v a i l a b i l i t y of 1 .35 resources 0 .00 R e a c t i o n of s i b l i n g s responses  'availability  intensity  2 days Mean  (Z= not  siblings'.  ( T a b l e 20)  of  was  R a n k i n g of C o n c e r n s o f Regarding Family 2 days v s . 1 month)  Item  Mean of  family.  'finances' increasing  discharge.  (1st 1st  demands',  r a n k i n g of t h e mean  demands' and  month  Table  'reaction  i n the  of  measures  f o r which the d i f f e r e n c e  significant  variation  two  scale  t h a t t h e mean r e s p o n s e s  sum  of  remained  the  items  similar  for  each  i n the c a t e g o r y  at both  measures.  of  73  Total In of  Items  analyzing  the d i f f e r e n c e  between  the t o t a l  p r i m i p a r a s a t two d a y s and one month a f t e r  Wilcoxin  matched  intensity  of c o n c e r n  The  ranking  with  'return  measure. the  Table  was  for total  test  t h e mean  intensity  increasing  21) Spearmans's .501  showed  t o be s i g n i f i c a n t  of f i q u r e '  (Table  ranks  ranking  of  pairs  (p<.05).  the  discharge, difference  scores  rho f o r the  showed  Mean  Recognizing i l l n e s s B e i n g a good mother Safety Fatigue Growth & Development F e e d i n g baby Baby's weight g a i n Baby's b e h a v i o u r Baby's c r y i n g T r a v e l l i n g w i t h baby P a i n from s t i t c h e s D r e s s i n g baby  2 .74 2 .68 2 .45 2 .38 2 .35 2 .32 2.1 9 2 .19 2. 1 3 2 .07 2 .07 2 .03  Mean o f r e s p o n s e s on 0-4  1  scale  of  A and B f o r  of c o n c e r n .  One  2 days  variation  comparison  21: P r i o r i t y R a n k i n g of T o t a l C o n c e r n s o f (1st 2 days v s . 1 month) 1st  in  on t h e s e c o n d  Appendix  i t e m s by mean i n t e n s i t y  I tern  the  (Z= -3.14; p=.0017).  in priority  See  concerns  Primiparas  month  I tern Recognizing i l l n e s s B e i n g a good mother Return of f i g u r e Fat igue Baby's b e h a v i o u r Safety Growth & Development Baby's s l e e p i n g Exercise Baby's f e e d i n g Baby's c r y i n g Diet  Mean 2.30 2.22 2.20 2.00 2.00 1 .94 1 .94 1 .90 1 .90 1 .87 1.81 1.81  74  The  chi-square  frequencies sum  of  the  of total  difference  and  One  2.15  (df=4)  responses  at each  items  not  f o r the  Difference  of  did  total  51  (p>.05)  for  the  l e v e l of c o n c e r n  demonstrate  concerns.  a  (Table  mean  for  the  significant  17)  i n Concerns of M u l t i p a r a s at F i r s t  Two  Days  Month  Self The  W i l c o x i n ranked  clearly  significant  concerns  of  month a f t e r  discharge There  difference  was  'exercise', and  'finding  time  of  The  the  two  item  highest (Table  on  t h e mean  fiqure'  of  first  two  of  self  the  'period',  was  measure  of concerns  time'  for this category  on  (Z =  which  the one  the  'diet',  'hemorrhoids', The  item  of  of s i g n i f i c a n t l y (p=.047). differed  being  moved up the  a  -3.73;  included:  Spearman's r h o  personal  of  d a y s and  for  t i e d down'.  second  intensity  'finding  items  interests'  indicated  intensity  which  and  of b e i n g  measures w i t h  concern 22)  individual  for personal  rankings  the  the  significant  'feelings  concern  for  between  were  not  greater  in  f o r the c a t e g o r y  ' r e t u r n of  'tension'  f o r matched p a i r s  difference  multiparas  p=.0002).  test  .506  somewhat (p<.05).  to the  second  The  second  measure.  75  Table  22:  Priority (1st  1st  2  R a n k i n g o f C o n c e r n s of M u l t i p a r a s Regarding Self 2 days v s . 1 month)  days  One  Item  Mean  Fatigue Return of f i g u r e B e i n g a good mother L a b o u r & D e l i v e r y exp. Breast soreness Emotional tension Care of b r e a s t s P a i n from s t i t c h e s Diet Exercise Lochia P e r s o n a l time Return of p e r i o d B e i n g t i e d down Lack of c o n c e n t r a t i o n Constipation Baby b l u e s Hemorrhoids  2 .25 2 .22 2 .03 1 .78 1 .75 1 .69 1 .67 1 .58 1 .67 1 .47 1 .42 1 .33 1 .25 1 .19 1 .17 1 .08 1 .06 0 .94  1  Mean o f r e s p o n s e s on  Table 4  23  shows t h a t  f o r t h e sum  significantly  0-4  of the  Mean  Return of f i g u r e Fat igue P e r s o n a l time B e i n g a good mother E x e r c i se Emotional tension Diet Care of b r e a s t s B e i n g t i e d down Lack of c o n c e n t r a t i o n Return of p e r i o d Breast soreness Baby B l u e s Lochia Constipation L a b o u r & d e l i v e r y exp. Hemorrhoids P a i n from s t i t c h e s  2 .06 1 .69 1 .69 1 .60 1 .58 1 .56 1 .47 1 .08 1 .19 1 .06 1 .06 0 .92 0 .89 0 .86 0 .83 0 .81 0 .78 0 .47  scale  the percentage  items  different  month  I tern  1  of r e s p o n s e s of  i n the c a t e g o r y of s e l f  for  the  two  measures  0 to  were n o t in  this  category.  Baby The of the  difference  baby was total  in intensity  f o u n d t o be category.  of c o n c e r n  significant Individual  f o r the c a t e g o r y  (Z -2.91; p= items  for  .0036) f o r which  the  76  Table  23:  P e r c e n t a g e o f M u l t i p a r a s ' R e s p o n s e s o f 0-4 T o t a l l e d a c r o s s Items i n E a c h C a t e g o r y ( f i r s t 2 d a y s v e r s u s 1 month)  Category  Time Measure  Level 1 2  0  of  Concern 3  4  Self 18 i t e m s  1st 2 d a y s 1 month  26. 1 36. 1  23 .8 25 .6  27 .7 22 .8  1 6. 1 1 2.2  6. 10 2. 80  Baby 21 i t e m s  1st 2 d a y s 1 month  28. 0 37. 6  21 .9 30 .4  26 .6 19 .0  19 .0 11 .0  4. 80 2. 10  Partner 6 items  1st 2 d a y s 1 month  28. 3 30. 0  23 .3 25 .0  26 .7 25 .0  18 .3 15 .0  3. 10 4. 80  Family 6 items  1st 2 d a y s 1 month  20. 0 26. 7  26 .7 30 .0  28 .3 30 .0  21 .7 1 1.5  3. 70 3. 70  Total 51 i t e m s  1st 2 d a y s 1 month  26. 3 34. 7  23 .3 28 . 1  27 .3 22 .4  10 .0 1 1.8  4. 90 2. 70  difference  was  not  significant  'fussiness',  'sleeping',  behaviour'.  The  scores  as  seen  Spearman's r h o Table for  t h e sum  23  included  'crying'  and  r a n k i n g o f t h e mean in  Table  24  f o r comparison  of  show  items  rashes',  'interpreting  infant's  intensity some  ranks being  g i v e s the percentage  o f t h e 21  'infant's  of  concern  variation .763  (p<.05).  of responses of  i n the c a t e g o r y of  with  baby.  0  to  4  77  Table  24: P r i o r i t y  Ranking of Concerns of R e g a r d i n g Baby (1st 2 days v s . 1 month)  1st  Multiparas  One  2 days  I tern  Mean  Safety Growth & D e v e l o p m e n t F e e d i n g baby Recognizing illness Baby's w e i g h t g a i n Baby's s l e e p i n g Immunizing baby D r e s s i n g baby Care of c o r d Baby's b e h a v i o u r Baby's r a s h e s P h y s i c a l appearance Baby's f u s s i n e s s Baby's c r y i n g T r a v e l l i n g w i t h baby Baby's b r e a t h i n g Bowel movements V i t a m i n s and f l o r i d e B a t h i n g baby  2 .08 1 .94 1 .92 1 .91 1 .77 1 .64 1 .64 1 .64 1 .56 1 .47 1 .47 1 .44 1 .44 1 .44 1 .44 1 .39 1 .39 1 .36 1 .25  Comfort i n h a n d l i n g baby Care of c i r c u m s i o n  1 .06 0 .50  Mean o f r e s p o n s e s on 0-4  month  Item  1  Mean  Safety Recognizing illness Growth & D e v e l o p m e n t Fussiness Baby's s l e e p i n g Baby's f e e d i n g Baby's r a s h e s Baby's c r y i n g D r e s s i n g baby I m m u n i z i n g baby Baby's B e h a v i o u r T r a v e l l i n g w i t h baby Baby's w e i g h t g a i n P h y s i c a l appearance Bowel movements Baby's B r e a t h i n g B a t h i n g baby V i t a m i n s and f l o r i d e Comfort i n h a n d l i n g baby  1 .56 1 .50 1 .36 1 .33 1 .33 1 .31 1 .31 1 .31 1 .22 1 .19 1. 1 4 1 .08 1 .08 1 .06 0 .94 0 .89 0 .81 0 .75  Care of c o r d Care of c i r c u m s i o n  0 .61 0 .42  0 .67  scale  Partner The d i f f e r e n c e i n t h e i n t e n s i t y category  of p a r t n e r  of  the  multiparas  ranking  o f t h e mean  measures (p<.05)  in  this  was (Z=  of the concerns  not s i g n i f i c a n t -1.12;  f o r t h e two  P=.2608).  intensity  scores  category  and  (Table  f o r the measures 25)  were t h e same f o r  Spearmans's  rho  was  The both .10  78 Table  25:  1st  Priority  R a n k i n g of C o n c e r n s of Regarding Partner (1st 2 days vs. 1 month) One  2 days  I tern  Mean  Birth control Time a l o n e t o g e t h e r Time f o r r e c r e a t i o n Relationship with partner Sexual r e l a t i o n s P a r t n e r b e i n g a good father  1 .81 1 .56 1 .47  1  Mean of The  level the  responses  sum  the  of c o n c e r n  items  1 .72 1 .53 1 .50 1 .22 1 .19 1 .05  scale  i n the percentage  intensity  of  Mean  Birth control Time a l o n e t o g e t h e r Time f o r r e c r e a t i o n R e l a t i o n s h i p with partner Sexual r e l a t i o n s P a r t n e r b e i n g a good father  1 .22 0-4  month  I tern  1  1 .36 1 .33  on  difference  of  Multiparas  in this  of  were a l s o  category.  concerns not  at  each  significant  (Table  for  23)  Family In a n a l y z i n g t h e the  difference  measures of -2.22; was  p =.0267).  'reaction  becoming  of  of  Individual  of  category  concern t o be  items  i n which the  intensity  There  of concern  greater concern  26)  Spearman's r h o  the  two  were  on  the  f o r the comparison  m e a s u r e s was  .899  (p<.05)  the  the  two (Z=  difference  lifestyle'  some c h a n g e s  second  family  significant  scores with  of  of  between  found  i n c l u d e d : 'change i n f a m i l y siblings'.  o f mean  t o the  intensity  t h e m u l t i p a r a s was  significant  ranking  in  responses  and  i n the  'finances'  measure. ranks  (Table between  79  Table  26:  Priority  R a n k i n g of C o n c e r n s of Regarding Family 2 days v s . 1 month)  (1st  1st  2 days  One  Item  Mean  Mean of  responses  Table each  level  category  of  Total In  f o r the  of  intense  Spearman's r h o (Table  27)  1 .72 R e a c t i o n of siblings 1 Finances .69 1 .65 H o u s e h o l d demands F a m i l y l i f e s t y l e c h a n g e 1 .25 A v a i l a b i l i t y of 1 .00 resources Limiting visitors 0 .97  scale  mean f r e q u e n c i e s of  for  the  sum  of  the  responses  items  in  at the  Items  ' r e t u r n of  most  Mean  family.  significant  intensity  0-4  the  of concern  between t h e  multiparas  with  shows  analyzing  concerns  be  23  on  month  Item  1  R e a c t i o n of siblings 2 .19 1 .89 Demands of h o u s e h o l d 1 .58 Finances F a m i l y l i f e s t y l e c h a n g e 1 .58 A v a i l a b i l i t y of 1 .25 resources 1 .22 Limiting visitors 1  Multiparas  the d i f f e r e n c e two  i n the  questionnaires  total  items,  scores  figure'  and  concerns f o r the  at  completed  the d i f f e r e n c e  (Z=-3.45; p=.0006). concern  intensity  The  ranking  f o r a l l items  'birth one  comparison  of  ranks  of  shows  control' month  was  after was  of  total  by  the  found the  to  mean  variation  becoming  the  discharge. .599  (p<.05)  80  Table  27: P r i o r i t y R a n k i n g o f T o t a l C o n c e r n s o f M u l t i p a r a s (1st 2 d a y s v s . 1 month) 1st  2 days  One month  Item  Mean  I tern  Fatigue Return of f i g u r e R e a c t i o n of s i b l i n g s Safety B e i n g a good m o t h e r Recognizing illness Demands o f h o u s e h o l d Birth control Labour & d e l i v e r y exp. Baby's w e i g h t g a i n Breast soreness Emotional tension  2.25 2.22 2.19 2.08 2.03 1 .91 1 .89 1.81 1 .78 1 .77 1 .'75 1 .69  Return of f i g u r e Birth control R e a c t i o n of s i b l i n g s Fatigue Personal interests Finances Demands o f h o u s e h o l d B e i n g a good mother Exercise Emotional tension Safety Recognizing illness  1  1  Mean o f r e s p o n s e s on 0-4  The concern not and  mean  of  responses  f o r t h e sum o f t h e t o t a l  one  month  (p>.05).  after  2.06 1 .72 1 .72 1 .72 1 .69 1 .69 1 .68 1 .60 1 .58 1 .56 1 .56 1 .50  scale  frequencies  show a s i g n i f i c a n t  Mean  items  a t each  for  multiparas  d i f f e r e n c e between t h e f i r s t discharge.  l e v e l of  Chi-square  did  two d a y s  =2.92  (df=4)  (Table 23).  Summary The in  results  this  of the a n a l y s i s of data  chapter  for  the  significant  d i f f e r e n c e i n the  multiparas  in  discharge  the  as w e l l  as  first any  two  purpose concerns days  significant  have been of of  or  reported  identifying  any  primiparas  and  one  month  difference  after between  81  these data  two  time  has  also  been  characteristics Analysis significant two  the  Wilcoxin  the  test  U test  level  Analysis  for  items  a l s o d i d not  of i n t e n s i t y  number of c o n c e r n  on t h e q u e s t i o n n a i r e .  implications  The  significance for  research  program in this  between  of  of  pairs  in  which  the  two  indicate  were between  of the d a t a  matched  using  h a s shown a  mothers  between  discharge for  except  partner.  the  difference  time any  measures. significant  o f c o n c e r n s m o t h e r s had a t f o r the following these  planning  area.  no the  There  i n which the d i f f e r e n c e  between  the  has shown  measure.  for a l lcategories  individual  between  the  the  c o n c e r n s o r any o f t h e  f o r both groups  significant  difference  further  time  significant.  c o n c e r n s and  not  discuss  describe  two d a y s a t home and one month a f t e r  total  items  to  of c o n c e r n  f o r the t o t a l  either  difference  Chi-square a n a l y s i s  each  in intensity  ranked  T h e r e were a g a i n was  i n order  Mann-Whitney  however,  two g r o u p s was  first  the  at  items  significant the  using  categories  the  of the demographic  o f t h e sample g r o u p o f m o t h e r s .  of mothers  individual  The a n a l y s i s  reported  difference  groups  four  measures.  sum  of  the  51  chapter  will  now  findings,  their  and r e c o m m e n d a t i o n s f o r  82  CHAPTER  F i n d i n g s and  5  Recommendations  Introduction The chapter  significance as  literature  well will  terms of  the  remaining  to  Implications  for  The  sample  will  the  of  be  four  as  in this  well  with The  the  of the  be  discussed  findings  in  the  first  population.  of  in The  to  the  their  study.  t h i s c l i e n t group  recommendations  the  of  in r e l a t i o n  hypotheses  as  previous  discussed  total  for  the  significance  will  program p l a n n i n g  identified  research  discussed.  the  findings  findings  a comparison  be  of  the  characteristics  significance  be  as  now  characteristics  of  will  for  future  month p e r i o d  i n which  mothers  i n the  210  area.  Sample During  the  were a p p r o a c h e d occurred births  a half  to p a r t i c i p a t e  within  the  section  Ninety-five  births  and  were known not  cesarean  when  two  or  study boundries. t o meet t h e low  birth  mothers consented to  approached during  this  in  the  live  Seventy-five  study c r i t e r i a weight  of  participate  hospital.  time p e r i o d  study  The  involved  births of  because  the in  of  infant. the  remaining mothers  these  who  study 35  live were  83  single,  who  different  did  not  hospital  speak  or  English,  for  whom  who  delivered in a  there  were  physical  complicat ions. The  ages  acceptable  of  the  criteria  with  primiparas the  and  population  wide  range  mothers w i t h w h i c h was The  29-34  The  groups  were  considering  educational  the  largest  group having  Canada c e n s u s area  of  resembled  slightly  the  of  East  lower  1981  having  study  school  for  and  10%  lived  for  the 1981  the  study  Chinese  ethnic  not  of  of  i n the  surprising  e n g l i s h speaking  also identified  a  sample  high  found  was  i n Canada  also  backgrounds  Indian  for  population.  tonque  which  for  w i t h i n the  distribution  f o r mother  23-28  was  completed  ethnic  e x c l u s i o n of non  for as  the the  information percentage  of  the  is typical  There  backgrounds  across  being  which  in this area.  of  the  spread  for multiparas,  distribution  area.  were  modal c a t e g o r y  also characteristic  Canada C e n s u s  this  the  of m o t h e r s  mothers c l o s e l y  in  mothers  the  less  mothers. population than  five  years. The and  percentage  r e t u r n i n g t o work  health  nurses  working  mothers  who  attended  previous  f i q u r e s with  attended their  while  of mothers b r e a s t f e e d i n g  their  f i t with  the  i n the  the study  area.  the  majority  The  of  of  The  p r e n a t a l c l a s s e s was  only a minority  second pregnancy.  opinions  infants  community number  consistent  primiparas  of m u l t i p a r a s  findings regarding  attended  of with  having with  h e l p a t home  84  were c o n s i s t e n t who  also  found  with those of G r u i s that  h u s b a n d s were most  as b e i n g t h e most h e l p f u l It  appears  population the  that  the  particularly  do  (1979)  identified  representative  the c r i t e r i a  taken  n o t meet  single  frequently  sample was  met  C a r e must be  t o m o t h e r s who  Pate  a t home.  o f m o t h e r s who  study.  (1974) and  the  for inclusion  in  in generalizing  the c r i t e r i a  mothers  of  and  for  those  the  findings  participation,  who  do  not  speak  English.  Difference the F i r s t  i n Concerns Two  The  Days  finding  o f no  overall  concerns  few  after  days  Gruis They  Pate  postpartum the  (1979) and  the  similar.  need mother  for  both  from  Hicks  of  (1983). over  of  the  regarding self  the d i f f e r e n c e priority  of  i t e m s were f o u n d  of the mothers.  supportive-educative  for  discharge  70%  first  findings  i n frequency of concerns  i n which  A l l of the  t o more t h a n  w i t h the  the  the  period.  items  ranking  between  m u l t i p a r a s i n the  H a r r i s o n and  c a t e g o r y of c o n c e r n s  individual  difference  o f p r i m i p a r a s and  f o u n d no d i f f e r e n c e  In  and  significant  discharge i s consistent  (1974),  total  no  o f P r i m i p a r a s and M u l t i p a r a s D u r i n g  primiparas  hospital.  o f some  findings  services  and  significant  concerns  t o be  These  was  t h e r e were  which  multiparas  was  very  concern  support  the  f o c u s on  the  soon  after  85  In  the category  difference such  as  between  o f baby t h e r e were  t h e two g r o u p s  'bathing  the  baby'  handling  t h e baby' a r e i n f a n t  logical  to  of  the  development', concern need  to  baby  again  both  as  groups  after  similar  a need with  to their  partner  about  the  increased  to  the  well  the  the  days  of t h i s  i n areas both  after  baby.  receiving  of i n f a n t  care. had  t o be t o g e t h e r ' a n d  expected  on b o t h  Once  support  groups of mothers  time  of  indicate a  primiparas  i s t o be  placed  early  were  considering  partners during the  d a y s a t home. 'Limiting  siblings'  difference different ranking again  demands  i t is  experience  for professional  'finding  r e c r e a t i o n ' which again  of  relate  to the w e l l being  'for  early  in  a s s i s t a n c e and support  concerns  previous  o f m o t h e r s w h i c h would  discharge  In r e g a r d s  f o r which  ' s a f e t y ' , 'normal g r o w t h a n d  and r e a s s u r a n c e  . i n regards  additional  items  Items  comfortable i n  g a i n ' a n d ' f e e d i n g t h e baby'  the f i n d i n g s i n d i c a t e  soon  care  'feeling  Items w h i c h  such  'weight  f o r support  discharge  and  f o r which the  significant.  assume t h a t t h e m u l t i p a r a s '  w o u l d make a d i f f e r e n c e . being  was  items  visitors' in  in  the  category  intensity  of  of  of p r i o r i t y  change  in  of the items with family  the  item  besides  family  concern  f o r t h e two g r o u p s a t t h i s  t o be e x p e c t e d  greater  was t h e o n l y  was  time.  in  'reaction which  the  significantly The  different  between t h e two g r o u p s was primiparas  lifestyle  and  experiencing more  a  frequent  86  visitors  f o r the f i r s t  multiparas home'  found  and  greatest In  baby.  As r e p o r t e d by Moss  the 'reaction  'meeting  concerns  demands  in this  examining  of of  the the  other  household'  at this  'return  a n d 'managing  household'  whereas  t o normal'  'recognizing illness 'safety'  'critical  concern'  Gruis  (1973),  found  'return  (1979)  of f i g u r e '  concerns  been due  to  fact  more to  concerned  Bull  hypothesis intensity the  first  concerns. specific  of  There areas  demands  of  f o r the multiparas  of  'being  a  good  about  their It  caring than  It no  is  demands' t o  sample  their  by t h e s e evident  however, have  be  included  primiparas  own  body  would  the  more  difference  that  as those the  multiparas  be a c c e p t e d  implications  This  null  i n frequency and  and  significant  be  ability  image.  f i n d i n g s as w e l l therefore  d a y s a t home must  (1983)  was t h e e x p e c t a t i o n t h a t  between p r i m i p a r a s  which  primiparas.  f o r t h e baby a n d t h e i r  significant  are  the  sample, w h i c h may have  few d a y s a t home t h e  of concern two  the  regarding  H a r r i s o n and H i c k s  of t h e i r  that  i s supported  (1981).  50%  and  primiparas.  mother e f f e c t i v e l y  expectation of  the  the f i r s t  concern  baby',  and 'household  overall  during  i n the  f o r more t h a n  Pate  than  t o be t h e  a n d ' f e e d i n g t h e baby' were o f 'much' t o  greatest  multiparas  time,  were o f g r e a t e s t c o n c e r n  mother',  at  i n the ranking of the t o t a l  i t e m s between t h e two g r o u p s  the  children  category.  the d i f f e r e n c e  of f i g u r e  (1981) t h e  in  f o r the t o t a l  differences  in  f o r those p l a n n i n g  87  programs  f o r these  Difference  i n Concerns of P r i m i p a r a s  Month A f t e r The  intensity after  the  analysis  has  o f no s i g n i f i c a n t of concerns  discharge  concern.  demonstrated  again  the  and m u l t i p a r a s  be a c c e p t e d  t h e r e were  which  The p r i m i p a r a s  regarding  'recognizing  specific  In mothers  is  i n these  logical  areas  month a f t e r  concerns  discharge  had g r e a t e r c o n c e r n s  Items s u c h  as  'fatigue'  to  more  of  primiparas  'recognizing  than  and  although  concern  are  the  multiparas'  o f t h e two  'birth  self  had  groups  and  demands'  some  of  that the family.  control',  70% o f t h e m u l t i p a r a s .  still  illness',  'reaction  were o f some More  concern  than  80%  regarding  'normal g r o w t h a n d d e v e l o p m e n t ' a n d  the o v e r a l l not  greater  fussiness',  i t was a p p a r e n t  'household  'baby's s l e e p i n g ' and ' f e e d i n g ' . that  t h a t must  behaviour',  'baby's  regarding  ' r e t u r n of f i g u r e ' ,  concern the  and the  items of  related to  have  infant  considering  multiparas  siblings',  to  and  areas.  looking at the t o t a l one  continued  null  one month  f o r the t o t a l  'interpreting  s i g n s of i l l n e s s '  again  experience  of  that  baby i n w h i c h t h e d i f f e r e n c e s were s i g n i f i c a n t  concern  One  d i f f e r e n c e i n the frequency  of p r i m i p a r a s  a l s o must  Once  be i d e n t i f i e d .  of  and M u l t i p a r a s  Discharge  data  hypothesis  clients.  It i s  apparent  d i f f e r e n c e i n means o f  statistically  significant,  therefore intensity there  are  88  differences  i n how t h e p r i o r i t y  two  groups  for  services directed  Difference and  data  difference home  a t one month  analysis  the  has  baby  f o r primiparas  intensity  of concern  a decrease  i n mean i n t e n s i t y  intensity of  score.  figure',  category  not  reduction ability  tied  measure.  month  the o v e r a l l  difference  one  in  involved  month  after  i n which the d i f f e r e n c e  focus  i s logical  more of time  on  at  i n the  of i n t e n s i t y  t h e r e was n o t  one  physical  month a n d t o  The s i g n i f i c a n t  discomfort  (1981) f i n d i n g s o f a d e c r e a s e  she  decrease i n  i s consistent  in intensity  one week a t home.  a  the mother's  t o do many o f t h e a c t i v i t i e s  Bull's  items a f t e r  that  'return  t h e i n c r e a s e was  considering  herself  t o motherhood. to  'exercise',  mean l e v e l  the fact  related  these  one  significant  Although  items  of  after  down' a n d ' p e r s o n a l t i m e '  significant  i n the concern  in prior  Two Days  significant  for  concern  increased i n their  recognize her lack engaged  of  of t h e items  on t h e s e c o n d  to  of mothers.  a t .05 t h e r e was an i n c r e a s e i n t h e mean  'being  statistically  implicatons  a  the  Items s u c h a s ' d i e t ' ,  of s e l f ,  of concern  f o r which  was s t a t i s t i c a l l y  many  was n o t s i g n i f i c a n t  demonstrated  of the concerns  A l l of the items  For  have  Discharge  concerns.  discharge.  between t h e  of P r i m i p a r a s i n the F i r s t  i n the i n t e n s i t y with  which  t o w a r d s t h e s e two g r o u p s  i n Concerns  One Month A f t e r The  at  a r e ranked  of the concerns  with  of concern  89  In  the  difference continued  category was  t o be  fussiness', behaviour' of  the  is  of  in concern  with  (1981)  f i n d i n g s of t h i s concerns concerns  in this  delivery  no  do  either 'baby's  'interpreting such as  that  infant  one  family after identify one  'finding  p a r t n e r ' may  or which c o n t i n u e beyond  the  the  care  such again items  week.  significant  not  'care  a skill  f o r the c o r d ' , which  partner after  with  and  the  f o r w h i c h t h e r e was  finding  a r e a s u c h as  'relationship  the  involved acquiring  found  which which  as  priority  items  'caring  study a l s o  in  those  such  low  p a r t n e r and  regarding  were  of concern a f t e r  also  regarding  items  'crying' of  Bull's  in intensity  concerns  and  The  ' b a t h i n g t h e baby' o r consistent  the  priority,  o r c o n t i n u e d t o be  Bull  and  high  'sleeping'  decrease  decreased  baby  significant  circumsision'.  greatest as  not  of  change  in  week.  The  one  a difference  month i n d i c a t i n g time a l o n e  in that  together'  have e x i s t e d immediate  prior  to  postpartum  period. This of  study d i d f i n d  family  such as  after  'limiting  decreasing logical  month f o r  visitors'  significantly  t o assume t h a t  allowed resolved. the  one  in  a difference  Bull's The  household'  did  and in  primiparas,  'change  study  than  decrease  the  It i s  one  for these concerns the  items  lifestyle'  of c o n c e r n .  r e g a r d i n g 'managing not  category  with  in family  intensity  i t takes longer  (1981)  concern  the  i n the t o t a l  week to  demands  significantly  after  be of one  90  month f o r t h e p r i m i p a r a s .  This  initial  mother may have had i n t h e e a r l y  help,  which  the  d a y s a t home, may no l o n g e r normal during  household the f i r s t  tasks  is  not  surprising  be a v a i l a b l e .  which  since  A l s o many o f  t h e mother may have  few weeks a t home may now b e g i n  the  ignored  to  demand  her a t t e n t i o n . In  looking  differs  at  the ranking  f o r the primiparas  apparent  that  significant. 'diet'  the  change  and  Hicks  (1983)  who  a n d ' m e e t i n g demands' t o  These  authors  a l s o found  t o be  mothers which  Difference  of  The  figure  to  also  i s not normal', a f t e r one  literature, continue  found be  of  moderate  Pate  which  (1979)  greatest  'infant  concern  to  and  'return of f i g u r e ' ,  for  concern.  behaviour'  both  groups  the f i n d i n g s of t h i s  i n the F i r s t  and of  study.  Two Days  Discharge  a n a l y s i s i n d i c a t e s that the n u l l in  i t is  priority  (1974)  i n Concerns of M u l t i p a r a s  data  home  the previous  'fatigue',  i s c o n s i s t e n t with  One Month A f t e r  concerns  a t one month f o r t h e p r i m i p a r a s  'diet'  'safety'  in  f o c u s i n g on t h e i n f a n t  priority  at  increased in p r i o r i t y  from t h e f i n d i n g s o f G r u i s  Harrison  and  one month  i s more c o n s i s t e n t w i t h  of higher  of the t o t a l  as ' r e t u r n of  ' e x e r c i s e ' have  however many i t e m s  differs  after  overall  Items s u c h  and  month w h i c h  be  how  no  difference  concerns  two  d a y s a n d one month a f t e r  of multiparas discharge  h y p o t h e s i s of  between  the f i r s t  must a l s o be r e j e c t e d  91  for  the t o t a l  areas  which  the  involved  intensity  category  of  'diet',  maintained  the  of concern  again  'emotional mean  the  items  period.  of  seek  include  'crying'  infant  may  and  baby  concern  These a r e a l s o a r e a s  concerns  of  were  assistance  These  'sleeping',  infant  which  have  the items  of  such  as  of concern  in  different  concern.  In  ' r e t u r n of  t e n s i o n ' and 'being  intensity  category  intensity  frequently  one  are  tied  after  priority  in  the items  which  down'  one month  the  overall  of items.  In their  there  was s i g n i f i c a n t l y  therefore increased in their  ranking  Once a g a i n  i n t h e mean i n t e n s i t y self,  their  primiparas  i s not s i g n i f i c a n t  f o r program p l a n n i n g .  a. d e c r e a s e  figure',  and  As w i t h  i n which the d i f f e r e n c e  implications  the  concerns.  beyond  in  'baby's  rashes', infant  i n which the mothers' very  therefore  different  multiparas  this  baby  is  which  the i n i t i a l  and ' i n t e r p r e t i n g  be  because  areas  maintained  from  may very  mothers postpartum  'fussiness', behaviour'.  experience that with  continue  another  to  different  with  have  from h e r  others. As  with  supported  the  i n the category  being  significantly  Birth  control  multiparas  primiparas  in  this  null  of p a r t n e r with  different  continued  the  in intensity  hypothesis  none o f t h e i t e m s after  one month.  t o be t h e h i g h e s t p r i o r i t y  category.  m u l t i p a r a s were r e e x a m i n i n g  It  is  was  possible  the i s s u e of ' b i r t h  f o r the that the  control'  in  92  terms  o f whether  were  considering  their  first In  they  to  d i d decrease  i t remained  seems  likely  their  initial The total  than  multiparas'  of  concern  they d i d a f t e r  concerns  after  other c h i l d r e n  resolved.  one  in this  many o f t h e m o t h e r s  were  found to  postpartum overall  many s i m i l a r i t i e s  the previous l i t e r a t u r e  as  'return  figure  demands' were i n c l u d e d  t o normal',  by H a r r i s o n and H i c k s  such  as ' b i r t h  control',  'fatigue'  (1983) a n d P a t e  'reaction  i n which a  in this  at the e f f e c t and the  finding two  that  the  beyond t h e  f o r the  but a l s o  some  primiparas Items  and  such  'household  study.  of p a r i t y no  groups  found  Items  'finances' to  be  The p r e v i o u s s t u d i e s on  the  significant of  (1979).  of s i b l i n g s ' ,  ' b e i n g a good m o t h e r ' were however a l s o priority  baby  i n the t e n h i g h e s t ranked concerns as  found  separate  new  i n which  m u l t i p a r a s were n o t c o n s i d e r e d s e p a r a t e l y .  concerns  the  of concerns  and  looking  a f t e r the  period.  identifies  of  It  that  i t is likely  r a n k i n g of the p r i o r i t y  from  even  category.  w o u l d have c o n t i n u e d t o be o f i m p o r t a n c e  items a g a i n  highest  month  In t h e f a m i l i e s  d i d occur with other s i b l i n g s  differences  and  regarding  r e g a r d i n g ' r e a c t i o n of  significantly  of their  concerns  concern  was now c o m p l e t e and  options  of highest p r i o r i t y  that  reaction  problem  the  intensity  though  initial  family  infant.  the  siblings'  their  alternative  regards  family,  felt  mothers  overall  when  while  number  difference  of  of  d i d not  examining  the  93  intensity account study  of concerns  f o r the  specific  despite  difference  regarding individual  the  difference  agreement  i n the concerns  Limitations  of  the  A limitation sample  of  population  an  was  t h e two  t h e s t u d y was  t h e use  the  be  taken  and  r e a d and  of  error  responses allow  ambiguous is  the  as  did  not  responses. that  this  overall  of  findings  error  and  in  An  and  must  also  be  subjects  who  patience  depth  limitation  q u e s t i o n n a i r e was  information  concerning  of  tool,  absence  the c l a r i f i c a t i o n  additional  and  i n c r e a s e d chance  the  the  the of  the  a l s o an  of  has  as a source  f o r those had  to  sample.  anonymity  Also, being a s t r u c t u r e d  permit  target  for data c o l l e c t i o n  used  in response  the  of the  o f t h i s method  was  volunteer, demographic  to those  observer  There  the o r i g i n a l  previous  a  generalizability.  providing  limitations  for variation  fact  therefore  and  obtained.  interviewer  similar  o n l y be  respond.  of  generalizing  w r i t e the language  to  not  such  could  motivation response  support  in  eliminating  It  may  groups.  those  questionnaire  However, d i s a d v a n t a g e s  recognized. could  a  advantages  respondents bias.  of  with  to  mothers w i t h c h a r a c t e r i s t i c s  certain  of  o f no  Comparing  sample  attempt  However, c a r e must  use  findings  finding  between  convenience.  characteristics  The  i n the  This  Study of  of  i n the  items.  the  i t did of  of unusual of t h i s revised  reliability  an or  study and and  94  validity As  could  mentioned  questionnaire nurses  i n Chapter  3  in  the  study  t o .81  for  the  category  For  discharge,  Hoyt's r e l i a b i l i t y  total  Chronbach's Alpha for  to  .85  scores  completed  the  items  the  from  after  discharge  possible in the  the q u e s t i o n n a i r e internal  The  the  the  items  one  month  d i d n o t have a  f o r Program  Planning  postpartum  study  support  f o r both  foci  of these  mothers as w e l l as over In p l a n n i n g  from  days  It i s  effect  on  identified  services  during  and m u l t i p a r a s . the f i n d i n g s  for  s e r v i c e s f o r t h e two t y p e s o f  the postpartum  services for  later.  t h e need  primiparas  r e c o m m e n d a t i o n s c a n be drawn  differing  two  The  instrument.  for supportive-educative period  also  a n d .83 when t h e  significant  of the o r i g i n a l  f i n d i n g s of t h i s  were  t h e r e v i s i o n s t h a t were made  reliability  the l i t e r a t u r e  Specific  completed  t o see t h e r e f o r e , t h a t  Implications  in  were  family.  time measures.  f o r the a d m i n i s t r a t i o n of the q u e s t i o n n a i r e  questionnaires  after  .98 f o r  of  reliability  .82 f o r t h e t o t a l  first  one month  score  was  health  estimate of  on  category  on b o t h  this  .97 f o r t h e t o t a l  family  for internal  the t o t a l  Hoyt's  measure r a n g e d  for  for  o f community  from  of  the q u e s t i o n n a i r e s  items  calculated  validity  area.  was c a l c u l a t e d and r a n g e d  measure.  the  content  was e s t a b l i s h e d by a p a n e l  working  reliability items  n o t be a p p l i e d .  the  new  period. mother  during  the  95  first  days  level  of f a t i g u e ,  considered be  after  able  discharge,  p a i n and e m o t i o n a l  to  participate  or telephone  have t r a d i t i o n a l l y supports  multiparas items  The  soon a f t e r  discharge  o n l y way t o r e l i e v e  assess  weight  gain  to  necessity  hands on r e a s s u r a n c e  baby's  tension  also  t h a t t h e mother  new  for  mothers both  from h o s p i t a l .  during  these  and  feeding  and  this  Many o f  early  individual.  regarding  and  mother  would  by  reassured  f o r reassurance i t  a  is  telephone  physically  care  hospital  need  f o r the  reassurance infant  whose p h i l o s o p h y  of educative  approach with a home v i s i t week a f t e r  for  support  the i n f a n t . f o r both  discharge  despite  supported  The their  their  T h i s study  provides  a  from  primiparas a b i l i t y to stay  in  patient teaching.  and m u l t i p a r a s  hospital.  that  contact  would a l s o r e q u i r e a d i r e c t  primiparas from  in  Both  of t h e i r  unlikely  someone who h a d n o t met h e r o r h e r . i n f a n t . a  the  i s t o w e i g h t h e baby a n d  a need  t o mother e f f e c t i v e l y  the  d a y s a t home  from t h e s u p p o r t i v e  ability  identified  will  p r i m i p a r a s and  the mother's concern  identified  be  be  nurses  t h e a d e q u a c y o f t h e g a i n a n d method o f f e e d i n g .  groups o f mothers  type  must  c o n t a c t s by community h e a l t h  been o f f e r e d  their  as the mothers'  i n p r o g r a m s o u t s i d e o f t h e home.  w h i c h were o f c o n c e r n  require  such  and t h e r e f o r e i t i s u n l i k e l y  Home v i s i t s  study  factors  a  This client  evidence  for  i n the f i r s t  96  For focus  the  primiparas  there  on t h e p h y s i c a l c a r e  wellness should  and  effective  be g i v e n  mothers'  at this  present  and  w o u l d need t o be i n c r e a s e d  of the i n f a n t mothering.  time  guidance  the normality  of  concerns.  The mother  have an o p p o r t u n i t y  to express  her concerns  change  and  lack  of  strategies  and  in lifestyle  management discussed of  being  to help decrease tied  Visits mothers' may and  the  to the  multiparas  concerns  regarding  from t h e i r  development.  The  of the other  first  attempts  The  multiparas  addressed  to  their  concerns  also  to  and  of  focus  infants'  previous  time  resources feelings  mother  to  help  demands o f t h e i r  days  assist a  in need  effectively them  household.  and  the which  growth  regarding  a l s o n e e d s t o be a d d r e s s e d  early  identify  on  behaviour,  concern  regarding b i r t h  these  more  children,  mothers'  children  o p t i o n s d i s c u s s e d which  resources  should  make t h e a d j u s t m e n t  during  multiparas  time  use  should  t h e sudden  o f f a t i g u e and  d a y s a t home and t e a c h i n g a n d  the  ability  effective  the  down.  be d i f f e r e n t  reaction  about  personal  the l e v e l  of  Anticipatory  regarding  future  and r e a s s u r a n c e  support as easy control and  given  may a l s o  making.  f o r reassurance  and  effectively  for  for  be and The  of t h e i r  strategies  manage  in  as p o s s i b l e .  information  decision  the  and  the i n c r e a s e d  97  The  findings regarding  discharge  indicate  intensity  of many o f  partially of  due  All  some s u p p o r t with  areas  fact  the  had  that  were  early  that  available  identified  discharge  such  of  this  point  h o u s e and  of  efficient  topics than  and  be  the  one  had  contact  the  majority  interval.  t h a t the  the concerns  this  some  month  in  use  this  by  the  resources study  identified  were  in  the  however t h a t t h e r e c o n t i n u e s  to  s e r v i c e s t o new  postpartum p e r i o d .  and  are  of p r i o r i t y  or  one  to get  combine  after  normal', be  office. out  of  exercise  the with  more e f f e c t i v e  and  contacts with p r o f e s s i o n a l s .  f o r s h a r i n g of c o n c e r n s  promote s u p p o r t  to  the  t e n s i o n ' cannot  usually able  be  of  month  physician's  may  mothers  Many  figure  'emotional  of concern  individual  programs c o u l d a l l o w  mothers  had  mothers  in a c l i n i c  mothers  may  t h a t they  p h y s i c i a n with  postpartum programs which  discussion cost  d e a l t with  mean  during  indicated  It is likely  being  time'  This  them  ' e x e r c i s e ' , ' r e t u r n of  personal  effectively By  as  as  the  c o n t a c t s were i n i t i a t e d  many o f  initial  concerns  'lack  to  for supportive educative  beyond the  in  after  t h e m o t h e r s made  them had  or  the  It i s apparent  need go  to  in reducing  days.  a  these  the p r o f e s s i o n a l .  effective  be  available  a l l of  month  concern.  several contacts during  i s unknown whether  mother or  of  sample m o t h e r s  a t home and  one  decrease  t h a t a l l of  a community h e a l t h n u r s e  having  The  the  to the  of  concerns  significant  p r o f e s s i o n a l resources  time.  It  a  the  from  the peer  among  group as w e l l  the as  98  reassurance  from  the p r o f e s s i o n a l s  t h e w e l l n e s s o f t h e baby. the  program  could  participation priority  running  Making e x e r c i s e  be  an  f o r both  a  component  important  since 'return of f i g u r e  concern  t h e program as t o  motivator  t o normal'  is  a  of for high  p r i m i p a r a s and m u l t i p a r a s a t t h i s  time. The for  findings  of t h i s  programs o f f e r e d  as p r e n a t a l before  such  have some  classes.  'limiting  implications pregnancy  Anticipatory  c o u l d be h e l p f u l  i t e m s a s 'change  siblings',  tension'.  also  t o mothers d u r i n g t h e i r  fitness  the d e l i v e r y  regarding other  and  study  such  quidance  i n reducing the concern  in lifestyle', visitors'  'reaction of  and  S e v e r a l o f t h e m o t h e r s commented t h a t  'emotional completing  t h e q u e s t i o n n a i r e r e a s s u r e d them  that  other  experience  Being  aware o f some o f t h e  prior  to delivery  these  common c o n c e r n s change  the  particularly  same c o n c e r n s .  of the postpartum postpartum  i n the e a r l y  other mothers share  Recommendations The  period  of  may  not  mother  but  her concerns.  Research  regarding  concerns  have now been  f o r the  must  d a y s a t home may r e a s s u r e h e r t h a t  f o r Future  findings  intensity  experience  mothers  the  of the data  primiparas  and  frequency  and  of p r i m i p a r a s during the postpartum  replicated  replication  overall  in several  regarding  multiparas  will  the be  studies.  Further  difference  between  necessary  to validate  99  these  findings.  concerns  of  Research  primiparas  mothers excluded They  would  section  i n t o the d i f f e r e n c e s  mothers  than v a g i n a l  who were n o t c o m f o r t a b l e of  feeding of  and e t h n i c  their  with  the v a r i a b l e s  who  use  programs  of  professional  the  English  resources  visits  new of  of the cost  mothers p r o v i d e d assistance  care  system.  these  Research  professionals  specific  during  and the  paternal infant's  of  Research  by t h e community i n reducing this the  strain  the  assumption. services  by t h e d i f f e r e n t p r o f e s i o n a l s the f i n a n c i a l  the  month may  measure.  to validate  effectiveness  to  w o u l d be  on t h e h e a l t h  i n t o how t h e m o t h e r s v i e w t h e r o l e o f and  their  information  expectations  regarding  be o f  in  year  of  life  having  value.  the types of maternal  c o n c e r n s w h i c h may p e r s i s t o r change first  to those  that  the f i r s t  the physician  c o n c e r n s a d d r e s s e d would a l s o  Descriptive  of concerns  study  o f home v i s i t s  to  considering  The  type of i n f a n t  be o f v a l u e  was made i n t h e p r e s e n t  maternal concerns are necessary A comparison  language.  clients.  the e f f e c t i v e n e s s or  or  i n f a n t alone; and mothers  have r e d u c e d t h e c o n c e r n s on t h e s e c o n d  nurse  cesarean  m o t h e r s who by c h o i c e  of age, e d u c a t i o n ,  f o r these  assumption  health  by  b a c k g r o u n d on t h e d i f f e r e n c e s  The  evaluating  be o f i n t e r e s t .  delivered  p r i m i p a r a s and m u l t i p a r a s would a l s o  planning  the  f o r the groups of  would a l s o  birth;  c i r c u m s t a n c e s were p a r e n t i n g  effects  multiparas  from t h i s study  include:  rather  and  between  would  also  throughout assist in  100  planning  area  ongoing p a r e n t i n g c l a s s e s or d i s c u s s i o n groups.  Finally  i t would  t o have  further indepth  concern  which  importance  it  concern  consistently  intervene with  such  i s n o t known  physiological knowledge  studies into  those  changes  are  I t i s a l s o n o t known  before  a  desired state.  also  be e x a m i n e d  this  area.  t o normal'  i n more d e p t h  of  i n order an  area  image, or  the  significant  the  a l a c k of  can h e l p h e r s e l f  Other  areas  f o r example  body  i f normal i s  in this  as b e i n g of  For  occuring,  t h e mother  to normal. or  concerns.  i s a problem with which  r e g a r d i n g how  rated  the l i t e r a t u r e  as ' r e t u r n of f i g u r e i f there  specific  been  t o the mothers throughout  to e f f e c t i v e l y of  have  i n c r e a s e t h e body o f knowledge  g e t back same  items  as  could  t o i n c r e a s e t h e knowledge  in  Conclusions In  conclusion,  body o f knowledge primiparas discharge  and  the along  early  of concerns  has a t t e m p t e d  the concerns  both  month  after  I t h a s been shown t h a t t h e r e  i s no  during  difference  d a y s o r one month a f t e r others  assumption  made  in in  the  the  in  of p r i m i p a r a s  the  needs  first  frequency  and m u l t i p a r a s discharge.  literature  practise  or  t o add t o t h e of  multiparas  overall  with  experience  study  regarding  from h o s p i t a l .  significant intensity  this  that  do  not  and  either in  The f i n d i n g s support  multiparas  a n d t h e r e f o r e do n o t r e q u i r e s u p p o r t i v e  have  the had  educative  101  s e r v i c e s d u r i n g the postpartum focus of the c o n c e r n s identified  which  results  significant early  have  implications  hospital.  This  supportive have  a  home  in intensity  and  one  finding  focus  for  show  soon  than  that  after that  postpartum  Finally  after  data  intensity  of concerns  in  terms  i n the responses  areas  concern.  working the  to  individual  between t h e  discharge  go  from  which  are planned to on  of  while  the  of i n d i v i d u a l  Therefore  while  the importance  of the i n d i v i d u a l  the p r o f e s s i o n a l  a  beyond  the  mean  this  study has  f r e q u e n c y and  mothers  in  wide many  the general trends i n  a r e v a l u a b l e t o program p l a n n e r s and t h o s e  i n the f i e l d ,  concerns  is  o f t h e sample m o t h e r s , t h e r e were  variations  of c o n c e r n s  there  discharge  programs t h a t  i t must be remembered t h a t  the  areas  planning  period.  examined  of  been  the mothers r e q u i r e  meet t h e needs o f t h e new m o t h e r s w h i c h initial  those  of concerns  month  implies  educative services  different  i n the  period.  of the study a l s o  difference  days a t  Differences  o f t h e two g r o u p s o f m o t h e r s have  programs f o r t h e p o s t p a r t u m The  period.  of  the  assessment  mother must be s t r e s s e d f o r  p r o v i d i n g the supportive educative  clients.  of  services  1 02  REFERENCES  Adams, M. 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A m e r i c a n J o u r n a l o f N u r s i n g , 77, 1173.  108  APPENDIX A PRIORITY RANKING OF TOTAL (1 ST 2 DAYS)  CONCERNS  109  APPENDIX A Priority Percent  Ranking* of T o t a l Concerns (1st 2 days)  of Mothers Responding:  Primiparas I tern  Percent 0 1 -2 3-4  0 = no c o n c e r n 1-2 = l i t t l e t o m o d e r a t e concern 3-4 = much t o c r i t i c a l concern Multiparas I tem  Percent 0 1-2 3-4  0 6 10 6  39 35 39 55  58 59 51 38  Fatigue Return of f i g u r e Safety R e a c t i o n of s i b s  1 1 1 1 22 1 7  47 39 39 39  42 50 39 44  1 3  42  45  23  45  F e e d i n g baby 10 Baby W e i g h t G a i n 1 3 I n t e r p r e t i n g baby behaviour 1 6 Baby's c r y i n g 1 9 T r a v e l w i t h baby 1 3 P a i n from stitches 26 D r e s s i n g baby 16 Baby's s l e e p i n g 19 Return of f i g u r e 10 Change i n f a m i l y 10 l i festyle 10 Breast soreness 1 0 Labour & d e l i v e r y 19 experience B a t h i n g t h e baby 1 6 B r e a t h i n g o f baby 1 3 Baby's f u s s i n e s s 1 6 F i n d i n g time alone together 1 3 Care of b r e a s t s 19 Time f o r recreation 10 Emotional tension 1 6  35 42  54 45  22 Be a good mother Normal growth and d e v e l o p m e n t 19 Infant feeding 1 7  47 44  39 39  35 42 48  48 39 39  36 50 47  42 39 33  32 42 42 55 55 65 55  42 42 39 35 35 26 36  R e c o g n i z e i l l n e s s 22 Demands o f home 1 1 Birth control 1 9 Labour & d e l i v e r y 17 experience I n f a n t wt g a i n 25 Breast soreness 8 E m o t i o n a l t e n s i o n 25  53 42 47 47  30 33 31 28  Care of b r e a s t s Diet  25 1 7  44 61  31 22  42 48 64 52  39 35 23 32  53 33 58 64  25 34 20 22  58 42  30 39  56 64  22 1 9  65 55  26 29  22 Baby's s l e e p i n g I m m u n i z i n g baby 33 D r e s s i n g baby 22 Finances 1 4 Change i n f a m i l y 22 1i f e s t y l e 17 Pain - S t i t c h e s F i n d i n g time alone together 25 19 Care of c o r d  47 53  28 28  Recognize i l l n e s s Be a good mother Safety Fatigue Normal growth & development  * Priority 4-27  d e t e r m i n e d by mean  intensity  scores  in  Tables  110  Appendix A Primiparas Item Giving vitamins or f l o r i d e Setting limits on v i s i t o r s Demands o f home Diet Baby's bowel movements  Percent 0 1-2 3-4  continued Multiparas Item  19 19 19 10 23  61 61 52 64 43  19 19 29 26 36  1 3  58  29  1 3  62  26  Time f o r recreation I n t e r p r e t i n g baby behaviour Baby's r a s h e s Exercise T r a v e l l i n g with baby Baby's p h y s i c a l appearance  26  39  35  32 23  26 48  42 29  Finances Family planning  26 29  48 39  26 32  Sexual r e l a t i o n s Baby's p h y s i c a l appearance Baby s k i n r a s h e s  23  48  30  23 23  55 55  23 23  Exercise  1 9  71  9  Constipation Hemorrhoids Lochia I n a b i l i t y to concentrate F e e l i n g s of b e i n g t i e d down Partner being a good f a t h e r A v a i l a b i l i t y of resources Time f o r p e r s o n a l interests  29 36 19  55 45 61  1 6 19 1 9  23  61  1 6  26  61  1 3  42  29  29  29  55  1 6  1 6  81  3  Baby b l u e s Return of p e r i o d Circumsion R e a c t i o n of siblings  23 26 81  71 65 10  6 10 9  100  0  0  Immunizing baby Comfort i n h a n d l i n g baby Relationship with partner Care of cord  Percent 0 1-2 3-4 25  53  22  22 30 19  59 44 67  19 25 1 4  25  53  22  25  53  22  Baby's c r y i n g  22  66  1 1  Baby's f u s s i n e s s Lochia Baby's bowel movements B r e a t h i n g o f baby Giving vitamins or f l o r i d e R e l a t i o n s h i p with partner Sexual r e l a t i o n s Time f o r p e r s o n a l interests A v a i l a b i l i t y of resources B a t h i n g t h e baby Return of p e r i o d Partner being a good f a t h e r  22 28  62 55  1 7 1 7  25 28  64 56  1 1 1 6  33  48  19  33 28  50 58  1 7 1 4  28  64  9  28 33 31  58 50 59  1 4 1 7 10  36  47  1 7  L i m i t i n g v i s i t o r s 25 F e e l i n g s of being t i e d down 31 I n a b i l i t y to concentrate 36  69  6  58  1 1  50  1 4  Constipation Comfort i n h a n d l i n g baby Baby b l u e s Hemorrhoids Care of c ircumsion  33  58  8  44 44 50  36 41 39  19 1 4 1 1  75  1 7  9  111  APPENDIX  B  PRIORITY RANKING OF TOTAL (1  MONTH)  CONCERNS  APPENDIX B Priority Percent  Ranking* of T o t a l Concerns (1 month)  of Mothers Responding:  Primiparas I tern  Percent 0 1-2 3-4  3 Recognize i l l n e s s Be a good mother 16 Return of f i g u r e 10 1 0 Fatigue  52 39 45 58  45 45 45 32  7 Baby's f u s s i n e s s Infant behaviour 10 Safety 26 Normal g r o w t h and d e v e l o p m e n t 1 9 Infant's s l e e p i n g 10 E x e r c i se 10 Baby's f e e d i n g 1 3  52 52 32  42 38 42  45 52 68 61  35 39 23 26  Baby's c r y i n g Diet Time a l o n e together D r e s s i n g baby  1 6 19  52 52  32 29  23 1 6  42 55  35 30  1 3  61  26  Emotional tension Relationship with partner H o u s e h o l d demands Sexual r e l a t i o n s Time f o r recreation T r a v e l l i n g with baby Time f o r p e r s o n a l interests  0 = no c o n c e r n 1-2 = l i t t l e t o m o d e r a t e concern 3-4 = much t o c r i t i c a l concern Multiparas I tern  Percent 0 1 -2 3-4  Return of f i g u r e Birth control Reaction of s i b s Fatigue Time f o r p e r s o n a l interests Finances H o u s e h o l d demands  1 1 28 1 7 1 7  50 44 39 64  39 28 44 19  1 7 1 7 1 7  64 67 64  19 1 7 19  Be a good mother Exercise Emotional tension Safety Time a l o n e together Recognize i l l n e s s Time f o r recreation Diet Normal g r o w t h and d e v e l o p m e n t  31 19 17 22  44 53 61 55  25 28 22 27  25 1 7  50 63  25 19  22 25  53 53  25 22  47  20  33 -  32 1 6 26  32 68 45  36 22 30  Baby's f u s s i n e s s Baby's s l e e p i n g F e e d i n g baby  22 28 22  70 52 58  8 19 20  19  59  22  Baby's  rashes  28  55  1 7  23  51  26  22  67  1 1  1 6  65  19  Baby's c r y i n g Change i n lifestyle  25  64  1 1  11 3  Appendix Primiparas I tern Baby's w e i g h t gain Change i n l i festyles Baby's b r e a t h i n g Baby's p h y s i c a l appearance Birth control  B  Percent 0 1-2 3-4  Multiparas I tern  Percent 0 1-2 3-4  D r e s s i n g baby 25 R e l a t i o n s h i p with partner 36 Sexual r e l a t i o n s 33  64  1 1  50 56  1 4 1 1  Immunizing baby 39 F e e l i n g t i e d down 28 Interpreting behaviour 25  44 67  1 7 6  70  5  Care of b r e a s t s Baby's w e i g h t gain T r a v e l l i n g with Baby  42  44  1 4  39  47  1 4  30  59  1 1  Return of p e r i o d I n a b i l i t y to concentrate Baby's p h y s i c a l appearance Partner being a good f a t h e r A v a i l a b i l i t y of resources  36  53  1 2  39  50  1 1  39  50  1 1  39  50  1 1  39  50  1 1  L i m i t i n g v i s i t o r s 33 Baby's bowel movements 44  61  6  52  1 4  19 1 3  Breast soreness Baby b l u e s  56 42  31 53  1 4 6  42 42 46  1 3 1 6 1 6  50 42 58  36 55 33  1 4 3 9  52 48  32 32  1 7 20  Baby's b r e a t h i n g Lochia Constipation Labour & d e l i v e r y experience B a t h i n g baby  47 50  44 42  19 8  48  36  1 6  Hemorrhoids  56  36  10  32  39  29  1 6 29  62 45  22 26  32 36  39 32  30 32  F e e l i n g t i e d down 16 I n a b i l i t y to concentrate 23 Baby's bowel movements 39  61  22  65  13  29  32  Baby's r a s h e s Partner being a good f a t h e r  23  58  20  45  30  26  Immunizing  36  39  26  Return of p e r i o d  26  58  1 6  Finances  32  52  1 6  L i m i t i n g v i s i t o r s 32 A v a i l a b i l i t y of resources 29  52  1 7  55  1 6  Baby b l u e s Comfort i n h a n d l i n g baby B a t h i n g baby Giving vitamins or f l o u r i d e Constipation Lochia Labour & d e l i v e r y experience Care of b r e a s t s Pain of st i t c h e s  29  65  6  48 42  32 45  45 45 39  baby  continued  11 4  Appendix  Primiparas Item  0  B  Percent 1-2 3-4  Hemorrhoids  55  35  10  Breast soreness Care of c o r d  52 68  39 23  10 10  87  7  7  100  0  0  Care of circumsion R e a c t i o n of siblings * Priority 4-27  continued  determined  by  Multiparas Item  0  Giving vitamins or f l o u r i d e Comfort i n h a n d l i n g baby Care of c o r d D i s c o m f o r t from st itches Care of c i rcumsion mean  intensity  scores  Percent 1-2 3-4  47  47  6  58 64  33 28  8 9  72  23  6  81  1 1  9  in Tables  APPENDIX C MANN-WHITNEY U TEST PRIMIPARAS VERSUS  MULTIPARAS  1 16  APPENDIX C Mann-Whitney U T e s t V a l u e s and P r o b a b i l i t i e s : Primiparas versus Multiparas 1st  I tem  U  1 2 3 4 5 6 7 8 9 10 1 1 12 1 3 1 4 1 5 1 6 17 18 Total  Self  527 538 481 549 558 447 462 445 496 513 526 518 474 528 489 489 545 413 467  Baby  513 459 458 383 524 531 452 417 459 460 431 462 520 538 393 368 374 371 397 478 442 418  1 9 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 Total  2 days P  1 month U  P  .688 .796 .312 .901 .995 . 1 55 .209 .346 .420 .561 .671 .604 .270 .694 .366 .365 .868 .061 .252  467 466 518 471 535 421 491 546 555 518 471 512 434 542 491 482 534 391 488  .236 .234 .599 .249 .753 .047* .362 .868 .967 .598 .256 .544 . 1 04 .833 .375 .311 .753 .031* .375  .559 .199 . 1 96 .023* .659 .641 . 1 63 .065 .199 .755 .099 .211 .621 .791 .031* .014* .015* .015* .037* .302 .130 .077  463 426 450 493 549 521 407 395 459 533 366 409 499 431 471 305 434 337 421 474 419 417  .215 .087 . 1 57 .379 .893 .465 .050* .031* .190 .743 .012* .052 .431 .724 .230 .001* . 107 .004* .075 .280 .071 .076  11 7  Appendix C  continued  1 s t 2 days  1 month  I tern  U  40 41 42 43 44 45 Total  Partner  487 542 477 462 504 507 491  .353 .829 .294 .212 .488 .507 .399  457 507 502 520 437 510 492  .189 .501 .463 .617 .115 .535 .402  46 47 48 49 50 Total  Family  517 456 395 549 535 480  .587 .179 .033* .902 .759 .325  546 467 512 435 505 529  .876 .234 .542 .107 .483 .682  Total  I terns  430  .106  449  .168  * p<.05  P  U  P  118  APPENDIX D FIRST TWO WILCOXIN  DAYS VERSUS ONE MONTH  SIGNED RANKED TEST FOR MATCHED PAIRS  119  Wilcoxin  Primiparas Z Score P  I tem 1 2 3 4 5 6 7 8 9 1 0 1 1 12 13 1 4 1 5 16 1 7 18 Total 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 Total  APPENDIX D S i g n e d Ranked T e s t f o r M a t c h e d V a l u e s and P r o b a b i l i t i e s ( f i r s t 2 d a y s v e r s u s 1 month)  Pairs  Mult i p a r a s Z score P  Self  -0.28 -2.35 -1 .09 -0.78 -1 .96 -3.05 -1 .94 -2.59 -3.31 -3.04 -1 .69 -0.50 -0.21 -3.40 -0.62 -0.59 -1.41 -2.51 -2.42  .776 .019* .276 .435 .050* .002* .052 .013* .001* .002* .091 .614 .836 .001* .535 .551 .158 .012* .015*  -1 .40 -0.77 -1.16 -1.16 -2.67 -4.28 -1 .23 -0.69 -4.20 -3.40 -2.57 -0.83 -0.62 -3.92 -0.13 -1 .05 -1 .79 -2.37 -3.73  .159 .443 .247 .246 .007* .000* .219 .489 .000* .007* .010* .409 .535 .001* .900 .295 .074 .018* .002*  Baby  -0.66 -2.48 -2.59 -3.41 -3.66 -1 .60 -2.42 -1 .94 -1 .23 -0.71 -0.71 -0.49 -2.26 -2.38 -2.95 -1 .28 -1 .70 -2.36 -2.13 -2.90 -1 .60 -3.32  .509 .013* .009* .007* .003* . 1 08 .016* .052 .218 .476 .478 .627 .024* .017* .003* .201. .089 .018* .033* .003* . 1 05 .001*  -1 .96 -2.30 -2.94 -2.47 -3.88 -0.53 -2.85 -2.01 -1 .88 -0.96 -0.54 -1 .33 -2.65 -1 .85 -2.41 -1.57 -0.69 -1 .80 -2.16 -2.70 -2.20 -2.91  .049* .012* .003* .014* .001 * .594 .004* .044* .061 .339 .588 . 185 .008* .064 .016* .115 .487 .073 .031* .007* .026* .004*  1  1 20  Appendix D Primiparas Z Score  I tern 40 41 42 43 44 45 Total  continued  P  Partner  -0.28 -0.31 -0.91 -0.70 -0.34 -0.47 -0.90  .776 .755 .363 .485 .733 .641 .368  46 47 48 49 50 51 Total  Family  -0.43 -2.02 -2.69 -1 .93 -1 .02 -1 .00 -2.20  Total  I terns  -3.14  * P<.05  Z  Multiparas score P -1 .26 -1 .05 -0.05 -0.33 -1.19 -0.45 -1.12 .  .209 .296 .959 .740 .233 .653 .261  .668 .043* .007* .054 .306 • .317 .028*  -1 .53 -1 .89 -1 .56 -0.92 -1 .58 -2.24 -2.22  .126 .057 .118 .356 .114 .025* .027*  .002*  -3.45  .001*  APPENDIX E MATERNAL CONCERNS QUESTIONNAIRE (1st  two d a y s )  1 22  PLEASE COMPLETE ON YOUR FIRST OR SECOND DAY AT HOME WITH YOUR INFANT MATERNAL  Date today  The  CONCERNS  Date of Discharge  f o l l o w i n g are some concerns  Date o f D e l i v e r y  experienced by some mothers a f t e r the b i r t h o f a baby.  A concern i s anything that- i s a q u e s t i o n , worry, or problem to you. item and decide how much the i t e m concerns  you.  Please read each  Then c i r c l e your response  according  to the f o l l o w i n g s c a l e :  0  No concern  1  Little  2  Moderate  3  Much concern  4  C r i t i c a l concern  concern concern  Please answer the items as t o how you f e e l  A.  Concerns about  yourself. J^Q  .  Concern 1.  Food you eat  0  2.  Exercise habits  0  3.  Return of f i g u r e t o normal  0  4.  Return of menstrual  period  0  5. 6.  Vaginal discharge (lochia) Discomfort from s t i t c h e s (episiotomy)  0  7. 8.  NOW  Little Concern  Moderate Concern  Much Concern  Critical Concern  2  3  4  2  3  4  2  3  4  2  3  4  2  3  4  0  2  3  4  Constipation  0  2  3  4  Hemorrhoids  0  2  3  4  3  4  9.  Breast soreness  0  2  10.  Care of b r e a s t s  0  2  3  4  11.  Fatigue (lack o f s l e e p )  0  2  3  4  12.  Emotional  0  2  3  4  13.  I n a b i l i t y to c o n c e n t r a t e  0 .  2  3  4  14.  Your labour and d e l i v e r y experiences  0  2  3  4  F e e l i n g s of b e i n g t i e d down  0  2  3  4  15-  tension  16. "Baby B l u e s " ( f e e l i n g depressed) 17.  F i n d i n g time f o r p e r s o n a l interests Beinc  ='ood m o t h e r  Q  0  123  No Concern  Concerns about babv  19.  I n f a n t ' s p h y s i c a l appearance  0  20.  Normal growth and development  0  21.  The amount of weight the baby has gained  0  22.  B a t h i n g the baby  0  23.  Care o f the c o r d / u m b i l i c u s  0  24.  Care of the c i r c u m s i o n  0  25.  Feeding  the baby  0  26.  The way the baby breathes  0  27.  Baby's bowel movements  0  28.  Rashes on the baby's s k i n  0  29.  Baby's f u s s i n e s s  0  30.  How the baby s l e e p s  0  31.  When t o g i v e v i t a m i n s o r f l o r i d e  0  32.  G e t t i n g the baby immunized  0  33.  F e e l i n g comfortable  0  34.  I n t e r p r e t i n g i n f a n t ' s behaviour  0  35.  Baby's c r y i n g  0  36.  Recognizing  0  37.  T r a v e l l i n g w i t h baby  0  38.  Safety (preventing accidents)  0  39.  How to dress baby ( c l o t h i n g that i s too warm o r too c o l d f o r the environment)  0  h a n d l i n g baby  signs of i l l n e s s  No Concern  Concerns about p a r t n e r  40.  Your r e l a t i o n s h i p with father  the baby's 0  41.  P a r t n e r b e i n g a good f a t h e r  42.  F i n d i n g time to be alone  0  together  0  43.  F i n d i n g time f o r r e c r e a t i o n  0  44.  Sexual  0  45.  Family p l a n n i n g  relations (birth  control)  0  Little Concern  Moderate Concern  Much Concern  Critical Concern  Little Concern  Moderate Concern  Much Concern  Critical Concern  124  D.  Concerns about'Family  46.  Managing  No Concern  Little Concern  Moderate Concern  Much Concern  Critical Concern.  1  2  3  4  the demands o f the  household  .0  47.  Change i n the f a m i l y ' s l i f e s t y l e  0  1  2  3  4  48.  S e t t i n g l i m i t s on v i s i t o r s  0  1  2  '3  4  49. 50.  Finances The a v a i l a b i l i t y o f community resources (i.e. babysitters, c l i n i c s , parent c l a s s e s )  0  1  2  3  4  0  1  2  3  4  Reaction o f your o t h e r c h i l d r e n to the baby  0  1  2  3  4  51.  COMMENTS Do you have o t h e r concerns that are not l i s t e d ?  1 25  BACKGROUND INFORMATION  P l e a s e  f i l l  1.  What  2.  i n  o r  c i r c l e  i s  y o u r  p r e s e n t  Is  t h i s  y o u r  f i r s t  3.  I f  no,  4.  What  5.  How  6.  What  a r e  t h e  t h e  s e x  of  many  i s  d a y s  t h e  d i d  m a i n  answer  Check  y o u r some  ages  y o u r  y o u  Y e s  o f  y o u r  MOST  c o m p l e t e d  D i d  9.  I f  y o u  s o ,  c h i l d r e n ?  M a l e  i n  of  h o s p i t a l  f e e d i n g  w i t h  t h e  t h i s  r e c e n t  l e v e l  o f  f o r m a l  e d u c a t i o n :  s c h o o l  some  h i g h  c o m p l e t e d  s c h o o l  p r e n a t a l  some  w h i c h  c l a s s e s  u n i v e r s i t y  t h i s  H e a l t h  u n i v e r s i t y  g r a d u a t e  c o m p l e t e d  w i t h  t y p e :  d e l i v e r y ?  B o t h  v o c a t i o n a l / c o l l e g e  a t t e n d  c i r c l e  F e m a l e  b a b y ?  v o c a t i o n a l / c o l l e g e  c o m p l e t e d  8.  o t h e r  baby?  s p e n d  m e t h o d  No  B o t t l e  h i g h  some  a p p r o p r i a t e .  age?  B r e a s t  7.  as  c h i l d ?  what  i s  t h e  s c h o o l  g r a d u a t e  p r e g n a n c y ?  s c h o o l  Y e s  D e p a r t m e n t  H o s p i t a l  10.  What  i s  y o u r  11.  How  many  12.  A r e  y o u  13.  Who  i s  14.  Who  e l s e  e t h n i c  y e a r s  h a v e  p l a n n i n g  t h e  i s  m o s t  t o  A g e n c y  P r i v a t e  I n d i v i d u a l  o r i g i n ?  y o u  l i v e d  r e t u r n  h e l p f u l  h e l p f u l  P r i v a t e  to  to  p e r s o n  you?  i n  Canada?  work?  a t  home  Yes  d u r i n g  No  t h e  f i r s t  week?  No  APPENDIX F MATERNAL CONCERNS QUESTIONNAIRE (one month)  1  27  PLEASE COMPLETE ONE MONTH AFTER COMING HOME WITH YOUR INFANT MATERNAL CONCERNS  Date  The  today  Date o f D i s c h a r g e  Date o f D e l i v e r y  f o l l o w i n g a r e some c o n c e r n s e x p e r i e n c e d by some m o t h e r s a f t e r t h e b i r t h  A concern i s anything that i s a q u e s t i o n , worry, o r problem i t e m and d e c i d e how much t h e i t e m c o n c e r n s y o u . to  the following  0  No c o n c e r n  1  Little  2  Moderate  3  Much c o n c e r n  A  Critical  Concerns  Please read  each  Then c i r c l e y o u r r e s p o n s e a c c o r d i n g  scale:  concern concern  concern  P l e a s e a n s w e r t h e i t e m s a s t o how y o u f e e l  A.  to you.  o f a baby.  about  yourself.  No Concern  NOW  Little Concern  Moderate Concern  Much Concern  Critical Concern  2  3  A  1.  Food y o u e a t  0  2.  Exercise  0  2  3  A  3.  Return o f f i g u r e t o normal  0  2  3  A  A.  Return o f menstrual  period  0  2  3  A  5.  Vaginal discharge  (lochia)  0  2  3  A  6.  Discomfort from (episiotomy)  0  2  3  A  Constipation  0  2  3  A  Hemorrhoids  0  2  3  A  2  3  A  habits  stitches  9.  Breast  soreness  0  10.  Care o f b r e a s t s  0  2  3  A  11.  Fatigue  0  2  3  A  12.  Emotional tension  0  2  3  A  13.  Inability  to concentrate  0  2  3  A  IA.  Your l a b o u r and d e l i v e r y experiences  0  2  3  A  Feelings of being tied  0  2  3  A  15.  (lack of sleep)  down  16. "Baby B l u e s " ( f e e l i n g d e p r e s s e d )  i;  F i n d i n g time f o r p e r s o n a l interests  18.  B e i n g a good mother  0  1  B.  Concerns  about  19.  I n f a n t ' s  p h y s i c a l  20.  Normal  21.  The  growth  amount  No  babv  and  of  Concern  L i t t l e  Moderate  Concern  Concern  Concern  Much  28  C r i t i c a l Concern  appearance  0  2  3  4  development  0  2  3  4  0  2  3  4  weight  the  baby  has  gained 22.  B a t h i n g  the  baby  0  2  3  4  23.  Care  of  the  c o r d / u m b i l i c u s  0  2  3  4  24.  Care  of  the  c i r c u m s i o n  0  2  3  4  25.  Feeding  the  baby  0  2  3  4  26.  The  the  baby  0  2  3  4  27.  Baby's  bowel  0  2  3  4  28.  Rashes  on  0  2  3  4  29.  Baby's  f u s s i n e s s  0  2  3  4  30.  How  0  2  3  4  31.  When  0  2  3  4  32.  G e t t i n g  the  0  2  3  4  33.  F e e l i n g  comfortable  0  2  3  4  34.  I n t e r p r e t i n g  0  2  3  4  35.  Baby's  0  2  3  4  36.  R e c o g n i z i n g  0  2  3  4  37.  T r a v e l l i n g  0  2  3  4  38.  S a f e t y  0  2  3  4  39.  How i s  way  breathes  movements  the  b a b y ' s  s k i n  the  baby  sleeps  to  g i v e  v i t a m i n s  to too  baby  or  immunized h a n d l i n g  i n f a n t ' s  *  signs w i t h  of  baby or  i l l n e s s  baby  ( p r e v e n t i n g dress  baby  behaviour  c r y i n g  warm  f l o r i d e  a c c i d e n t s ) ( c l o t h i n g  too  cold  for  that the  environment)  C.  Concerns  40.  Your  0  about  No  p a r t n e r  r e l a t i o n s h i p  with  Concern  the  baby's  f a t h e r  0  41.  P a r t n e r  b e i n g  42.  F i n d i n g  time  a to  good be  father  0  alone  together  0  4 3.  F i n d i n g  time  f o r  44.  Sexual  r e l a t i o n s  45.  Family  p l a n n i n g  r e c r e a t i o n  0 0  ( b i r t h  c o n t r o l )  0  L i t t l e  Moderate  Concern  Concern  Much Concern  C r i t i c a l Concern  129  D.  Concerns  46.  about- F a m i l y  Managing  the  demands  No  of  L i t t l e  Moderate  Concern  Concern  Concern  0  1  Change  i n  48.  S e t t i n g  49.  Finances  50.  The  the  0  1  parent  Reaction  of  the  l i f e s t y l e  v i s i t o r s  of  ( i . e .  c l i n i c s ,  to  on  a v a i l a b i l i t y  resources  51.  f a m i l y ' s  l i m i t s  C r i t i c a l Concern.  the  household 47*.  Much Concern  2 2  3  4  3  4  0  1  3  4  0  1  2  3  4  0  1  2  3  4  0  1  2  3  4  2  community  b a b y s i t t e r s , c l a s s e s )  your  other  c h i l d r e n  baby  COMMENTS  Do  you  1.  have  What  other  concerns  p r o f e s s i o n a l  that  have  you  are  not  l i s t e d ?  consulted  since  coming  Type Family  home  with  Number  of  your  baby?  Contacts  Doctor  Community  Health  Nurse  P e d i a t r i t i o n Other 2.  Have since  If  there the  yes,  been b i r t h  b r i e f l y  any of  extraordinary your  e x p l a i n .  i n f a n t  events  that  may  that effect  have your  occurred degree  i n of  your  family  concern?  APPENDIX G  Letter  of  Consent  131  V A N C O U V E R  H E A L T H  D E P A R T M E N T  SOUTH EAST UNIT SOUTH OFFICE 6405 KNIGHT STREET. VANCOUVER. B.C. V5P 2V9  Dear  New  I  Mother:  am  M a s t e r ' s  a  Community  degree  improve  p a r t i c i p a t i o n i n  You  ten  the  on  your  from  to  a  the  study  e f f e c t you  i s  have  do  not  i n  the  study  asked f i r s t  to or  at and  these  any  you  to  c a l l  In  at  nurse  times.  a  the  that  home  I t  to  am  towards  a  e f f e c t i v e l y r e q u e s t i n g of  your  new  The  from  your  me  to  You you  a g a i n  you  w i l l to  be  to  the  r e c e i v e  the  w i l l  month  a  phone  the  be  c o n f i d e n t i a l .  you  can  p a r t i c i p a t e  h e a l t h  one  complete  c o m p l e t e l y that  your  a p p r o x i m a t e l y  q u e s t i o n n a i r e s  p a r t i c i p a t i o n ask  r e g a r d i n g  then  take  remind  r e f u s i n g  about or  to  concerns  and  w i l l  understand  r e c e i v e  I  q u e s t i o n n a i r e at  w i l l  to  w o r k i n g  o r d e r  community  q u e s t i o n n a i r e .  you  and  c u r r e n t l y  d e l i v e r y .  day  responses  time  the  l o o k s  a f t e r  the  i s  B.C.  h o s p i t a l .  two  q u e s t i o n s  h e s i t a t e  i n  second  f o r  of  that  h e a l t h  your  who  complete  from  complete  s e r v i c e s  any  mothers  month  important at  the  t h i s  Nurse  U n i v e r s i t y  new  community  coded  I t  to  d i s c h a r g e  q u e s t i o n n a i r e number  be  H e a l t h  the  f i r s t  the  minutes  c a l l  i n  w i l l  concerns a f t e r  at  s e r v i c e s  mothers  TELEPHONE 321-6151  withdraw w i l l  not  department.  If  i n  community  t h i s  study  h e a l t h  from  please  l i a s o n  nurse  h o s p i t a l . Thank-you i n  t h i s  f o r  c o n s i d e r i n g  p a r t i c i p a t i o n  s t u d y ,  Sharon  Tobert  Community South  R.N.  H e a l t h  H e a l t h  U n i t  B „ S . N . Nurse 321-6151  MEMBER OF THE METROPOLITAN HEALTH SERVICE OF GREATER VANCOUVER  

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