Exploring postpartum women's experiences, perspectives, and expectations in maternal health care at a Chinese maternity care center: A qualitative study

Exploring postpartum women's experiences, perspectives, and expectations in maternal health care at a Chinese maternity care center: A qualitative study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Exploring postpartum women's experiences, perspectives, and expectations in maternal health care at a Chinese maternity care center: A qualitative study Xiaoqian Zhang, Yang Liu, Tang Li, Frank Buntinx, Mieke Vermandere This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4194919/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 07 Jan, 2025 Read the published version in BMC Pregnancy and Childbirth → Version 1 posted 10 You are reading this latest preprint version Abstract Background The postpartum period presents critical challenges for new mothers, involving significant physical and emotional adjustments. Traditionally, Chinese culture has addressed this phase through "doing the month," emphasizing rest and specific cultural practices. With the shift towards modernization, urban China has seen a rise in professional maternal care centers, yet research on the experiences and expectations of women utilizing these services remains scarce. This study focuses on exploring the experiences, perspectives, and expectations of postpartum women in a Chinese maternal care center, assessing the integration of traditional practices with modern healthcare standards. Methods In this study, 16 participants who had utilized the hospital's maternal care center within the previous year were chosen via purposive sampling in Qingdao, China. Data were collected through semi-structured in-depth interviews and analyzed employing The Qualitative Analysis Guide of Leuven (QUAGOL). Results Analysis revealed three main themes: co-created health management, shared knowledge and growth, and interpersonal connections and support. The study highlighted the benefits of a collaborative approach to healthcare, where personalized care and maternal autonomy were prioritized. It also pointed out the educational aspect of motherhood, emphasizing the role of community support and shared experiences in knowledge acquisition. Furthermore, the study highlighted the positive impact of social dynamics, such as family, peer, and professional support, emphasizing their crucial contribution to the postpartum recovery process. Conclusion The research shed light on the intricate balance between traditional Chinese postpartum practices and modern medical care, underlining the necessity for a holistic approach that caters to the physical, emotional, and social well-being of new mothers. The findings advocate for co-created health management, emphasizing the role of shared knowledge and interpersonal support in enhancing postpartum care. Additionally, the impact of cultural and societal elements on postpartum experiences calls for culturally sensitive healthcare practices. This study contributes valuable insights into improving postpartum care in China, suggesting an integrated approach that incorporates both traditional and contemporary healthcare practices to support the holistic well-being of new mothers. Future studies are encouraged to expand the research scope to encompass a broader array of experiences and to utilize quantitative methods for further validation. Postpartum care Experiences Perspectives Expectations China Qualitative research Figures Figure 1 1. Background The tradition of taking a month to recuperate and bond with the baby following birth is deeply rooted in Chinese culture and dates back at least 1000 years. It demonstrates respect for new mothers and allows them to adjust to their new role ( 1 ). This cultural practice, commonly known as "doing the month" or "zuo yue zi" involves a set of prescribed and proscribed behaviors, including a specific diet and abstaining from cold water and outdoor activities ( 2 , 3 ). These practices are usually followed in the woman’s own home for a full month after giving birth ( 4 ). There are still a many women across Asia who follow this tradition because they believe that these practices may improve their current health and prevent future illness ( 3 ). According to some studies, this tradition may reduce the prevalence of postpartum depression as well as be nutritionally beneficial to maternal and infant health ( 5 – 7 ). Currently, the average hospital stay for uncomplicated births is approximately five days in China ( 8 ). Changing lifestyles and widespread availability of information about postpartum care options have prompted adaptations in the traditional practice of “doing the month” ( 9 , 10 ). This transformation has resulted in a growing demand for high-quality, professional maternity care centers, particularly in urban areas. To meet this demand, new maternal centers specifically designed to support the practice of “doing the month” have been established. These centers often offer stays of up to one month ( 8 , 11 – 13 ). Building on this foundation, hospitals have begun to integrate specialized maternity centers within their facilities, extending the concept of postpartum care to include comprehensive medical programs following delivery. These hospital-based maternity centers are designed to offer a holistic approach to postpartum care, encompassing special diets, sufficient rest, and gentle exercise to support the recovery process. New mothers have the opportunity to enroll in month-long medical programs that are staffed by a multidisciplinary team, including doctors, midwives, nurses, dietitians, physical therapists, and social workers, all dedicated to providing a supportive, healing environment. However, since maternity centers in hospitals are a relatively new phenomenon in China, little is known about the experiences and expectations of the women who have utilized these facilities ( 14 ). In present-day China, the majority of families expecting children belong to a generation that grew up as only children. Consequently, numerous new parents, mothers in particular, may find themselves with limited experience in childcare ( 15 ). Moreover, new mothers often face various difficulties and challenges during their puerperium, both physically and psychologically ( 16 ). There are many health issues that new mothers may experience, including pain, incontinence, constipation, sleep disturbances, loneliness, anxiety, helplessness, and exhaustion ( 17 – 20 ). Although the maternity centers provide excellent care for new mothers ( 12 ), there is a gap in understanding how this care aligns with women's perceptions and needs, especially regarding psychological well-being ( 21 , 22 ). Women may experience social isolation during this confinement period ( 3 , 22 ). Additionally, Chinese women may feel reluctant to share their experiences or preferences regarding postpartum care, due to either cultural norms or concerns about being judged or stigmatized ( 23 ). A failure to address this issue can have substantial consequences for their health and well-being, as well as for their newborns and families ( 24 ). Therefore, there is a pressing need for qualitative research that investigates the experiences, viewpoints, and needs of new mothers who have stayed in maternity centers in hospitals during the first postpartum month. Understanding these women’s experiences, preferences, and expectations will enable healthcare providers to tailor their services more effectively, ensuring new mothers receive the necessary care and support during this vulnerable time. The purpose of this research is to explore Chinese women’s experiences, perspectives, and expectations when accessing maternal healthcare services, focusing on the practice of “doing the month”. The study aims to identify the challenges, influencing factors, and opportunities for enhancing the quality of medical services provided during this vital postpartum phase. 2. Methods 2.1 Study design The study employed qualitative semi-structured interviews, which were meticulously analyzed using The Qualitative Analysis Guide of Leuven (QUAGOL) ( 25 ). To ensure thorough and transparent reporting of the findings, the study adhered to the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist. 2.2 Participants and sampling Inclusion and exclusion criteria Purposive sampling was employed, with inclusion criteria consisting of being 18 years of age or older, having given birth within the past year, being able to understand either English or Chinese, and expressing interest in participating in the study. A strategy to maximize variation in the sample was employed, with efforts made to recruit women from different age groups, education levels, economic status, and postpartum periods within 1 year after delivery. Postpartum women who had a history of any diagnosed mental health disorders, such as depression, schizophrenia, bipolar disorder, and other mental conditions, as well as those with chronic pain, were excluded from the study group to ensure that the results were not influenced by pre-existing health conditions. Recruitment strategy The hospital managers used email or phone to invite potential participants. Participants were recruited for the study only after they had completed the "doing the month" postpartum period in the hospital within the past year. The sample size was determined based on the principle of data saturation, which is a widely recognized criterion for determining sample size in qualitative research ( 26 ). We defined data saturation as the moment when the two prior interviews did not contribute any new information, and when all dimensions and variations of a certain category had been fully explained. As a consequence, further interviews would not provide additional insight. 2.3 Setting This study was conducted at the United Family Hospital, a private secondary hospital located in Qingdao, China. Qingdao, in the eastern region of China, is widely recognized as a highly dynamic and promising core area in China's economic development pattern, particularly within the Shandong province. In 2018, the city’s GDP was recorded at around 186.07 billion USD, an urbanization rate of 74%, and a resident population of approximately 10 million people ( 27 ). At the United Family Hospital, most women seeking medical care are of Han Chinese ethnicity, with a smaller proportion belonging to various ethnic minorities or other nationalities. 2.4 Ethical considerations Ethical approval was obtained from the Ethics Board of Qingdao Binhai University Affiliated Hospital (QDBHUH20230302007) and university hospital of KU Leuven (S67895). Prior to inclusion in the study, participants were provided with a comprehensive explanation of the research's purpose, methodology, procedures, benefits, and potential risks. Written informed consent was then obtained from all participants to ensure their full understanding and willingness to participate. Participants were also informed of their right to withdraw from the study at any point during the interview. To ensure the confidentiality and anonymity of the participants' information, the audio recordings and transcripts of the interviews were securely coded and stored in a private database at the Qingdao United Family Hospital in China. 2.5 Data collection A semi-structured face-to-face interview was conducted between May 1st 2023 and July 30th 2023 in Qingdao, using an audio recording. Two primary previously-trained researchers (XQ.Z and Y.L) from the team conducted the interview through use of an audio recording. The interviews were conducted by one researcher while the other assisted with recording, taking notes, observing the nonverbal behaviors, summarizing, and supplementing the data as necessary. While conducting the interview, field notes pertaining to non-verbal expressions were taken and added into the account when coding the transcription. Socio-demographic information was collected simultaneously by the researchers. The primary researcher who conducted the interviews transcribed verbatim the recorded data, and another primary researcher reviewed the transcript. No previous relationships existed between the researchers and participants, and no treatment was provided to participants by the researchers. Each interview was recorded with a digital recorder. To ensure that the interview questions were appropriate and acceptable, a pilot interview was conducted with two test participants. As a result, ten open-ended questions were developed to guide the interviewing process. Twenty potential participants were identified, and data collection was terminated after 16 participants due to saturation of data. All interviews were conducted in Chinese, the native language of both interviewers and authors. 2.6 Data analysis Data analysis was performed using The Qualitative Analysis Guide of Leuven (QUAGOL) qualitative content analysis method, with constant data comparison and an interactive team discussion regarding reflections and concepts ( 28 ). The transcribed data and field notes were analyzed line by line by the two primary researchers separately, then a discussion between them. The analysis process is comprised of two parts: a careful preparation of the coding process, which involves the use of a pencil and paper, and the actual coding process using qualitative software (Atlas.ti). The transcribed data and analyzed results, including both spoken information and non-verbal signs, were shared with senior researchers (M.V, T.L, and F.B) who have experience in qualitative research in order to ensure objectivity in the analysis process. Conculsions were revised through advisory and discussion processes in order to reach consensus among all members of the research team. The entire data analysis process was conducted in Chinese and then translated into English by using a professional language editor. In order to protect identifiable information, the outside researcher had no direct access to patient information or case records, but only to the transcribed data and analyzed results. 3. Results 3.1 Participants characteristics Sixteen participants were selected consecutively, and data collection was terminated after the sixteenth participant when data saturation was reached. Participants had a mean age of 30.6 years. There were seven primipara and nine multiparas. All participants were of Chinese descent. Eleven participants underwent vaginal deliveries and five gave birth via cesarean section. Other general characteristics are presented in Table 1 . All participants chose a postpartum recovery period of at least 28 days in the hospital. None of the participants needed further non-routine follow-up from an obstetrician after their delivery. Table 1 Demographic characteristics of participating postpartum women Participant Age Delivery experiences Mode of delivery Feeding Previous psychiatric conditions Occupation Educational level 1 33 Multipara Vaginal Breastfeeding None Employed Master 2 38 Multipara Cesarean Breastfeeding None Housewife Master 3 24 Primipara Vaginal Breastfeeding None Employed University 4 26 Primipara Vaginal Breastfeeding None Employed University 5 35 Multipara Cesarean Breastfeeding None Housewife PhD 6 26 Primipara Vaginal Breastfeeding None Housewife High school 7 36 Multipara Cesarean Formula feeding None Employed University 8 32 primipara Cesarean Breastfeeding None Employed University 9 28 Multipara Vaginal Mixed feeding None Housewife University 10 31 Multipara Vaginal Formula feeding None Employed University 11 29 Primipara Vaginal Breastfeeding None Employed University 12 22 Primipara Vaginal Breastfeeding None Housewife High school 13 37 Multipara Vaginal Breastfeeding None Employed University 14 40 Multipara Vaginal Breastfeeding None Employed Master 15 27 Multipara Vaginal Formula feeding None Employed University 16 25 Primipara Cesarean Breastfeeding None Employed University 3.2 Data categories A total of 527 codes were derived from constant comparisons of the statements. Codes were categorized into seven sub-categories and grouped into three main categories. The main categories comprised “co-created health management”, “shared knowledge and growth”, and “interpersonal connections and support” (Table 2 ). We identified three main themes that emerged as significant needs and perspectives from the participants, potentially influencing their experiences during their hospital stay. These themes were derived from the participants' expressions during the interviews. Each theme was then thoroughly analyzed through more detailed subcategories for a comprehensive understanding. 3.3 Findings This study identified three main categories in postpartum care: Co-created health management, shared knowledge and growth, and interpersonal connections and support. These categories are informed and shaped by the interplay between modern western medical practices and traditional Chinese customs, illustrating the complex backdrop against which postpartum care is provided and experienced (Fig. 1). Figure 1. The figure visualizes the interplay of three main themes in postpartum care: co-created health management, shared knowledge and growth, and interpersonal connections and support, each influenced by the mix of traditional Chinese customs and modern healthcare. These themes collectively shape new mothers' postpartum experiences, blending time-honored practices with current medical standards to meet their health needs and expectations. 3.3.1 Main category 1: Co-created health management When exploring positive experiences, participants underscored that efficacious postpartum care embodies an interactive and dynamic process. Within this context, healthcare professionals and new mothers engage in a collaborative partnership, jointly shaping the postpartum experience. This cooperative approach caters to the contemporary needs and expectations of new mothers, thereby ensuring that the care provided is not only effective and gratifying but also deeply respectful of the mother’s pivotal role in fostering value throughout this critical period. The concept of co-created health management was dissected into three sub-categories, as illustrated in Table 2 . These three sub-categories encompassed: 1) Physical and emotional well-being; 2) Professional medical care and specialized services; and 3) Hospital policies and value considerations. 3.3.1.1 Sub-category: physical and emotional well-being Participants stressed how important it is to have professional medical care and advice to help with their physical discomfort like pain, fatigue, and insomnia, etc. They pointed out that it was valuable when healthcare providers and patients work together. This collaboration is particularly crucial in the context of maternal and infant health, necessitating access to experienced doctors, nurses and other postpartum caregivers. Furthermore, they also repeatedly said how important it is to have medical care that is specially designed for each mom and baby. “I feel that in the hospital, in terms of medical care, the nurses' skills are insufficient, and the ward rounds are quite formalized. There are just fixed rounds every day, but they don't address my personal issues.” (participant 1, 33 years old) Healthcare professionals and caregivers play a vital role in offering emotional support and reducing anxiety. Many participants express a desire for a supportive environment that respects privacy, personal preferences, and includes personalized emotional wellness follow-ups by doctors. “Confinement during the postpartum period is quite boring for me, and I don't feel disturbed by the ward rounds. Since I'm having trouble with breastfeeding, coupled with physical pain and conflicts with my family, I feel a sense of loneliness." (participant 4, 26 years old) 3.3.1.2 Sub-category: Professional medical care and specialized services Participants highly value the presence of professional medical staff, including doctors and nurses, especially when addressing specific health concerns for themselves and their babies. They appreciate personalized medical care, with services such as physiotherapy, lactation consulting, and nutritional advice being particularly beneficial. Educational sessions offered by healthcare experts are also valued for helping them make informed choices. The adaptability of medical staff in responding to patient feedback and changing needs is crucial for effective co-created health management. Additionally, comprehensive care in hospitals, encompassing high-quality medical and non-medical support services like cleaning, entertainment, and wellness treatments, plays a significant role in enhancing the physical and mental well-being of new mothers. Trust in the medical staff's expertise and the reliability of professional healthcare are key factors in the selection of a postpartum care facility. “Concerned about the child's health, we would only choose to spend the postpartum confinement period in a hospital, as the hygiene and professionalism there are more reliable. We trust the pediatricians in the hospital and hope that the hospital employs experienced doctors. As first-time parents with no experience, we hope to receive guidance from professionals during the postpartum period, such as doctors in the hospital, rather than from our family members.” (participant 2, 38 years old) "If we get tired of the three meals a day in the hospital, it can make the postpartum confinement period quite difficult to endure. Often, the suggestions made by the nutritionist are not well implemented, and the dietary restrictions are not followed. We hope that the food quality can be improved and wish for better implementation of the nutritionist's advice, focusing not only on nutrition but also on taste.” (participant 11, 29 years old) 3.3.1.3 Sub-category: Hospital policies and value considerations The concept of co-created health management in postpartum care aligns with modern expectations, highlighting the critical role of the mother's active participation in her postpartum journey. This approach is particularly relevant in developing hospital policies and evaluating their value, focusing on individualized care, professional support, and the overall well-being of both the mother and the child. Different maternity centers offer different care programs at varying costs. Therefore, economic factors, such as the cost and perceived value of care, play a pivotal role in shaping patients' decision-making processes. Consequently, individuals tend to choose the most cost-effective options for their care. Postpartum centers should be designed to adapt to the unique needs of each mother and child, with services ranging from medical consultations to wellness programs. Policies often prioritize the safety and well-being of both the mother and the newborn. However, participants mentioned the need for flexibility within these policies, which can adapt to their personal needs. Such flexibility enables a more customized approach to postpartum care, ensuring that individual needs are effectively addressed. "Because I was staying in the hospital, some policies couldn't be changed, such as the nurses' rounds at night. I informed them that this was not necessary, but due to hospital policies, the nurses refused my request." (participant 12, 22 years old) The economic aspect is a significant factor, with many families weighing the cost against the perceived value of the services. High-quality care often comes at a higher price, making it crucial for hospitals to balance affordability with the level of care provided. The economic considerations extend beyond immediate costs to the long-term health benefits for the mother and child. Investing in quality postpartum care can lead to improved health outcomes, which may reduce future healthcare costs. It's essential for hospitals to align their services with new mothers' expectations and needs, offering a mix of medical care at a reasonable price. “The cost of postpartum care in hospitals can be quite expensive, and I'm torn between the high price and my fear of getting sick. I really like the idea of staying in a hospital for postpartum care, but I also need to consider the cost.” (participant 6, 26 years old) 3.3.2 Main category 2: Shared knowledge and growth Mothers frequently exchanging information that aids in their own development and the care of their babies. During the postpartum period, they encounter various challenges, learn from both other mothers and professionals, and evolve through these experiences. The concept of shared knowledge and growth can be divided into two sub-categories: 1) Learning journey in motherhood; and 2) Personal development and future planning, which involves mothers thinking about their own experiences and making plans for the future. 3.3.2.1 Sub-category: Learning journey in motherhood The experience of motherhood and infant care in postnatal care centers represents a blend of challenges and opportunities for learning. Breastfeeding is identified as a particularly intricate aspect that necessitates personalized and empathetic support. The complexities of infant care underscore the necessity for practical skills and emotional strength. Learning and growth are pivotal, underscoring the importance of shared knowledge and community support in fostering confident and informed parenting. Breastfeeding often involves challenges such as milk supply issues, latching difficulties, and emotional stress from societal expectations. Many mothers struggle with confidence and feel pressured to continue despite difficulties. Support from lactation consultants and hearing other mothers' experiences can greatly enhance confidence in breastfeeding. However, academic approaches may not always cater to these individual needs, potentially causing feelings of inadequacy or guilt. Mothers value pertinent information and support to make informed decisions for themselves and their babies, without feeling judged. "I feel that breastfeeding is torture; I can't sleep at night, and my child doesn't seem to get enough to eat. Comparing with other mothers, the pressure is even greater." (participant 8, 32 years old) New parents frequently grapple with the practicalities of infant care, including managing crying, sleep routines, and feeding. The intense emotions of early parenthood, often exacerbated by lack of sleep and post-childbirth recovery, can be overwhelming. Postpartum care centers offer a structured setting that helps ease the transition into parenthood. The supportive assistance from professionals and peers is vital in overcoming these challenges. "The nursing approach at the postpartum care center is very evidence-based, and I've acquired a wealth of knowledge from the medical staff." (participant 9, 28 years old) Mothers greatly appreciate learning from healthcare professionals about infant care and postnatal recovery in postpartum centers. This education encompasses practical skills, medical knowledge, and emergency care techniques. This period also marks considerable personal growth for new mothers, who learn to adapt, make informed decisions, and build resilience amidst challenges. "Because the older generation lacks experience in childcare, I often have to seek answers to many parenting questions on my own. I am slowly learning and adjusting while taking care of my child. During the postpartum period, the maternity nurse imparts skills, which helps me feel more confident when taking care of my child at home." (participant 3, 24 years old) 3.3.2.2 Sub-category 2: Personal development and future planning Motherhood is characterized by personal development, the pursuit of a balance between career and family life, and the need for improved postpartum care services. New mothers undergo substantial personal development as they adjust to the demands of nurturing a newborn. This entails acquiring a range of childcare abilities, encompassing feeding and comforting techniques, as well as gaining insight into the baby's health requirements. Concurrently, they grapple with physical and emotional transformations, hormonal fluctuations, and the evolving dynamics within their family relationships, particularly when older generations hold divergent childcare beliefs. They progressively realize the significance of maintaining their own health and overall well-being. "I feel like I don't need much help from my in-laws or my own parents, as they are getting older, and their sleep patterns are disrupted. If I were to do postpartum confinement in the hospital, my family wouldn't have to be with me constantly. Having a professional postnatal nanny makes me feel at ease. In fact, my family members have tried to help with taking care of the baby, but their experience and skills are quite limited. It's better for me to stay in the hospital." (participant 5, 35 years old) Many mothers face the challenging, but rewarding task of balancing career goals with motherhood. The desire to return to work or continued education while caring for a newborn presents both challenges and opportunities for personal and professional development. Mothers learn to manage their time efficiently, balancing baby care with personal interests and work commitments. This often involves adapting to a new routine and learning to prioritize tasks. The role of support systems cannot be overstated. Whether it's postpartum care centers, partners, family, or professional caregivers such as maternity nurses, their contribution is crucial. They provide a nurturing environment that is essential for mothers to successfully balance their professional aspirations with the demands of motherhood. "After giving birth to my second child, I didn't want to compromise on my career, so I enrolled my eldest, who is two years old, in daycare. This way, I have more time to focus on my work. I can also allocate more time to pursue my career aspirations. During the day, the postnatal nanny and my mother-in-law assist me in taking care of my second child, allowing me to go to work." (participant 14, 40 years old) 3.3.3 Main category 3: Interpersonal connections and support The postpartum period is crucial, heavily influenced by interpersonal dynamics and social support. Effective family relationships, particularly with spouses, elders, and extended family, are vital for a new mother's well-being. The social environment of postpartum care centers, including peer and professional support, significantly impacts their emotional health. Quality interactions, emphasizing effective communication, empathy, and consistent expert care with medical staff, nurses, and postnatal nannies are key in shaping a positive postpartum experience. These elements not only provide crucial emotional and practical assistance but also significantly contribute to a beneficial postpartum journey for new mothers. 3.3.3.1 Sub-category 1: Family and social dynamics Many mothers expressed difficulties in communicating with older family members, particularly around child-rearing practices and traditional beliefs (e.g., drinking herbal soups). This often leads to tension and arguments, affecting the mother’s mental well-being. Husbands play a significant role in providing emotional support. Their involvement in child-rearing decisions, such as the choice of postpartum care centers and support in breastfeeding decisions, significantly impacts the mother’s experience. Sometimes, the involvement of older family members can intensify stress due to differing views on childcare. New mothers opt for maternity centers to avoid conflicts with in-laws or parents, preferring professional care to traditional family practices ( 29 ). Sharing experiences and tips with other mothers at maternity centers benefits mental health and practical learning. The bond with professional caregivers, including nurses and postnatal nanny, is vital. Group activities and educational sessions are highly valued for socializing and learning, aiding mothers in adjusting to their new roles. Some mothers experience isolation, underlining the significance of social interactions for mental well-being in the postpartum period. “I trust the hospital's nursing methods a lot more because they're based on solid evidence. My parents sometimes suggest traditional Chinese medicine, but those methods can feel a bit old-fashioned to me. Staying in the hospital helps me sidestep any arguments with them about this. Plus, the doctors at the maternal center really know their stuff, and they're better able to help me out.” (participants 13, 37 years old) “During the postpartum period, I can meet other new mothers, which I believe is very important. Chatting with other mothers helps me understand that we all face similar issues, which makes me feel more relaxed mentally.” (participant 10, 31 years old) 3.3.3.2 Sub-category 2: Effective communication in healthcare Mothers in postpartum care centers often encounter a mix of experiences in their interactions with healthcare professionals. These interactions range from appreciative and trust-building to challenging or unsatisfactory. The quality of communication and the expertise of medical staff and postnatal nannies significantly impact the mothers' postpartum experiences. Positive experiences stem from empathetic, clear communication and professional, responsive care, which significantly reduces anxiety and aids in emotional support during this sensitive period. Expert care, personalized to each mother's unique needs and inclusive decision-making, profoundly enhances their well-being. Consistency in the healthcare team fosters trust and security, encouraging open communication. In contrast, a lack of empathy, especially in managing emotional fluctuations, and unprofessional behavior can negatively impact the mothers' experiences, exacerbating anxiety and hindering the development of trust. “I have great trust in my postnatal nanny, and our communication is very smooth. She has provided me with a lot of experience in caring for my child. This is my second time in the hospital for postpartum care. My previous experience has taught me that good communication with doctors and the postnatal nanny is crucial.” (participant 7, 36 years old) Table 2 Analysis of participants’ experiences and needs during the postpartum period Main categories Sub-categories Co-created health management Physical and emotional well-being Professional medical care and specialized services Hospital policies and value considerations Shared knowledge and growth Learning journey in motherhood Personal development and future planning Interpersonal connections and support Family and social dynamics Effective communication in healthcare 4. Discussion 4.1 Summary of the results This qualitative study aimed to gain a deeper understanding of the experiences, perspectives and expectations of postpartum women who participated in the traditional Chinese practice of ‘doing the month’ at a maternity care center during their first month after delivery. The research identified three main themes: Co-created health management, shared knowledge and growth, and interpersonal connections and support. These themes illuminate the complex interplay of postpartum care, underscoring how the blend of modern Western medical practices with traditional Chinese customs influences women’s experiences, perspectives and expectations (Fig. 1). "Co-created health management" stresses a collaborative model between healthcare providers and new mothers, emphasizing personalized care that actively involves mothers and respecting their autonomy. This approach is tailored to the distinct requirements of each mother-child pair, leading to increased personal satisfaction ( 30 ). "Shared knowledge and growth" underlines the educational journey intrinsic to motherhood, spotlighting the significance of shared experiences and support networks in empowering mothers. Finally, "interpersonal connections and support" illuminates the importance of social dynamics and communication in the postpartum phase, incorporating spousal support, familial relations, and interactions with other new mothers and healthcare professionals. 4.2 Strengths and limitations of the study A major strength of this study lies in its focus on a recently emerging phenomenon among new mothers in China, a demographic that has been under-researched. The study provides a comprehensive examination of postpartum experiences from various viewpoints, offering valuable insights into the complex nature of individual postpartum care experiences. Furthermore, the study's use of constant comparison analysis between emerging categories and data adds to the robustness of the results. Repeated reviews of the semi-structured interview audio recordings ensured accurate capture of the postpartum women's expectations and experiences. However, the study faces limitations, including potential biases in participant selection and the subjective nature of qualitative data. The experiences captured may not represent all new mothers, especially those from different cultural or socioeconomic backgrounds. The exclusive use of Chinese in interviews potentially excluded perspectives of minority women who do not speak Chinese. 4.3 Comparison with the literature The categories identified in this study align with existing literature which emphasizes the importance of individualized care, the role of social support, and the need for effective communication in postpartum care. Firstly, this study's discovery of "co-created health management" highlights the vital role of autonomy, as emphasized in the renowned Self-Determination Theory (SDT) ( 31 ). This category enriches the SDT framework by demonstrating how autonomy can be effectively nurtured in postpartum care environments. Our findings align with previous research in this area, adding new insights into the practical application of autonomy in maternity care ( 29 ). Secondly, the category of "shared knowledge and growth" aligns with SDT's principle of competence. Our study extends this concept further, demonstrating how group-based learning and shared experiences in postpartum care centers are instrumental in enhancing mothers' confidence in newborn care. This collective-learning model transcends the individual-focused perspective of SDT, shedding light on the communal aspects of learning and growth in maternal health. Lastly, the category of "interpersonal connections and support" reflects the relatedness aspect of SDT. Our research delves deeper into the nature of these interactions, emphasizing the significance of empathetic communication and supportive relationships in both family and healthcare settings. Previous studies also discussed the importance of emotional and physical well-being for maternal selfcare in the postpartum period ( 32 ). This expanded interpretation of relatedness in postpartum care broadens the application of SDT, highlighting the multifaceted support systems essential for maternal well-being. Additionally, our study highlights the influence of cultural and societal factors on these themes, emphasizing the importance of cultural context in shaping postpartum experiences. For instance, the role of extended family in different cultures can significantly impact a mother's sense of autonomy and competence. This is consistent with findings that cultural factors significantly impact postpartum depression ( 33 ). Comparative analysis with studies from various geographical locations reveals that the application of SDT in postpartum care varies across different healthcare systems and societal norms ( 34 ). These insights advocate for culturally-sensitive postpartum care practices. This comparative perspective highlights the necessity for a more tailored application of SDT in postpartum care, taking into account the diverse cultural, societal, and healthcare system differences that uniquely shape each mother's experience. 4.4 Implications for future studies Future research should expand the demographic and geographic scope to include a more diverse range of postpartum experiences. Quantitative studies could be employed to validate the findings of this study and to quantify the impact of various factors on postpartum experiences. Longitudinal studies would be valuable to understand how postpartum experiences evolve over time and to assess the long-term outcomes of different care approaches. Finally, intervention studies could be designed to test the effectiveness of strategies identified as beneficial in this study. 5. Conclusion This study provides important insights into postpartum care, highlighting the essential need for a holistic, personalized approach that addresses the physical, emotional, and social aspects of a new mother’s well-being. The findings underscore the importance of co-created health management, shared knowledge and growth, and interpersonal connections and support in enhancing postpartum care. Moreover, the influence of cultural and societal factors on these experiences suggests the need for culturally-sensitive practices. Our research contributes to a better understanding of postpartum experiences and lays a foundation for future studies to build upon. Future research should focus on expanding the diversity of participants and employing quantitative methods to validate these findings. Longitudinal and intervention studies could further elucidate the long-term effects of various postpartum care models, paving the way for improved practices in maternal health care. Abbreviations QUAGOL: The Qualitative Analysis Guide of Leuven COREQ: Consolidated Criteria for Reporting Qualitative Research SDT: Self-Determination Theory Declarations This study was carried out in accordance with the Declaration of Helsinki. All procedures were approved separately by the Ethics Board of Qingdao Binhai University Affiliated Hospital (QDBHUH20230302007) and university hospital of KU Leuven (S67895). All participants provided written informed consent prior to participation, and it was clearly explained to all participants that they were free to withdraw from any part of the study at any point in time. Consent for publication Not applicable Availability of data and materials Quotes from the interview contents are published in this article. Full transcripts of the qualitative datasets are not publicly available due to confidentiality restrictions. Transcripts are available from the corresponding author upon reasonable request. Competing interests The authors declare that they have no conflict of interest. Funding This study was conducted with no specific funding support. Contribution Authors’ Contributions XQ.Z, M.V designed the review, XQ.Z and Y.L contributed to the conception and design of the study, data acquisition, and analysis and interpretation of data. XQ.Z participated in writing the first draft of the paper. M.V, T.L, and F.B revised critically for important intellectual content and gave final approval for the version to be published. All authors contributed to the intellectual content and read and approved the final manuscript. Corresponding author Correspondence to Xiaoqian Zhang. Acknowledgements The authors would like to thank the participants who spent their extra time in the study. The authors are also grateful to the staffs of the Qingdao United Family Hospital, Qingdao, China. Author’s information Authors and Affiliations Academic Center for General Practice , Department of Public Health and Primary Care, KU Leuven, Belgium Xiaoqian Zhang; Frank Buntinx; Mieke Vermandere Qingdao United Family Hospital, Qingdao, China Xiaoqian Zhang Qingdao University Medical College, Qingdao, China Tang Li Qingdao Municipal Hospital, Qingdao, China Yang Liu References Chin Y, Jaganathan M, Hasmiza A, Wu M. Zuo yuezi practice among Malaysian Chinese women: tradition vs modernity. British Journal of Midwifery. 2010;18(3):170-5. Yue J, Liu J, Williams S, Zhang B, Zhao Y, Zhang Q, et al. Barriers and facilitators of kangaroo mother care adoption in five Chinese hospitals: a qualitative study. BMC Public Health. 2020;20(1):1-11. Chang SH-C. Experiences of Chinese immigrant women following zuo yue zi in the lower mainland of British Columbia: University of British Columbia; 2016. Ding G, Tian Y, Yu J, Vinturache A. Cultural postpartum practices of ‘doing the month’in China. Perspectives in public health. 2018;138(3):147-9. Liu YQ, Maloni JA, Petrini MA. Effect of postpartum practices of doing the month on Chinese women’s physical and psychological health. Biological research for nursing. 2014;16(1):55-63. Chu WS. Analyzing Elements of Postpartum Confinement and the Effect on Overall Health: An Integrative Review. 2022. Chien LY, Tai CJ, Ko YL, Huang CH, Sheu SJ. Adherence to “Doing‐the‐month” practices is associated with fewer physical and depressive symptoms among postpartum women in Taiwan. Research in Nursing & Health. 2006;29(5):374-83. Lomoro O, Ehiri J, Qian X, Tang S. Mothers’ perspectives on the quality of postpartum care in Central Shanghai, China. International Journal for Quality in Health Care. 2002;14(5):393-401. Raven JH, Chen Q, Tolhurst RJ, Garner P. Traditional beliefs and practices in the postpartum period in Fujian Province, China: a qualitative study. BMC pregnancy and childbirth. 2007;7:1-11. Wang Q, Chaloumsuk N, Fongkaew W. An Ethnography of “doing the month” and Modern Postpartum Practices among Rural Women in Jiangxi, China. Pacific Rim International Journal of Nursing Research. 2022;26(2):341-54. Kharas H, Dooley M. China’s influence on the global middle class. Brookings Institution [online] chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://wwwbrookingsedu/wp-content/uploads/2020/10/FP_20201012_china_middle_class_kharas_dooley pdf. 2020. Hung CH, Yu CY, Liu CF, Stocker J. Maternal satisfaction with postpartum nursing centers. Research in nursing & health. 2010;33(4):345-54. Meijian Y. Study on the new model of puerperal women health care. Chinese Community Doctors. 2017;33(5):152-. Lu TT. New models of postpartum women's health care. Seek Medical And Ask The Medicine. 2012;10(6):839-40. Zeng Y, Hesketh T. The effects of China's universal two-child policy. The Lancet. 2016;388(10054):1930-8. Webb DA, Bloch JR, Coyne JC, Chung EK, Bennett IM, Culhane JF. Postpartum physical symptoms in new mothers: Their relationship to functional limitations and emotional well‐being. Birth. 2008;35(3):179-87. Gonzalo-Carballes M, Ríos-Vives MÁ, Fierro EC, Azogue XG, Herrero SG, Rodríguez AE, et al. A pictorial review of postpartum complications. Radiographics. 2020;40(7):2117-41. Brousseau EC, Danilack V, Cai F, Matteson KA. Emergency department visits for postpartum complications. Journal of Women's Health. 2018;27(3):253-7. Navodani T, Gartland D, Brown SJ, Riggs E, Yelland J. Common maternal health problems among Australian-born and migrant women: a prospective cohort study. PLoS One. 2019;14(2):e0211685. Luoma I, Korhonen M, Puura K, Salmelin RK. Maternal loneliness: concurrent and longitudinal associations with depressive symptoms and child adjustment. Psychology, health & medicine. 2019;24(6):667-79. Yeh YC, St John W, Venturato L. Doing the month in a Taiwanese postpartum nursing center: An ethnographic study. Nursing & Health Sciences. 2014;16(3):343-51. Liu YQ, Petrini M, Maloni JA. “Doing the month”: Postpartum practices in Chinese women. Nursing & health sciences. 2015;17(1):5-14. Chapman J, Estcourt CS, Hua Z. Saving ‘face’and ‘othering’: getting to the root of barriers to condom use among Chinese female sex workers. Sexual health. 2008;5(3):291-8. Slomian J, Honvo G, Emonts P, Reginster J-Y, Bruyère O. Consequences of maternal postpartum depression: A systematic review of maternal and infant outcomes. Women's Health. 2019;15:1745506519844044. Kiger ME, Varpio L. Thematic analysis of qualitative data: AMEE Guide No. 131. Medical teacher. 2020;42(8):846-54. Fusch PI, Ness LR. Are we there yet? Data saturation in qualitative research. The qualitative report. 2015;20(9):1408. Fu S, Zhuo H, Song H, Wang J, Ren L. Examination of a coupling coordination relationship between urbanization and the eco-environment: a case study in Qingdao, China. Environmental Science and Pollution Research. 2020;27:23981-93. de Casterlé BD, Gastmans C, Bryon E, Denier Y. QUAGOL: A guide for qualitative data analysis. International journal of nursing studies. 2012;49(3):360-71. Zhang Y, Hanser A. Be the mother, not the daughter: Immigrant Chinese women, postpartum care knowledge, and mothering autonomy. Sociology of Health & Illness. 2023. Brenning K, Soenens B. A self‐determination theory perspective on postpartum depressive symptoms and early parenting behaviors. Journal of Clinical Psychology. 2017;73(12):1729-43. Ryan RM, Deci EL. Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. American psychologist. 2000;55(1):68. Lambermon F, Vandenbussche F, Dedding C, van Duijnhoven N. Maternal self-care in the early postpartum period: An integrative review. Midwifery. 2020;90:102799. Borji M, Shahbazi F, Nariman S, Otaghi M, Safari S. Investigating the relationship between mother-child bonding and maternal mental health. Journal of Comprehensive Pediatrics. 2018;9(1). Klainin P, Arthur DG. Postpartum depression in Asian cultures: a literature review. International journal of nursing studies. 2009;46(10):1355-73. Additional Declarations No competing interests reported. Supplementary Files annex.docx Cite Share Download PDF Status: Published Journal Publication published 07 Jan, 2025 Read the published version in BMC Pregnancy and Childbirth → Version 1 posted Editorial decision: Revision requested 11 Nov, 2024 Reviews received at journal 25 Oct, 2024 Reviewers agreed at journal 30 Sep, 2024 Reviews received at journal 18 Jul, 2024 Reviewers agreed at journal 18 Jul, 2024 Reviewers invited by journal 11 Jul, 2024 Editor invited by journal 04 Apr, 2024 Submission checks completed at journal 31 Mar, 2024 Editor assigned by journal 31 Mar, 2024 First submitted to journal 31 Mar, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4194919","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":285858483,"identity":"0943d48d-fb98-47c2-8d0b-ef12fd3ac9e6","order_by":0,"name":"Xiaoqian Zhang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA7UlEQVRIiWNgGAWjYBACfmbm4z8YG4AsdhBhYEFYi2Q7W4IEWAvPAZAWCcJaDM7zGEC0SCSA+ERoYTjMlmD4c4ddnnzk86sbfhRIMPC3dyfg1cHYzHwgQfJMcrHh7Zyymz1Ah0mcObsBrxZmZraEA4ZtzIkbZ+ek3QA6EuidXPxa2Jh5DBsS2+oTN848k3bzDzFaeJh5jBkOth1OnC/Bfuw2UbZIMLOlMTa2HU/cwJPDdlvGQIKHoF/szx8+xvizrTpxfvvxZzff/LGR42/vxa8FDgwO8BiAXUqcchCQb2B/QLzqUTAKRsEoGFEAAELvSKscHBh/AAAAAElFTkSuQmCC","orcid":"","institution":"KU Leuven","correspondingAuthor":true,"prefix":"","firstName":"Xiaoqian","middleName":"","lastName":"Zhang","suffix":""},{"id":285858484,"identity":"a0670dcd-3a3a-4057-92ea-10f526b9d094","order_by":1,"name":"Yang Liu","email":"","orcid":"","institution":"Qingdao Municipal Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yang","middleName":"","lastName":"Liu","suffix":""},{"id":285858485,"identity":"b44905fd-9792-4353-9aef-88c6feb613ce","order_by":2,"name":"Tang Li","email":"","orcid":"","institution":"Qingdao University Medical College","correspondingAuthor":false,"prefix":"","firstName":"Tang","middleName":"","lastName":"Li","suffix":""},{"id":285858486,"identity":"8208ba7a-58ed-49a5-add0-6932ff9ec5b9","order_by":3,"name":"Frank Buntinx","email":"","orcid":"","institution":"KU Leuven","correspondingAuthor":false,"prefix":"","firstName":"Frank","middleName":"","lastName":"Buntinx","suffix":""},{"id":285858487,"identity":"7d23932a-6ab3-4d52-99ba-cf0dd6fd37b1","order_by":4,"name":"Mieke Vermandere","email":"","orcid":"","institution":"KU Leuven","correspondingAuthor":false,"prefix":"","firstName":"Mieke","middleName":"","lastName":"Vermandere","suffix":""}],"badges":[],"createdAt":"2024-03-31 09:14:21","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4194919/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4194919/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12884-024-07087-6","type":"published","date":"2025-01-07T15:57:50+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":54039952,"identity":"2f5ee896-eaf2-42b0-b8a6-e203255111e5","added_by":"auto","created_at":"2024-04-03 17:25:01","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":523853,"visible":true,"origin":"","legend":"\u003cp\u003eThe figure visualizes the interplay of three main themes in postpartum care: co-created health management, shared knowledge and growth, and interpersonal connections and support, each influenced by the mix of traditional Chinese customs and modern healthcare. These themes collectively shape new mothers' postpartum experiences, blending time-honored practices with current medical standards to meet their health needs and expectations.\u003c/p\u003e","description":"","filename":"Figure1.Dynamicsamongmaincategoriesinpostpartumcarepractices..png","url":"https://assets-eu.researchsquare.com/files/rs-4194919/v1/555a6cdd37c28f1510fe6330.png"},{"id":73693954,"identity":"a7a5d579-1b84-4d80-8a7e-6841af35b451","added_by":"auto","created_at":"2025-01-13 16:09:55","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1648365,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4194919/v1/ed3c3f2b-f6a9-4584-a50d-01b40ca93aff.pdf"},{"id":54038951,"identity":"f1e75c40-c777-4691-b41b-87e845e45f8f","added_by":"auto","created_at":"2024-04-03 17:17:01","extension":"docx","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":21990,"visible":true,"origin":"","legend":"","description":"","filename":"annex.docx","url":"https://assets-eu.researchsquare.com/files/rs-4194919/v1/b51a130f9fb1b165712988c7.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Exploring postpartum women's experiences, perspectives, and expectations in maternal health care at a Chinese maternity care center: A qualitative study","fulltext":[{"header":"1. Background","content":"\u003cp\u003eThe tradition of taking a month to recuperate and bond with the baby following birth is deeply rooted in Chinese culture and dates back at least 1000 years. It demonstrates respect for new mothers and allows them to adjust to their new role (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). This cultural practice, commonly known as \"doing the month\" or \"zuo yue zi\" involves a set of prescribed and proscribed behaviors, including a specific diet and abstaining from cold water and outdoor activities (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). These practices are usually followed in the woman\u0026rsquo;s own home for a full month after giving birth (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). There are still a many women across Asia who follow this tradition because they believe that these practices may improve their current health and prevent future illness (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). According to some studies, this tradition may reduce the prevalence of postpartum depression as well as be nutritionally beneficial to maternal and infant health (\u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eCurrently, the average hospital stay for uncomplicated births is approximately five days in China (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Changing lifestyles and widespread availability of information about postpartum care options have prompted adaptations in the traditional practice of \u0026ldquo;doing the month\u0026rdquo; (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). This transformation has resulted in a growing demand for high-quality, professional maternity care centers, particularly in urban areas. To meet this demand, new maternal centers specifically designed to support the practice of \u0026ldquo;doing the month\u0026rdquo; have been established. These centers often offer stays of up to one month (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan additionalcitationids=\"CR12\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Building on this foundation, hospitals have begun to integrate specialized maternity centers within their facilities, extending the concept of postpartum care to include comprehensive medical programs following delivery. These hospital-based maternity centers are designed to offer a holistic approach to postpartum care, encompassing special diets, sufficient rest, and gentle exercise to support the recovery process. New mothers have the opportunity to enroll in month-long medical programs that are staffed by a multidisciplinary team, including doctors, midwives, nurses, dietitians, physical therapists, and social workers, all dedicated to providing a supportive, healing environment. However, since maternity centers in hospitals are a relatively new phenomenon in China, little is known about the experiences and expectations of the women who have utilized these facilities (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn present-day China, the majority of families expecting children belong to a generation that grew up as only children. Consequently, numerous new parents, mothers in particular, may find themselves with limited experience in childcare (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Moreover, new mothers often face various difficulties and challenges during their puerperium, both physically and psychologically (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). There are many health issues that new mothers may experience, including pain, incontinence, constipation, sleep disturbances, loneliness, anxiety, helplessness, and exhaustion (\u003cspan additionalcitationids=\"CR18 CR19\" citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). Although the maternity centers provide excellent care for new mothers (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e), there is a gap in understanding how this care aligns with women's perceptions and needs, especially regarding psychological well-being (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). Women may experience social isolation during this confinement period (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). Additionally, Chinese women may feel reluctant to share their experiences or preferences regarding postpartum care, due to either cultural norms or concerns about being judged or stigmatized (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). A failure to address this issue can have substantial consequences for their health and well-being, as well as for their newborns and families (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). Therefore, there is a pressing need for qualitative research that investigates the experiences, viewpoints, and needs of new mothers who have stayed in maternity centers in hospitals during the first postpartum month. Understanding these women\u0026rsquo;s experiences, preferences, and expectations will enable healthcare providers to tailor their services more effectively, ensuring new mothers receive the necessary care and support during this vulnerable time. The purpose of this research is to explore Chinese women\u0026rsquo;s experiences, perspectives, and expectations when accessing maternal healthcare services, focusing on the practice of \u0026ldquo;doing the month\u0026rdquo;. The study aims to identify the challenges, influencing factors, and opportunities for enhancing the quality of medical services provided during this vital postpartum phase.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Study design\u003c/h2\u003e \u003cp\u003eThe study employed qualitative semi-structured interviews, which were meticulously analyzed using The Qualitative Analysis Guide of Leuven (QUAGOL) (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). To ensure thorough and transparent reporting of the findings, the study adhered to the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Participants and sampling\u003c/h2\u003e \u003cp\u003e \u003cem\u003eInclusion and exclusion criteria\u003c/em\u003e \u003c/p\u003e \u003cp\u003ePurposive sampling was employed, with inclusion criteria consisting of being 18 years of age or older, having given birth within the past year, being able to understand either English or Chinese, and expressing interest in participating in the study. A strategy to maximize variation in the sample was employed, with efforts made to recruit women from different age groups, education levels, economic status, and postpartum periods within 1 year after delivery. Postpartum women who had a history of any diagnosed mental health disorders, such as depression, schizophrenia, bipolar disorder, and other mental conditions, as well as those with chronic pain, were excluded from the study group to ensure that the results were not influenced by pre-existing health conditions.\u003c/p\u003e \u003cp\u003e \u003cem\u003eRecruitment strategy\u003c/em\u003e \u003c/p\u003e \u003cp\u003eThe hospital managers used email or phone to invite potential participants. Participants were recruited for the study only after they had completed the \"doing the month\" postpartum period in the hospital within the past year. The sample size was determined based on the principle of data saturation, which is a widely recognized criterion for determining sample size in qualitative research (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). We defined data saturation as the moment when the two prior interviews did not contribute any new information, and when all dimensions and variations of a certain category had been fully explained. As a consequence, further interviews would not provide additional insight.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Setting\u003c/h2\u003e \u003cp\u003eThis study was conducted at the United Family Hospital, a private secondary hospital located in Qingdao, China. Qingdao, in the eastern region of China, is widely recognized as a highly dynamic and promising core area in China's economic development pattern, particularly within the Shandong province. In 2018, the city\u0026rsquo;s GDP was recorded at around 186.07\u0026nbsp;billion USD, an urbanization rate of 74%, and a resident population of approximately 10\u0026nbsp;million people (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). At the United Family Hospital, most women seeking medical care are of Han Chinese ethnicity, with a smaller proportion belonging to various ethnic minorities or other nationalities.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.4 Ethical considerations\u003c/h2\u003e \u003cp\u003e \u003cstrong\u003eEthical approval\u003c/strong\u003e \u003cp\u003e was obtained from the Ethics Board of Qingdao Binhai University Affiliated Hospital (QDBHUH20230302007) and university hospital of KU Leuven (S67895). Prior to inclusion in the study, participants were provided with a comprehensive explanation of the research's purpose, methodology, procedures, benefits, and potential risks. Written informed consent was then obtained from all participants to ensure their full understanding and willingness to participate. Participants were also informed of their right to withdraw from the study at any point during the interview. To ensure the confidentiality and anonymity of the participants' information, the audio recordings and transcripts of the interviews were securely coded and stored in a private database at the Qingdao United Family Hospital in China.\u003c/p\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e2.5 Data collection\u003c/h2\u003e \u003cp\u003eA semi-structured face-to-face interview was conducted between May 1st 2023 and July 30th 2023 in Qingdao, using an audio recording. Two primary previously-trained researchers (XQ.Z and Y.L) from the team conducted the interview through use of an audio recording. The interviews were conducted by one researcher while the other assisted with recording, taking notes, observing the nonverbal behaviors, summarizing, and supplementing the data as necessary. While conducting the interview, field notes pertaining to non-verbal expressions were taken and added into the account when coding the transcription. Socio-demographic information was collected simultaneously by the researchers. The primary researcher who conducted the interviews transcribed verbatim the recorded data, and another primary researcher reviewed the transcript. No previous relationships existed between the researchers and participants, and no treatment was provided to participants by the researchers. Each interview was recorded with a digital recorder. To ensure that the interview questions were appropriate and acceptable, a pilot interview was conducted with two test participants. As a result, ten open-ended questions were developed to guide the interviewing process. Twenty potential participants were identified, and data collection was terminated after 16 participants due to saturation of data. All interviews were conducted in Chinese, the native language of both interviewers and authors.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e2.6 Data analysis\u003c/h2\u003e \u003cp\u003eData analysis was performed using The Qualitative Analysis Guide of Leuven (QUAGOL) qualitative content analysis method, with constant data comparison and an interactive team discussion regarding reflections and concepts (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). The transcribed data and field notes were analyzed line by line by the two primary researchers separately, then a discussion between them. The analysis process is comprised of two parts: a careful preparation of the coding process, which involves the use of a pencil and paper, and the actual coding process using qualitative software (Atlas.ti). The transcribed data and analyzed results, including both spoken information and non-verbal signs, were shared with senior researchers (M.V, T.L, and F.B) who have experience in qualitative research in order to ensure objectivity in the analysis process. Conculsions were revised through advisory and discussion processes in order to reach consensus among all members of the research team. The entire data analysis process was conducted in Chinese and then translated into English by using a professional language editor. In order to protect identifiable information, the outside researcher had no direct access to patient information or case records, but only to the transcribed data and analyzed results.\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e3.1 Participants characteristics\u003c/h2\u003e \u003cp\u003eSixteen participants were selected consecutively, and data collection was terminated after the sixteenth participant when data saturation was reached. Participants had a mean age of 30.6 years. There were seven primipara and nine multiparas. All participants were of Chinese descent. Eleven participants underwent vaginal deliveries and five gave birth via cesarean section. Other general characteristics are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. All participants chose a postpartum recovery period of at least 28 days in the hospital. None of the participants needed further non-routine follow-up from an obstetrician after their delivery.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic characteristics of participating postpartum women\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParticipant\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDelivery experiences\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMode of delivery\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eFeeding\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ePrevious psychiatric conditions\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eOccupation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eEducational level\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMultipara\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eVaginal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBreastfeeding\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eEmployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eMaster\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMultipara\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCesarean\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBreastfeeding\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eHousewife\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eMaster\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePrimipara\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eVaginal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBreastfeeding\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eEmployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eUniversity\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePrimipara\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eVaginal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBreastfeeding\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eEmployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eUniversity\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMultipara\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCesarean\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBreastfeeding\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eHousewife\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003ePhD\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePrimipara\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eVaginal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBreastfeeding\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eHousewife\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eHigh school\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMultipara\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCesarean\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eFormula feeding\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eEmployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eUniversity\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eprimipara\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCesarean\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBreastfeeding\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eEmployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eUniversity\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMultipara\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eVaginal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMixed feeding\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eHousewife\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eUniversity\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMultipara\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eVaginal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eFormula feeding\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eEmployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eUniversity\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePrimipara\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eVaginal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBreastfeeding\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eEmployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eUniversity\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePrimipara\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eVaginal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBreastfeeding\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eHousewife\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eHigh school\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMultipara\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eVaginal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBreastfeeding\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eEmployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eUniversity\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMultipara\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eVaginal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBreastfeeding\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eEmployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eMaster\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMultipara\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eVaginal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eFormula feeding\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eEmployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eUniversity\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePrimipara\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCesarean\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBreastfeeding\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eEmployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eUniversity\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e3.2 Data categories\u003c/h2\u003e \u003cp\u003eA total of 527 codes were derived from constant comparisons of the statements. Codes were categorized into seven sub-categories and grouped into three main categories. The main categories comprised \u0026ldquo;co-created health management\u0026rdquo;, \u0026ldquo;shared knowledge and growth\u0026rdquo;, and \u0026ldquo;interpersonal connections and support\u0026rdquo; (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eWe identified three main themes that emerged as significant needs and perspectives from the participants, potentially influencing their experiences during their hospital stay. These themes were derived from the participants' expressions during the interviews. Each theme was then thoroughly analyzed through more detailed subcategories for a comprehensive understanding.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e3.3 Findings\u003c/h2\u003e \u003cp\u003eThis study identified three main categories in postpartum care: Co-created health management, shared knowledge and growth, and interpersonal connections and support. These categories are informed and shaped by the interplay between modern western medical practices and traditional Chinese customs, illustrating the complex backdrop against which postpartum care is provided and experienced (Fig.\u0026nbsp;1).\u003c/p\u003e \u003cp\u003e \u003cb\u003eFigure 1.\u003c/b\u003e The figure visualizes the interplay of three main themes in postpartum care: co-created health management, shared knowledge and growth, and interpersonal connections and support, each influenced by the mix of traditional Chinese customs and modern healthcare. These themes collectively shape new mothers' postpartum experiences, blending time-honored practices with current medical standards to meet their health needs and expectations.\u003c/p\u003e \u003cdiv id=\"Sec13\" class=\"Section3\"\u003e \u003ch2\u003e3.3.1 Main category 1: Co-created health management\u003c/h2\u003e \u003cp\u003eWhen exploring positive experiences, participants underscored that efficacious postpartum care embodies an interactive and dynamic process. Within this context, healthcare professionals and new mothers engage in a collaborative partnership, jointly shaping the postpartum experience. This cooperative approach caters to the contemporary needs and expectations of new mothers, thereby ensuring that the care provided is not only effective and gratifying but also deeply respectful of the mother\u0026rsquo;s pivotal role in fostering value throughout this critical period.\u003c/p\u003e \u003cp\u003eThe concept of co-created health management was dissected into three sub-categories, as illustrated in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. These three sub-categories encompassed: 1) Physical and emotional well-being; 2) Professional medical care and specialized services; and 3) Hospital policies and value considerations.\u003c/p\u003e \u003cdiv id=\"Sec14\" class=\"Section4\"\u003e \u003ch2\u003e3.3.1.1 Sub-category: physical and emotional well-being\u003c/h2\u003e \u003cp\u003eParticipants stressed how important it is to have professional medical care and advice to help with their physical discomfort like pain, fatigue, and insomnia, etc. They pointed out that it was valuable when healthcare providers and patients work together. This collaboration is particularly crucial in the context of maternal and infant health, necessitating access to experienced doctors, nurses and other postpartum caregivers. Furthermore, they also repeatedly said how important it is to have medical care that is specially designed for each mom and baby.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I feel that in the hospital, in terms of medical care, the nurses' skills are insufficient, and the ward rounds are quite formalized. There are just fixed rounds every day, but they don't address my personal issues.\u0026rdquo; (participant 1, 33 years old)\u003c/em\u003e \u003c/p\u003e \u003cp\u003eHealthcare professionals and caregivers play a vital role in offering emotional support and reducing anxiety. Many participants express a desire for a supportive environment that respects privacy, personal preferences, and includes personalized emotional wellness follow-ups by doctors.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Confinement during the postpartum period is quite boring for me, and I don't feel disturbed by the ward rounds. Since I'm having trouble with breastfeeding, coupled with physical pain and conflicts with my family, I feel a sense of loneliness.\" (participant 4, 26 years old)\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section4\"\u003e \u003ch2\u003e3.3.1.2 Sub-category: Professional medical care and specialized services\u003c/h2\u003e \u003cp\u003eParticipants highly value the presence of professional medical staff, including doctors and nurses, especially when addressing specific health concerns for themselves and their babies. They appreciate personalized medical care, with services such as physiotherapy, lactation consulting, and nutritional advice being particularly beneficial. Educational sessions offered by healthcare experts are also valued for helping them make informed choices. The adaptability of medical staff in responding to patient feedback and changing needs is crucial for effective co-created health management. Additionally, comprehensive care in hospitals, encompassing high-quality medical and non-medical support services like cleaning, entertainment, and wellness treatments, plays a significant role in enhancing the physical and mental well-being of new mothers. Trust in the medical staff's expertise and the reliability of professional healthcare are key factors in the selection of a postpartum care facility.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Concerned about the child's health, we would only choose to spend the postpartum confinement period in a hospital, as the hygiene and professionalism there are more reliable. We trust the pediatricians in the hospital and hope that the hospital employs experienced doctors. As first-time parents with no experience, we hope to receive guidance from professionals during the postpartum period, such as doctors in the hospital, rather than from our family members.\u0026rdquo; (participant 2, 38 years old)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\"If we get tired of the three meals a day in the hospital, it can make the postpartum confinement period quite difficult to endure. Often, the suggestions made by the nutritionist are not well implemented, and the dietary restrictions are not followed. We hope that the food quality can be improved and wish for better implementation of the nutritionist's advice, focusing not only on nutrition but also on taste.\u0026rdquo; (participant 11, 29 years old)\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section4\"\u003e \u003ch2\u003e3.3.1.3 Sub-category: Hospital policies and value considerations\u003c/h2\u003e \u003cp\u003eThe concept of co-created health management in postpartum care aligns with modern expectations, highlighting the critical role of the mother's active participation in her postpartum journey. This approach is particularly relevant in developing hospital policies and evaluating their value, focusing on individualized care, professional support, and the overall well-being of both the mother and the child. Different maternity centers offer different care programs at varying costs. Therefore, economic factors, such as the cost and perceived value of care, play a pivotal role in shaping patients' decision-making processes. Consequently, individuals tend to choose the most cost-effective options for their care.\u003c/p\u003e \u003cp\u003ePostpartum centers should be designed to adapt to the unique needs of each mother and child, with services ranging from medical consultations to wellness programs. Policies often prioritize the safety and well-being of both the mother and the newborn. However, participants mentioned the need for flexibility within these policies, which can adapt to their personal needs. Such flexibility enables a more customized approach to postpartum care, ensuring that individual needs are effectively addressed.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"Because I was staying in the hospital, some policies couldn't be changed, such as the nurses' rounds at night. I informed them that this was not necessary, but due to hospital policies, the nurses refused my request.\" (participant 12, 22 years old)\u003c/em\u003e \u003c/p\u003e \u003cp\u003eThe economic aspect is a significant factor, with many families weighing the cost against the perceived value of the services. High-quality care often comes at a higher price, making it crucial for hospitals to balance affordability with the level of care provided. The economic considerations extend beyond immediate costs to the long-term health benefits for the mother and child. Investing in quality postpartum care can lead to improved health outcomes, which may reduce future healthcare costs. It's essential for hospitals to align their services with new mothers' expectations and needs, offering a mix of medical care at a reasonable price.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;The cost of postpartum care in hospitals can be quite expensive, and I'm torn between the high price and my fear of getting sick. I really like the idea of staying in a hospital for postpartum care, but I also need to consider the cost.\u0026rdquo; (participant 6, 26 years old)\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section3\"\u003e \u003ch2\u003e3.3.2 Main category 2: Shared knowledge and growth\u003c/h2\u003e \u003cp\u003eMothers frequently exchanging information that aids in their own development and the care of their babies. During the postpartum period, they encounter various challenges, learn from both other mothers and professionals, and evolve through these experiences. The concept of shared knowledge and growth can be divided into two sub-categories: 1) Learning journey in motherhood; and 2) Personal development and future planning, which involves mothers thinking about their own experiences and making plans for the future.\u003c/p\u003e \u003cdiv id=\"Sec18\" class=\"Section4\"\u003e \u003ch2\u003e3.3.2.1 Sub-category: Learning journey in motherhood\u003c/h2\u003e \u003cp\u003eThe experience of motherhood and infant care in postnatal care centers represents a blend of challenges and opportunities for learning. Breastfeeding is identified as a particularly intricate aspect that necessitates personalized and empathetic support. The complexities of infant care underscore the necessity for practical skills and emotional strength. Learning and growth are pivotal, underscoring the importance of shared knowledge and community support in fostering confident and informed parenting.\u003c/p\u003e \u003cp\u003eBreastfeeding often involves challenges such as milk supply issues, latching difficulties, and emotional stress from societal expectations. Many mothers struggle with confidence and feel pressured to continue despite difficulties. Support from lactation consultants and hearing other mothers' experiences can greatly enhance confidence in breastfeeding. However, academic approaches may not always cater to these individual needs, potentially causing feelings of inadequacy or guilt. Mothers value pertinent information and support to make informed decisions for themselves and their babies, without feeling judged.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"I feel that breastfeeding is torture; I can't sleep at night, and my child doesn't seem to get enough to eat. Comparing with other mothers, the pressure is even greater.\" (participant 8, 32 years old)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e New parents frequently grapple with the practicalities of infant care, including managing crying, sleep routines, and feeding. The intense emotions of early parenthood, often exacerbated by lack of sleep and post-childbirth recovery, can be overwhelming. Postpartum care centers offer a structured setting that helps ease the transition into parenthood. The supportive assistance from professionals and peers is vital in overcoming these challenges.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"The nursing approach at the postpartum care center is very evidence-based, and I've acquired a wealth of knowledge from the medical staff.\" (participant 9, 28 years old)\u003c/em\u003e \u003c/p\u003e \u003cp\u003eMothers greatly appreciate learning from healthcare professionals about infant care and postnatal recovery in postpartum centers. This education encompasses practical skills, medical knowledge, and emergency care techniques. This period also marks considerable personal growth for new mothers, who learn to adapt, make informed decisions, and build resilience amidst challenges.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"Because the older generation lacks experience in childcare, I often have to seek answers to many parenting questions on my own. I am slowly learning and adjusting while taking care of my child. During the postpartum period, the maternity nurse imparts skills, which helps me feel more confident when taking care of my child at home.\" (participant 3, 24 years old)\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section4\"\u003e \u003ch2\u003e3.3.2.2 Sub-category 2: Personal development and future planning\u003c/h2\u003e \u003cp\u003eMotherhood is characterized by personal development, the pursuit of a balance between career and family life, and the need for improved postpartum care services. New mothers undergo substantial personal development as they adjust to the demands of nurturing a newborn. This entails acquiring a range of childcare abilities, encompassing feeding and comforting techniques, as well as gaining insight into the baby's health requirements. Concurrently, they grapple with physical and emotional transformations, hormonal fluctuations, and the evolving dynamics within their family relationships, particularly when older generations hold divergent childcare beliefs. They progressively realize the significance of maintaining their own health and overall well-being.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"I feel like I don't need much help from my in-laws or my own parents, as they are getting older, and their sleep patterns are disrupted. If I were to do postpartum confinement in the hospital, my family wouldn't have to be with me constantly. Having a professional postnatal nanny makes me feel at ease. In fact, my family members have tried to help with taking care of the baby, but their experience and skills are quite limited. It's better for me to stay in the hospital.\" (participant 5, 35 years old)\u003c/em\u003e \u003c/p\u003e \u003cp\u003eMany mothers face the challenging, but rewarding task of balancing career goals with motherhood. The desire to return to work or continued education while caring for a newborn presents both challenges and opportunities for personal and professional development. Mothers learn to manage their time efficiently, balancing baby care with personal interests and work commitments. This often involves adapting to a new routine and learning to prioritize tasks. The role of support systems cannot be overstated. Whether it's postpartum care centers, partners, family, or professional caregivers such as maternity nurses, their contribution is crucial. They provide a nurturing environment that is essential for mothers to successfully balance their professional aspirations with the demands of motherhood.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"After giving birth to my second child, I didn't want to compromise on my career, so I enrolled my eldest, who is two years old, in daycare. This way, I have more time to focus on my work. I can also allocate more time to pursue my career aspirations. During the day, the postnatal nanny and my mother-in-law assist me in taking care of my second child, allowing me to go to work.\" (participant 14, 40 years old)\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section3\"\u003e \u003ch2\u003e3.3.3 Main category 3: Interpersonal connections and support\u003c/h2\u003e \u003cp\u003eThe postpartum period is crucial, heavily influenced by interpersonal dynamics and social support. Effective family relationships, particularly with spouses, elders, and extended family, are vital for a new mother's well-being. The social environment of postpartum care centers, including peer and professional support, significantly impacts their emotional health. Quality interactions, emphasizing effective communication, empathy, and consistent expert care with medical staff, nurses, and postnatal nannies are key in shaping a positive postpartum experience. These elements not only provide crucial emotional and practical assistance but also significantly contribute to a beneficial postpartum journey for new mothers.\u003c/p\u003e \u003cdiv id=\"Sec21\" class=\"Section4\"\u003e \u003ch2\u003e3.3.3.1 Sub-category 1: Family and social dynamics\u003c/h2\u003e \u003cp\u003eMany mothers expressed difficulties in communicating with older family members, particularly around child-rearing practices and traditional beliefs (e.g., drinking herbal soups). This often leads to tension and arguments, affecting the mother\u0026rsquo;s mental well-being. Husbands play a significant role in providing emotional support. Their involvement in child-rearing decisions, such as the choice of postpartum care centers and support in breastfeeding decisions, significantly impacts the mother\u0026rsquo;s experience. Sometimes, the involvement of older family members can intensify stress due to differing views on childcare. New mothers opt for maternity centers to avoid conflicts with in-laws or parents, preferring professional care to traditional family practices (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSharing experiences and tips with other mothers at maternity centers benefits mental health and practical learning. The bond with professional caregivers, including nurses and postnatal nanny, is vital. Group activities and educational sessions are highly valued for socializing and learning, aiding mothers in adjusting to their new roles. Some mothers experience isolation, underlining the significance of social interactions for mental well-being in the postpartum period.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I trust the hospital's nursing methods a lot more because they're based on solid evidence. My parents sometimes suggest traditional Chinese medicine, but those methods can feel a bit old-fashioned to me. Staying in the hospital helps me sidestep any arguments with them about this. Plus, the doctors at the maternal center really know their stuff, and they're better able to help me out.\u0026rdquo; (participants 13, 37 years old)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;During the postpartum period, I can meet other new mothers, which I believe is very important. Chatting with other mothers helps me understand that we all face similar issues, which makes me feel more relaxed mentally.\u0026rdquo; (participant 10, 31 years old)\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section4\"\u003e \u003ch2\u003e3.3.3.2 Sub-category 2: Effective communication in healthcare\u003c/h2\u003e \u003cp\u003eMothers in postpartum care centers often encounter a mix of experiences in their interactions with healthcare professionals. These interactions range from appreciative and trust-building to challenging or unsatisfactory. The quality of communication and the expertise of medical staff and postnatal nannies significantly impact the mothers' postpartum experiences. Positive experiences stem from empathetic, clear communication and professional, responsive care, which significantly reduces anxiety and aids in emotional support during this sensitive period. Expert care, personalized to each mother's unique needs and inclusive decision-making, profoundly enhances their well-being. Consistency in the healthcare team fosters trust and security, encouraging open communication. In contrast, a lack of empathy, especially in managing emotional fluctuations, and unprofessional behavior can negatively impact the mothers' experiences, exacerbating anxiety and hindering the development of trust.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I have great trust in my postnatal nanny, and our communication is very smooth. She has provided me with a lot of experience in caring for my child. This is my second time in the hospital for postpartum care. My previous experience has taught me that good communication with doctors and the postnatal nanny is crucial.\u0026rdquo; (participant 7, 36 years old)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAnalysis of participants\u0026rsquo; experiences and needs during the postpartum period\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMain categories\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSub-categories\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eCo-created health management\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePhysical and emotional well-being\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eProfessional medical care and specialized services\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHospital policies and value considerations\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eShared knowledge and growth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLearning journey in motherhood\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePersonal development and future planning\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eInterpersonal connections and support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFamily and social dynamics\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEffective communication in healthcare\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cdiv id=\"Sec24\" class=\"Section2\"\u003e \u003ch2\u003e4.1 Summary of the results\u003c/h2\u003e \u003cp\u003eThis qualitative study aimed to gain a deeper understanding of the experiences, perspectives and expectations of postpartum women who participated in the traditional Chinese practice of \u0026lsquo;doing the month\u0026rsquo; at a maternity care center during their first month after delivery. The research identified three main themes: Co-created health management, shared knowledge and growth, and interpersonal connections and support. These themes illuminate the complex interplay of postpartum care, underscoring how the blend of modern Western medical practices with traditional Chinese customs influences women\u0026rsquo;s experiences, perspectives and expectations (Fig.\u0026nbsp;1).\u003c/p\u003e \u003cp\u003e\"Co-created health management\" stresses a collaborative model between healthcare providers and new mothers, emphasizing personalized care that actively involves mothers and respecting their autonomy. This approach is tailored to the distinct requirements of each mother-child pair, leading to increased personal satisfaction (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). \"Shared knowledge and growth\" underlines the educational journey intrinsic to motherhood, spotlighting the significance of shared experiences and support networks in empowering mothers. Finally, \"interpersonal connections and support\" illuminates the importance of social dynamics and communication in the postpartum phase, incorporating spousal support, familial relations, and interactions with other new mothers and healthcare professionals.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec25\" class=\"Section2\"\u003e \u003ch2\u003e4.2 Strengths and limitations of the study\u003c/h2\u003e \u003cp\u003eA major strength of this study lies in its focus on a recently emerging phenomenon among new mothers in China, a demographic that has been under-researched. The study provides a comprehensive examination of postpartum experiences from various viewpoints, offering valuable insights into the complex nature of individual postpartum care experiences. Furthermore, the study's use of constant comparison analysis between emerging categories and data adds to the robustness of the results. Repeated reviews of the semi-structured interview audio recordings ensured accurate capture of the postpartum women's expectations and experiences.\u003c/p\u003e \u003cp\u003eHowever, the study faces limitations, including potential biases in participant selection and the subjective nature of qualitative data. The experiences captured may not represent all new mothers, especially those from different cultural or socioeconomic backgrounds. The exclusive use of Chinese in interviews potentially excluded perspectives of minority women who do not speak Chinese.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec26\" class=\"Section2\"\u003e \u003ch2\u003e4.3 Comparison with the literature\u003c/h2\u003e \u003cp\u003eThe categories identified in this study align with existing literature which emphasizes the importance of individualized care, the role of social support, and the need for effective communication in postpartum care.\u003c/p\u003e \u003cp\u003eFirstly, this study's discovery of \"co-created health management\" highlights the vital role of autonomy, as emphasized in the renowned Self-Determination Theory (SDT) (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). This category enriches the SDT framework by demonstrating how autonomy can be effectively nurtured in postpartum care environments. Our findings align with previous research in this area, adding new insights into the practical application of autonomy in maternity care (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSecondly, the category of \"shared knowledge and growth\" aligns with SDT's principle of competence. Our study extends this concept further, demonstrating how group-based learning and shared experiences in postpartum care centers are instrumental in enhancing mothers' confidence in newborn care. This collective-learning model transcends the individual-focused perspective of SDT, shedding light on the communal aspects of learning and growth in maternal health.\u003c/p\u003e \u003cp\u003eLastly, the category of \"interpersonal connections and support\" reflects the relatedness aspect of SDT. Our research delves deeper into the nature of these interactions, emphasizing the significance of empathetic communication and supportive relationships in both family and healthcare settings. Previous studies also discussed the importance of emotional and physical well-being for maternal selfcare in the postpartum period (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). This expanded interpretation of relatedness in postpartum care broadens the application of SDT, highlighting the multifaceted support systems essential for maternal well-being.\u003c/p\u003e \u003cp\u003eAdditionally, our study highlights the influence of cultural and societal factors on these themes, emphasizing the importance of cultural context in shaping postpartum experiences. For instance, the role of extended family in different cultures can significantly impact a mother's sense of autonomy and competence. This is consistent with findings that cultural factors significantly impact postpartum depression (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). Comparative analysis with studies from various geographical locations reveals that the application of SDT in postpartum care varies across different healthcare systems and societal norms (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). These insights advocate for culturally-sensitive postpartum care practices. This comparative perspective highlights the necessity for a more tailored application of SDT in postpartum care, taking into account the diverse cultural, societal, and healthcare system differences that uniquely shape each mother's experience.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec27\" class=\"Section2\"\u003e \u003ch2\u003e4.4 Implications for future studies\u003c/h2\u003e \u003cp\u003eFuture research should expand the demographic and geographic scope to include a more diverse range of postpartum experiences. Quantitative studies could be employed to validate the findings of this study and to quantify the impact of various factors on postpartum experiences. Longitudinal studies would be valuable to understand how postpartum experiences evolve over time and to assess the long-term outcomes of different care approaches. Finally, intervention studies could be designed to test the effectiveness of strategies identified as beneficial in this study.\u003c/p\u003e \u003c/div\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eThis study provides important insights into postpartum care, highlighting the essential need for a holistic, personalized approach that addresses the physical, emotional, and social aspects of a new mother\u0026rsquo;s well-being. The findings underscore the importance of co-created health management, shared knowledge and growth, and interpersonal connections and support in enhancing postpartum care. Moreover, the influence of cultural and societal factors on these experiences suggests the need for culturally-sensitive practices. Our research contributes to a better understanding of postpartum experiences and lays a foundation for future studies to build upon. Future research should focus on expanding the diversity of participants and employing quantitative methods to validate these findings. Longitudinal and intervention studies could further elucidate the long-term effects of various postpartum care models, paving the way for improved practices in maternal health care.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e\u003cstrong\u003eQUAGOL:\u003c/strong\u003e The Qualitative Analysis Guide of Leuven\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCOREQ:\u003c/strong\u003e Consolidated Criteria for Reporting Qualitative Research\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSDT:\u003c/strong\u003e Self-Determination Theory\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eThis study was carried out in accordance with the Declaration of Helsinki. All procedures were approved separately by the Ethics Board of Qingdao Binhai University Affiliated Hospital (QDBHUH20230302007) and university hospital of KU Leuven (S67895). All participants provided written informed consent prior to participation, and it was clearly explained to all participants that they were free to withdraw from any part of the study at any point in time.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eQuotes from the interview contents are published in this article. Full transcripts of the qualitative datasets are not publicly available due to confidentiality restrictions. Transcripts are available from the corresponding author upon reasonable request.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted with no specific funding support.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eContribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAuthors’ Contributions\u003c/em\u003e\u003cbr\u003e\u0026nbsp;XQ.Z, M.V designed the review, XQ.Z and Y.L contributed to the conception and design of the study, data acquisition, and analysis and interpretation of data. XQ.Z participated in writing the first draft of the paper. M.V, T.L, and F.B revised critically for important intellectual content and gave final approval for the version to be published. All authors contributed to the intellectual content and read and approved the final manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eCorresponding author\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eCorrespondence to\u0026nbsp;Xiaoqian Zhang.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank the participants who spent their extra time in the study. The authors are also grateful to the staffs of the Qingdao United Family Hospital, Qingdao, China.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor’s information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAuthors and Affiliations\u003c/em\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cstrong\u003e\u003cem\u003eAcademic Center for General Practice\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003e, Department of Public Health and Primary Care, KU Leuven, Belgium\u003c/em\u003e\u003c/strong\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eXiaoqian Zhang; Frank Buntinx; Mieke Vermandere\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cstrong\u003e\u003cem\u003eQingdao United Family Hospital, Qingdao, China\u003c/em\u003e\u003c/strong\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eXiaoqian Zhang\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cstrong\u003e\u003cem\u003eQingdao University Medical College, Qingdao, China\u003c/em\u003e\u003c/strong\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eTang Li\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cstrong\u003e\u003cem\u003eQingdao Municipal Hospital, Qingdao, China\u003c/em\u003e\u003c/strong\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eYang Liu\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eChin Y, Jaganathan M, Hasmiza A, Wu M. 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Investigating the relationship between mother-child bonding and maternal mental health. Journal of Comprehensive Pediatrics. 2018;9(1).\u003c/li\u003e\n\u003cli\u003eKlainin P, Arthur DG. Postpartum depression in Asian cultures: a literature review. International journal of nursing studies. 2009;46(10):1355-73.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Postpartum care, Experiences, Perspectives, Expectations, China, Qualitative research","lastPublishedDoi":"10.21203/rs.3.rs-4194919/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4194919/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThe postpartum period presents critical challenges for new mothers, involving significant physical and emotional adjustments. Traditionally, Chinese culture has addressed this phase through \"doing the month,\" emphasizing rest and specific cultural practices. With the shift towards modernization, urban China has seen a rise in professional maternal care centers, yet research on the experiences and expectations of women utilizing these services remains scarce. This study focuses on exploring the experiences, perspectives, and expectations of postpartum women in a Chinese maternal care center, assessing the integration of traditional practices with modern healthcare standards.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eIn this study, 16 participants who had utilized the hospital's maternal care center within the previous year were chosen via purposive sampling in Qingdao, China. Data were collected through semi-structured in-depth interviews and analyzed employing The Qualitative Analysis Guide of Leuven (QUAGOL).\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eAnalysis revealed three main themes: co-created health management, shared knowledge and growth, and interpersonal connections and support. The study highlighted the benefits of a collaborative approach to healthcare, where personalized care and maternal autonomy were prioritized. It also pointed out the educational aspect of motherhood, emphasizing the role of community support and shared experiences in knowledge acquisition. Furthermore, the study highlighted the positive impact of social dynamics, such as family, peer, and professional support, emphasizing their crucial contribution to the postpartum recovery process.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe research shed light on the intricate balance between traditional Chinese postpartum practices and modern medical care, underlining the necessity for a holistic approach that caters to the physical, emotional, and social well-being of new mothers. The findings advocate for co-created health management, emphasizing the role of shared knowledge and interpersonal support in enhancing postpartum care. Additionally, the impact of cultural and societal elements on postpartum experiences calls for culturally sensitive healthcare practices. This study contributes valuable insights into improving postpartum care in China, suggesting an integrated approach that incorporates both traditional and contemporary healthcare practices to support the holistic well-being of new mothers. Future studies are encouraged to expand the research scope to encompass a broader array of experiences and to utilize quantitative methods for further validation.\u003c/p\u003e","manuscriptTitle":"Exploring postpartum women's experiences, perspectives, and expectations in maternal health care at a Chinese maternity care center: A qualitative study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-04-03 17:16:56","doi":"10.21203/rs.3.rs-4194919/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-11-11T10:43:16+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-10-25T15:45:14+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"180587170332839588641944006782516036976","date":"2024-09-30T06:58:11+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-07-18T16:17:54+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"97920606727331854169435418184013920573","date":"2024-07-18T13:16:18+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-07-11T17:36:36+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-04-04T06:50:27+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-03-31T14:08:36+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-03-31T14:08:36+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pregnancy and Childbirth","date":"2024-03-31T09:03:16+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"2a20a5a8-6b65-4376-a2a7-86c9304de878","owner":[],"postedDate":"April 3rd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-01-13T16:03:42+00:00","versionOfRecord":{"articleIdentity":"rs-4194919","link":"https://doi.org/10.1186/s12884-024-07087-6","journal":{"identity":"bmc-pregnancy-and-childbirth","isVorOnly":false,"title":"BMC Pregnancy and Childbirth"},"publishedOn":"2025-01-07 15:57:50","publishedOnDateReadable":"January 7th, 2025"},"versionCreatedAt":"2024-04-03 17:16:56","video":"","vorDoi":"10.1186/s12884-024-07087-6","vorDoiUrl":"https://doi.org/10.1186/s12884-024-07087-6","workflowStages":[]},"version":"v1","identity":"rs-4194919","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4194919","identity":"rs-4194919","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}