Breastfeeding, Maternal Functioning, and Resilience

Childbirth is one of the most unique and important events in a woman's life. The postpartum period is defined as the period that begins immediately after childbirth and ends six weeks later. The period corresponding to the first twenty-four hours is called the immediate period; the period from the first twenty-four hours to the end of the first week is called the early period; and the period from the second week after childbirth to the end of the sixth week is called the late period. We can say that the postpartum period is a critical period for women, newborns, and other family members. For primiparous women, it is a very challenging process that requires adaptation to new roles and brings with it emotional, physical, social, and spiritual changes and confusion.

The postpartum period is also a transition period during which women and family members must adapt to new physical, psychological, and social circumstances In many developed countries, the hospital stay after vaginal delivery is typically less than 48 hours during this transition period. In Turkey, the hospital stay for the mother and newborn is a maximum of 24 hours after a normal birth and 48 hours after a cesarean section . However, this period is quite short in terms of providing education related to the postpartum period, monitoring potential complications, and addressing psychological issues. In this context, home visits are of great importance for the early detection and intervention of difficulties faced by women who cannot access adequate healthcare services, for educating them on how to care for themselves and their babies, and for providing other personal care services. Home visits during the postpartum period contribute to the protection and improvement of the mother's health by providing technical, psychological, and therapeutic support regarding her care, education, and needs at home.

The World Health Organization (WHO) recommends at least four follow-up visits for all mothers and newborns within six weeks after birth. These should be conducted on the 1st day (first 24 hours), 3rd day (48-72 hours), 7-14th days, and 30-42nd days . It is believed that face-to-face physical examinations and/or screenings of the mother and newborn are more effective during these follow-ups. Midwives can provide personalized postpartum care through home visits tailored to the needs of the mother and newborn. Midwife-led postpartum care is an important public health intervention for women, newborns, and other family members . Midwife-led postpartum home visits can increase awareness among mothers regarding breastfeeding initiation, breastfeeding continuation, manual milk expression and proper milk storage, family planning and postpartum contraception, lochia monitoring, home hygiene, and newborn care .

Unfortunately, there is currently no strong evidence that home visits improve postpartum maternal and infant health, and there is a need for evidence-based research on these topics . Research on midwife-led postpartum home visits and home care is not at the desired level. A Swedish study examining the postpartum care experiences of first-time mothers after discharge from the hospital showed that midwives played a supportive role and increased parents' self-confidence . A Norwegian study on women's experiences of home visits by midwives in the early postpartum period identified three main themes: relational continuity, postpartum conversation, and vulnerability . A study conducted in the UK found that pregnancy, childbirth, and postpartum care were associated with improved health outcomes for women and babies in socially disadvantaged and diverse communities. A home visitation program conducted in Australia for vulnerable families in disadvantaged areas demonstrated improvements in participants' parenting skills and well-being, participation in community networks, and access to support services . In Sweden, vulnerable women who received long-term home visits reported improved parenting skills and increased confidence when discussing issues with professionals . A longitudinal study investigating the impact of home visits in Germany also reported improvements in the skills of mothers receiving care in areas such as newborn care, managing family relationships, and seeking, receiving, and accepting external help .

Becoming a mother is a physiological process in which behaviors specific to women and different from the norm are observed. The transition to motherhood can be considered an important developmental event in a woman's life . The process of assuming the role of motherhood should begin during pregnancy and continue until the birth of the baby . Although the role of motherhood begins during pregnancy, it truly begins after the baby is born, when the mother becomes aware of her maternal functions, roles, and responsibilities through interaction with the baby . The success of the maternal role indicates the quality of parenting behaviors and has a significant impact on the social development of the newborn. The formation of maternal identity also contributes to a woman's psychosocial development .

Breastfeeding is one of the actions that not only affects the growth and development of the baby but also the health of the family and society . Breastfeeding provides babies with the nutrients they need for healthy growth and development in the best possible way. The World Health Organization (WHO) recommends that mothers exclusively breastfeed their children for the first six months of life and continue breastfeeding with complementary foods until the age of two or beyond. However, approximately 40% of infants worldwide are exclusively breastfed during the first six months of life . At the national level in Turkey, this rate is similar. Breastfeeding rates among women are influenced by many factors, including sociodemographic characteristics, psychosocial factors, attitudes toward breastfeeding, knowledge about breastfeeding, and self-efficacy in breastfeeding .

Women may experience some psychological distress due to the effects of postpartum hormones. The most common psychological disorder during this period is postpartum depression. Postpartum depression is defined as a mood disorder that can last from the first 2-4 weeks after birth to the first year . Although it cannot be attributed to a single cause, it is thought to be caused by genetic predisposition, hormonal imbalances, and psychological and physiological factors during this process . The symptoms of postpartum depression vary from mother to mother, but they can include sleep problems, inability to enjoy life, unexplained weight loss, feelings of inadequacy, guilt, tension, and thoughts of suicide . When considering the causes of postpartum depression, unexpected health problems, insufficient social support, health problems in the newborn, a history of psychiatric illness, the type of delivery, the number of births, and, in addition, the woman's birth experience, how she perceives the birth, and how she records it in her memory are among the influencing factors.

Similar studies have been conducted in the literature. Bostancı Daştan and colleagues examined the mental health of pregnant women through home visits and emphasized that pregnancy can cause crisis and that depression symptoms should be detected as early as possible. Erenel and Eroğlu conducted an experimental study to determine the effect of a breastfeeding education model supported by home visits in the early postpartum period on effective breastfeeding behavior. They found that a large proportion of the women participating in the study continued effective breastfeeding, while the rate of effective breastfeeding in the control group was much lower. In the experimental study conducted by Demir Yıldırım and Hotun Şahin, it was determined that home visits during pregnancy monitoring were an effective model in increasing pregnant women's knowledge about the prenatal period, their desire for vaginal delivery, and the duration of initial and subsequent breastfeeding. However, no study has been found in the literature regarding the effect of individualized home visits on maternal function, breastfeeding attitudes, and depression levels. The aim of this planned study is to support the postpartum care process conducted at the primary care level through home visits led by midwives and to observe its effect through a control group. The home visits are intended to increase satisfaction with the services provided during the postpartum period, ensure the provision of quality postpartum care, and thereby minimize the risk of bleeding and infection and facilitate adaptation to motherhood. In addition, the aim is for women to receive the necessary education about the postpartum period, to perform postpartum self-care appropriately, to meet the feeding and care needs of the newborn, to increase their self-efficacy in breastfeeding, and to minimize the risk of postpartum depression.