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Chautems C. "I Felt Like I Was Cut in Two": Postcesarean Bodies and Complementary and Alternative Medicine in Switzerland. Cult Med Psychiatry 2024; 48:329-349. [PMID: 38709356 PMCID: PMC11217038 DOI: 10.1007/s11013-024-09856-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/18/2024] [Indexed: 05/07/2024]
Abstract
In neoliberal cultural contexts, where the ideal prevails that female bodies should be unchanged by reproductive processes, women often feel uncomfortable with their postpartum bodies. Cesareaned women suffer from additional discomfort during the postpartum period, and cesarean births are associated with less satisfying childbirth experiences, fostering feelings of failure among women who had planned a vaginal delivery. In Switzerland, one in three deliveries is a cesarean. Despite the frequency of this surgery, women complain that their biomedical follow-up provides minimal postpartum support. Complementary and alternative medicine (CAM) therapists address these issues by providing somatic and emotional postcesarean care. CAM is heavily gendered in that practitioners and users are overwhelmingly women and in that most CAM approaches rely on the essentialization of bodies. Based on interviews with cesareaned women and with CAM therapists specialized in postcesarean recovery, I explore women's postpartum experiences and how they reclaim their postcesarean bodies.
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Affiliation(s)
- Caroline Chautems
- Center for Gender Studies, Institute of Social Sciences, University of Lausanne, Lausanne, Switzerland.
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2
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Glavina WSN, Silva CM, Martins EL, Monteiro JCDS, Silva IW, Brito APA, Ferreira FM, Ruela LDO, Tomaz RGDO. Puerperal women's social interactions related to their sexual health after childbirth. Rev Esc Enferm USP 2024; 57:e20230056. [PMID: 38381890 PMCID: PMC10881122 DOI: 10.1590/1980-220x-reeusp-2023-0056en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 12/07/2023] [Indexed: 02/23/2024] Open
Abstract
OBJECTIVE To analyze puerperal women's experiences of sexual health after childbirth from the perspective of symbolic interactionism. METHOD Descriptive, qualitative study. Twenty semi-structured interviews were conducted by videoconference with women in the remote puerperium, captured by snowball technique and searched for "seeds" on Instagram®. Bardin's content analysis and Symbolic Interactionism were used as references. RESULTS The puerperal women signify sexual health from a perspective of comprehensive healthcare. However, due to the duality between "being a woman" and "being a mother", they recognize fear, bodily transformations and changes in focus from the love relationship to caring for the baby as factors that interfere with sexual health. And they choose to put themselves aside, prioritizing caring for others. They re-signify sexual health by recognizing the importance of taking care of themselves in biopsychosocial aspects and try to recover self-care for a healthy sexual experience. CONCLUSION Despite the meanings attributed, women's social interactions with the puerperium interfere negatively with sexual health. Professionals should be sensitized to the inclusion of actions that promote changes in the social action of these women towards self-care.
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Affiliation(s)
| | - Carla Marins Silva
- Universidade de São Paulo, Escola de Enfermagem, Departamento de Enfermagem Materno-Infantil e Psiquiátrica, São Paulo, SP, Brazil
| | - Elaine Lutz Martins
- Universidade do Estado do Rio de Janeiro, Faculdade de Enfermagem, Departamento de Enfermagem Materno-Infantil, Rio de Janeiro, RJ, Brazil
| | - Juliana Cristina dos Santos Monteiro
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Departamento de Enfermagem Materno-Infantil e Saúde Pública, Ribeirão Preto, SP, Brazil
| | | | | | - Fernanda Marçal Ferreira
- Universidade de São Paulo, Escola de Enfermagem, Departamento de Enfermagem Materno-Infantil e Psiquiátrica, São Paulo, SP, Brazil
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Ollivier R, Aston M, Price S, Sheppard-LeMoine D, Steenbeek A. 'Feeling Ready': A Feminist Poststructural Analysis of Postpartum Sexual Health. QUALITATIVE HEALTH RESEARCH 2024; 34:252-262. [PMID: 37967315 PMCID: PMC10768324 DOI: 10.1177/10497323231209842] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Abstract
There exists a lack of literature surrounding how postpartum individuals define feeling 'ready' to resume sexual activities after childbirth. Many factors may influence feelings of desire or readiness for sexual activities, such as breastfeeding. Therefore, it is important to understand why and how postpartum individuals understand and make meaning of their experiences surrounding postpartum sexual activities, as well as how those experiences are influenced or negotiated through relations of power. This study was guided by feminist poststructuralism and discourse analysis. Eleven participants who were between 1 and 6 months postpartum and living in Nova Scotia, Canada, were interviewed using semi-structured interviews. Participants challenged certain discourses surrounding sexual activities postpartum, including the social discourse that positions sexual activities as a requirement within romantic relationships and the discourse that positions health care providers as the authority on postpartum sexual health. 'Feeling ready' centered on four main issues: (1) navigating physical recovery; (2) personal knowing and emotional readiness; (3) the 6-week check; and (4) redefining intimacy. This article describes one branch of the findings within the overall study. Choosing to resume sexual activities postpartum, or feeling ready to do so, is individual, fluid, and complex. This research has important implications for practice and policy, specifically as it pertains to postpartum care.
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Affiliation(s)
- Rachel Ollivier
- School of Nursing, Dalhousie University, Halifax, NS, Canada
| | - Megan Aston
- School of Nursing, Dalhousie University, Halifax, NS, Canada
| | - Sheri Price
- School of Nursing, Dalhousie University, Halifax, NS, Canada
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Willett A, Etowa J. A critical examination of epistemological congruence between intersectionality and feminist poststructuralism: Toward an integrated framework for health research. Nurs Inq 2023; 30:e12564. [PMID: 37248779 DOI: 10.1111/nin.12564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 05/05/2023] [Accepted: 05/11/2023] [Indexed: 05/31/2023]
Abstract
The theoretical perspectives of intersectionality and poststructuralism have contributed meaningfully to advancing issues of social injustice within the realm of women's health research. However, the question of whether the two approaches are epistemologically commensurate has been at the heart of a polarized debate within third- and fourth-wave feminist literature in recent years. In this paper, we draw on the extant literature to explore existing dilemmas within this debate and critically reflect on points of epistemological tension and congruence between the two perspectives. It will be demonstrated that intersectionality and poststructuralism, especially feminist poststructuralism, represent concordant theoretical perspectives and a synthesized theoretical framework for application in qualitative research into women's health will be proposed. We argue that an intersectional feminist poststructuralist framework contributes to a deepened analysis of women's disparate healthcare experiences, and the social mechanisms, power relations, and discourses that mediate these experiences, while offering avenues for advocacy and political praxis on a multitude of levels.
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Affiliation(s)
- Andrea Willett
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Josephine Etowa
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
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5
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Benoit B, Aston M, Price S, Iduye D, Sim SM, Ollivier R, Joy P, Nassaji NA. Mothers’ Access to Social and Health Care Systems Support during Their Infants’ First Year during the COVID-19 Pandemic: A Qualitative Feminist Poststructural Study. NURSING REPORTS 2023; 13:412-423. [PMID: 36976690 PMCID: PMC10057522 DOI: 10.3390/nursrep13010038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/24/2023] [Accepted: 02/27/2023] [Indexed: 03/09/2023] Open
Abstract
Social support and health services are crucial for mothers and families during their infants’ first year. The aim of this study was to explore the effect of self-isolation imposed by the COVID-19 pandemic on mothers’ access to social and health care systems support during their infants’ first year. We utilized a qualitative design using feminist poststructuralism and discourse analysis. Self-identifying mothers (n = 68) of infants aged 0 to 12 months during the COVID-19 pandemic in Nova Scotia, Canada completed an online qualitative survey. We identified three themes: (1) COVID-19 and the Social Construction of Isolation, (2) Feeling Forgotten and Dumped: Perpetuating the Invisibility of Mothering, and (3) Navigating and Negotiating Conflicting Information. Participants emphasized a need for support and the associated lack of support resulting from mandatory isolation during the COVID-19 pandemic. They did not see remote communication as equivalent to in-person connection. Participants described the need to navigate alone without adequate access to in-person postpartum and infant services. Participants identified conflicting information related to COVID-19 as a challenge. Social interactions and interactions with health care providers are crucial to the health and experiences of mothers and their infants during the first year after birth and must be sustained during times of isolation.
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Affiliation(s)
- Britney Benoit
- Rankin School of Nursing, St. Francis Xavier University, Antigonish, NS B2G 2W5, Canada
- Correspondence: ; Tel.: +1-(902)-867-1396
| | - Megan Aston
- School of Nursing, Dalhousie University, Halifax, NS B3H 4R2, Canada
| | - Sheri Price
- School of Nursing, Dalhousie University, Halifax, NS B3H 4R2, Canada
| | - Damilola Iduye
- School of Nursing, Dalhousie University, Halifax, NS B3H 4R2, Canada
| | - S Meaghan Sim
- Research, Innovation & Discovery, Nova Scotia Health, Halifax, NS B3S 1B8, Canada
| | - Rachel Ollivier
- School of Nursing, Dalhousie University, Halifax, NS B3H 4R2, Canada
| | - Phillip Joy
- Department of Applied Human Nutrition, Mount Saint Vincent University, Halifax, NS B3M 2J6, Canada
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6
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Harrison LN, Neiterman E, MacEachen E, Gibson MF. Navigating return to sex: A qualitative Reddit analysis of parents' perceptions about the timing of resuming sex after a birth. SEXUAL & REPRODUCTIVE HEALTHCARE 2022; 34:100782. [PMID: 36179395 DOI: 10.1016/j.srhc.2022.100782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 07/22/2022] [Accepted: 09/09/2022] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Given the many transitions that occur in the postpartum period as men and women navigate the return to sex after a birth, this study aimed to explore parents' experiences of resuming sexual activity. METHODS This was a qualitative study that used posts from both men and women from the online public forum Reddit. Data were analysed using constructivist grounded theory. RESULTS This study found that the discourse surrounding sexual activity in the postpartum period was dominated by an understanding that medical guidelines prohibited sex prior to six weeks after giving birth. Although some parents disagreed, many Reddit users perceived a high degree of risk in resuming sex prior to six weeks and medical expertise was highly valued as parents negotiated the return to sex. While Reddit users were largely in agreement that penetrative vaginal sex prior to six weeks was a risky activity, there was less consensus as to the risk involved in other sexual activities. CONCLUSION This study recommends that medical practitioners initiate conversations with men and women about returning to sexual activity after a birth, and that these conversations should consider parents' emotional well-being as they resume sex. Further research is needed to establish evidence-based and comprehensive guidelines to facilitate these conversations.
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Affiliation(s)
- Lauren Nicole Harrison
- School of Public Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, ON N2L 3G1, Canada.
| | - Elena Neiterman
- School of Public Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, ON N2L 3G1, Canada
| | - Ellen MacEachen
- School of Public Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, ON N2L 3G1, Canada
| | - Margaret F Gibson
- Social Development Studies, Renison University College, 240 Westmount Rd N, Waterloo, ON N2L 3G4, Canada
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Delgado-Pérez E, Rodríguez-Costa I, Vergara-Pérez F, Blanco-Morales M, Torres-Lacomba M. Recovering Sexuality after Childbirth. What Strategies Do Women Adopt? A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19020950. [PMID: 35055771 PMCID: PMC8775547 DOI: 10.3390/ijerph19020950] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 01/10/2022] [Accepted: 01/11/2022] [Indexed: 01/15/2023]
Abstract
This study aimed to determine the strategies used by women to adapt to the changes that affect the first sexual relations after childbirth. A qualitative study with a phenomenological approach used three data collection techniques (in-depth interviews, discussion groups, and online forums). Thirty-six women in the first six months postpartum participated in the study, from physiotherapy centers with maternal child specialties in several locations in Spain. Women with different types of delivery, presence or absence of perineal trauma during delivery, previous deliveries, and different types of breastfeeding were included. Among the strategies, closeness support and understanding were the ones that women used to adjust to the new situation, in order to improve the couple's relationship, intimacy, and cope with the significant changes that appear in the first six months postpartum. Changes and adaptations in sexual practices become a tool for coping with a new sexuality, especially if it is affected by the presence of pain or discomfort associated with physical changes. Personal time facilitates emotional management and improvement of emotional changes related to the demands of motherhood. Accepting the changes that motherhood brings is critical to dealing with the new situation. Strategies used by postpartum women focus on acceptance, self-care, partner, couple time, personal time, and adapting encounters. The findings of this study are of interest to health professionals as they provide insight into how women cope with the changes that appear in the first six months postpartum. In this way, the findings will be able to transmit to couples the alternatives they can adopt before the resumption of sexual relations to improve satisfaction both as a couple and in terms of sexuality after childbirth.
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Affiliation(s)
- Esther Delgado-Pérez
- Physiotherapy Department, Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain; (E.D.-P.); (M.B.-M.)
| | - Isabel Rodríguez-Costa
- Humanization in the Intervention of Physiotherapy for the Integral Attention to the People (HIPATIA) Research Group, Physiotherapy Department, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, 28801 Madrid, Spain
- Correspondence:
| | - Fernando Vergara-Pérez
- Physiotherapy in Women’s Health (FPSM) Research Group, Physiotherapy Department, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, 28801 Madrid, Spain; (F.V.-P.); (M.T.-L.)
| | - María Blanco-Morales
- Physiotherapy Department, Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain; (E.D.-P.); (M.B.-M.)
| | - María Torres-Lacomba
- Physiotherapy in Women’s Health (FPSM) Research Group, Physiotherapy Department, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, 28801 Madrid, Spain; (F.V.-P.); (M.T.-L.)
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8
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Delgado-Pérez E, Yuste-Sánchez MJ, Pérez-Martín Y, Abuín-Porras V, Rodríguez-Costa I. New Motherhood Concepts, Implications for Healthcare. A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182413118. [PMID: 34948727 PMCID: PMC8701737 DOI: 10.3390/ijerph182413118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 12/03/2021] [Accepted: 12/06/2021] [Indexed: 12/14/2022]
Abstract
The aim of this study was to explore the experience of women who take care of their children in postpartum and who desire to be understood by society, with no judgements. For this purpose, a qualitative methodology was followed. In-depth interviews, discussion groups, and an online forum were used for data collection. The participants were Spanish women that had given birth in the past 6 months, and their partners. Healthcare specialists with experience in the topic were also included. Results showed three main categories: lack of priority, self-demand, and self-esteem changes. As a conclusion, the concept of motherhood needs to be redefined, as women feel that they are living under the pressure of being a “perfect mother”. It is important that mothers allow themselves to fail in reaching the imposed requirements. Simple acceptance of motherhood boundaries could help in this transition.
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Affiliation(s)
- Esther Delgado-Pérez
- Physiotherapy Department, Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain; (E.D.-P.); (V.A.-P.)
| | - Maria José Yuste-Sánchez
- Physiotherapy in Women’s Health (FPSM) Research Group, Physiotherapy Department, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, 28805 Madrid, Spain;
| | - Yolanda Pérez-Martín
- Humanization in the Intervention of Physiotherapy for the Integral Attention to the People (HIPATIA) Research Group, Physiotherapy Department, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, 28805 Madrid, Spain;
| | - Vanesa Abuín-Porras
- Physiotherapy Department, Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain; (E.D.-P.); (V.A.-P.)
| | - Isabel Rodríguez-Costa
- Humanization in the Intervention of Physiotherapy for the Integral Attention to the People (HIPATIA) Research Group, Physiotherapy Department, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, 28805 Madrid, Spain;
- Correspondence:
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O'Malley D, Smith V, Higgins A. Sexual health issues postpartum-A mixed methods study of women's help-seeking behavior after the birth of their first baby. Midwifery 2021; 104:103196. [PMID: 34767981 DOI: 10.1016/j.midw.2021.103196] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 10/05/2021] [Accepted: 10/25/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To identify women's help-seeking behavior in relation to sexual health issues after the birth of their first baby. DESIGN A mixed methods sequential explanatory study design was utilized. Phase one of the study consisted of a prospective cohort study to identify the help-seeking behavior of women experiencing sexual health issues at 3, 6, and 12 months postpartum. Phase two consisted of a qualitative descriptive design to explore women's help-seeking behavior for sexual health issues postpartum. SETTING & PARTICIPANTS The setting was a large urban tertiary referral maternity unit (greater than 8000 births per year) in the Republic of Ireland. Nulliparous women aged 18 years and over were invited to participate in phase one. Phase two consisted of a subsample of women who consented to being contacted for further research on admission to the study. FINDINGS Few women consulted a clinician for postpartum sexual health issues at each of the study's three, six and twelve month time-points. For example, only 2.9% (n=18) of women experiencing dyspareunia, and 3.6% (n=16) of those experiencing a lack of vaginal lubrication spoke to their General Practitioner (GP) about these issues at three months postpartum. The qualitative data supported the quantitative findings and suggested that even when women proactively sought help from healthcare professionals they were met with unhelpful responses. In the absence of support from practitioners, women became active agents and sought information from other women or the internet. In an effort to improve practice women recommended a greater focus on their physical and emotional recovery from birth. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Very few women consulted with a clinician about their experience of sexual health issues after birth. Findings will contribute to and assist policy makers in planning future postnatal services for women to include extending the final postnatal assessment beyond six weeks after birth.
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Affiliation(s)
- Deirdre O'Malley
- School of Nursing and Midwifery, University of Dublin Trinity College, 24 D'Olier Street, Dublin, Ireland..
| | - Valerie Smith
- School of Nursing and Midwifery, University of Dublin Trinity College, 24 D'Olier Street, Dublin, Ireland
| | - Agnes Higgins
- School of Nursing and Midwifery, University of Dublin Trinity College, 24 D'Olier Street, Dublin, Ireland
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Pardell-Dominguez L, Palmieri PA, Dominguez-Cancino KA, Camacho-Rodriguez DE, Edwards JE, Watson J, Leyva-Moral JM. The meaning of postpartum sexual health for women living in Spain: a phenomenological inquiry. BMC Pregnancy Childbirth 2021; 21:92. [PMID: 33509133 PMCID: PMC7844957 DOI: 10.1186/s12884-021-03578-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 01/20/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Sexual health is a multidimensional phenomenon constructed by personal, social, and cultural factors but continues to be studied with a biomedical approach. During the postpartum period, a woman transitions to mother, as well as partner-to-parent and couple-to-family. There are new realities in life in the postpartum period, including household changes and new responsibilities that can impact the quality of sexual health. This phenomenon is understudied especially in the context of Spain. The purpose of this study was to describe the lived experience of postpartum sexual health among primiparous women giving birth in Catalonia (Spain). METHODS This was a phenomenological study with a purposive sample of primiparous women. Data was collected through semi-structured interviews until saturation. Analysis followed Colaizzi's seven-step process with an eighth translation step added to limit cross-cultural threats to validity. Also, the four dimensions of trustworthiness were established through strategies and techniques during data collection and analysis. RESULTS Ten women were interviewed from which five themes emerged, including: Not feeling ready, inhibiting factors, new reality at home, socio-cultural factors, and the clinician within the health system. Returning to sexual health led women to engage in experiential learning through trial and error. Most participants reported reduced libido, experienced altered body image, and recounted resumption of sexual activity before feeling ready. A common finding was fatigue and feeling overloaded by the demands of the newborn. Partner support was described as essential to returning to a meaningful relationship. Discussions about postpartum sexual health with clinicians were described as taboo, and largely absent from the care model. CONCLUSION Evidence-based practices should incorporate the best evidence from research, consider the postpartum sexual health experiences and preferences of the woman, and use clinician expertise in discussions that include the topic of postpartum sexual health to make decisions. As such, human caring practices should be incorporated into clinical guidelines to recognize the preferences of women. Clinicians need to be authentically present, engage in active communication, and individualize their care. More qualitative studies are needed to understand postpartum sexual health in different contexts, cultures, and countries and to identify similarities and differences through meta-synthesis.
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Affiliation(s)
- Lidia Pardell-Dominguez
- Department d'Infermeria, Facultat de Medicina, Universitat Autònoma de Barcelona, Avda. Can Domènech, Edifici M. Despatx M3/213. Campus de la UAB, 08193, Bellaterra, (Cerdanyola del Vallès), Barcelona, Spain
| | - Patrick A Palmieri
- Vicerrectorado de Investigación, Universidad Norbert Wiener, Av. Arequipa 444, 15046, Lima, Peru. .,College of Graduate Health Studies, A. T. Still University, 800 West Jefferson Street, Kirksville, MO, 63501, USA. .,Center for Global Nursing, Texas Woman's University, 6700 Fannin Street, Houston, TX, 77030, USA. .,Center for Qualitative Research, EBHC South America: A Joanna Briggs Institute Affiliated Group, Calle Cartavio 402, 15023, Lima, Peru.
| | - Karen A Dominguez-Cancino
- Center for Qualitative Research, EBHC South America: A Joanna Briggs Institute Affiliated Group, Calle Cartavio 402, 15023, Lima, Peru.,Universidad Científica del Sur, Carr. Panamericana Sur 19, Villa EL Salvador, 15067, Lima, Peru.,Escuela de Salud Pública, Universidad de Chile, Independencia 939, Independencia, 8380453, Santiago de Chile, Chile
| | - Doriam E Camacho-Rodriguez
- Center for Qualitative Research, EBHC South America: A Joanna Briggs Institute Affiliated Group, Calle Cartavio 402, 15023, Lima, Peru.,School of Nursing, Universidad Cooperativa de Colombia, Calle 30, Santa Marta, Magdalena, Colombia
| | - Joan E Edwards
- Center for Global Nursing, Texas Woman's University, 6700 Fannin Street, Houston, TX, 77030, USA.,Nelda C. Stark College of Nursing, Texas Woman's University, 6700 Fannin St, Houston, TX, 77030, USA
| | - Jean Watson
- Watson Caring Science Institute, 4450 Arapahoe Avenue, Suite 100, Boulder, CO, 80304, USA.,College of Nursing, Anschutz Medical Campus University of Colorado, 13120 East 19th Avenue, Aurora, CO, 80045, USA
| | - Juan M Leyva-Moral
- Department d'Infermeria, Facultat de Medicina, Universitat Autònoma de Barcelona, Avda. Can Domènech, Edifici M. Despatx M3/213. Campus de la UAB, 08193, Bellaterra, (Cerdanyola del Vallès), Barcelona, Spain.,Center for Global Nursing, Texas Woman's University, 6700 Fannin Street, Houston, TX, 77030, USA.,Center for Qualitative Research, EBHC South America: A Joanna Briggs Institute Affiliated Group, Calle Cartavio 402, 15023, Lima, Peru
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