The perception of being in control
The women felt that the home visit helped provide security and
calm in a hectic postnatal period. Many of them told us that they
looked forward to the midwife’s visit. The women were aware of what
the midwife could provide, and that the visit was voluntary and
agreed beforehand. The women thus felt that they were prepared for
the visit and in control of the situation:
‘When you come home, it’s much calmer than being in the
hospital, it’s easier to think through the things that you wonder
about or questions to be asked.’
‘It was very good that we were prepared ... that way, the entire
process becomes natural and informal.’
The women felt more secure when receiving support and
confirmation from the midwife.
Prior to the home visit, many of the women had believed that the
visit would entail checking or assessment of the home and of them
as parents. One of the mothers described it as ‘scary’. All the
women described the sense of security and the advantage of
receiving help based on their own needs as the key element of the
‘The impression that I had beforehand, what I learned from
others, was that they come to check that everything is in order in
the house and all that, but certainly also because it was the
midwife, it felt just like having a friend visiting, a friend who
also has the knowledge.’
The women described various experiences of coping associated
with matters being as expected, and that they were able to cope
with new roles and tasks. One woman had a strong perception of
coping in the context of the birth itself. She described it as
important for her to share this experience with the midwife during
the home visit:
‘So that was really great, because now I can finally do it, and
had the confirmation that I can’ (breastfeeding).
‘We did everything ourselves ... I really felt that sense of
The need for knowledge and support
During the home visit, it is crucial that the women receive
answers to their questions, advice and guidance. The participants
described the conversation with the midwife about the pregnancy and
birth as essential for their understanding and confirmation:
‘We had prepared ourselves ... made notes of questions and such,
so that we could ask about what we were unsure of.’
‘Then we talked a lot about the birth ... I really needed that –
that it was her I told what I felt about or what my hopes were
before the birth ... because she had been involved all the way,
even though she hadn’t been present during the birth itself.’
The partner’s role in the home visit was underscored as
essential, because the partner could support the woman. The
partner’s questions and experiences were considered:
‘It was good that he could be there too, then we receive the
same information, and he also had some questions.’
Many reported that preparing adequately for the postnatal period
was difficult, and that manoeuvring through the available
information could present problems:
‘No matter how well one prepares, one can never prepare enough,
because one cannot know what lies ahead.’
The women’s need for counselling and guidance varied from simple
advice and confirmation of normality to more comprehensive guidance
regarding matters such as breastfeeding, the birth or how to cope
with overwhelming emotions. The women reported feeling safer in
their new role after having been provided with support and
confirmation by the midwife:
‘I feel quite a lot more trust in the midwife, it’s because I
know that she’s a midwife, she knows about me too, not just the
‘It’s important to hear when one is so uncertain and emotional
and very fearful of doing something wrong’ (about
Perception of continuity and the relationship to the
The home visit was described as meaningful and informal. The
continuity in the relationship between the woman and the midwife
emerged when the woman reported that the midwife was familiar with
her condition during pregnancy and that the conversation ‘flowed’
immediately. Many described how they continued the conversation
with the midwife during the consultations at the public health
‘With the midwife it’s like: “Hello, how did the birth go?” and
then we just start chatting.’
‘After all, the midwife knows how things have gone from day one,
that makes it a different conversation.’
Many of the women reported that they felt confident in
discussing their emotions and experiences. The relationship to the
midwife was important and appeared to help reinforce the woman’s
sense of coping. One of the women was previously unfamiliar with
the midwife, but described how she felt the visit was useful
because of the help and support that it provided to her:
‘It wouldn’t have been as easy to sit there and be open about
emotions and the birth experience with someone who does not know
you a little from before.’
‘When we were talking and I was telling her about it all, I
could breathe, I felt relieved.’
The women felt confident about their early discharge from the
maternity ward when knowing that the midwife would come in a couple
of days. Because information about the visit was provided
beforehand, the woman could take control of the situation and
choose whether or not to make use of this option. We interpret this
to mean that predictability was important to the women. A Norwegian
study confirms that being able to choose for oneself inspires
confidence (17). Pursuant to the Patients’ and Users’ Rights Act,
the woman is entitled to choose whether or not to accept a home
The fact that the women believed that the visit involved being
checked, can be seen as indicating that the women were in a
vulnerable situation in their new role. The asymmetry of the
situation, in which the woman was in need of the midwife’s help,
may also have had an effect. Ruyter and collaborators claim that
autonomy is not a constant, but varies in light of the condition
and situation of the individual (19). The postpartum woman is in a
vulnerable situation, and it may therefore be said that her
autonomy may be limited. Establishing a good relationship may help
the party involved in the relationship reinforce and regain her
autonomy (20, 21). After the visit, none of the women felt that it
had constituted a control measure. This might be associated with
the fact that the relationship between the woman and the midwife
was known, and that the midwife was skilled in building
All the women felt a need to discuss issues associated with the
child’s weight and breastfeeding.
Other research shows that women who have received home visits
are more satisfied than those who have been in a maternity ward.
This is most likely due to the busy environment at the hospital and
the perceived importance of continuity and relational interaction
between the midwife and the woman (7, 8). When the woman feels
accommodated and trusts the midwife and her skills, she can work to
enhance her own insight and self-confidence through this
relationship. Thereby, she obtains a better opportunity to make
correct and autonomous decisions for herself and her child. This is
crucial in the formation of a secure basis for the ties between
mother and child, as well as for the child’s health in later life
The need for knowledge and support
At the stage when breastfeeding had barely started, guidance in
breastfeeding and feeding was essential. Breastfeeding is
appropriate both in terms of child nutrition and bonding. Guidance
on breastfeeding in the early postnatal period, combined with home
visits, may help sustain breastfeeding over time (22, 23). All the
women felt the need to discuss issues associated with the child’s
weight and breastfeeding. Other important topics included how to
understand the child’s signals, sleep balance and the woman’s own
This study shows that the ability to accommodate the child’s
needs may help the women to feel a sense of coping. Other studies
confirm that the child’s health and well-being are crucial for the
mothers’ feeling of confidence (6, 24, 25). Seemingly, when the
women felt confident about the condition of the child, they could
start thinking of themselves and their own needs. Talking about the
birth was important to the women. We interpret this to mean that a
discussion of expectations and actual experiences could help
enhance the understanding of the birth process. Most of the women
described it as appropriate and natural to have this conversation
with the midwife, whom they knew from before. However, one woman
described it as rewarding despite her not having previous
acquaintance with the midwife.
The women felt confident in talking to a midwife they knew from
their pregnancy period.
Aune et al. found that during the home visit, attention was
focused on perceptions and experiences from pregnancy and birth,
more than on future events (9). These findings may confirm that the
perception of coherence and understanding of the process are
important to the women. This may corroborate the argument that
midwifery skills are crucial in the early postnatal period. The
women expressed difficulty in preparing adequately for the
postnatal period, and felt secure when the midwife could contribute
her knowledge and skills. Women may need support to take care of
themselves during the first week of the postnatal period (26,
The objective of the guidance is to support the woman and to
provide her with better knowledge and skills to enhance her
self-confidence and self-efficacy. She can thus better address her
new life situation and have power, influence and control of the
situation (27, 28). The study appears to show that attention to
individual needs and the ability to cope helped promote empowerment
in the woman, which is consistent with other studies (8, 9,
Having their partner present during the home visit was important
for the majority of the women. Giving both of them the opportunity
to discuss their questions and thoughts may help bolster the
chances of a positive and equal collaboration in their new family
setting (30, 31). If the woman is provided with information to be
shared later with her partner, this may result in an asymmetric
relationship (19, 20).
Perception of continuity and the relationship with the
The study shows that the women felt confident in speaking with a
midwife they knew from their pregnancy period and who had
competence with regard to the newborn child as well to them as
women. The continuity in the relationship is claimed to help
bolster the women’s trust in the midwife’s expertise, advice and
guidance, and in addition, the midwife can reinforce the women’s
trust in their own resources (9, 32).
Many of the women described how they were overwhelmed by the
initial period. The postnatal period is a vulnerable time for the
woman because of the major changes that occur in her life (20, 33,
34). The midwife’s skills in communication and
relationship-building appear to have an impact on the benefits that
the woman derives from the home visit. Razurel et al. emphasise
that emotional and social support is more crucial than practical
knowledge during the early postnatal period (35). Whether the women
were facing challenges or a normal process appeared to have little
bearing on the need to obtain support or confirmation from the
midwife. The support and confirmation that the midwife gave
regarding the women’s choices or understanding of the situation
could provide them with confidence, self-efficacy and a sense of
coping. These are the main elements of empowerment thinking and can
thus be interpreted as evidence that the midwife may help promote
empowerment in the woman (11, 28).
The midwife may use her skills and previous relationship with
the mother to accommodate her individual needs (32, 36). This could
be an opportunity for continuity, even if the woman and the midwife
are not known to each other from the pregnancy period. The
midwife’s professional skills may help the woman perceive
consistency and continuity in her understanding of the process.
Studies show that women are greatly satisfied with the information
and guidance provided by the midwife during the home visit (7,
Whether the women were facing challenges or a normal process
appeared to have little bearing on the need to obtain support or
confirmation from the midwife.
The tasks of the midwife and the health visitor overlap during
the home visit; for example, both may provide guidance on
breastfeeding. They both focus on health promotion and include the
family, the woman and the newborn child, but they possess different
skills. The midwife’s skills include maternal health, pregnancy,
birth and the postnatal period (37). She makes a home visit one to
six days after the woman’s discharge from hospital, when she mainly
focuses on the woman and the newborn child. The midwife may, for
example, help strengthen the woman in her new life situation, which
may assist in developing her skills as a mother. The health visitor
has competence with regard to children, adolescents and their
families (38). She makes a home visit six days to two weeks after
discharge, focusing on the child’s health and development within
the family. The health visitor may, for example, help in
establishing positive bonding and good family relationships.
Better collaboration and understanding between health visitors
and midwives during home visits may help better adapt the follow-up
options for the early postnatal period to the woman, the child and
the individual needs of the family. Moreover, it is likely that
better interdisciplinary collaboration and familiarity with each
other’s competencies may help ensure a better utilisation of
resources and competencies.
Validity of the study
The study elucidates the perceptions and experiences of women
from home visits by a municipal midwife in the early postnatal
period. This topic has not previously been highlighted in Norwegian
studies. The first author is a midwife with experience from
community midwifery services. She is familiar with the conditions
related to the topic that the study seeks to explore. This
knowledge may help lend considerable relevance to the questions in
the interview guide, but may also entail the risk that certain
elements are overlooked or underestimated. We attempted to reduce
this risk by clarifying our preconceptions throughout the research
process (12, 16, 39).
The fact that the first author is a midwife may have influenced
the women, causing them not to report any negative aspects out of
fear of appearing unfriendly. To reduce the risk of such an effect,
the first author informed the participants about her role as a
researcher prior to the interview. No questions related to
midwifery were brought up during or after the interview.
Reflections were noted immediately after the interview and used for
purposes of validation during the analysis. We believe that
undertaking the interviews in the woman’s home environment helps
reinforce the validity and credibility of the study (40). The women
were recruited by locally employed midwives on the basis of
availability, which may have had an effect, in that the women’s
attitude to home visits by a midwife was known in advance (15).
Efforts were made to reduce this effect by recruiting the women
consecutively after the home visits had been undertaken. This may
help enhance the validity of the study.
The study shows that a community midwife may help establish a
perception of consistency and continuity by maintaining regular
contact with the woman throughout the pregnancy until the home
visit. The visit may provide an opportunity to accommodate the
women’s individual needs, in light of the previously established
relationship and the midwife’s competence in maternal health,
pregnancy, birth and the postnatal period. When the woman feels
that she is regarded as ‘an expert on her own situation’, is
permitted to participate in the process of identifying the best
solutions and thus remain in control of her own life situation,
this may help reinforce her empowerment.
Home visits by a midwife may thus help advance the woman’s
perception of coping and reinforce her empowerment, which will
promote the health of the woman, the child and the family. The
midwife and the health visitor possess different skills, and home
visits by both may be appropriate in terms of health promotion.
Interdisciplinary collaboration is important, and more research on
how best to make use of resources and skills is needed.
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