Effect of Internet Plus-based postpartum healthcare services on postpartum depression of primipara and growth and development of neonates

Abstract

BACKGROUND

First-time mothers may encounter various problems during postpartum, which can result in negative emotions that can affect infant care. In today’s Internet era, continuous nursing services can be provided to mothers and their babies after delivery through Internet-based platforms. This approach can help reduce negative emotions of primiparas and promote better health for both mothers and babies.

AIM

To explore the effect of Internet Plus-based postpartum healthcare services on postpartum depression of primiparas and neonatal growth and development and thus provide a scientific basis for strengthening postpartum healthcare measures and better protect maternal and child health.

METHODS

The study retrospectively collected data of primiparas and their newborns who underwent prenatal examination and successfully delivered at the Ninth People’s Hospital of Suzhou City. The observation group included 30 primiparas and their newborns who received Internet Plus-based postpartum healthcare services between July and December 2024. According to the principle of matching (1:1) control study, the control group included 30 primiparas and their newborns who received routine postpartum healthcare services between January and June 2024. The maternal role adaptation questionnaire scores, breastfeeding rates, Edinburgh postnatal depression scale (EPDS) scores, and newborn growth and development (height, head circumference, and weight) were compared between the two groups at the time of discharge after delivery and 6-week postpartum follow-up.

RESULTS

Upon hospital discharge, the two groups did not demonstrate significant differences in maternal role adaptation scores, breastfeeding rates, EPDS scores, as well as newborn height, head circumference, and weight at birth (P > 0.05). At the 6-week postpartum follow-up, the maternal role adaptation score and breastfeeding rate were higher in the observation group than in the control group (P < 0.05). In addition, one case of postpartum depression was reported in the observation group and eight in the control group. Moreover, the control group exhibited a significant increase in EPDS scores compared with scores at hospital discharge (P < 0.05), whereas the observation group showed only a marginal, nonsignificant increase in EPDS scores (P > 0.05). The EPDS score of the observation group was significantly lower than that of the control group (P < 0.05), indicating a lower risk of postpartum depression in the observation group. The length, head circumference, and weight of the newborns 6 weeks after birth were increased compared with those at birth, and the growth rate was higher in the observation group than in the control group (P < 0.05), indicating better growth and development in the observation group.

CONCLUSION

Internet Plus-based postpartum healthcare services improve maternal role adaptation, increase breastfeeding rates, mitigate postpartum depression risk, and promote neonatal growth and development in primiparas.

Key Words: Internet Plus; Postpartum health services; Primiparas; Postpartum depression; Newborn; Growth and development

Core Tip: Primiparas are at a higher risk of experiencing postpartum depression, which can negatively affect the growth and development of their newborns owing to their limited parenting experience. This study focuses on the introduction of Internet Plus-based postpartum healthcare services to effectively improve maternal role adaptation and increase breastfeeding rates among primiparas. This approach was found to positively contribute to reducing postpartum depression and promoting neonatal growth and development.

INTRODUCTION

During puerperium, the maternal physiology remarkably changes, along with changes in psychological adaptation characteristics, physical recovery following delivery, and considerations related to infant care, breastfeeding, etc. Women who do not receive scientific and reasonable treatments and postpartum healthcare services following delivery are often prone to anxiety, irritability, depression, and other negative emotions, which in turn increases the risk of postpartum depression[1]. Relevant studies have shown that postpartum depression affects not only the mental health of mothers but also the quality of life, interpersonal relationships, and social function of mothers[2], which contributes to the inability of mothers to effectively take care of their newborns and affects the normal development of the newborn’s emotions, cognition, and behavior[3]. Another study showed that severe postpartum depression can lead to hallucinations, suicide, or infanticide, which have negative effects on family and social stability[4]. At present, China’s postpartum healthcare services are mainly based on health education before hospital discharge, supplemented by regular telephone follow-up (such as asking about the status of mothers and newborns and giving corresponding guidance and suggestions). This model lacks the necessary binding force on maternal self-behavior, resulting in poor outcomes. Therefore, further examination on ways to enhance and ensure effective postpartum healthcare services for both mothers and infants is necessary, as this is an important strategy for preventing postpartum depression and promoting neonatal growth and development. After successful delivery, mothers are usually discharged as soon as possible to rest at home. Consequently, mothers typically have a short hospital stay, being discharged 3-4 days after delivery. This limited time prevents primiparas who have no childbirth and parenting experience from fully understanding postpartum self-care, neonatal care, neonatal feeding, and other related knowledge, and often encounter other problems when returning home[5]. These conditions are more likely to cause postpartum depression and may affect neonatal growth and development. A study showed that an Internet Plus-based continuous service management model demonstrated a positive effect on improving the psychological and emotional views of pregnant women[6]. Therefore, this study aimed to explore the effect of Internet Plus-based postpartum healthcare services on postpartum depression and neonatal growth and development in primiparas to provide a scientific basis for strengthening postpartum healthcare measures and better protect maternal and child health.

MATERIALS AND METHODS

Research participants

This retrospective study enrolled primiparas who received antenatal care and delivered without complications at Suzhou Ninth People’s Hospital, along with their neonates. Beginning in July 2024, our hospital implemented the Internet Plus-based postpartum healthcare service for mothers and infants. Thirty primiparas and their neonates receiving this intervention between July and December 2024 were selected as the observation group. Following the matched (1:1) case-control study principle, 30 primiparas and their neonates receiving routine postpartum care between January and June 2024 were assigned to the control group.

Inclusion and exclusion criteria

Inclusion criteria: (1) Primiparas age ≥ 18 years; (2) Singleton pregnancy and full-term delivery; (3) Ability to read, write, and communicate; (4) Living in the city or the surrounding area of the city and have access to Internet services; (5) Discharge from hospital 3-4 days after delivery; and (6) Provision of informed and signed consent.

Exclusion criteria: (1) A history of mental illness; (2) Diagnosis with depression before delivery; (3) A history of mental illness in direct relatives; (4) Physical disability; (5) Medical disputes with hospitals; (6) Unclear questionnaire content and inability to fill out the questionnaire; (7) Serious deformity in the newborn; and (8) Presence of serious postpartum complications, such as postpartum hemorrhage and infection.

Intervention methods

The control group received routine postpartum healthcare services. Nursing staff provides routine health education to postpartum women before hospital discharge, such as postpartum exercise guidance, medication guidance, psychological counseling, breastfeeding guidance, newborn health guidance, and primary caregiver health education. Moreover, they verify the information of the parturient, conduct regular telephone follow-up after the hospital discharge, inquire about the current situation of the parturient and newborn, patiently answer any questions that the parturient may have during the recovery period, and provide guidance and suggestions based on the situation. If the problem cannot be solved through telephone communication, the nursing staff instructs the parturient to return to the hospital for reexamination as soon as possible.

The observation group also received Internet Plus-based postpartum healthcare services in addition to the routine postpartum healthcare services. Specifically: (1) The extended obstetric service system offers access to “medical care and online consultations”. It supports various applications, such as WeChat public account, Alipay, and mini-programs, creating a user service entry according to the actual needs of the project; (2) After delivery, the puerpera is encouraged to input her personal information into the platform, including her health status and family circumstances. This allows the hospital to gain insight into her specific needs and promptly deploy nursing staff familiar with those needs and provide on-site nursing services, maternal and child care, health education, and other services for the puerpera, her family, and newborn; (3) To ensure that all primiparas continue to receive better postpartum nursing services after discharge, the obstetric extension service system platform disseminates weekly information on postpartum depression, postpartum nursing and rehabilitation, neonatal feeding and nursing care, common neonatal diseases and nursing care, and the interaction between the parturient and her newborn. The information was combined into an engaging popular science essay using both text and pictures, allowing mothers to understand and access postpartum healthcare at any time; and (4) The platform also outlines the specific charging standards of the on-site service items provided by the nursing staff. Parturients choose nursing services according to their actual needs, such as care for postpartum perineal wound care, perineal suture removal, lactation support, neonatal jaundice detection, neonatal foot blood collection, neonatal umbilical disinfection care, and neonatal bathing. Upon receiving the maternal request order, the postpartum healthcare service department first evaluates the maternal information and then sends the order. After receiving the order, the obstetric medical staff promptly provides on-site services. During this process, the staff inquire about the mother’s wound healing and uterine contractions, outline postpartum precautions to prevent postpartum complications, explain the benefits of breastfeeding, and guide the mother on proper vulval and breast care in her daily routine. Moreover, the staff guide the family members in assisting the primipara with standardized breastfeeding techniques, help them master baby-holding postures, lactation skills, feeding methods, neonatal bathing, skin care, umbilical care, and diaper replacement. This support can boost the confidence of the primipara in feeding her baby and ensure the healthy growth and development of the newborn. The staff also encourages increased communication between family members and primiparas, allowing them to feel the support of their families. Moreover, family members and primiparas are encouraged to watch children’s songs and dances and parent-child programs together to strengthen their bonds and help primiparas in transitioning to a new role. In addition, for mothers experiencing negative emotions or those lacking parenting knowledge, postpartum health care service personnel should provide psychological counseling, patiently listen to their concerns, and actively help them alleviate negative emotions.

Observation indexes

(1) General data collection: A general data sheet was used to collect maternal age, education level, place of residence, mode of delivery, pregnancy complications (such as gestational hypertension and gestational diabetes), neonatal sex, and other related information; (2) Maternal role adaptation: The maternal role adaptation questionnaire was used to assess primiparas upon hospital discharge and 6 weeks after delivery. The questionnaire included role cognition, care behavior, and parent-child attachment, with a total of three dimensions and 16 items. A 5-level Likert (1-5 points) scoring method was used. The total questionnaire score was 16-80 points: The higher the score, the higher the maternal role adaptation; (3) Breastfeeding rate: The exclusive breastfeeding rates at discharge and 6 weeks postpartum were compared; (4) Evaluation of postpartum depression: The Edinburgh postnatal depression scale (EPDS) was utilized to assess the presence of depression among primiparas upon hospital discharge and again 6 weeks postpartum in the outpatient department. This scale consists of 10 items, encompassing mood, enjoyment, crying, self-blame, self-harm, sadness, depression, coping ability, fear, and insomnia. Each item offers four response options: Never (0 points), occasionally (1 point), often (2 points), and always (3 points). The total score ranges from 0 to 30 points. A score ≥ 9 points indicates postpartum depression[7], and a higher score reflects a greater severity of postpartum depression; and (5) Assessment of newborn growth and development: At birth and during the outpatient follow-up at 6 weeks, neonatal length, weight, and head circumference were measured to assess and analyze the growth and development indicators of both groups of newborns.

Statistical analysis

IBM SPSS version 25.0 was used for data analysis. The measurement data were first confirmed to conform to the normal distribution by the Shapiro-Wilk method, expressed as mean ± SD, and the two groups were compared by the independent sample t-test. The adoption rate and composition ratio of the count data were expressed as n (%), and the two groups were compared using the χ² test. P < 0.05 indicated a significant difference.

RESULTS

Comparison of baseline data between the two groups

No significant difference was found in the baseline data of age, education level, place of residence, mode of delivery, pregnancy complications, neonatal sex, and neonatal birth length, head circumference, and birth weight between the two groups (P > 0.05; Table 1).

Table 1 Comparison of baseline data between the two group, n (%).

Baseline information	Control group (n = 30)	Observers group (n = 30)	t/χ2 value	P value
Age (years), mean ± SD	26.43 ± 2.76	26.92 ± 2.98	0.661	0.511
Standard of culture			0.071	0.791
High school and below	11 (36.67)	12 (40.00)
College or higher	19 (63.33)	18 (60.00)
Place of abode			0.067	0.796
Cities and towns	14 (46.67)	15 (50.00)
Rural district	16 (53.33)	15 (50.00)
Delivery method			0.341	0.559
Natural birth	23 (76.67)	21 (70.00)
Caesarean birth	7 (23.33)	9 (30.00)
Pregnancy complications			0.577	0.448
Not have	3 (10.00)	5 (16.67)
Have	27 (90.00)	25 (83.33)
Gender of newborn			0.069	0.793
Male baby	17 (56.67)	18 (60.00)
Female infant	13 (43.33)	12 (40.00)

Comparison of each dimension score and total score of maternal role adaptation between the two groups

No significant difference was noted in the role cognition, care behavior, parent-child attachment, and total scores of role adaptation between the two groups on hospital discharge (P > 0.05). At the 6-week postpartum follow-up, the observation group had higher scores in role cognition, caregiving behavior, parent-child attachment domains and overall role adaptation score than the control group (t = 2.285, 3.331, 3.012, and 3.434, respectively, P < 0.05; Table 2, Figure 1).

Figure 1 Differences in maternal role adaptation. A: Role cognition score; B: Care behavior score; C: Parent-child attachment score; D: The total score of role adaptation. ^aP < 0.05.

Table 2 Comparison of maternal role adaptation scores between the two groups, mean ± SD.

Index (point)	Stage	Control group (n = 30)	Observers group (n = 30)	t value	P value
Role cognition score	When leaving hospital after delivery	12.58 ± 2.74	12.45 ± 3.16	0.170	0.865
	At 6 weeks postpartum	17.75 ± 3.98a	20.11 ± 4.02a	2.285	0.026
Care behavior score	When leaving hospital after delivery	9.24 ± 2.16	9.12 ± 2.13	0.217	0.829
	At 6 weeks postpartum	12.47 ± 2.51a	14.83 ± 2.96a	3.331	0.002
Parent-child attachment score	When leaving hospital after delivery	10.29 ± 2.15	10.25 ± 2.07	0.073	0.941
	At 6 weeks postpartum	13.54 ± 2.76a	16.94 ± 3.38a	3.012	0.004
Total score of role adaptation	When leaving hospital after delivery	32.11 ± 5.54	31.82 ± 5.17	0.209	0.835
	At 6 weeks postpartum	44.76 ± 7.43a	51.88 ± 8.59a	3.434	0.001

^aP < 0.05.

Comparison of breastfeeding rates between the two groups

No significant difference was found in the exclusive breastfeeding rates between the two groups upon discharge after delivery (P > 0.05). At the 6-week postpartum follow-up, the exclusive breastfeeding rate was significantly higher in the observation group than in the control group (P < 0.05; Table 3).

Table 3 Comparison of breastfeeding rates between two groups of primiparous, n (%).

Index	stage	Control group (n = 30)	Observers group (n = 30)	χ2 value	P value
Exclusive breastfeeding rate	When leaving hospital after delivery	14 (46.67)	13 (43.33)	1.071	0.301
	At 6 weeks postpartum	18 (60.00)	26 (86.67)	5.455	0.020

Comparison of EPDS scores between the two groups

At the time of delivery and discharge, two groups did not show signs of postpartum depression, and the difference in EPDS scores was not significant (P > 0.05). However, at the 6-week postpartum follow-up, one case of postpartum depression was noted in the observation group and eight cases in the control group. The control group exhibited a significant increase in EPDS scores at the 6-week postpartum follow-up compared with scores at hospital discharge (P < 0.05), whereas the observation group showed only a marginal, nonsignificant increase in EPDS scores during the same period (P > 0.05). The EPDS score of the observation group at 6 weeks postpartum was significantly lower than that of the control group (P < 0.001; Table 4, Figure 2).

Figure 2 Comparison of Edinburgh postnatal depression scale scores between the two groups of primiparas. EPDS: Edinburgh postnatal depression scale. ^aP < 0.05.

Table 4 Comparison of Edinburgh postnatal depression scale scores between the two groups of primiparas, mean ± SD.

Index	Stage	Control group (n = 30)	Observers group (n = 30)	t value	P value
EPDS score (points)	When leaving hospital after delivery	5.03 ± 1.18	5.17 ± 1.25	0.446	0.657
	At 6 weeks postpartum	7.98 ± 2.53a	5.66 ± 1.28	4.482	< 0.001

^aP < 0.05.

EPDS: Edinburgh postnatal depression scale.

Comparison of neonatal growth and development between the two groups

No significant difference was found in neonatal length, head circumference, and weight between the two groups at birth (P > 0.05). At the 6-week follow-up after birth, the length, head circumference, and weight of both groups increased compared with those at birth, and the growth rate of the observation group was greater than that of the control group (P < 0.001; Table 5, Figure 3).

Figure 3 Differences in growth and development of newborns. A: Newborn length; B: Newborn head circumference; C: Newborn weight. ^aP < 0.05.

Table 5 Comparison of neonatal growth and development between the two groups, mean ± SD.

Index	Stage	Control group (n = 30)	Observers group (n = 30)	t value	P value
Neonatal length (cm)	At birth	49.32 ± 2.28	49.05 ± 2.19	0.468	0.642
	Born 6 weeks	55.54 ± 4.12a	59.25 ± 3.76a	3.643	< 0.001
Neonatal head circumference (cm)	At birth	33.15 ± 1.63	33.12 ± 1.58	0.072	0.943
	Born 6 weeks	35.23 ± 1.85a	36.74 ± 1.98a	3.052	0.003
Birth weight (kg)	At birth	3.34 ± 0.65	3.26 ± 0.74	0.445	0.658
	Born 6 weeks	4.81 ± 0.79a	5.59 ± 0.85a	3.682	< 0.001

^aP < 0.05.

DISCUSSION

Postpartum women experience a decline in estrogen and progesterone levels, reduced catecholamine secretion, and endocrine imbalances, which can lead to emotional instability and delay postpartum recovery[8]. In particular, primiparas undergo tremendous psychological, physiological, and social changes as they transition from pregnancy to childbirth and then to motherhood for the first time. Inadequate adaptation to this role transformation may result in emotional fluctuations and even postpartum depression. Slomian et al[9] demonstrated that the maternal emotional state is closely associated with neonatal growth and development. Hassan et al[10] further suggested that postpartum depressive symptoms may cause mothers to develop significant aversion toward breastfeeding and infant crying, leading to neglect of breastfeeding and subsequent effects on infant development. These findings emphasize how maternal postpartum depression can adversely affect neonatal growth. Related studies have shown that good maternal role adaptation can reduce negative postpartum emotions, improve lactation to a certain extent[11], and promote neonatal growth and development[12]. Owing to the lack of maternal role experience, adopting a new role after delivery is challenging. Therefore, providing good-quality postpartum health services is essential for primiparas.

Most puerperium women expect that care teams continuously offer professional guidance on parenting and self-care during the postpartum period[13]. Therefore, assisting primiparas in strengthening the mother-infant bond and addressing negative emotions can have a lasting positive effect on the well-being of mothers and the growth and development of newborns[14]. In this study, the role cognition, caregiving behavior, parent-child attachment score, and overall role adaptation scores of the observation group were higher than those of the control group at the 6-week postpartum follow-up. This indicates that primiparas receive postpartum health care services, with the help of Internet Plus to build an obstetric extension service system framework that can help provide maternal and infant postpartum healthcare services, ensuring the delivery of effective postpartum healthcare services for primiparas. For example, by utilizing the Internet Plus platform, we can share popular science essays that feature a combination of words and images, such as interactions between mothers and their newborns. This provides primiparas access to essential information during the postpartum period, thereby strengthening the bond between mothers and their newborns and aiding them in their adjustment to motherhood[15].

Moreover, compared with the control group, the observation group had a significantly higher exclusive breastfeeding rate at 6 weeks postpartum. This may be attributed to the Internet Plus-based postnatal healthcare services, which not only highlight the importance of early mother-baby contact but also promote the benefits of exclusive breastfeeding for both newborns and mothers. Consequently, mothers are likely to gain confidence in exclusive breastfeeding and actively engage in exclusive breastfeeding[16].

Through the platform, mothers can also seek online consultations on newborn diseases and care, feeding practices, and other related topics, which can alleviate the anxiety of those having difficulty obtaining information on newborn health. Andreu-Pejó et al[17] showed that utilizing the Internet to understand maternal emotional status can help in alleviating maternal negative emotions. In this study, only one case of postpartum depression occurred in the observation group at 6 weeks postpartum, whereas eight cases of postpartum depression were recorded in the control group. At 6 weeks postpartum, the EPDS score of the observation group was significantly lower than that of the control group, indicating the effectiveness of the Internet Plus-based postpartum healthcare services for primiparas. For example, the use of the Internet Plus-based platform to share scientific information related to postpartum depression can reduce, to a certain extent, psychological distress among primiparas. Moreover, through the door-to-door nursing setup, primiparas can request for home care services when they encounter some issues. When a medical staff visits primiparas for in-home care, they can assess maternal wound healing and uterine contractions on-site while addressing maternal and infant problems that primiparas encounter during the postpartum period. This on-site support can effectively reduce maternal worries and anxiety, thereby reducing the risk of postpartum depression. Conversely, routine postpartum healthcare services typically rely on telephone follow-up to provide guidance and suggestions based on maternal demands, which may be challenging for primiparas without parenting experience. The Internet Plus-based postpartum healthcare service is mainly based on the demands sent by the mothers through the online platform, and the nursing staff then provides door-to-door nursing care. During the on-site nursing visits, the medical staff can also provide psychological counseling to help the puerpera learn some effective emotional release methods and build their confidence in parenting. By actively helping primiparas alleviate negative emotions, the risk of postpartum depression can be reduced. Many studies have shown that breastfeeding can reduce the risk of postpartum depression[18-20] while supporting the growth and development of newborns. In this study, the length, head circumference, and weight of newborns in the observation group were significantly higher than those in the control group 6 weeks after birth. This may be attributed to the Internet Plus-based postpartum healthcare service platform that regularly provides primiparas with information on neonatal breastfeeding and feeding methods, highlighting the importance of breastfeeding and ensuring the growth and development of newborns. Alahmed et al[21] showed that Internet-based breastfeeding education can improve the exclusive breastfeeding rate 1 month after birth, which also supports the results of the present study. Therefore, through the Internet Plus-based model, medical staff can promptly respond to feeding concerns raised by primiparas on the online platform. This approach not only improves maternal’s understanding of neonatal feeding practices but also effectively reduces the time cost on primiparas. Moreover, this leads to increased breastfeeding rates and the number of breastfeeding mothers, ensuring the growth and development of newborns.

This study has some limitations. Although this study found that Internet Plus-based postpartum healthcare services have a positive effect on reducing postpartum depression and promoting the growth and development of newborns, this is a single-center retrospective study analyzing a small sample. Thus, it may not fully represent different populations. Therefore, future studies are encouraged to analyze a large sample and conduct multicenter prospective analysis to further verify the findings of this study.

CONCLUSION

Internet Plus-based postpartum healthcare services can improve the role adaptation of primiparas, increase the breastfeeding rate, promote the growth and development of newborns, and reduce the risk of postpartum depression of parturients.