Article Text

Original research
Insight into the process of postpartum care utilisation and in-home support among vulnerable women in the Netherlands: an in-depth qualitative exploration
  1. Lyzette T Laureij1,
  2. Marije van der Hulst1,
  3. Jacqueline Lagendijk1,
  4. Jasper V Been2,
  5. Hiske E Ernst-Smelt1,
  6. Arie Franx1,
  7. Marjolein Lugtenberg3
  1. 1Department of Obstetrics and Gynaecology, Erasmus MC, Rotterdam, The Netherlands
  2. 2Department of Paediatrics, Erasmus MC, Rotterdam, The Netherlands
  3. 3Department of Public Health, Erasmus MC, Rotterdam, The Netherlands
  1. Correspondence to Dr Marjolein Lugtenberg; m.lugtenberg{at}


Objective To gain insight into the process of postpartum care utilisation and in-home support among vulnerable women.

Design, method, participants and setting A qualitative interview study was conducted among 23 pregnant and postpartum vulnerable women in the Netherlands, following a grounded theory approach. Women were determined as vulnerable by their healthcare providers. Theoretical sampling of participants was applied and was alternated by data analysis to include information-rich cases until saturation was achieved.

Results A conceptual framework of postpartum care utilisation was generated consisting of three phases: pregnancy, early postpartum period and late postpartum period. Within these phases, information provision, parenting self-efficacy and social network were identified as overarching themes. Perceived inadequate information on content of postpartum care posed a major barrier to forming realistic expectations during pregnancy and hindered its utilisation. Low self-efficacy facilitated postpartum care utilisation. All women experienced increased self-efficacy during and after postpartum care. Support from a social network influenced expectations regarding the added value of postpartum care during pregnancy, and lowered actual utilisation during the postpartum period. The costs of postpartum care and the role of the maternity care assistant acted as general barriers or facilitators influencing the three overarching themes and therefore postpartum care utilisation indirectly.

Conclusions Our findings suggest that postpartum care utilisation among vulnerable women may be improved by considering the particular phase and relevant themes applying to individual women, and adapt care accordingly. We recommend to provide comprehensive, understandable information and to emphasise the gains of postpartum care in improving self-efficacy for vulnerable women. Moreover, involving a woman’s social network in postpartum care may add value to this care for this population.

  • obstetrics
  • primary care
  • public health
  • qualitative research

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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  • Contributors LTL, JL, HEE-S, JVB, AF and ML designed the study. LTL performed the data collection. LTL and MvdH analysed the data under supervision of ML. All authors interpreted the data. LTL, MvdH, JL and ML wrote the first version of the manuscript. All authors revised all versions of the manuscript and approved the final version.

  • Funding This study was funded by the Netherlands Organisation for Health Research and Development (ZonMw), grant number 209070002.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.