Comparing midwives' and women's assessment of wellbeing in the postnatal period
Evidence indicates that many women continue to experience significant physical and psychological problems following childbirth. This is a time when midwives have a unique opportunity to assess women's wellbeing. However, there is scant research on the content and process of midwifery care to women in the postnatal period. This exploratory study investigates agreement between midwives' assessment of women's physical, psychological and social wellbeing at home in the postnatal period, with the women's self reports. A questionnaire was completed by women and midwives, in three study sites in Grampian, Scotland. Aspects of wellbeing were compared between individual midwives and women using a combination of approaches to assess agreement. Regression analyses were used to identify the midwives' and women's characteristics that correlated with midwives' assessment of the women's risk of postnatal depression. To account for the different number of cases the midwives had, a random effect model was applied. The total number of eligible matches were 121. Midwives under-estimated the number of physical problems reported by women. There was better agreement for aspects of physical wellbeing than for psychological or social wellbeing. In the regression models, only how well the midwife considered the woman to be prepared for motherhood correlated significantly (P = 0.05), with the midwife's assessment of risk of PND and the woman's EPDS score. Whether the midwife reported knowing the woman well and whether the woman reported that a midwife knew her well also correlated, but were not statistically significant. This thesis contributes in three main areas. It employed a combination of approaches and used one to one comparisons to assess agreement. In this area of health care this approach has not been reported elsewhere. Secondly, it added to what is already known in the neglected area of postnatal care to the small, but growing, body of knowledge. Thirdly, through considering the physical, psychological and social aspects of wellbeing, it recognised that a balance between these interrelated aspects is required.