How Does Spousal Support Affect Women’s Quality of Life in the Postpartum Period in Turkish Culture?

Introduction

In the postpartum period, women may experience physical and psychological changes (Taşkın, 2014). Women may also experience physical symptoms that may affect their quality of life (Taşkın, 2014; Webb et al., 2008). In addition, the woman’s husband may experience physical and psychosocial changes owing to becoming a parent and having to perform new tasks in this period (Ribeiro et al., 2015). In short, the postpartum period is a very important stage in the life of the family because both the woman and her immediate surroundings can be affected physically and psychologically. Within Turkish culture, motherhood is considered a holy concept, and thus social support increases in this period (Alan & Ege, 2013). This period is also a time when there is a change in the need for social support and family relations (Huang, Tao, Liu, & Wu, 2012) because it brings new roles and responsibilities (Altuntuğ & Ege, 2013; Ribeiro et al., 2015). The term quality of life has a complex meaning that involves many aspects (Prick et al., 2015; Ribeiro et al., 2015). The quality of life of a woman can be adversely affected by lack of support as well as the physical and psychological problems experienced by the woman (Cacciatore, Schnebly, & Froen, 2009; Mermer, Bilge, Yücel, & Çeber, 2010; Webster, Nicholas, Velacott, Cridland, & Fawcett, 2011).

While the woman adapts to parenting in this period, the support that she receives from the family is important for coping with emerging problems and new tasks (Herguner, Çiçek, Annagur, Herguner, & Ors, 2014; Sampson, Villarreal, & Padilla, 2015). Social support that is provided by relatives, such as spouses and family members, in particular, plays a protective role. This support is also important in reducing the effects of stress on the physical and psychological health of women (Razurel, Bruchon-Schweitzer, Dupanloup, Irion, & Epiney, 2011), thereby significantly improving women’s quality of life (Cacciatore et al., 2009). If women’s support needs are adequately met, the support provided has been found to have a positive effect on their physical and mental well-being (Aksakallı, Çapık, Apay, Pasinlioğlu, & Bayram, 2012; Altuntuğ & Ege, 2013; Webster et al., 2011). However, low levels of support increase the stress and depression of the woman and this situation negatively affects the quality of life (Cacciatore et al., 2009; Herguner et al., 2014; Lee, Holditch-Davis, & Miles, 2007; Sampson et al., 2015; Xie, He, Koszycki, Walker, & Wen, 2009).

A sociocultural feature of Turkish society is that mothers attract significant interest and receive good support soon after giving birth, but as time goes by this diminishes (Danaci, Dinç, Deveci, Sen, & Icelli, 2002). In the literature it is stated that spouses are more likely to give support than other social support resources and that the spouse’s support is more important than others’ (Don & Mickelson, 2012; Güven, Şener, & Yıldırım, 2011; Salmela-Aro, Nurmi, Saisto, & Halmesmaki, 2010).

However, in the postpartum period, the relationship between quality of life and social support, in particular the support of spouses, remains unclear. To the best of our knowledge, there is no study on the relationship between spousal support and postnatal quality of life in the literature. Therefore, there is a need for research that investigates the effect of spousal support on quality of life in the postpartum period.

In this study, the relationship between spousal support and postpartum quality of life is examined. It is particularly important that the study is conducted using a quality of life scale specific to the postpartum period. The relative contributions of family and spousal support to the quality of life in this period are unknown, but it is thought that spousal support plays a major role in the adaptation period after birth, improving the quality of life and dealing with problems the woman may face. The purpose of this study is to determine the relationship between spousal support and postpartum women’s quality of life.

Method

Results

Comparison of Average Scores of SSS and MPQLQ in Terms of Characteristics of Women

In the analysis women with graduate degrees had a degree of spousal support of 77.25 ± 2.95 with an MPQLQ score average of 15.27 ± .07. Women also had average spousal support of 76.27 ± 5.75 and an MPQLQ score of 15.27 ± .07 in the group of spouses with graduate degrees (Table 1).

Table 1.

Spouse Support and MPQLQ Score Averages According to Some Descriptive Characteristics of Women

There was a statistically significant difference in the age groups of women in terms of spousal support and postpartum quality of life (MPQLQ) scores (p < .05).

When the spousal support scores according to the birth type were examined, it was determined that the mean scores of the deliveries by cesarean section were 166.00 ± 8.73 and the mean scores for vaginal delivery were 135.00 ± 11.20. However, when the MPQLQ scores were examined, it was found that the difference between the mean scores of the birth types was not significant (p > .05).

It was found that the spousal support score of women with planned pregnancies was 72.38 ± 9.10, while for those with unplanned pregnancies it was 65.72 ± 11.67 (p < .05). The former group had an average MPQLQ score of 15.21 ± 0.10 while the latter group had an average MPQLQ score of 15.17 ± .11; the difference was statistically significant (p < .05) (Table 2).

Table 2.

Spouse Support and MPQLQ Score Averages According to Some Descriptive Characteristics of Women

In our study, for women who had been married 1–3 years, the average spousal support was 72.90 ± 9.818 and the mean MPQLQ score was 15.22 ± 0.10 (p < .05). The average spousal support and MPQLQ scores were than among women married for more than 1–3 years (Table 2).

The mean score of spousal support for the “good” partner agreement was 73.49 ± 7.41 and the MPQLQ average score was the highest (15.22 ± .09) in this group. In addition, the analysis found that for women who were happy in marriage the mean score of spousal support was 72.69 ± 7.98 and the mean score of the MPQLQ was 15.21 ± .09, which is the highest among the groups (Table 2). It was determined that the average spousal support score of spouses who spend enough time at home was 73.49 ± 7.93 and the average score on the MPQLQ was 15.23 ± .09 (Table 2).

Relationship between Spousal Support and Postpartum Quality of Life

There was a moderate positive correlation between spousal support scores and the subscales concerning dimensions of emotional support, financial and information support, appreciation support, and social support, as well as on postpartum quality of life scores. The data are shown in Table 3.

Table 3.

Investigation of the Relationship between Spousal Support and Postpartum Quality of Life

Discussion

In our study, there was a positive relationship between general spousal support and quality of life after birth. As spousal support increases in the postpartum period, the quality of life after birth also increases. In some studies, it is reported that social support influences the overall quality of life after birth (Emmanuel & Sun, 2014; Irwin, Beeghly, Rosenblum, & Muzik, 2016; Webster et al., 2011).

When the relation of spousal support by age groups was examined, it was found that as age increases the spousal support scores and quality of life decrease. Aksakallı et al. (2012) also reported that postpartum support decreases with age. It is thought that with advanced age, motherhood and the decrease in spousal support may cause difficulties in baby care and this may effectively reduce the quality of life.

According to the results, it was thought that, as the level of education increases, couple’s expressiveness and sharing increases. However, in a similar study, it was found that the mother’s education status did not influence social support (Sampson et al., 2015). The difference in the results is thought to be due to marital or cultural differences in the sample groups. Similarly, as the education level of women and their spouses increased, the quality of life after birth also increased significantly. Similarly, Çelik, Türkoğlu, and Pasinlioğlu (2014) also found that women with graduate degrees had a higher quality of life than others, although Prick et al. (2015) found that the educational status of the woman had no effect on the quality of life. It can be assumed that the difference between the studies is due to the marital and cultural characteristics of the samples. As the level of mothers’ education increases, their awareness of needs after birth will increase, as their expectations for both social support and health care will do; thus their quality of life will increase insofar as those needs are satisfied.

In our study, women’s delivery method influenced the spousal support they perceived. It has been determined that spousal support provided to those with cesarean deliveries was greater than for those with vaginal deliveries. These results may be due to the fact that women who give birth through cesarean delivery are thought to need more help. However, there were no differences in postpartum quality of life scores between women who delivered vaginally or by cesarean section. The relationship between the delivery type and quality of life is not clear. While one study found no difference between the quality of life of women who delivered vaginally and those who delivered by cesarean (Huang et al., 2012), some studies found that the health-related quality of life of women in the former group was higher than that of women who had elective and urgent cesarean sections (Emmanuel & Sun, 2014; Çelik et al., 2014; Prick et al., 2015). In cesarean births, it may be that there is a marked decrease in the comfort of the mother compared to vaginal deliveries, due to post-operative pain, fatigue, adverse effects of anesthesia, self-care, difficulty in meeting daily life activities, nursing care, breastfeeding problems, and so on.

Whether the pregnancy was planned also affected the spousal support that women perceived in our study. According to the results, planned pregnancy is usually a desired and expected situation and it is thought that the spousal support received may be higher because the baby is wanted. In a similar study, it was also shown that women with planned pregnancies perceived more postpartum spousal support (Hildingsson, Tingvall, & Rubertsson, 2008). Whether the pregnancy is planned has been found to affect the quality of life after birth, although in the study conducted by Çelik and colleagues, it was noted that this factor does not affect the quality of life of women after delivery (Çelik et al., 2014). Alternatively, it may be thought that having a planned pregnancy better prepares women for the postnatal period and thereby increases their quality of life.

The duration of marriage among women affected perceived spousal support in our study. According to marriage patterns, the scores of the spouses of the participants who got married while getting better acquainted with each other were higher than those of participants who married without knowing their spouse well because of a family request or a very short courtship. Güven et al. (2011) stated that the perceived spousal support of couples married after being better acquainted is higher than that of those married after very short courtships or those married to relatives. Accordingly, it can be assumed that spouses give greater support when they marry the partners they choose and they get along with each other. In our study, partners’ dealings with each other affect the perceived spousal support. Similarly, our results show that the duration of marriage affects the quality of life after birth, and the quality of life decreases as the duration of the marriage increases. As the duration of the marriage affects spousal support, it can be assumed that the quality of life also decreases as spousal support decreases.

The scores of the women who have good agreement with their spouses and who are happy in their marriage are found to be higher than those of the other participants. Spouses with good marital relationships are reported to feel better and more comfortable at helping and supporting their partners (Don & Mickelson, 2012). Similarly, in the literature, it was found that the marital satisfaction of the individuals who received support from their spouses was also high (Çağ & Yıldırım, 2013). In our study, it was determined that the quality of life of postpartum women who were in agreement with their spouses and were happy in marriage was higher than that of the other participants. The literature states that women who have better relationships with their husbands have a higher functional status and that a good relationship may also contribute to the role of motherhood and quality of life (Uban, 2012).

Conclusion

In our study, it was determined that there is a moderate relationship between spousal support and quality of life. This study shows how spousal support is important to women after birth.

It is important to raise the awareness of spouses about the importance of helping their partners improve the quality of life during the postpartum period. To raise awareness of the fathers about unsatisfied needs and their knowledge about other issues during this period, midwives and nurses working in family health centers should take the initiative to involve fathers. In-service training can be conducted to raise the awareness of health professionals about supporting fathers. Frequent checks can also be made during the postnatal period, and plans can be made to support women who do not have support for their housework or for child care.

Pre-conception and pregnancy training programs for women and their spouses can be planned and opportunities can be created for fathers to be included in these trainings (with flexible working hours), because the regulation of the education classes can affect the quality of life of the mother in a positive manner. In this regard, midwives and nurses working in family health centers must take the initiative.

In Turkey, workers and civil servants are allowed five or ten days of paternal leave during the postpartum period, respectively. Mother and fathers may also work half time to share the care of their child; however, in that case monthly salaries would decrease. In the postpartum period, it is possible to extend the paid paternity leave period for all workers/civil servants and to re-arrange the fathers’ working hours. We suggest that this study be repeated in different national and international populations to provide to increase its generalizability.

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