The Predictive Role of Receiving Respectful Maternal Care on Breastfeeding Attitudes and Postpartum Depression

Öz

Backgrounds: Respectful maternity care positively affects mother and baby health in both the short and long term. Objectives: The purpose of this study is to determine the relationship between primiparous women's receiving respectful maternity care and breastfeeding attitudes and postpartum depression. Methods: The study is descriptive and correlational in type and was conducted between March and October 2024. The research universe consisted of puerperal women who gave birth in a public hospital in the north of Turkey, and the sample consisted of 266 people. Data were collected using the Personal Information Form, Women's Perception of Respectful Maternity Care Scale, Breastfeeding Attitudes of The Evaluation Scale and Edinburgh Postpartum Depression Scale. In the analysis of the data, Mann-Whitney U and Kruskal Wallis tests, Spearman correlation and Linear regression analysis were performed. Results: The mean scores of primiparous women on the Women's Perception of Respectful Maternity Care Scale, Breastfeeding Attitudes of The Evaluation Scale and Edinburgh Postpartum Depression Scale were found to be 57.11±12.65, 120.96±44.34 and 9.01±6.54, respectively. A weak and negative correlation was found between the scores of the Women's Perception of Respectful Maternity Care Scale and the Edinburgh Postpartum Depression Scale, and a weak and positive statistically significant correlation was found between the Breastfeeding Attitudes of The Evaluation Scale and the Edinburgh Postpartum Depression Scale (p<.05). Conclusion: Women's perception of respectful maternal care was at a moderate level, and it was found that as women's perception of respectful maternal care scores increased, their postpartum depression scores decreased.

Anahtar Kelimeler

• Breastfeeding Attitude
• Depression
• Postpartum
• Respectful Care

Saygılı Annelik Bakımı Alma Durumunun Emzirme Tutumu ve Postpartum Depresyon Üzerindeki Yordayıcı Rolü

Öz

Giriş: Saygılı annelik bakımı anne ve bebek sağlığı hem kısa hem de uzun vadede olumlu yönde etkilenmektedir. Amaç: Bu araştırmanın amacı, primipar kadınların saygılı annelik bakımı alma durumunun emzirme tutumu ve postpartum depresyon ile ilişkisini tespit etmektir. Yöntem: Araştırma, tanımlayıcı ve ilişki arayıcı tipte olup, Mart-Ekim 2024 tarihleri arasında yapıldı. Araştırma evrenini, Türkiye’nin kuzeyinde yer alan bir kamu hastanesinde doğum yapan lohusalar, örneklemini ise 266 kişi oluşturdu. Veriler Kişisel Bilgi Formu, Kadınların Saygılı Annelik Bakımı Algısı Ölçeği, Emzirme Tutumunu Değerlendirme Ölçeği ve Edinburg Doğum Sonrası Depresyon Ölçeği ile toplandı. Verilerin analizinde ise Mann-Whitney U ile Kruskal Wallis testleri, Spearman korelasyon ve Lineer regresyon analizi yapıldı. Bulgular: Primipar kadınların Saygılı Annelik Bakımı, Emzirme Tutumunu ve Edinburg Doğum Sonrası Depresyon ölçek puan ortalamaları sırasıyla; 57.11±12.65, 120.96±44.34 ve 9.01±6.54 olduğu saptandı. Kadınların Saygılı Annelik Bakımı Algısı Ölçeği ile Edinburg Doğum Sonrası Depresyon Ölçeği puanları arasında zayıf seviyede ve negatif yönde; Emzirme Tutumunu Değerlendirme Ölçeği ile Edinburg Doğum Sonrası Depresyon Ölçeği arasında zayıf seviyede ve pozitif yönde istatistiksel olarak anlamlı bir ilişki olduğu bulundu (p<.05). Sonuç: Kadınların saygılı annelik bakımı algısı orta düzeyde olup kadınların saygılı annelik bakımı algısı puanları arttıkça postpartum depresyon puanlarının azaldığı bulundu.

Anahtar Kelimeler

• Depresyon
• Emzirme Tutum
• Lohusa
• Saygılı Bakım

Kaynakça

1. Aktaş, Reyhan, F., & Dağlı, E. (2023). Kadınların saygılı annelik bakımı doğrultusunda doğum deneyimlerinin değerlendirilmesi: Nitel bir araştırma. Sakarya Üniversitesi Holistik Sağlık Dergisi, 6(1), 124-141.
2. Alzyoud, F., Khoshnood, K., Alnatour, A., & Oweis, A. (2018). Exposure to verbal abuse and neglect during childbirth among jordanian women. Midwifery, 58, 71-76.
3. Ansari, H., & Yeravdekar, R. (2021). Respectful maternity care and breastfeeding. Global Health Promotion, 28(3), 70-72.
4. Arslan, Özkan. (2015). Emzirme tutumunu değerlendirme ölçeği. Kadın Sağlığı Hemşireliği Dergisi, 2(1), 53-58.
5. Ayoubi, S., Pazandeh, F., Simbar, M., Moridi, M., Zare, E., & Potrata, B. (2020). A questionnaire to assess women’s perception of respectful maternity care (WP-RMC): Development and psychometric properties. Midwifery, 80, 102573.
6. Azevedo-Pereira, H. A., Lettiere-Viana, A., Gomes, Sponholz, F., & Monteiro, J. C. (2024). Repercussions of obstetric violence on the breastfeeding process: Analysis from a racial perspective. Acta Paul Enferm, 37, eAPE00774
7. Ballesta-Castillejos, A., Rodríguez-Almagro, J., De-Mateos, S. G. Ortiz-Esquinas, I., Martinez-Galiano, J. M., & Hernandez-Martinez, A. (2025). Influence of abuse and disrespect during childbirth on early initiation of breastfeeding. Int Breastfeed J, 20, 15.
8. Bohren, M. A., Tunçalp, Ö., & Miller, S. (2020). Transforming intrapartum care: Respectful maternity care. Best Practice & Research Clinical Obstetrics & Gynaecology, 67, 113-126.

9. Bradley, S., McCourt, C., Rayment, J., & Parmar, D. (2019). Midwives´ perspectives on (dis) respectful intrapartum care during facility-based delivery in sub-Saharan Africa: A qualitative systematic review and meta-synthesis. Reproductive Health, 16(1), 1.
10. Bulto, G. A., Demissie, D. B., & Tulu, A. S. (2020). Respectful maternity care during labor and childbirth and associated factors among women who gave birth at health institutions in the west Shewa zone, Oromia region, Central Ethiopia. BMC Pregnancy Childbirth, 20, 1.
11. Burrowes, S., Holcombe, S. J., Jara, D., Carter, D., & Smith, K. (2017). Midwives’ and patients’ perspectives on disrespect and abuse during labor and delivery care in Ethiopia: A qualitative study. BMC Pregnancy and Childbirth, 17(1), 1-14.
12. Butler, M. S., Young, S. L., & Tuthill, E. L. (2021). Perinatal depressive symptoms and breastfeeding behaviors: A systematic literature review and biosocial research agenda. J Affect Disord, 283, 441-471.
13. Cohen, J. (2013). Statistical power analysis for the behavioral sciences. New York: Routledge.
14. Cox, J. L., Holden, J. M., & Sagovsky, R. (1987). Detection of postnatal depression: Development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry, 150, 782-786.
15. Çamlıbel, M., Uludağ, E., & Pazandeh, F. (2022). Psychometric evaluation of the women’s perception of respectful maternity care scale Turkish version. Women & Health, 62(8), 700-710.
16. da, Conceição, H. N., Gomes, Gonçalves, C. F., Medeiros, Mascarenhas, M. D., Pacheco, Rodrigues, M. T., & Madeiro, A. P. (2023). Disrespect and abuse during childbirth and postpartum depression: A scoping review. Cad. Saúde Pública, 39(5), e00236922.
17. Deki, S., & Wangmo, K. (2020). Women’s Views and experience of respectful maternity care while delivering in three regional referral hospitals of Bhutan. Amarjeet Kaur Sandhu, 12(2), 2134.
18. Dhakal, P., Creedy, D. K., Gamble, J., Newnham, E., & McInnes, R. (2022). Educational interventions to promote respectful maternity care: A mixed-methods systematic review. Nurse Education in Practice, 60, 103317.
19. Dzomeku, V. M., Mensah, A. B., Nakua, E. K., Agbadi, P., Lori, J. R., & Donkor, P. (2021). Midwives’ experiences of implementing respectful maternity care knowledge in daily maternity care practices after participating in a four-day rmc training. BMC Nurs, 20(1), 39.
20. Engindeniz, A. N., & Küey, Kültür, S. (1996). Edinburg Doğum Sonrası Depresyon Ölçeği Türkçe formu geçerlilik ve güvenirlik çalışması. Bahar Sempozyumları, 1, 51-52.
21. Fares, K. K., & Ahmed, H. M. (2021). Effect of respectful maternity care and effective communication during labor on postpartum depression: An interventional study. Turkish Journal of Physiotherapy and Relationship, 33(3), 31314-31342.
22. Fey, C. F., Hu, T., & Delios, A. (2023). The measurement and communication of effect sizes in management research. Management and Organization Review, 19(1), 176-197.
23. Gadappa, S. N. & Deshpande, S. S. (2021). A Quasi experimental study to compare the effect of respectful maternity care using intrapartum birth companion of her choice on maternal and newborn outcome in tertiary care centre. The Journal of Obstetrics and Gynecology of India, 71(2), 84-89.
24. Gebremichael, M. W., Worku, A., Medhanyiea, A. A., & Berhane, Y. (2018). Mothers’ experience of disrespect and abuse during maternity care in northern Ethiopia. Global Health Action, 1(1), 1-6.
25. Hacettepe Üniversitesi Nüfus Enstitüsü. (2018). Türkiye Nüfus ve Sağlık Araştırması-2018.
26. Hajizadeh, K., Vaezi, M., Meedya, S., Alizadeh, Charandabi, S. M., Mirghafourvand, M. (2020). Respectful maternity care and its relationship with childbirth experience in Iranian women: A prospective cohort study. BMC Pregnancy and Childbirth, 20, 468.
27. Henshaw, E. J. (2023). Breastfeeding and postpartum depression: A review of relationships and potential mechanisms. Curr Psychiatry Rep, 25(12), 803-808.
28. Hughes, C. S., Kamanga, M., Jenny, A., Zieman, B., Warren, C., Walker, D., & Kazembe, A. (2022). Perceptions and predictors of respectful maternity care in malawi: A quantitative crosssectional analysis. Midwifery, 103403.
29. Ige, W. B., & Cele, W. B. (2022). Barriers to provision of respectful maternity care during childbirth by midwives in south-west, nigeria: Findings from semi-structured interviews with midwives. International Journal of Africa Nursing Sciences, 17, 100449.
30. Jiru, H. D., & Sendo, E. G. (2021). Promoting compassionate and respectful maternity care during facility-based delivery in Ethiopia: Perspectives of clients and midwives. BMJ Open, 11(10), e051220
31. Kassa, Z. Y., & Husen, S. (2019). Disrespectful and abusive behavior during childbirth and maternity care in Ethiopia: A systematic review and meta-analysis. BMC Research Notes, 12(1), 83.
32. Kassa, Z. Y., Tsegaye, B., & Abeje, A. (2020). Disrespect and abuse of women during the process of childbirth at health facilities in sub-Saharan Africa: A systematic review and meta-analysis. BMC Int Health Hum Rights, 20(1), 23.
33. KC, A., Acharya, A., Bhattarai, P., Basnet, O., Shrestha, A., Rijal, G., & Skalkidou, A. (2023). Association of disrespectful care after childbirth and COVID-19 exposure with postpartum depression symptoms- a longitudinal cohort study in Nepal. BMC Pregnancy Childbirth, 23, 145.
34. Khresheh, R., Barclay, L., & Shoqirat, N. (2019). Caring behaviours by midwives: Jordanian women's perceptions during childbirth. Midwifery, 74, 1-5.
35. Leite, T. H., Carvalho, T. D. G., Marques, E. S., Pereira, A. P. E., daSilva, A. A. M., Nakamura, Pereira, M., & do Carmo, Leal, M. (2022). The association between mistreatment of women during childbirth and postnatal maternal and child health care: Findings from “birth in Brazil”. Women and Birth, 35(1), e28-e40.
36. Martinez-Vázquez, S., Hernández-Martínez, A., Rodríguez-Almagro, J., Delgado-Rodríguez, M., & Martínez-Galiano, J. M. (2022). Relationship between perceived obstetric violence and the risk of postpartum depression: An observational study. Midwifery, 108, 1-8.
37. Mastylak, A., Miteniece, E., Czabanowska, K., Pavlova, M., & Groot, W. (2023). The "Blessing" of pregnancy? Barriers to accessing adequate maternal care in Poland: A mixed-method study among women, healthcare providers, and decision-makers. Midwifery, 116, 103554.
38. Maung, T. M., Mon, N. O., Mehrtash, H., Bonsaffoh, K. A., Vogel, J. P., Aderoba, A. K., Irinyenikan, T. A., Balde, M. D., Pattanittum, P., Tuncalp, Ö., & Bohren, M. A. (2021). Women's experiences of mistreatment during childbirth and their satisfaction with care: Findings from a multicountry community-based study in four countries. BMJ Glob Health, 5(Suppl 2), e003688.
39. Milinco, M., Travan, L., Cattaneo, A., Knowles, A., Sola, M. V., Causin, E., Cortivo, C., Degrassi, M., Tommaso, F. D., Verrardi, G., Dipietro, L., Piazza, M., Scolz, S., Rossetto, M., & Ronfani, L. (2020). Effectiveness of biological nurturing on early breastfeeding problems: A randomized controlled trial. International Breastfeeding Journal, 15, 21.
40. Mizuhata, K., Taniguchi, H., Shimada, M., Hikita, N., & Morokuma, S. (2020). Effects of breastfeeding on stress measured by saliva cortisol level and perceived stress. Asian Pac Isl Nurs J, 5, 128-138.
41. Moyer, C. A., McNally, B., Aborigo, R. A., Williams, J. E., & Afulani, P. (2021). Providing respectful maternity care in northern ghana: A mixedmethods study with maternity care providers. Midwifery, 94, 102904.
42. Nagel, E. M., Howland, M. A., Pando, C., Stang, J., Mason, S. M., Fields, D. A., & Demerath, E. W. (2022). Maternal psychological distress and lactation and breastfeeding outcomes: A narrative review. Clin Ther, 44, 215-227.
43. Nieminen, P. (2022). Application of standardized regression coefficient in meta-analysis. BioMedInformatics, 2(3), 434-458.
44. Pathak, P., & Ghimire, B. (2020). Perception of women regarding respectful maternity care during facility-based childbirth. Obstetrics and Gynacology International, 1-8.
45. Rosen, H.E., Lynam, P.F., Carr, C., Reis, V., Ricca, J., Bazant, E.S., Linda, A., Bartlett on behalf of the Quality of Maternal and Newborn Care Study Group of the Maternal and Child Health Integrated Program. (2015). Direct observation of respectful maternity care in five countries: A cross-sectional study of health facilities in east and southern Africa. BMC Pregnancy and Childbirth, 15, 1.
46. Shakibazadeh, E., Namadian, M., Bohren, M. A., Vogel, J. P., Rashidian, A., Pileggi, V. N., Madeira, S., Leathersich, S., Tunçalp, Ö., Oladapo, O. T., Souza, J. P., & Gülmezoğlu, A. M. (2017). Respectful care during childbirth in health facilities globally: A qualitative evidence synthesis. An International Journal of Obstetrics & Gynaecology, 125(8), 932-942.
47. Shimao, M., Matsumura, K., Tsuchida, A., Kasamatsu, H., Hamazaki, K., Inadera, H., & The Japan Environment and Children's Study Group. (2021). Influence of infants’ feeding patterns and duration on mothers’ postpartum depression: a nationwide birth cohort-The Japan Environment and Children's Study (JECS). J Affect Disord, 285, 152-159.
48. Silveira, M. F., Mesenburg, M. A., Bertoldi, A. D., De, Mola, C. L., Bassani, D. G., Domingues, M. R., Stein A., & Coll, C. V. (2019). The association between disrespect and abuse of women during childbirth and postpartum depression: Findings from the 2015 pelotas birth cohort study. Journal of Affective Disorders, 256, 441-447.
49. Toledo, C., Cianelli, R., Villegas, Rodriguez, N., De, Oliveira, G., Gattamorta, K., Wojnar, D., & Ojukwu, E. (2022). The significance of breastfeeding practices on postpartum depression risk. Public Health Nurs, 39, 15-23.
50. Thul, T. A., Corwin, E. J., Carlson, N. S., Brennan, P. A., & Young, L. J. (2020). Oxytocin and postpartum depression: A systematic review. Psychoneuroendocrinology, 120, 104793.
51. Uludağ, E., & Çamlıbel, M. (2024). Doğumda verilen destekleyici bakımın kadınların saygılı annelik bakımı algısını yordama durumunun incelenmesi. Etkili Hemşirelik Dergisi, 17(3), 351-361.
52. Uzun, K., Kolcu, M., & Kurap, Öcebe, D. (2018). Anne sütü ile beslenmede kanıta dayalı uygulamalar. Hemşirelik Bilimleri Dergisi, 1(2), 29-32.
53. Wang, Z., Liu, J., Shuai, H., Cai, Z., Fu, X., Liu, Y., Xiao, X., Zhang, W., Krabbendam, E., Liu, S., Liu, Z., Li, Z., & Yang, B. X. (2021). Mapping global prevalence of depression among postpartum women. Transl Psychiatr, 11, 543.
54. Wassihun, B., & Zeleke, S. (2018). Compassionate and respectful maternity care during facility based child birth and women’s intent to use maternity service in bahir dar, ethiopia. BMC Pregnancy and Childbirth, 18(1), 1-9.
55. White Ribbon Alliance. (2019). Respectful maternity care charter: universal rights of mothers and newborns. Washington DC: White Ribbon Aliance.
56. Wouk, K., Tucker, C., Pence, B. W., Meltzer-Brody, S., Zvara, B., Grewen, K., & Stuebe, A. M. (2020). Positive emotions during infant feeding and breastfeeding outcomes. J Hum Lact, 36, 157-167.
57. World Health Organization. (2018). Recommendations: Intrapartum care for a positive childbirth experience.
58. World Health Organization. (2022). Global breastfeeding scorecard 2022: Protecting breastfeeding through further investments and policy actions.
59. Venkatesan, L., & Kaur, P. (2022). Respectful maternity care: Knowledge, attitude and practice of health care workers and maternal perception about RMC-A scoping review. J Comp Nurs Res Care, 7(2), 185.
60. Xia, M., Luo, J., Wang, J., & Liang, Y. (2022). Association between breastfeeding and postpartum depression: A meta-analysis. J Affect Disord, 308, 512-519.
61. Yazgı, Demir, Z. G., & Yılmaz, M. (2024). Postpartum depresyonun oluşumunda potansiyel bir risk faktörü: Obstetrik şiddet. Ege Üniversitesi Hemşirelik Fakültesi Dergisi, 40(2), 305-311.