Postnatal Companion Support The Effect of Education on Maternal Depression and Fatigue: A Randomised Controlled Trial

One of the most important turning points in a woman's life is the pregnancy and birth process. In some cases, these milestones can turn into a crisis and lead to mental problems. In addition, for parents, preparing for and caring for a new baby is inherently a period of change and transition. With the addition of the responsibility of caring for the baby, more negative health problems may occur in the postpartum period. It is a risky period in terms of fatigue, emotional disorders, and postpartum depression during the transition to motherhood in the postpartum period. In the first three postnatal days, more than 50% of mothers experience maternal sadness, which is the mildest psychological disorder with symptoms of crying, sadness and unstable emotions. When this situation cannot be managed, postnatal depression occurs. According to previous research, 15% of mothers experience postnatal depression. The main symptoms of postnatal depression include lack of interest, low self-confidence, fatigue, sadness, sleep disturbance, loss of appetite, hostile attitude towards babies, self-blame and feelings of humiliation, and symptoms last for at least two weeks. Postnatal fatigue (PFF) is generally known to cause both a decrease in energy that prevents mothers from engaging in physical and mental activities after birth and impaired concentration and distraction that cannot be easily eliminated by rest or sleep. Edinburgh Postnatal Depression Scale is the gold standard for screening. The Turkish version has been used in Turkey since 1996 and the cut-off score is accepted as 13. In Turkey, the sensitivity of the scale is estimated to be 0.84 with a specificity of 0.88, indicating that 16% of women are overlooked for postnatal depression. It should be underlined that the scale is not routinely used in postnatal care and follow-up. In addition, it is difficult for women to diagnose themselves in terms of postnatal depression. Moreover, many mothers believe that they should not complain about the mental difficulties brought by the postnatal period. Therefore, self-assessment as well as the assessment of others is important.

In developed countries, almost all women and their babies receive labour and postnatal care. However, the quality and frequency of this care vary significantly. In developing countries, the need for care and support after birth remains unmet. Despite all its importance, this period is often the most neglected period. In the study conducted to evaluate the postnatal care services provided in family medicine units in terms of quantity and quality in our country, it is stated that although it is seen that postnatal care is provided at the level of developed countries in terms of quantity, the services provided in terms of content are insufficient, and the services provided should be evaluated not only in terms of quantity but also in terms of quality. PPF should provide physical relaxation by deliberately preventing and alleviating fatigue in the postpartum period with effective approaches. Postnatal care is defined as the most neglected aspect of maternity services and it is generally stated that less resources are allocated to it than antenatal care or delivery. Many developing countries with limited resources have difficulty in developing and implementing policies to prevent the treatment gap from increasing. Prevention or early detection and intervention programmes have been developed to reduce the burden of these two disorders. Effective community-based programmes have been shown to reduce depression. However, due to the lack of home visits in postnatal care services and inadequate quality, companion support is important in the postnatal period. Especially considering the quality of postnatal care in our country and the lack of home visits, the importance of companion support in this period comes to the fore. In a study examining the effect of companion support on acute stress reactions and postnatal depressive symptoms in the first three weeks after birth, it was reported that companion support reduced acute stress reactions and postnatal depressive symptoms. In a study, it is stated that companion support has a positive effect on the mother's mood and self-efficacy. In another study, it was stated that early and appropriate interventions to reduce PPF may increase the mitigation of negative effects on physical activity and therefore improve postnatal maternal health. In this period, the importance of the evaluation of the woman's own condition as well as the evaluation of health professionals and companions is emphasised. It is stated that observation of postnatal women by a close third person, especially by spouses and parents, will be beneficial.

Postnatal depression and fatigue are common problems in our country. However, postnatal care services are inadequate and unqualified. For this reason, studies should be carried out on alternative supports in postnatal care. In this context, "Postpartum Depression Parent Rating Scale for Postpartum Depression" was developed to increase the quality of early postnatal diagnosis and care: The Turkish validity and reliability study of the "Postpartum Depression Parent Rating Scale: Mother Monitoring Scale by Parents" and proving the effect of companion training on postpartum depression and fatigue constitute the original value of the project and our main motivation. The project has a unique value for a sustainable future in terms of its effects on the social level in terms of positive postnatal period and qualified support for puerperas and babies in general. In the project, ensuring that puerperas receive evidence and science-based postnatal support and care in line with our culture and traditions is also of unique value. It will also provide data for the comparison of innovative care models with traditional methods. Thus, it will help to improve, organise or develop capacity for future initiatives.