Adaptation, postpartum concerns, and learning needs in the first two weeks after caesarean birth

Abstract

Aims. The purpose of this Roy Adaptation Model-based study was to describe women's physical, emotional, functional and social adaptation; postpartum concerns; and learning needs during the first two weeks following caesarean birth and identify relevant nursing interventions. Background. Studies of caesarean-delivered women indicated a trend toward normalisation of the caesarean birth experience. Escalating caesarean birth rates mandate continued study of contemporary caesarean-delivered women. Design. Mixed methods (qualitative and quantitative) descriptive research design. Methods. Nursing students collected data from 233 culturally diverse caesarean-delivered women in urban areas of the Midwestern and Northeastern USA between 2002-2004. The focal stimulus was the planned or unplanned caesarean birth; contextual stimuli were cultural identity and parity. Adaptation was measured by open-ended interview questions, fixed choice questionnaires about postpartum concerns and learning needs and nurse assessment of post-discharge problems. Potential interventions were identified using the Omaha System Intervention Scheme. Results. More positive than negative responses were reported for functional and social adaptation than for physical and emotional adaptation. Women with unplanned caesarean births and primiparous women reported less favourable adaptation than planned caesarean mothers and multiparas. Black women reported lower social adaptation, Hispanic women had more role function concerns and Black and Hispanic women had more learning needs than White women. Post-discharge nursing assessments revealed that actual problems accounted for 40% of identified actual or potential problems or needs. Health teaching was the most commonly recommended postpartum intervention strategy followed by case management, treatment and surveillance interventions. Conclusions. Caesarean-delivered women continue to experience some problems with adapting to childbirth. Recommended intervention strategies reflect the importance of health teaching following hospital discharge. Relevance to clinical practice. Women who experience caesarean birth require comprehensive assessment during the early postpartum period. Nurses should devise strategies to continue care services for these women following hospital discharge. © 2009 Blackwell Publishing Ltd.