The fallacy of normalcy : a multiphase study exploring women’s help-seeking for health problems in the 12 months after childbirth

Post-childbirth morbidities have burdened many women around the world, and women often do not seek treatment for them. Studies suggest that they are inhibited in expressing their needs, and so seek informal rather than professional help for their health problems, though admittedly there is limited evidence about women’s help-seeking behaviour. Therefore, this study aimed to explore the key influences on women’s help-seeking behaviour in the 12 months post-childbirth. Three different study phases were adopted to answer three questions: (i) what evidence exists in the peer-review literature about women’s perceptions of the barriers and facilitators they experience in seeking help from health professionals within the first the 12 months post-childbirth? (ii) What health problems do women feel require help during the 12-month period after childbirth and what is their help‐seeking behaviour? (iii) What do women who participate in post-childbirth online support forum discuss about their health issues? This study was underpinned by a feminist pragmatist paradigm and used a multiphase mixed methods design. Feminist pragmatism considers multiple views and values experience, which provided a useful lens through which to study women’s health problems by hearing women’s voices. In the first study phase, a systematic qualitative meta-aggregation was applied to literature about women’s perceptions of the barriers and facilitators they experience in seeking help from health professionals. The Behavioural Model of Health Service Use (BMHSU) was used as a lens to view the qualitative research evidence. In phase two, concept mapping, an integrative participatory mixed method, was used to study women’s perspectives on help-seeking behaviour for postpartum health problems. Bradshaw`s Taxonomy of Needs was used to explain the results of women’s felt need after childbirth. Concept mapping involved an online group of participants creating 83 brainstorm statements about post‐childbirth health problems and help‐seeking, and a second group of 15 women sorting and rating the statements based on their perception of the prevalence of the issues and the help‐seeking advice they would offer others. For phase three, the content of messages posted by women to an Australian online forum was imported into NVivo 12 Pro for qualitative data analysis. The data were evaluated using directed qualitative content and thematic analysis. The findings showed that women often did not seek professional help because they accepted problems as a normal part of the motherhood role. Women were more likely to share their problems with family and friends as people they trusted. Online platforms have allowed women to share their problems anonymously, but the support provided demonstrated some normalising of abnormal problems. Feminist pragmatism explains why the normalisation of health problems after childbirth dominates help-seeking behaviour for women after childbirth. The views of women, family and friends, and health care providers more closely adhere to ‘the fallacy of normalcy’ than recognition of health problems. Family and friends were successful when they encouraged women to seek professional help, but when women do seek professional help the availability and source of help is important. Some health care providers contribute to ‘the fallacy of normalcy’ for health problems, again decreasing the number of women who can readily access quality care. This thesis highlights a need to reconsider (qualitatively and quantitatively) the approach to care after childbirth for women’s trusted people and healthcare providers by acknowledging ‘the fallacy of normalcy’ if women are to receive timely and appropriate postnatal care. This thesis highlights a need to reconsider (qualitatively and quantitatively) the approach to care after childbirth for women’s trusted people and healthcare providers by acknowledging ‘the fallacy of normalcy’ if women are to receive timely and appropriate postnatal care