Abdollahpour S, Heidarian Miri H, Khadivzadeh T. The global prevalence of maternal near miss: a systematic review and meta-analysis. Health Promot Perspect. 2019; 9:(4)255-262

Albers LL. Health problems after childbirth. J Midwifery Womens Health. 2000; 45:(1)55-57

Alston M, Allan J, Dietsch E Brutal neglect: Australian rural women's access to health services. Rural Remote Health. 2006; 6:(1)

Andersen RM. National health surveys and the behavioral model of health services use. Med Care. 2008; 46:(7)647-653

Andersen RM, Davidson PL, Baumeister SE. Improving access to care in America. In: Kominsky GF. San Francisco: John Wiley and Sons; 2011

Aston M, Price S, Etowa J The power of relationships: exploring how public health nurses support mothers and families during postpartum home visits. J Fam Nurs. 2015; 21:(1)11-34

Bina R. Seeking help for postpartum depression in the Israeli Jewish orthodox community: factors associated with use of professional and informal help. Women Health. 2014; 54:(5)455-473

Brown S, Gartland D, Perlen S, McDonald E, MacArthur C. Consultation about urinary and faecal incontinence in the year after childbirth: a cohort study. BJOG. 2015; 122:(7)954-962

Buurman MBR, Lagro-Janssen ALM. Women's perception of postpartum pelvic floor dysfunction and their help-seeking behaviour: a qualitative interview study. Scand J Caring Sci. 2013; 27:(2)406-413

Cassiano ADN, de Holanda CSM, Costa RKdS, Morais FRR, Maranhão T. Nursing care to woman in immediate puerperium: a narrative description. Revista de Pesquisa: Cuidado é Fundamental. 2015; 7:(1)

Chou D, Tunçalp Ö, Firoz T Constructing maternal morbidity – towards a standard tool to measure and monitor maternal health beyond mortality. BMC Pregnancy Childbirth. 2016; 16:(1)

Cornally N, McCarthy G. Help-seeking behaviour: a concept analysis. Int J Nurs Pract. 2011; 17:(3)280-288

Creswell JW. Research design, qualitative, quantitative and mixed methods approaches.Newcastle: SAGE; 2013

Finlayson K, Crossland N, Bonet M, Downe S. What matters to women in the postnatal period: a meta-synthesis of qualitative studies. PLoS One. 2020; 15:(4)

Fisher VM. Help-seeking for depression in rural women: a community portrait.Richmond, Virginia: Virginia Commonwealth University; 2005

Fonseca A, Canavarro MC. Women's intentions of informal and formal help-seeking for mental health problems during the perinatal period: yhe role of perceived encouragement from the partner. Midwifery. 2017; 50:78-85

Guillot EE. Patterns of help for post-partum mothers. Children. 1964; 11:147-151

Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005; 15:(9)1277-1288

Jacobs LC. Help-seeking behaviour of women with urinary incontinence.Stellenbosch, South Africa: Stellenbosch University; 2017

Klima CS. Women's health care: a new paradigm for the 21st century. J Midwifery Womens Health. 2001; 46:(5)285-291

Koch LH. Help-seeking behaviors of women with urinary incontinence: an integrative literature review. J Midwifery Womens Health. 2006; 51:(6)e39-e44

Liepins R. Making men: the construction and representation of agriculture-based masculinities in Australia and New Zealand. Rural Sociol. 2000; 65:(4)605-620

MacArthur C, Lewis M, Knox G. Health after childbirth: an investigation of long term health problems beginning after childbirth in 11701 women.London: His Majesty's Stationery Office; 1991

Maher J, Souter K. ‘It's much easier to get help for the baby’: women, postpartum health and maternal and child health care groups. Health Sociol Rev. 2006; 15:(1)104-111

Magaard JL, Seeralan T, Schulz H, Brütt AL. Factors associated with help-seeking behaviour among individuals with major depression: a systematic review. PLoS One. 2017; 12:(5)

McIntosh J. Postpartum depression: women's help-seeking behaviour and perceptions of cause. J Adv Nurs. 1993; 18:(2)178-184

Mousa O, Sabati SYA, Khars FA. Postpartum depression: neglected issue in maternal health. Int J Nurs Educ. 2023; 15:(1)

Rooney P. Feminist-pragmatist revisionings of reason, knowledge, and philosophy. Hypatia. 1993; 8:(2)15-37

Rouhi M. Assessment of postpartum maternal morbidity, 6 weeks after delivery in Tabriz.Tabriz, Iran: Tabriz Islamic Azad University of Medical Science; 2001

Rouhi M, Mohammed-alizadeh S, Usefi H, Rouhi N. Postpartum morbidity and help-seeking behaviours in Iran. Br J Midwifery. 2011; 19:(3)178-184

Rouhi M, Heravi M, Usefi H, Salehi K, Habibzadeh S, Shojaee M. Prevalence and persistence of health problems after child birth and maternal correlations with parity. J Health Promotion Manage. 2012; 1:(4)

Rouhi M, Vizheh M, Rouhi L, Esmaili H, Vaziri L, Gherekhlou ZF. Postpartum morbidities in Iranian women 5 years after childbirth: a longitudinal study. Br J Midwifery. 2016; 24:(4)268-274

Rouhi M, Rouhi N, Vizheh M, Salehi K. Male child preference: is it a risk factor for antenatal depression among Iranian women?. Br J Midwifery. 2017; 25:(9)572-578

Rouhi M, Rouhi N, Mohamadpour S, Tajrishi HP-R. Vitamin D reduces postpartum depression and fatigue among Iranian women. Br J Midwifery. 2018; 26:(12)787-793

Rouhi M, Stirling C, Ayton J, Crisp EP. Women's help-seeking behaviours within the first twelve months after childbirth: a systematic qualitative meta-aggregation review. Midwifery. 2019a; 72:39-49

Rouhi M, Stirling C, Crisp EP. Mothers' views of health problems in the 12 months after childbirth: a concept mapping study. J Adv Nurs. 2019; 75:(12)3702-3714

The fallacy of normalcy: a multiphase study exploring women's help-seeking for health problems in the 12 months after childbirth. 2020. (accessed 21 August 2023)

Rouhi M, Stirling C, Crisp EP. Fallacy of normalcy: a content analysis of women's online post childbirth health-related support. Women Birth. 2021; 34:(3)e262-e270

Taylor RS. UN Women's feminist engagement with governance by indicators in the millennium and sustainable development goals. Glob Soc Policy. 2020; 20:(3)352-366

Vaismoradi M, Turunen H, Bondas T. Content analysis and thematic analysis: implications for conducting a qualitative descriptive study. Nurs Health Sci. 2013; 15:(3)398-405

Wagg AR, Kendall S, Bunn F. Women's experiences, beliefs and knowledge of urinary symptoms in the postpartum period and the perceptions of health professionals: a grounded theory study. Prim Health Care Res Dev. 2017; 18:(05)448-462

Whipps J, Lake D. Pragmatist feminism. In: Zalta EN, Nodelman U. Stanford, CA: Stanford University; 2004

Wuytack F, Curtis E, Begley C. The health-seeking behaviours of first-time mothers with persistent pelvic girdle pain after childbirth in Ireland: a descriptive qualitative study. Midwifery. 2015; 31:(11)1104-1109

‘Fallacy of normalcy’ in post-childbirth maternal morbidities: a feminist-pragmatist exploration

02 September 2023
Volume 31 · Issue 9



Women worldwide experience post-childbirth morbidities such as incontinence and pain. While there is limited evidence of women's help-seeking behaviour, many do not seek treatment. This study aimed to explore the key influences on women's help-seeking behaviour 12 months after birth.


Three different study approaches were used: a meta-aggregation systematic review, concept mapping and a directed qualitative content approach.


Women often did not seek help because they accepted problems as a normal part of motherhood. They were more likely to share problems with family and friends. Online platforms allowed women to share their problems anonymously, but the support provided demonstrated some normalising of abnormal problems.


The feminist pragmatic approach highlighted the ‘fallacy of normalcy’ as underpinning women's help-seeking behaviour after childbirth.

Maternal morbidity can be defined as ‘any health condition attributed to and/or complicating pregnancy and childbirth that has a negative impact on the woman's wellbeing and/or functioning’ (Chou et al, 2016). The prevalence of maternal morbidities varies from 70–90% during the first 8 weeks and 12 months after childbirth, respectively (Rouhi et al, 2020). Maternal morbidities remain a challenge to define, interpret and measure, and the prevalence of both general and specific morbidities has been inadequately addressed in the literature (Abdollahpour et al, 2019). Reduction of maternal morbidity post-childbirth is the United Nations' sustainable development goal 3, of ensuring healthy lives and promoting wellbeing for all at all ages (Taylor, 2020).

Many women worldwide experience morbidities that they may ignore, or that healthcare providers neglect (Maher and Souter, 2006; Cassiano et al, 2015; Finlayson et al, 2020). Cassiano et al (2015) and Finlayson et al (2020) found that after childbirth, women are less concerned about their physical and mental health problems, as they focus on caring for their newborn and responsibilities at home. Consequently, their health has been ignored and marginalised.

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