| Abstract | CILJ ovog istraživanja bio je utvrditi utjecaj obiteljske podrške tijekom postporođajnog razdoblja na pojavnost postporođajne tuge u rodilja i spremnost rodilja na prihvaćanje novorođenčeta.
ISPITANICI: Istraživanje je provedeno u „Klinici za ženske bolesti i porođaje“ KBC-Split i Patronažnoj službi Doma zdravlja Splitsko dalmatinske Županije u razdoblju od 1. lipnja do 15. kolovoza 2014. godine.
U istraživanju su u tri mjerenja sudjelovale 282 rodilje. 395 rodilja sudjelovalo je u prvom mjerenju dok ih je 328 sudjelovalo u prvom i drugom mjerenju. Osipanje uzorka je 113 rodilja. Rodilja starosne dobi od 18 do 22 godine je 6,40%, od 23 do 28 godina je 32,93%, od 29 do 36 godina je 47,56%, a iznad 36 godina je 13,10% rodilja. Najviše je rodilja s srednjom stručnom spremom 55,79%, 42,98% rodilja sa višom i 1,21% rodilja s visokom stručnom spremom te sa osnovnom školom. U bračnoj zajednici živi 89,32% rodilja, u nevjenčanoj 10,36%, a samohrana majka je jedna (0,30%). Prvorotkinja je 46,04%, a višerotkinja 53,96%. U gradu živi 53,92% rodilja, 46,08% rodilja živi u ruralnom naselju. Nezaposlenih je 37,19% rodilja, a u radnom odnosu je 59,75%.
METODE: U provedenoj prospektivnoj studiji sva tri mjerenja sudjelovale su 282 rodilje. One su popunjavale upitnike dan pred otpust iz rodilišta, 10. i 30. dan poslije otpusta iz rodilišta. Uz sociodemografski upitnik primijenjeni su validirani upitnici: Blues Questionnaire: Kennerley 1989.(40); Postpartum Bonding Questionnaire (73) i Family Functioning Questionnaire (74).
REZULTATI: U ispitivanom uzorku 282 rodilje njih 30,13% treći dan po porodu iskazuje smetnje odnosa majka dijete bilo da se radi o graničnom odnosu ili patološkom. Taj je udio u drugom mjerenju 23,02% rodilja, dok su smetnje prisutne u 22,68% rodilja mjesec dana poslije (Tablica 5.b.). Nemogućnost organiziranja osnovne skrbi o novorođenčetu, nespremnost rodilje za odgoj djeteta i loš odnos s partnerom mjere su obiteljskog funkcioniranja koje doprinose oblikovanju patoloških obrazaca ponašanja u odnosu majke prema djetetu 33 dana nakon poroda. Ograničen opseg i kvaliteta socijalnih kontakata i loša iskustva rodilje iz primarne obitelji mjere su obiteljskog funkcioniranja koje doprinose oblikovanju granično poremećenih obrazaca ponašanja u odnosu majke prema djetetu 33 dana nakon poroda. 37,19% rodilja je nezaposleno što je za približno 12% više od hrvatskog prosjeka. Značajne poteškoće u svim mjerama obiteljskog funkcioniranja imaju rodilje s nezadovoljavajućim financijskim stanjem, rodilje s neriješenim stambenim pitanjem i rodilje koje žive u nuklearnoj obitelji. Rodilje s jednim djetetom imaju značajnije poteškoće od rodilja s dvoje, troje i više djece. Poteškoće se očituju u njihovoj pripremljenost za odgojne zadatke, u opsegu i kvaliteti socijalnih kontakata i iskustvima koja su imale u svojoj primarnoj obitelji. Gornja vršna procjena (cut-off point) simptoma postporođajne tuge treći dan nakon poroda u našem uzorku rodilja iznosi >5,03. 33,67% rodilja imalo je izražen teški poremećaj postporođajne tuge treći dan nakon poroda. Gornja vršna procjena simptoma postporođajne tuge 13 dana nakon poroda >3,32, a 33 dana nakon poroda je >3.12. To upućuje na opadanje teških simptoma postporođajne tuge u rodilje koji su naglašeni treći dan. 13 dana nakon poroda simptomi postporođajne tuge bili su manje izraženi. Slijed opadanja izraženosti simptoma procijenjen je i na kraju mjeseca (33 dana nakon poroda) (42, 44). Postoje značajne razlike u izraženosti simptoma postporođajne tuge između procjena rodilje 3 i 33 dana nakon poroda (Tablica 12.c.). Simptomi postporođajne tuge značajno su najnaglašeniji treći dan nakon poroda u rodilja koje su imale komplikacije u porodu, u onih u kojih je napravljena epiziotomija, u rodilja u kojih je napravljen carski rez i u onih žena čija su novorođenčad imala Apgar procjenu od 5-8. Emocionalna tupost bila je naglašenija u rodilja 33 dana nakon porodna i to u onih čija su djeca nakon rođenja imala Apgar procjenu od 5-9.
Simptomi postporođajne tuge primarna tuga i smanjeno samopouzdanje značajno otežavaju uspostavu veze majka novorođenče treći dan života novorođenčeta. Ova dva simptoma postporođajne tuge doprinose 21% objašnjenju varijabiliteta uspostavljene veze majka novorođenče.Trinaesti dan nakon poroda simptomi postporođajne tuge preosjetljivost i smanjeno samopouzdanje rodilje značajno otežavaju uspostavu veze majka novorođenče. Ova dva simptoma postporođajne tuge doprinose 23% objašnjenju varijabiliteta uspostavljene veze majka novorođenče. 33 dana nakon poroda iste varijable značajno otežavaju uspostavu veze majka novorođenče (Tablica 19. a-c.). Simptomi postporođajne tuge preosjetljivost i smanjeno samopouzdanje doprinose 20% objašnjenju varijabiliteta uspostavljene veze majka novorođenče.
Smanjeno samopouzdanje majke je konstantna mjera postporođajne tuge koja rodilji 33 dana nakon poroda otežava uspostavljanje veze majka novorođenče.
ZAKLJUČAK: Emocionalno stanje rodilje doprinosi uspostavi veze majka dijete u značajnom, ali znatno manjem omjeru nego što se mislilo. Simptomi postporođajne tuge primarna tuga, preosjetljivost i smanjeno samopouzdanje doprinose 21% (3 dana nakon poroda), 23% (13 dana nakon poroda) i 20% (33 dana nakon poroda) objašnjenju varijabiliteta uspostavljenog odnosa majka novorođenče. Okolinski i situacijski čimbenici kao obiteljsko funkcioniranje, socijalni status, osobne karakteristike rodilje i osobitosti poroda objašnjavaju veći dio tog odnosa. To upućuje da se pažnja s majčinog ponašanja naspram djeteta usmjeri na emocionalne potencijale koje nudi proširena obitelj rodilje i na međugeneracijski dodir u brizi za novorođenče. |
| Abstract (english) | AIM: The goal of this study was to examine the influence of family support during the postpartum period on the incidence of postpartum blues among young mothers and their readiness to accept their newborn child
STUDY POPULATION: This study took place at the „Hospital for women's health and labors“ at the Clinical Hospital Center Split and at „Home care service“ of Splitsko-Dalmatinska County Health Center. Study was conducted during the period of June 1st until August 15th of 2014. In this study, all three measurements were completed by 282 parturient women. At the beginning of the study, 395 mothers were enrolled during the first measurement while 328 completed second measurement. However, the final stage and third measurement was reached and completed by 282 women, establishing a dropout rate of 28%.
In terms of age distribution among the women who gave birth, most of them fit the range between 29 to 36 years of age (47.6%), while third of them (32.9%) were in between 23 to 28 years of age. Youngest age group (18 to 22 years of age) was represented by 6.4% while there were 13.1% of women who were older than 36 years. Majority of mothers (55.8%) had a high school diploma, 43% had a higher education while 1.21% had high education diploma or had only elementary school diploma.
Dominant majority of mothers were married (89.3%), 10.4% were not married while one mother (0.3%) identified herself as a single parent. More than half of women were multiparous (54%) while 46% gave birth for the first time. Likewise, 54% lived in the urban, city setting while 46% lived in the rural areas. Most of the women were employed (59.8%) while 37.2% were unemployed.
METHODS: In this prospective study, all three designated instruments were completed by 282 mothers. They were asked to complete a first questionnaire the day before they were discharged from hospital and then on the 10th (second questionnaire) and 30th day (third questionnaire) after being discharged. Along with the sociodemographic questionnaire, following validated questionnaires were used: Blues Questionnaire (Kennerley 1989) (40), Postpartum Bonding Questionnaire (73) and Family Functioning Questionnaire(74).
RESULTS: In our sample pool (N=282), almost a third (30.1%) of mothers exhibited disturbances in terms of mother-newborn relationship at the 3rd day postpartum. This relationship was either borderline or pathological. This proportion changed to 23% at the second measurement while disturbances were still reported in 22.7% of women, 30 days after their discharge from hospital. The inabilities to organize a basic care about a newborn, unpreparedness of a mother to raise a child and a bad relationship with their partner are established measures of family functioning that contribute to the possible development of pathological patterns in terms of mother’s behavior towards the child - 33 days postpartum.
The limited magnitude and quality of social contacts and bad previous experiences of a mother, originating from their primary family, are measures that contribute to borderline pathological patterns of behavior of a mother towards her child. In our study, 37.2% mothers were unemployed which is 12% above the Croatian national unemployment rate. Significant difficulties were identified in all measures of family functioning among those women who had insufficient financial resources, who did not have adequate housing or lived in a nuclear family. Women with only one child had significantly more difficulties than those women who had more children. These problems among first-time mothers arise due to their level of preparedness for upcoming challenges and the range and quality of social contacts and experiences that they had in their primary family.
The upper cut-off point for postpartum blues symptoms at the 3rd day after labor in our sample was > 5.03, meaning that 33.7% of mothers had a substantial postpartum blues, three days after labor. The upper cut-off point for postpartum blues symptoms, thirteen days after labor was > 3.32 and more than 3.12 on a 33rd day. This trend suggests that the severe symptoms of a postpartum blues were declining after the day three when they were expressed the most. This trend was observed at the day 13 and continued towards the end of the month (33rd day postpartum).
Certain statistical differences were identified in terms of the expression of the postpartum blues symptoms among the mothers, based on first (day 3) and last measurement (33 days postpartum). Symptoms of postpartum blues on a day three were significantly worse among those mothers who had the episiotomy, who gave birth via caesarean section and whose newborns had Apgar score ranging from 5 to 8. Emotional dullness was the most highlighted symptom among mothers whose newborns had Apgar score ranging from 5 to 9. This was recorded at the third measurement (day 33 postpartum).
Symptoms of postpartum blues – primary depression and decreased self-confidence are factors that significantly complicate the normal relationship between a mother and a child, three days after labor. These two symptoms contributed 21% to the explanation of the variability of a mother-child formed connection. Thirteen days after labor, dominant symptoms of postpartum blues were emotional hypersensibility and decreased self-confidence. These symptoms complicate mother-child relationship as well and contribute by 23% to variability of the mother-child established relationship.
These mentioned variables also significantly complicate the mother-child relationship 33 days postpartum and contribute by 20% to the variability of the mother-child bond formation.
Data clearly showed that the decreased self-confidence of a mother was a constant measure (factor) of postpartum blues that has been persistent at all stages of measurement during the 33 day postpartum period. This variable burdened the mother-child bond formation.
CONCLUSION: The emotional state of the mother contributes to a successful formation of mother-child relationship, however, to a significantly lesser extent than previously thought. Symptoms of postpartum blues: primary depression, hypersensitivity and decreased self-confidence contribute 21 % (3 days postpartum), 23% (13 days postpartum) and 20% (33 days postpartum) to variability of formed mother-child relationship. Environmental and situational determinants such as family functioning, social status, individual characteristics of a mother along with the circumstances of the laboring process explain the most part of mother-child relationship formation. This suggests that the attention should be diverted towards the emotional potentials that are offered through the expanded family of the women and towards the intergenerational paradigm in the care for the newborn. |
