INTRODUCTION:

The lived experiences and perceived consequences of postnatal care among women who are in the process of receiving services at the Federal Medical Centre (FMC) Umuahia in Abia State in Nigeria expose the intricately complex dynamic between factors in the healthcare system, social-cultural forces, and individuals' expectations. Postnatal care is a critical window of opportunity for both the mother and newborn where complications can be identified and managed to curb morbidity and mortality (Lawn et al., 2014; WHO, 2018; Tura et al., 2020; Abor et al., 2017; Okeke et al., 2021). Women's experiences at FMC Umuahia confirm that though the organizational capacity for offering routine postnatal care is in general adequate enough, gaps in the process of delivering services and interactions between people are primary determinants of patient satisfaction and outcomes (Umeora and Egwuatu, 2013; Nnebue et al., 2014; Nwankwo et al., 2019; Oladapo et al., 2017; Ugochukwu et al., 2018). These organizational circumstances converge with social-cultural expectations and social norms in Abia State where customary postpartum beliefs guide women's approaches to formal health intervention (Eze et al., 2016; Nwosu et al., 2020; Onah et al., 2015; Iheanacho and Agbakwuru, 2022; Chukwu et al., 2019). The plurality of forces emphasizes the need to site postnatal care in the lived worlds of Nigerian women.

The women's perceptions of the quality of postnatal care at FMC Umuahia are primarily structured by the presence of skilled health workers and medical infrastructure, which give women confidence in the safety of the institution (Ibekwe et al., 2019; Okafor and Nwosu, 2021; Onwujekwe et al., 2018; Eze et al., 2017; Obi et al., 2022). However, such trust is periodically eroded by negative experiences in the personal relationship between women and healthcare workers in terms of perceived rudeness or neglectness from healthcare workers, which can reduce women's desire to pursue subsequent care (Okeke et al., 2019; Akinyemi et al., 2017; Umeora et al., 2018; Nnebue et al., 2015; Onoh et al., 2020). These findings correlate with larger patterns in Nigeria's maternal health care where disrespect and abuse of women in maternity care have been reported (Ogbuabor and Onwe, 2018; Adebayo et al., 2016; Okonofua et al., 2018; Ojelade et al., 2021; Akintayo et al., 2019). The contrast between technical proficiency and interpersonal deficiency highlights the necessity for integrated solutions in which both the clinical quality of care and respectful maternity care are combined to enhance postnatal service experiences.

Socio-cultural practices have significant impacts on women's postnatal care experiences, especially through the cultural phenomenon of ‘Omugwo’ – postpartum care through either the new mother's mother or older female relatives' support and attentions (Onwuka et al., 2020; Eze et al., 2018; Nwosu et al., 2017; Okeke et al., 2016; Ibeziako et al., 2019). Highly entrenched in the local culture of Abia State, the practice of ‘Omugwo’ has considerable psychosocial benefits such as emotional support and support in the care of the infant with positive impacts on the well-being of the mother (Umeh et al., 2019; Nwankwo et al., 2020; Eze et al., 2021; Chukwuma and Umeora, 2017; Akachukwu and Onwuliri, 2015). However, ‘Omugwo’ can bring conflicting advice in infant care contrary to biomedical advice at FMC Umuahia and may bring about confusion and incoherent care (Onah et al., 2018; Uzochukwu et al., 2019; Iheanacho and Agbakwuru, 2022; Eze et al., 2019; Okeke et al., 2020). The conflict between postpartum care as seen in the culture and modern health practices reveals the difficulty of harmonizing cultural values with evidence-based medicine in postnatal care situations in Nigeria. The perceived impacts of postnatal care for women at FMC Umuahia present a dichotomy between observed improvements in health and persistent concerns related to the adequacy of services. Most women corroborate positive health impacts like prompt detection and control of postpartum complications, efficient breastfeeding support, and psychological reassurance as attributed to the quality of professional care (Okeke et al., 2021; Nwankwo et al., 2019; Umeora and Egwuatu, 2013; Eze et al., 2017; Obi et al., 2022). However, others complain of dissatisfaction in terms of postnatal follow-up frequency and continuity due to prolonged waiting times at clinics with short operational hours and lack of attention to the psychological well-being of mothers (Nnebue et al., 2015; Onoh et al., 2020; Okeke et al., 2019; Akintayo et al., 2019; Ibekwe et al., 2019). The disparity in observed outcomes among these women illustrates structural and operational barriers in the healthcare system, calling for improved integration of services and resource input to enhance postnatal care at FMC Umuahia.

The socio-economic factors have the most significant impact on women's use of and participation in postnatal care services. Women who belong to higher socio-economic classes have higher health knowledge, means of transportation, and economic capacity to visit the postnatal unit as scheduled, which is related to better maternal and newborn health outcomes (Okafor and Nwosu, 2021; Onwujekwe et al., 2018; Obi et al., 2022; Akinyemi et al., 2017; Umeora et al., 2018). On the other hand, economically disadvantaged women are hampered by transport charges, competing domestic demands for their time and attention, and lack of postnatal care awareness for their importance, culminating in missed appointments and postponed health-seeking activities (Nwankwo et al., 2020; Okeke et al., 2021; Onoh et al., 2020; Eze et al., 2019; Onah et al., 2018). These disparities perpetuate inequities in maternal health outcomes and require intervention efforts aimed at enhancing the use of postnatal services among susceptible populations in Abia State. Family and community support systems also influence women's experiences of postnatal care at FMC Umuahia. Male partner and community health worker involvement has been demonstrated to enhance awareness and uptake of facility-based postnatal care and improve utilization and adherence to health advice (Umeh et al., 2019; Chukwu et al., 2019; Ibeziako et al., 2019; Akachukwu and Onwuliri, 2015; Iheanacho and Agbakwuru, 2022). On the other hand, existing beliefs in communities favoring home postpartum care and reservations about biomedical intervention lead to underutilization of formal services (Nwosu et al., 2017; Onah et al., 2018; Eze et al., 2019; Okeke et al., 2020; Uzochukwu et al., 2019). This presents the need for culturally appropriate health promotion and engaging communities in order to bridge the gaps between modern healthcare and traditional practices.

Analyzing the perceived consequences and experiences of postnatal care at FMC Umuahia reveals how better maternal and new-born health is best achieved through multi-level intervention aimed at moving beyond clinic-level care. Effort must go into building healthcare providers' communication skills and encouraging respectful maternity care in order to build patient trust and satisfaction (Okeke et al., 2019; Ogbuabor and Onwe, 2018; Adebayo et al., 2016; Okonofua et al., 2018; Ojelade et al., 2021). In addition to this, building interaction between formal health systems and cultural practices like ‘Omugwo’ will help in diminishing conflicting advice on care and increase adherence to postnatal practice recommendations (Onwuka et al., 2020; Eze et al., 2018; Chukwuma and Umeora, 2017; Akachukwu and Onwuliri, 2015; Umeh et al., 2019). Removal of socio-economic barriers through policy- and community-level intervention is needed to promote equitable postnatal care access, and engaging family and members of the population helps in enhancing support networks and positive health attitudes (Nwankwo et al., 2020; Obi et al., 2022; Iheanacho and Agbakwuru, 2022; Chukwu et al., 2019; Umeh et al., 2019). At its core, the experiences of women in FMC Umuahia highlight that high-quality postnatal care is not just the availability of services but also the extent to which care is culturally appropriate, respectful, accessible, and responsive to the unique needs of each client. Interventions in the future should focus on humanized care, engaging the community, and socio-economic support systems to maximize both perceived and actual postnatal outcomes in Abia State and other settings in Nigeria (Lawn et al., 2014; WHO, 2018; Nwankwo et al., 2019; Okeke et al., 2021; Umeora and Egwuatu, 2013).

METHODS:

Study design:

The mixed-methods phenomenological research design was employed in this research to examine women's lived experience and perceived experiences of postnatal care at the Federal Medical Centre (FMC) in Abia State, Nigeria. The research combined quantitative measures of service utilisation and satisfaction with qualitative accounts of emotional and subjective experiences. The mixed-methods research guaranteed in-depth comprehension of both tangible patterns and contextual meaning women ascribe to postnatal care.

Inclusion criteria:

The postpartum women who had given birth at FMC Umuahia and utilized at least one postnatal care service within six weeks of childbirth comprised the population for the study. A total of 248 women completed the quantitative survey, and 10 of the participants were purposively selected for in-depth qualitative interviews. Ethical clearance was obtained from the Institutional Review Board of the hospital and informed consent from all the participants.

Instrumentation and data collection:

Quantitative information was gathered through the use of a pre-tested structured questionnaire completed by trained research assistants. The tool addressed demographic details, frequency of postpartum visits, patient satisfaction with services, and self-assessed health outcomes for both mother and child. The survey instrument had Likert-scale and multiple-choice questions. SPSS software version 25 was utilized to analyze the information using descriptive statistics and chi-square testing to establish trends and associations between demographic variables and self-perceived outcomes.

For qualitative purposes, in-depth interviews were held with chosen participants who were both willing and capable of sharing detailed narratives of their postnatal experiences. Interviews were between 30–45 minutes in length and were either conducted in Igbo or in English at the participant's choice. Interviews were all tape-recorded, transcribed word for word, and translated as required.

DATA ANALYSIS:

The qualitative analysis was guided by Braun and Clarke's six-step thematic analysis approach. The transcripts were read several times for familiarity purposes before generating the initial codes. The codes were then combined into themes representing recurring patterns in the stories. The key themes were reviewed, defined, and labeled in line with the research purposes to accurately capture the experience of the participants. Member checking was also done with five of the participants for purposes of verifying the accuracy of transcriptions as well as interpretations. Integration of the data was done at the interpretation stage in which the quantitative trends were contrasted with qualitative themes in order to glean in-depth insights. For example, high levels of satisfaction in the quantitative findings were contrasted against accounts to uncover what made for a good experience. Low levels of satisfaction were examined through accounts of neglect, poor communication, or disappointment of expectations. The technique allowed the research to go deeper beneath the surface-level indicators to capture postnatal care's emotional and cultural aspects. This allowed it to gain a grounded knowledge of how women interpret and internalize their experiences with the health system, thereby qualifying it as a strong means of measuring the quality of motherhood services.

RESULTS:

Thematic Analysis:

Thematic analysis from interviews of ten postpartum mothers at Federal Medical Center (FMC) Umuahia yielded deep insights into their experiences with postnatal care services. Four main themes emerged from their responses: emotional and mental health struggles, breastfeeding success and experience, attitude of health workers and communication, as well as gaps in services and systemic problems. These themes describe a complicated interconnection of personal, institutional, and cultural determinants of maternal health during the postnatal period.

Theme 1: Emotional and Mental Health Challenges:

A sizeable number of mothers reported feeling psychological distress after giving birth. Emotions ran from ongoing sadness, anxiety, irascibility, to a feeling of loneliness. None of these experiences, however, resulted in being screened for emotional health or offered any type of psychosocial support during postnatal check-ups, as reported by any of the interviewed women. For many of them, these emotions were internalized as a result of expectations to be strong by society, along with limited familiarity with postpartum depression as a clinical illness. One participant noted, "At 3 weeks I was feeling a bit depressed. the midwives never talked about any of such things in antenatal. now I hear is 'the blues'" (PN08). The dominant stigma around mental illness, along with a clinical focus on physical recovery, seems to have contributed to a systemic disregard for meeting women’s psychological needs in the postpartum period.

Theme 2: Breastfeeding Experiences and Success:

Table 1: Breastfeeding Experiences

Sub-theme

Description

Early Challenges

Pain and lack of milk flow

(2–4 weeks postpartum)

Late Recovery

Majority breastfed successfully by six weeks postpartum

Breastfeeding proved to be a pivotal yet difficult experience. Some reported difficulty early on, especially in the first two to four weeks after giving birth. Some experiences included pain during latching, poor milk production, and sore nipples. While there were setbacks, most mothers eventually found successful breastfeeding patterns by week six. Reference to support from health care providers was made, yet many mothers said that their support was not tailored to their needs. One mother described, "I couldn’t breast feed my baby for two to four weeks. but at week six I managed to breast feed normally" (PN03). The strength these women found was most often attributed to informal support from peers or relatives, not professional programs.

Theme 3: Staff Attitude and Communication:

Interpersonal interactions with health providers were generally reported in positive terms, as mothers valued respectful behavior and attentiveness of staff. Nevertheless, a common concern was that care was impersonal. Numerous women described that given care was generalized rather than specific to their needs. The absence of individualized counselling or emotional checks limited perceptions of depth in care. One mother said, "The midwives gave general support but not aone-on-one." (PN01). Although a total clinical environment was viewed as supportive and secure, absence of continuity in provider-patient relations diminished prospects for developing trust as well as openness.

Theme 4: Service Gaps and Systemic Challenges:

The mothers also pointed out a number of systemic problems that contributed to their dissatisfaction with postnatal care. Excessive waiting time in the clinic, paper-based systems that were not up to date, and inadequate organized follow-up care were common. Moreover, no printed information materials were given to any of the women, which, in their opinion, could have improved their awareness, knowledge, and retention of information provided during sessions. The lack of written information materials covering emotional health, breastfeeding, and child care was seen as a loss in terms of reinforcing health education.

Table 2: Perceived Outcomes of Postnatal Care

Domain	Positive Outcomes	Negative Outcomes
Physical Health	Perineal healing, medical checkups	Inadequate pain management
Emotional Support	Limited; midwives perceived as rushed	Feelings of neglect and being unheard
Infant Health	Growth monitored; immunization coverage lacking	Less than 50% immunization uptake
Information	Basic advice given; no in-depth breastfeeding help	No mental health discussions or pamphlets

These findings highlight the importance of individualized care, psychosocial screening, as well as efficient postnatal follow-up systems. Empathy, trust, and competence of health workers were most highly valued by mothers, directly impacting satisfaction and perceived outcomes of recovery

DISCUSSION:

The postpartum experiences of women in FMC Umuahia capture an intricate relationship between quality of services, emotional support, cultural demands, and perceived health outcome. This mixed-methods phenomenological research identifies not only what services were experienced but also how these were internally interpreted and lived through by mothers in a time of vulnerability. The findings from the data present how some biomedical demands were addressed but many of the women felt that emotional and psychosocial aspects of care were not attended to and hence produced mixed assessments of postnatal care quality. The quantitative findings indicated that many women had scored their overall experience as satisfactory. Beneath the surface of these ratings of overall experience were underlying frustrations uncovered through the qualitative interview process. For example, although 72% of mothers who were surveyed had described their care as “very good” or “good”, many described scenarios of rushed consultations on minimal information being shared and lacking emotional connection. This illustrates the possibility of normalization of less-than-optimal care in which women adapt their expectations against the constraints of the system or previous negative experiences, as also observed by Johansson et al. (2019) and Granero-Molina et al. (2019).

A number of themes were found in the qualitative accounts. The most prominent was “Transactional Care”, in which the mothers felt the postnatal visits were less concerned with building relationships and more concerned with ticking boxes. Most women described being processed as cases rather than being seen as an individual with specific issues. This type of impersonal care undermined trust in the system and deterred future interaction. Other research in sub-Saharan Africa has established that technical competence is not enough to guarantee maternal satisfaction; emotional connection and tailored attention are just as essential (Dol et al., 2022; Emmott et al., 2020). Another pervasive theme was “Silenced Emotions.” Participants often discussed anxiety, loneliness, and fear after childbirth, feelings not usually recognized or discussed by health workers. This absence of psychological care is concerning in light of documented postpartum depression and distress among mothers. A lack of formal emotional care is consistent with the research of Aune et al. (2021) and Hargreaves et al. (2022), who contend that maternal mental health continues to be an overlooked aspect in most low-resource settings.

In contrast, some of the women did have positive experiences within the theme of “Respectful Encounters." These women emphasized compassionate communication, support in breastfeeding, and culturally respectful attitude on the part of certain midwives or physicians. These anecdotal experiences suggest points of excellence in the system and can be models for applicability on an expanded scale. Providers who listened attentively, reassured them, and communicated in mother-friendly language were well-remembered and had higher ratings of satisfaction. These experiences align with international demands for respectful maternity care as advocated for by the World Health Organization (2020), and by Vahidi et al. (2023). A third significant theme was “Navigating Cultural Expectations.” Women reported conflict between clinical counseling and family-imposed customs, particularly those surrounding practices of confinement, herbalism, and bathing of the newborn. For some of them, these cultural expectations were absolute, and deviation from health provider suggestions resulted in an internal conflict and sense of confusion. This is in line with the findings of Adebami (2014) and Agbeno et al. (2021), who stipulated that maternal health has to be culturally appropriate in order to be successful. Use of community elders or traditional birth attendants in educational classes would potentially act as a link between medical and traditional knowledge.

Facility barriers were also ubiquitous in the accounts. Long waiting times, being overcrowded, and lack of privacy were mentioned as deterrents to optimal use. A few of the mothers had to wait for hours in order to receive a five-minute consultation, while some experienced embarrassment at discussing intimate matters against non-private backdrops. These have been supported by quantitative research as well, where infrastructure and waiting times had the lowest satisfaction ratings. These have also been recorded by Lawlor et al. (2023) as well as McLeish et al. (2020), reinforcing the necessity for structural reform in postnatal service provision. In addition to these attitudes, a number of women were also unclear on postnatal timelines and expectations. Some were not aware of why more than one follow-up was required or what particular services should be done at each appointment. This “Information Gap” discouraged them from participating and caused them to miss appointments. This demonstrates the worldwide issue of poor postnatal education (Bašková et al., 2023; Dol et al., 2022). Use of take-home educational materials and clear scheduling devices may help to overcome this barrier.

A remarkable observation was made in the "Shared Journeys" theme where mothers highlighted the significance of support from fellow women during hospital visits. Waiting rooms became informal counseling rooms where women shared tips, anxieties, and supported each other. Peer interactions in these cases often made up for the lack of emotional support from formal services. This observation supports findings from research by Preis and Alshahrani from 2019 and 2023 who recommend the integration of peer-led discussions or group counseling in mother health initiatives. In outcomes, mothers who had more positive experiences were found to give more positive accounts of rapid recovery, successful breastfeeding, and assertive mothering. Conversely, those who had negative experiences indicated ongoing anxiety, concerns with childcare, and hesitance to come back for future visits. This relationship between care experience and outcome lends support to the integrative model of quality postnatal care where it suggests that informational support, emotional support, and support in a physical sense must be provided together for optimal effects (Wampold and Flückiger, 2023).

Ultimately, what this discourse shows is that postnatal care is not just a series of medical tasks but is instead multifaceted and molded by social interactions, expectations, and emotions. The accounts from FMC Umuahia confirm that postnatal care must move beyond enhanced coverage of services to incorporate initiatives which make the experience of motherhood more human. Empathy, respect, clarity, and cultural responsiveness are not add-ons but rather essential for safe, satisfying, and efficient care.

CONCLUSION:

The experiences of postpartum women in FMC Umuahia highlight the complexity of postnatal care as being more than technical intervention but as an emotionally and socially infused process. Although overall satisfaction with postnatal services was indicated in qualitative findings, qualitative findings pointed to nuanced limitations in emotional support, tailored care, and culturally appropriate communication. The tension between biomedical standardization and entrenched cultural norms further complicates care engagement for women at times resulting in disorientation or inner conflict. Life circumstance issues at the facility including overcrowding, queuing times, and privacy issues add to the problems, which point to weaknesses in the system at an organizational level. On the other hand, isolated incidences of respectful and compassionate care highlight those positive experiences for mothers can be attained, with important implications for outcomes including breastfeeding success and confidence for mothers.

An informal support of peer networks also presented itself as integral in filling the psychological gaps. In general, the work presents the argument for high-caring postpartum care at FMC Umuahia as lying beyond technical competence in its need to have empathy, respectfulness, clear communication, and cultural competence. Redressing these in all its dimensions is key to enhancing maternal satisfaction, maximizing health outcome, and ensuring sustained use of postpartum care in Abia State and other similar settings.

RECOMMENDATION:

To enhance postnatal care experiences and outcomes at FMC Umuahia, some key recommendations are derived from the findings.

1. Firstly, respectful maternity care training should be imparted to healthcare workers on empathetic communication skill sets, active listening skills, and attention to individualized care to counter the pervasive feeling of transactional care and silenced emotions.

2. The incorporation of mental health screening and psychosocial support during routine postnatal consultations is essential to detect and manage postpartum depression and anxiety.

3. Culturally responsive care models should be formulated through collaborations with community elders and traditional birth attendants in learning programs that synthesize clinical advice with indigenous postpartum practices in order to reduce perplexities and promote trust between the mothers and the practitioners.

4. Upgrading of the facilities to enhance privacy, shorten waiting times, and increase comfort during consultation is needed.

5. Private take-home learning materials and appointment scheduling devices should be given to link the gaps in information and promote follow-up visit adherence.

6. Formalization of peer support networks in postnatal care settings can also unlock the powers of shared experience, avoiding isolation and empowering mothers. Together, all these measures would create an improved holistic postnatal care environment for women's physical healing, emotional well-being, and continued health engagement.

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Received on 10.11.2025 Revised on 04.12.2025

Accepted on 20.01.2026 Published on 30.04.2026

Available online from May 02, 2026

Int. J. Nursing Education and Research. 2026;14(2):129-135.

DOI: 10.52711/2454-2660.2026.00026

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. Creative Commons License.