Social support, First-time mothers, Postpartum, Nursing, Midwifery, Public health nurses





Purpose: To identify support needs, formal and informal support networks, and types of support provided to first-time mothers for infant care practices at 6 weeks after delivery in Ireland.


Methods: This was a quantitative descriptive design that used a 28-item questionnaire to measure social support needs and formal and informal support networks in the context of infant care practices. A convenience sample of 135 first-time mothers was recruited; 74% (n = 99) completed questionnaires at 6 weeks after birth.


Results: Most of the women reported informal social networks as their primary source of support in caring for their infants. Husbands/partners and the women's mothers were the persons identified most frequently as having provided them with each type of social support. From professional social networks, public health nurses and midwives were identified as having provided informational, instrumental, and appraisal support.


Clinical Implications: Findings from this study have differentiated between informal and formal social support sources and the functional types of support they provide. Nurses who work with first-time mothers should remember that social support is not a uniform phenomenon but rather a support provided by various sources, both from a woman's social network and from healthcare professionals.


Article Content

The aim of this study was to identify the sources of support for first-time mothers and to identify the types of support women receive concerning infant care practices. The genesis for the study was the author's clinical background as a public health nurse (PHN) in Ireland and her observations that a woman's transition to motherhood, although a joyous occasion in most instances, also could be a distressing time, particularly because first-time mothers are faced with the demands of learning new skills relating to infant care practices, such as feeding, settling/sleeping, bathing, changing, and dressing the infant.

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Maternity Services in Ireland

In Ireland, maternity services are free under the mother and infant care scheme. This care entitles every woman to general practice (GP) and hospital obstetric services. Midwives are employed to work in the hospital system and provide antenatal, labor, and postnatal care. Once a woman is discharged from the hospital, postnatal care is provided by the GP and the public health nursing service. The latter is geographically based and mandated to provide a nursing service to new mothers and their infants in the community from birth through the school years. The public health nursing service is available to all mothers and infants and involves both home visits and attendance at mother and baby clinics. First-time mothers frequently seek advice from PHNs about infant care.


Transition to Motherhood

Transition to motherhood-a process of personal and interpersonal change that occurs as a woman assumes maternal tasks and appraises herself as a mother-has been studied often (Mercer, 2004; Nelson, 2003; Pridham & Chang, 1992; Wilkins, 2006). The postnatal period is characterized by the adjustment to new roles, caring for a new infant, and coping with physical, emotional, and social change (Brage Hudson, Elek, & Fleck, 2001). Providing support for mothers in caring for their infants in the postnatal period is an important concern for PHNs and midwives, because research has shown that social support can facilitate women's transition to motherhood (Cohen & Syme, 1985; Cronenwett, 1985; Haggerty Davis, Brucker, & MacMullen, 1988; Leahy-Warren, 2005; Logsdon & Davis, 2003; Tarrka, Paunonen & Laippala, 1999; Wilkins, 2006). However, it has been acknowledged that support needs to be context specific and theory guided (Logsdon & Davis, 2003). The underpinning theory guiding this study was the social exchange theory (Blau, 1964), which stated that social exchange takes place between people and involves reciprocity or reward.


Defining Social Support

Social support has been defined in many ways in the literature, leading to a lack of clarity about its true meaning (House & Khan, 1985; Keeling, Price, Jones, & Harding, 1996). In order to attain clarity of definition for this study, the author analyzed frequently cited definitions of social support with reference to the social exchange theory (Cobb, 1976; Cronenwett, 1985; House & Khan, 1985; House, 1981; Keeling, Price, Jones, & Harding, 1996; Khan & Antonucci, 1980; Schumaker & Brownell, 1984). The definition proposed by House (1981) was chosen for use in this study: "a flow of emotional concern, instrumental aid, information, and/or appraisal (information relevant to self evaluation) between people" (p.26).


Structural and Functional Dimensions of Social Support

Social support has both structural and functional dimensions. Structural dimensions include:


* Interpersonal social network


* Number of friends and acquaintances


* Degree to which the network members have a relationship with each other


* Frequency of contact



Functional dimensions of social support are:


* Exchange activities, such as informational, instrumental, emotional, and appraisal support


* Appropriateness of support



When considering the structural dimension of social support, some degree of connectedness is necessary to receive support from social networks (Hinson Langford, Bowsher, Maloney, & Lillis, 1997; Oakley, 1992). However, this does not necessitate that the relationship be of a personal nature; it may occur within a professional relationship in which there is some degree of connectedness, such as nurses working with vulnerable mothers and during intrapartum care (Mulcahy, 2004; Sauls, 2006). Functional dimensions of social support represent exchange activities that take place in a relationship. The four functional dimensions of social support (informational, instrumental, emotional, and appraisal support) were the dimensions used in this study. Informational support refers to information exchanged between individuals or a group that has a positive outcome for the recipient (Cobb, 1976). Instrumental support refers to transactions in which direct aid or assistance is given (Khan & Antonucci, 1980). Emotional support refers to emotional concern for the recipient. Appraisal support refers to affirmation or expressions of agreement or rightness of some act or point of view (House, 1981).


In previous research, mothers reported that help from their husbands and mothers-both with household chores and infant care-were of great importance to them (Barclay, Everitt, Rogan, Schmied, & Wyllie, 1997). Help with tasks may be especially important to a mothers' adaptation in her infant's early months (McVeigh, 1997; Pridham & Zavoral, 1988). Much research about mothers' experiences of nurses'/midwives' practice of information about infant feeding has related primarily to breastfeeding (Hoddinott & Pill, 1999; Hillan, 1992), but other areas of importance included bathing baby (Beger & Cook, 1998), physical care of baby, and infant sleeping (Kerr, Jowett, & Smith, 1996).


It has been suggested that informational support during this period allows mothers to adapt to motherhood with ease and confidence. Several small studies suggested that new mothers benefit from emotional support, particularly support provided by partners and significant others (Podkolinski, 1998; Maloni, 1994; Oakley, 1992). Intimate and regular contact with relatives, neighbors, and friends enhances competence as a parent (Mercer, 2004; Pridham & Chang, 1992). Tarrka et al. (1999) found appraisal support to be the least common type of support received by first-time mothers. Nevertheless, a positive correlation was found between appraisal support and first-time mother's coping with infant care (r = .27, p < .0001). Mothers in Barclay et al.'s (1997) qualitative study indicated that they liked being with other mothers in similar circumstances, because this reassured them that their own experiences were valuable. Decades ago, Cronenwett (1985), using the four functional dimensions of social support with a sample of first-time parents in the postpartum period, found a significant positive relationship between the number of child care supports and satisfaction with the marital relationship. However, the sources and types of support provided to new mothers in the context of caring for their infants were not evaluated.


Because social support has been defined in multiple ways in the literature, this study was designed to use one specific definition and apply that definition to learn about one issue: how new mothers receive support in the context of infant care practices, such as infant feeding, infant settling, infant bathing, and infant changing. All four dimensions of functional support were examined among formal and informal sources of support for these first-time mothers.


Design and Methods


Social support is an interpersonal process that is context specific; instruments used to measure this construct should demonstrate sensitivity within specific contexts (Finfgeld-Connett, 2005). Although several research instruments are available that measure social support (Brandt & Weinert, 1981; Logsdon, Usui, Birkimer, & McBride, 1996; Norbeck, Lindsey, & Carrieri, 1981), none was found that measured both the structural and functional dimensions of social support in the specific context of infant care practices. Therefore, a 28-item questionnaire was designed for the study to elicit information on demographic details, social support network, and types of support provided for infant care practices, such as infant feeding, settling/putting baby to sleep, bathing, and dressing/changing. The instrument examined social support networks using detail of both formal (i.e., midwife, PHN, GP) and informal (e.g., partner/husband, mother) sources of support. Statements were presented in the context of functional dimensions of social support (informational, instrumental, emotional, and appraisal) with reference to infant care practices. For example, mothers were asked to place a mark in the appropriate box if they perceived that their husband/partner "carried out infant care tasks, such as feeding, changing, bathing and settling your baby." Similarly with regard to appraisal support, mothers were asked to mark the appropriate box if they perceived that the PHN "praised you for doing a good job in caring for your baby." A Likert scale was used, ranging from strongly disagree to strongly agree and included the option of cannot decide. Examples of questions were "I was pleased with the amount of information I received from family/friends on settling and putting my baby to sleep" (measuring informational support), "Since having my baby the routine housework has been mostly my responsibility" (measuring instrumental support), "There was someone I felt close to that made me feel secure" (measuring emotional support), and "My husband/partner let me know I was doing a good job in bathing my baby" (measuring appraisal support). Content validity was established by a review of the research literature with each question formulated from some aspect of the review. Two experts in this field also examined the instrument. Finally, a pilot study was carried out and appropriate changes were made to the questionnaire. Cronbach's alpha was used to assess internal consistency, with index values for individual scales of sources of social support (0.84), informational support (0.83), instrumental support (0.69), emotional support (0.73), and appraisal support (0.82).


Sample and Procedures

Ethical approval was sought and obtained from the ethics committee of the two maternity hospitals accessed. A convenience sample of first-time mothers (n = 135) in the postnatal wards was recruited and consent obtained. The response rate was 74% (n = 99) of first-time mothers who returned completed questionnaires 6 weeks later. For each respondent, summated scores were yielded from each of the four subscales. Summated scores were then divided into three categories of support: high support, moderate support, and low support.



Demographic data revealed that 26% of respondents were in the 27- to 30-year-old category and 23% were in the 18- to 22-year-old category. More than 50% (57.6%) of respondents were educated at the secondary school level, and a further 43% had education after secondary school. More than one fourth (26%) stated their occupation as typist and machine operator and 18% as professionals (e.g., authors/teachers). More than one half of first-time mothers were living with their husbands, 23% were living with their parents, 19% were living with their partners, and 7% were living alone. Table 1 outlines the demographic details of respondents.

Table 1 - Click to enlarge in new windowTABLE 1. Demographic Characteristics of Respondents

A comparison of social networks for each type of social support as reported by first-time mothers is presented in Table 2. Most first-time mothers reported informal social networks as their source of support in caring for their infants since birth. Husbands/partners and their own mothers were the persons identified most frequently by first-time mothers as having provided them with each type of social support. From their professional social network, PHNs were reported by most first-time mothers (76%) as having provided them with both informational and appraisal support. An equal percentage of first-time mothers (76%) reported receiving informational support from their own mothers and PHNs, which indicated the contribution of informational support from maternal mothers to this sample of first-time mothers. Midwives were also identified by a lesser number (n = 52) of first-time mothers as having provided them with informational support. Conversely, midwives as sources of instrumental support were reported by more first-time mothers (n = 26) compared to that of PHNs (n = 9).

Table 2 - Click to enlarge in new windowTABLE 2. Percentage of Types of Support From Social Networks (

In relation to aspects of infant care practices, more first-time mothers (n = 47) indicated that they relied on family/friends for information on infant settling/sleeping than on professionals (n = 31). However, 38% of first-time mothers indicated that they would have liked more information on infant settling and sleeping from professionals. Two thirds of first-time mothers (63%) indicated relying on professionals for information on infant feeding, yet nearly half (46%) would have liked more information in this regard from professionals. First-time mothers reported that they received conflicting information from professionals across all areas of infant care, but most notably infant feeding (41%). The sources of instrumental support were found to be primarily from their informal social network, with 84% reporting receiving instrumental support from their husbands/partners and fewer mothers (67%) indicating their own mothers as sources of instrumental support. Husbands/partners were found to provide respondents with the most hands-on help with infant care, with the exception of infant bathing. First-time mothers received hands-on help from their husbands/partner to settle baby to sleep (71%), change and dress baby (67%), feed baby (62%), and bathe baby (48%). More than half of first-time mothers (52%) reported that they did not have someone to help them with routine housework.


In this study, most first-time mothers reported high levels of emotional support, primarily from their informal social network. Most respondents indicated that they received emotional support from their husbands/partners and own mothers, friends, and sisters (Table 2). However, a small number of first-time mothers (n = 6) also indicated that they would have liked more emotional support from their husbands/partners.


With regard to appraisal support, first-time mothers (n = 76) reported their husbands/partners as having provided them with appraisal support. Their own mothers were also reported by most first-time mothers as providing appraisal support (n = 69). From their formal social networks, PHNs were reported as a support resource by more than half of the respondents (51%), and this percentage was higher than for other professionals (Table 2). Most first-time mothers (84%) indicated that they were appreciated by their husband/partner for doing a good job in caring for their infant. A similar percentage of first-time mothers indicated that family and friends let them know they were doing a good job regarding infant feeding, with a lesser number (73%) receiving feedback regarding infant bathing.


Clinical Implications

Nurses can use the information in this study to educate pregnant and postpartum women about the issues they are most concerned about and help them access the social support they need. The results here indicating that new mothers receive informational support from their own mothers support the results of Maloni (1994), but with a larger sample and for a longer time period. The mothers in this study stated that they needed more information from professionals about putting their infant to sleep. This possibility has been suggested by Kerr et al. (1996), who evaluated a structured sleep educational program and found that sleep intervention may need to be implemented earlier and in the first 6 weeks after delivery. Haggerty Davis's study (1988), which suggested that feeding was the primary issue for new mothers, was supported in this study as well. It is important for nurses to remember, however, that the provision of informational support from professionals tailored to the needs of first-time mothers may be ineffective if the information offered is conflicting in nature. Furthermore, for informational support to be facilitative, support that is actually received must match the support that is expected or desired. Conflicting advice may be a contributing factor that influenced first-time mothers' decision to give up breastfeeding in the early postnatal period (Hillan, 1992). This study is interesting because it provides evidence on the percentage of first-time mothers who are likely to give up breastfeeding in the 6-week postnatal period, with almost half (n = 24) not breastfeeding by 6 weeks, most of whom (43%, n = 22) had ceased breastfeeding by the end of the first postnatal week. This finding has implications for the development of public health nursing services in the provision of informational support on breastfeeding.


The study findings that a high percentage of first-time mothers reported receiving instrumental support from their informal social networks is comparable with previous studies (Barclay et al., 1997; Pridham & Zavoral, 1988; McVeigh, 1997). However, the findings from this study are more detailed because individual persons from informal social networks were identified. For example, in comparison with Tarrka et al.'s (1999) study, in which mothers named the spouse/father of the child (98%, n = 248), grandparents (96%, n = 244), and friends (88%, n = 224) as providing instrumental support, this study further differentiated between maternal and paternal grandmothers and grandfathers. An additional feature in this study not evaluated in Tarrka et al's (1999) or Pridham and Zavoral's (1988) study was that social support networks were measured in the context of infant care practices. Fifty-one percent of first-time mothers reported not receiving hands-on help with routine housework. Comparisons are difficult because of differences in sample size and the inclusion of both primiparas and multiparas.


Instrumental support from formal networks, that is professionals, was reported by very few first-time mothers, with midwives the most notable source of support in this regard. The proximity of midwives in the first few days after the birth of the infant may have contributed to this finding. Although most first-time mothers did not indicate that professionals provided them with instrumental support, it is clear that professionals can make a contribution to mothers in this regard. Midwives and PHNs could advise first-time mothers and their families how best to implement instrumental support. The findings from this study offer a basis for this advice with a particular emphasis on weighting the balance of support between infant care tasks and household tasks.


Emotional support has been suggested by House (1981) as the most important category through which the perception of support is conveyed to others. Similar to previous study findings (Barclay et al., 1997; McVeigh, 1997; Podkolinski, 1998), most first-time mothers reported receiving emotional support from husbands/partners. An additional finding was that most first-time mothers (80%) received emotional support from their own mothers. This finding is interesting because Irish family structure has changed in the past few decades from the extended to the nuclear family. Nevertheless, as evidenced in this study, respondents' own mothers provided emotional support without necessarily having a physical presence.


With regard to the sources of appraisal support, Tarrka et al. (1999) found (similar to this study) that husbands/partners were identified by most first-time mothers. However, a finding not previously identified was the mothers' own mothers as providers of this type of support. Another source of appraisal support not identified in previous studies was PHNs. A finding evident in previous studies but not noted in this study was the appraisal support of other mothers in similar situations to new mothers (Wilkins, 2006), particularly concerning infant feeding (Barclay et al., 1997). Despite their lack of social comparison opportunities with other mothers, first-time mothers in this study overall reported moderate (n = 52) to high (n = 19) levels of appraisal support. This finding compares favorably to Tarrka et al.'s (1999) study, in which appraisal support was reported to be the least common form of social support received by mothers. One reason for a higher percentage of respondents receiving appraisal support in this study may be that in Tarrka et al.'s (1999) study, which targeted mothers when their infants were 3 months old, mothers' experiences of appraisal support had waned over time.


Findings from this study are important because they have differentiated between informal and formal social support sources and functional types of support provided to first-time mothers in the context of infant care practices over a 6-week postpartum period. Nurses can use this information to assist new mothers through anticipatory guidance of what to expect when going home with a new baby.


Social support is not a uniform phenomenon but rather is provided by various sources from first-time mothers' social network with equal consideration. Educational curricula for PHNs and midwives should focus on the evidence about both the structural and functional dimensions of social support in the context of infant care practices. Furthermore, interdisciplinary education programs need to be developed so that PHNs and midwives can work collaboratively in facilitating social support for first-time mothers in caring for their infants, helping them to explore the variety of individuals who could provide different types of support for them. Further research in the area of social support for first-time mothers in the context of first-time motherhood is recommended to extend current knowledge base in relation to outcomes.



Funding was awarded by the Health Research Board, Dublin, Ireland. The author would like to thank all the first-time mothers who participated in the study.




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