The Effect of Individualized Home Visits Under the Supervision of Midwives on Maternal Functioning, Breastfeeding, and Resilience: a Randomized Controlled Trial

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 .