Early Parenting Support Services for Women Who Gave Birth in a Private Hospital: An Explanatory Sequential Mixed-Methods Analysis

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The transition to motherhood increases the risk of developing or exacerbating a mental disorder, which can have negative outcomes for the woman, her baby and family. Both early parenting support and maternal self-efficacy can ameliorate the risk of developing a perinatal mental disorder. The main aim of this study was to examine early parenting support services for women giving birth in a private hospital and how these support services influence perinatal mental disorder. There were two research objectives: 1) to determine the risk of postnatal mental disorder for women who gave birth in a private hospital compared to women who gave birth in a public hospital in NSW; and 2) to explain the difference through the exploration and interpretation of maternal self-efficacy in stakeholder experience of social support services for women who gave birth in a private hospital. An explanatory, sequential, mixed methods study was undertaken in two phases. The mixed methods design combined the large sample size and generalisability of the quantitative method and the depth and detail of qualitative methods to explore the complexity of perinatal social support services. In Phase 1, binary regression analysis of state-wide population data determined that the women who gave birth in private hospitals (n = 47 609) were more likely to be admitted to hospital in the postnatal year with a primary diagnosis of a mental disorder (rate=2.54 %, 95%CI=2.40-2.68 %), compared with the women who gave birth in public hospitals (n = 148 864) (rate=1.68 %, 95%CI=1.61-1.75 %). In Phase 2, exploration and interpretation of stakeholder experience of support services for new mothers provided possible explanation of this result. Thematic and template analysis were underpinned by social exchange theory and self-efficacy theory. Interview data from clinicians (n = 23), primigravid women (n = 8) and administrators (n = 3) at two private hospitals provided three support service themes: Perinatal Assessment of Risk of Mental Disorder; π˜”π˜’π˜΅π˜¦π˜³π˜―π˜’π˜­ 𝘚𝘦𝘭𝘧-𝘌𝘧𝘧π˜ͺ𝘀𝘒𝘀𝘺 and 𝘐𝘯𝘧𝘒𝘯𝘡 𝘍𝘦𝘦π˜₯π˜ͺ𝘯𝘨 𝘚𝘢𝘱𝘱𝘰𝘳𝘡 𝘚𝘦𝘳𝘷π˜ͺ𝘀𝘦𝘴 𝘒𝘯π˜₯ π˜—π˜’π˜³π˜¦π˜―π˜΅π˜ͺ𝘯𝘨 π˜™π˜¦π˜’π˜΄π˜΄π˜Άπ˜³π˜’π˜―π˜€π˜¦ 𝘒𝘯π˜₯ π˜”π˜’π˜΅π˜¦π˜³π˜―π˜’π˜­ 𝘚𝘦𝘭𝘧-π˜‹π˜°π˜Άπ˜£π˜΅. The first theme explained that comprehensive psychosocial assessment was not provided as part of routine perinatal care, which may increase the risk of developing a mental disorder. The second theme determined that infant feeding support services did not facilitate women to achieve their own feeding goals, which may undermine maternal self-efficacy. The third theme highlighted a disjuncture between women’s belief of the advantages and clinician’s belief in the disadvantages of parenting reassurance through online support. This disjoint may also undermine maternal self-efficacy. As maternal self-efficacy may not have been supported the risk of a mental disorder may have been increased. This study demonstrated that women who gave birth in a private hospital were at increased risk of a mental disorder and that lack of provision for psychosocial assessment as part of routine care and support services that impede or do not support maternal self-efficacy may contribute to this risk.
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